A Review of Handwriting A Review of Handwriting AssessmentsAssessments

Presented by:Presented by:Rachel KirkRachel KirkShannon MunfordShannon MunfordSelena Mehr, BCABASelena Mehr, BCABACaldwell CollegeCaldwell College

HandwritingHandwritingWhy focus heavily on handwriting Why focus heavily on handwriting skills/remediation?skills/remediation? Record and communicate informationRecord and communicate information Compete in the regular education classroom Compete in the regular education classroom Personal use (class notes, shopping lists)Personal use (class notes, shopping lists) Written communication to others (letters, Written communication to others (letters, memos)memos)

Writing related to seeking employment and Writing related to seeking employment and job-related skills (applications)job-related skills (applications)

To obtain information from others To obtain information from others (Stowitschek et. al., 1989)(Stowitschek et. al., 1989)

HandwritingHandwritingPoor Handwriting can “cause”:Poor Handwriting can “cause”:

Teachers place importance on clear, Teachers place importance on clear, concise, good handwriting. Poor concise, good handwriting. Poor handwriting in the early grades linked handwriting in the early grades linked to poor academic performance in the to poor academic performance in the future. (Harvey and Henderson 1997)future. (Harvey and Henderson 1997)

Some develop mind-set that they cannot Some develop mind-set that they cannot write and give up. (Berninger 1998)write and give up. (Berninger 1998)

Lack of confidence then leads to stress, Lack of confidence then leads to stress, poor self-esteem, poor career poor self-esteem, poor career prospects. (Sassoon 1997)prospects. (Sassoon 1997)

HandwritingHandwritingReason for Assessment:Reason for Assessment:

Standardized or systematic procedures Standardized or systematic procedures are seldom used are seldom used

Poor letter formation skills are evident Poor letter formation skills are evident in the handwriting of many studentsin the handwriting of many students

Few special or general educators have Few special or general educators have been trained to teach and remediate been trained to teach and remediate handwritinghandwriting

Distinguish between student ability and Distinguish between student ability and actual handwriting performanceactual handwriting performance

(Stowitschek et. al., 1989)(Stowitschek et. al., 1989)

MHAMHAThe Minnesota The Minnesota HandwritingHandwritingAssessmentAssessment

Developed by:Developed by:Judith Reisman (1993) Judith Reisman (1993)

Development of MHT:Development of MHT: MHA is a way:MHA is a way:

to assist school-based occupational to assist school-based occupational therapists in the identification of therapists in the identification of children with writing difficulties/assess children with writing difficulties/assess treatment.treatment.

A more sophisticated alternative to the A more sophisticated alternative to the “rating scales.”“rating scales.”

MHA can determine: MHA can determine: Speed, accuracy, letter size, spacing, and Speed, accuracy, letter size, spacing, and can show where students difficulties are.can show where students difficulties are.

(Reisman 1993)(Reisman 1993)

MHAMHADesigned forDesigned for: : 11stst and 2 and 2ndnd graders graders

Age Range:Age Range:(5 to 7 years)(5 to 7 years)

Administration:Administration:Individual or Group- 5 to 10 minutes; 10 to 30 Individual or Group- 5 to 10 minutes; 10 to 30 minutes to score minutes to score

Test is used to identify how students are Test is used to identify how students are performing in relationship to their peers. performing in relationship to their peers.

(Reisman 1993)(Reisman 1993)

MHA: MaterialsMHA: Materials Complete kit:Complete kit: Includes manual, 1 manuscript and 1 Includes manual, 1 manuscript and 1 D'Nealian Pad, 25 sheetsD'Nealian Pad, 25 sheets

Additional copies of materials:Additional copies of materials:Manuscript Print Pads, pack of 4 Manuscript Print Pads, pack of 4 pads (25 sheets per pad) D'Nealian pads (25 sheets per pad) D'Nealian Print Pads, pack of 4 pads (25 Print Pads, pack of 4 pads (25 sheets per padsheets per pad))

MHA: FormatMHA: Format Rate score (writing speed): # of letters Rate score (writing speed): # of letters

completed during the timed portion.completed during the timed portion. More time given:More time given:1.1. LegibilityLegibility2.2. FormForm3.3. AlignmentAlignment4.4. SizeSize5.5. SpacingSpacing The total maximum point scored on The total maximum point scored on

the test is 170.the test is 170.(Reisman 1993)(Reisman 1993)

MHAMHAProcedure:Procedure: Sentence is given in jumbled form Sentence is given in jumbled form

