The Grind: EBP Review - A Systematic Review of the Efficacy of Handwriting Programs

Last year, I completed two courses in Evidenced Based Practice (EBP).  Prior to them, I thought I was doing my due diligence in reading and applying knowledge learned through continuing education courses and reading articles both peer reviewed and not.  But I was completely missing the ball on being an effective consumer of research. It's not just about reading the content, but also analyzing it.  Basically, how efficiently did the authors answer the WH questions of who? what? when? where? why? how?   Therefore, in an effort to keep my brain percolating with the evidence to make informed decisions in treatment and evaluation, I will share my interpretations of current studies and how they might apply to school-based services.  

Welcome to The Grind.

I was intrigued when I came across the systematic review by Engel, Lillie, Zurawski, and Travers (2018).   Engel et al. searched through 455 sources to get to 13 studies that met the extensive criteria of peer-reviewed journal articles within 2006 and 2015 that examined if, which, and by how much handwriting curricula were effective in improving legibility, speed, and fluency.  Ultimately, the studies that were robust enough to be included in the analysis focused on the following handwriting curriculum-based interventions:

• The Write Start
• Peterson Directed Handwriting Curriculum
• Handwriting Without Tears (PreK and Elementary)
• Fine Motor and Early Writing Pre-K curriculum (which seems to be a part of the Pathways to Learning by Mead)
• Size Matters
• Write Direction (only found a reference to it on YouTube)
• handwriting clubs
• Explicit Handwriting Program

Nitty Gritty

• Curriculum-based handwriting programs (CBHP) do have a positive effect on legibility/letter formation.  Size Matters, Write Start, and Explicit Handwriting Program had the biggest effect sizes on legibility
• There is mixed evidence that supports CBHPs improving speed of handwriting, in fact it may slow some children down
• There isn't enough evidence that CBHP improves fluency of writing
• There were not significant relations between age of instruction or amount of time spent on instructing and outcome on legibility or speed

So what did this mean to me?

• I have been a user of Handwriting Without Tears for years.  I can say that I may not use every piece of the curriculum with the fidelity to the extent that I would like, but I believed that the curriculum was based in research.  But clearly, there are many other handwriting curricula available on and off the market that can have an impact. 
• I am going to have to do some professional development on the Write Start and Size Matters.  It might be worth it for me to expand my repertoire of interventions to see if either would be relevant for my caseload.  Heck, I am pretty confident I have a manual somewhere in my office at work for at least one of them.   
• I could not find anything about what exactly the Explicit Handwriting Program was or how it was implemented, so it's not high on my radar.
• And if the curriculum do not impact speed of handwriting, what does? Guess I'll have to do more searching.

The nice thing about systematic reviews is that the authors are taking on the brunt of the work.   Are there limitations?  Of course!  As a consumer of research,  you are dependent on the authors to include what you are looking for in population, intervention, and outcome.   However, systematic reviews typically give you the most bang for the buck.  You can always dive further into specifics by weeding through the references.  If you don't have NBCOT or AOTA membership, I highly recommend that you get it.  They provide you with access to research relevant to practice.  It really is worth every penny.  If not, there are other avenues to try, that I will address in later posts.

Let me know what you thoughts are. 

Engel, C., Lille, K., Zurawski, S. & Travers, B. G. (2018). Curriculum-based handwriting programs: A systematic review with effects sizes.  American Journal of Occupational Therapy, 72, https://doi.org/10.5014/ajot.2018.027110

September SpOT Light Series: Handwriting with Katherine

Handwriting With Katherine is where you can find all things related to handwriting from Occupational Therapist Katherine Collmer's point of view.  With 17 years of therapeutic experience ranging from psychiatric, neurologic, geriatrics and of course pediatrics, it is her expertise in Assessment and Remediation of Children’s Handwriting Development Skills that she shares with parents and therapists alike.

"I have been interested in writing since I was a teenager.  I still have the short stories that I scribed way back then.  Blogging, however, wasn’t even in my vision back in 2009 when this type of writing found a place in my life.  I was getting restless during a transition in my pediatrics career and a friend of mine suggested that with my interest in writing I should look into blogging.  She suggested that I contact the Advance Magazine online blog editor…and that’s where it all began!"

