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WVU Occupational Therapy researchers evaluate handwriting intervention among homeschooled children in West Virginia

When it comes to success in school, many may think of test skills as the key differentiator. But occupational therapists at West Virginia University say that for some children, success comes down to a much finer point – the pencil grip.

Limitations with handwriting are one of the most common reasons for occupational therapy referral for children in public schools, according to Carrie Smith-Bell, OTR/L, faculty member and occupational therapist.

“From pencil grip to posture, handwriting is a complex fine motor activity that can present challenges to many children,” she said. “Our concern is what happens to students who aren’t in the public school’s referral pipeline – are those children getting the help they need?”

To help answer this question, Smith-Bell and other researchers in the School of Medicine’s Division of Occupational Therapy are evaluating the effectiveness of handwriting intervention for elementary-aged homeschooled children.

Smith-Bell explained that while many elementary schools have transitioned to children typing much of their schoolwork on computers, handwriting remains highly relevant. Handwriting notes is associated with improved learning of new information. Children who are able to write legibly and rapidly perform better in written composition tasks including vocabulary, spelling and organization.

West Virginia children who are homeschooled are most often not eligible for school-based occupational therapy services. The number of West Virginia children who are homeschooling is about 15%, which is well above the national average of 5%.

Realizing a critical need for handwriting remediation in this group, Smith-Bell and her research student, Abby Kuhns, a current Master of Occupational Therapy student, are conducting a handwriting camp for homeschooled children.

Abby Kuhns, a current Master of Occupational Therapy student, conducts a handwriting camp for homeschooled children.
Occupational Therapy student Abby Kuhns conducts handwriting assessments. 

The camp program uses the Handwriting Without Tears® method, a multi-sensory program developed by an occupational therapist. The WVU research team is collecting and analyzing data to evaluate the program’s efficacy on this population and to determine if particular interventions are more successful than others.

“In my experience, intervention normally happens in the classroom with a teacher recognizing a child’s limitation with handwriting,” Smith-Bell said. “Parents realize their child is having an issue, but they are looking at the outcome of writing a letter or number and not the entire activity from all points of view to see what is causing the issue with legibility. That’s where an occupational therapist comes in.”

Occupational therapists analyze the finer details of handwriting – assessing skills like bilateral coordination of the hands, visual perception, fine motor coordination, attention, seating, posture, pencil grasp, hand strength and core strength.

Children attending camp undergo initial assessments to test their visual-motor integration skills and gauge their handwriting legibility. Then, they complete a series of six, hour-long intervention sessions that include their caregiver with Smith-Bell and Kuhns tailoring interventions to each individual’s unique needs and interests. Finally, the children retake the initial assessments so the WVU researchers can calculate changes in performance.

“I’ve learned to build relationships with children and their families during this research,” Kuhns said. “Occupational therapists work with clients of all ages and it can be hard to envision how you’ll interact with different clients, but this experience is allowing me to see how I will apply what I learn in the classroom after I graduate.”

After completing the assessments, Smith-Bell and Kuhns follow up with families via Zoom to collect qualitative data on their perception of their experience and if they see themselves integrating into their homeschooling the techniques they learned in handwriting camp.

“As a mom of a child who once had handwriting limitations, this research is so important to me,” Smith-Bell explained. “The overall goal is to provide these children with the ability to participate fully in school without their self-esteem suffering or being wrongly identified as poor academic performers because their handwriting isn’t legible.”

Children attend handwriting camp.
Homeschooled children attend handwriting camp with WVU Occupational Therapy researchers.

So far, 13 children have completed the interventions with many of the children demonstrating improved handwriting performance. Further research will examine how caregivers choose to integrate the multisensory writing program into their homeschooling activities and how their children perform during a handwriting reassessment. This will provide valuable information that could be integrated into expanding this program to other homeschooled children.

“I’m grateful that the WVU OT program has a focus on hands-on research,” Kuhns said. “I don’t think I would have gotten this type of experience elsewhere.”

Learn more about the Occupational Therapy program at WVU at