Ex: “the quick brown fox jumped over the Ex: “the quick brown fox jumped over the lazy dog”lazy dog”

Small triangles: starting point.Small triangles: starting point. Write for a timed period (2 ½ minutes)Write for a timed period (2 ½ minutes)

(Reisman 1991) used 2.5 minutes made after pilot (Reisman 1991) used 2.5 minutes made after pilot test with 1test with 1stst and 2 and 2ndnd graders graders

timed for 1.0, 1.5, 2.0, 2.5, 4.0 and 5.0 minutes. timed for 1.0, 1.5, 2.0, 2.5, 4.0 and 5.0 minutes. 67% of the 267% of the 2ndnd graders finished at least 31 of the graders finished at least 31 of the 34 sample letters in 2.5 minutes. 34 sample letters in 2.5 minutes.

Stop and circle last letter writtenStop and circle last letter written Then finish the sentenceThen finish the sentence(Feder & Majnemer 2003)(Feder & Majnemer 2003)

MHAMHA Legibility/ScoringLegibility/Scoring::

Letter is recognizable out of context (dots on Letter is recognizable out of context (dots on letters i/j)letters i/j)

Complete with all strokes presentComplete with all strokes present Contains no reversals (letter k) Contains no reversals (letter k)

34 maximum points34 maximum points Scoring is Scoring is discontinueddiscontinued if the students writing is if the students writing is

illegible.illegible. This rule was adopted b/c:This rule was adopted b/c:

It is impossible to obtain reliable measurements It is impossible to obtain reliable measurements for the other categories if a letter is for the other categories if a letter is illegibleillegible

(Reisman 1993)(Reisman 1993)

MHAMHA2.2. Form/Scoring:Form/Scoring: Measures letter Measures letter

qualityquality Lines: curved or Lines: curved or

pointed in certain pointed in certain parts of the parts of the letter.letter.

no gaps or overlaps no gaps or overlaps greater than 1/16” greater than 1/16” between letter between letter partsparts

Maximum 34 pointsMaximum 34 points

3.3. Alignment/Alignment/Scoring:Scoring:

Position of the Position of the letters on the letters on the line.line.

Letters within Letters within 1/16” of the 1/16” of the solid baseline.solid baseline.

Maximum 34 Maximum 34 pointspoints

MHAMHA4.4. Size/Scoring:Size/Scoring: Measures all Measures all

other parts of other parts of the letter to the letter to the midline, the midline, upper and upper and lower lines.lower lines.

Maximum points Maximum points 3434

5.5. Spacing/Scoring:Spacing/Scoring: Correct letter Correct letter

and word spacingand word spacing ““daylight” daylight”

between letters.between letters. Maximum points Maximum points

3434

ResearchResearchReisman, J.E., (1993). Development and Reliability of the Reisman, J.E., (1993). Development and Reliability of the

Research Version of the Minnesota Handwriting TestResearch Version of the Minnesota Handwriting Test.. Physical and Physical and Occupational Therapy in Pediatrics, 13Occupational Therapy in Pediatrics, 13(2), 41-55.(2), 41-55.

6 raters trained in 3 sessions6 raters trained in 3 sessions 11stst session: Brief explanation of the scoring rules. session: Brief explanation of the scoring rules.

Took an average of 2 hours to scoreTook an average of 2 hours to score After 1After 1stst session: discussion b/w Reisman and the session: discussion b/w Reisman and the raters.raters.

22ndnd session: repeated the process. session: repeated the process. After 2After 2ndnd session: errors made raters was very session: errors made raters was very small.small.

33rdrd session: repeated the process. session: repeated the process. Took an average of 25 minutes to scoreTook an average of 25 minutes to score Reliability increased to 95%.Reliability increased to 95%.

Manual for the MHA: 3 sets of 10 handwriting Manual for the MHA: 3 sets of 10 handwriting samples, can be compared to Reismans grading of the samples, can be compared to Reismans grading of the samples.samples.

Explains scoring procedure as in the study. Explains scoring procedure as in the study.

Research con’t:Research con’t: Cornhill, H., Case-Smith, J. (1996). Factors that Cornhill, H., Case-Smith, J. (1996). Factors that relate to good and poor handwriting. relate to good and poor handwriting. American American Journal of Occupational Therapy, 56(3),Journal of Occupational Therapy, 56(3), 305-312. 305-312.

48 typical 148 typical 1stst graders identified as either good graders identified as either good or poor handwriters.or poor handwriters.

Motor accuracy test, visual-motor integration Motor accuracy test, visual-motor integration test and 2 in-hand manipulation tests.test and 2 in-hand manipulation tests.