Katherine integrates research-based evidence into many of her posts, making them both useful and insightful.  For example, in a recent post titled Handwriting and Learning: A Vital Link to Skilled Writing, she reflects "Learning through the use of our hands continues to be a vital link for educational success throughout life, with handwriting playing a major role;" all the while, she incorporated ten references to support the idea.

Katherine is also a strong advocate for identifying visual deficits issues early since it is such a crucial element of handwriting.

"Sitting Posture Can Indicate Vision Concerns"

 "Every time I connect a child’s parents with a developmental optometrist and they uncover a hidden visual skill deficit, I consider that a memorable therapeutic moment.  However, my most memorable is the little boy who put on glasses for the first time at the age of 5 and said, “Hey, mommy, look at those pictures on the wall!”  His mommy cried because he’d walked down that hospital hallway many, many times in his young life and had never even seen them before.  Priceless."

Now into her sixth year of publishing, Handwriting With Katherine continues to provide teachers, parents and therapists with easy to use tips, from Pre K to Older Students.  Hop on over now to Handwriting with Katherine to discover what the three handwriting performance areas that simply need to be taught and reinforced right from the start.  And if you want to discover more about Katherine, just “Send me a note!”.   You can also check out her newest adventure Go-To-For-OT on which she pairs up with #therabloggers Stacy Turke, Marie Toole, and Molly Shannon as they share insights on pediatric development and the most frequently asked questions from parents and teachers.

           

'Appy Hour: Writing Wizard

'Appy Hour is going to include reviews of educational, special needs, and just for fun apps.  Many of these apps I find by subscribing to a variety of app developers such as Grasshopper Apps that does a Free The App option, by checking Bridging Apps a great website that has a search engine based on skills, and Apps Gone Free, an app that provides daily "free" apps for short periods of time.

Today's review was discovered on Apps Gone Free a few weeks ago: Writing Wizard by L'Escapadou.  Normally $2.99, I found it for free via AGF.  And it is now on my go-to list of apps for handwriting support.

This app is worth every penny with a cherry on top.  Having tried apps including Handwriting Without Tears (for $6.99 mind you and that will come in a later review), I have been very leery with writing apps for their customizability, visuals, and overall usability.  But Writing Wizard has met these criteria, hands down.

First,  this app is quite customizable.   Not only do you have the option in handwriting formats including D'Nealian, Zaner-Bloser and Handwriting without Tears, but you have access to capitals, letters, numbers and words.  You also have the option to create reports of tracing history to examine accuracy of motor planning over time.

Under section "For Parents", after you answer a quick math question to unlock parental control~ a cute feature~ it describes how to add words to the "My Words" list.  This can be incredibly helpful for spelling practice, reading practice, or name writing.  It also provides instructions how to use their "5 Star" Mode during which the practice becomes more challenging; and when the child meet the criteria they get a start.

Visuals and Audio.  This app is really appealing. First the child is given a demonstration as well as the name of the letter and its letter sound.  As the child traces within the given parameter, cool pictures like tiger heads, flowers, and cupcakes act as the line.  After the letter is completed, a cool and kinda trippy thing will happen, reinforcing the letter building.  This app does not have over powering backgrounds or background sounds, which I find incredibly useful in the therapeutic and educational setting.

Lastly, overall usability.  I have used this app with children pre-K to 5th grade with a variety of special needs including Downs Syndrome, Autism, Cerebral Palsy, Developmental Delay, and ADHD.  This is a kid and adult friendly app.  My students with and without disabilities, and my own children, enjoy exploring the letters.  They find it highly motivating and engaging.  And when paired with paper/pencil tasks, I have noticed improvement with behavior, completion, attention and visual motor skills.

I have to say, it was also very refreshing for the app developers to state to use a stylus.  This is a pet peeve of mine.  Using a stylus is incredibly important to build the dexterity for writing and coloring with tools.  We don't write with our finger tips on paper, so please get a stylus to promote good habits.

When compared to other writing apps out there, this is by far one of my favorites.  I would recommend it to teachers, therapists and parents as another way in addition to paper/pencil task, to engage their early learners in another writing skill development.  Kudos, L'Escapadou!

Click here for the YouTube video by L'Escapadou.