All test scores significantly higher for students All test scores significantly higher for students with good handwriting.with good handwriting.

Then given the MHA.Then given the MHA. ResultsResults::

Eye-hand coordination, visual-motor integration Eye-hand coordination, visual-motor integration and in-hand manipulation have a direct and in-hand manipulation have a direct association to handwriting skillsassociation to handwriting skills

MHA is a valid tool that accurately shows a MHA is a valid tool that accurately shows a students current handwriting skillsstudents current handwriting skills

Research con’t:Research con’t:Owens, L.L (2004). Owens, L.L (2004). The Effects of the Handwriting Without The Effects of the Handwriting Without

Tears Program on the Handwriting of Students in Inclusion Tears Program on the Handwriting of Students in Inclusion Classrooms.Classrooms. Master’s Thesis. Virginia Master’s Thesis. Virginia Commonwealth University, Richmond, Virginia.Commonwealth University, Richmond, Virginia.

2 Experimental groups(41 students)- received 2 Experimental groups(41 students)- received HWT methodHWT method

2 Comparison groups(40 students)- general 2 Comparison groups(40 students)- general handwriting instruction.handwriting instruction.

Handwriting performance measured using MHA.Handwriting performance measured using MHA. Pretest scores: no difference b/w both groupsPretest scores: no difference b/w both groups Posttest scores: experimental classes showed Posttest scores: experimental classes showed improvement in the areas of size (.008) and improvement in the areas of size (.008) and spacing (.014).spacing (.014).

MHA: MHA: Individualization/ModificatioIndividualization/Modificationn The initial MHA evaluation shows handwriting The initial MHA evaluation shows handwriting illegibility.illegibility.

The teacher could customizes the MHA test by:The teacher could customizes the MHA test by:1.1. Teaching specific commonly used letters. Teaching specific commonly used letters.

Example: e, a, h, f, t, i, r, d, s, y.Example: e, a, h, f, t, i, r, d, s, y.2.2. Combining these letters into words.Combining these letters into words.

Example: “The first day.”Example: “The first day.”3.3. Practice writing these words.Practice writing these words.4.4. Take MHA using the learned letters, words Take MHA using the learned letters, words

and phrases.and phrases.5.5. Contriving this procedure until all the Contriving this procedure until all the

letters have been used and evaluated.letters have been used and evaluated.

MHAMHAProsPros Reinforce/teach hand dexterity Reinforce/teach hand dexterity (kinesthetic)(kinesthetic)

knowledge (cognitive) is knowledge (cognitive) is motivationalmotivational

Helps with perception/motor skillsHelps with perception/motor skills Easy to scoreEasy to score Easy to administerEasy to administer Clear, easy to understand manualClear, easy to understand manual Reisman: “MHA can be administered to Reisman: “MHA can be administered to children with a variety of children with a variety of disabilities.” disabilities.”

MHAMHAConsCons Test is relatively newTest is relatively new No extensive clinical trials or No extensive clinical trials or researchresearch

Children who can not read are at a Children who can not read are at a disadvantage in the timing portion.disadvantage in the timing portion.

Write letter by letterWrite letter by letter Some pre-req: hold a pencil, see, Some pre-req: hold a pencil, see, concentrate and understand.concentrate and understand.

Can be difficult for many Can be difficult for many developmentally disabled childrendevelopmentally disabled children

DRHPDRHPThe The DDiagnosis and iagnosis and RRemediation of emediation of

HHandwriting andwriting PProblemsroblems

Authors:Authors:Denis H. Stott, Fred A. Moyes, and Denis H. Stott, Fred A. Moyes, and Sheila E. Henderson (1985)Sheila E. Henderson (1985)

DRHPDRHPAccording to Stott et. al. (1987)…According to Stott et. al. (1987)…Purpose:Purpose: Systematically identify and Systematically identify and classify handwriting problemsclassify handwriting problems

To be used as a clinical toolTo be used as a clinical tool Advance research in handwritingAdvance research in handwriting Provide remedial materials for Provide remedial materials for teacher educationteacher education

DRHPDRHPAccording to Stott et. al. (1987)According to Stott et. al. (1987)……

Population Intended to Assess:Population Intended to Assess: Children with two years Children with two years experience handwritingexperience handwriting(3(3rdrd grade) grade)

Adults who have loss skill of Adults who have loss skill of handwriting due to brain injuryhandwriting due to brain injury

DRHPDRHPMaterials Materials Manual Manual Scoring templates for size and Scoring templates for size and slantslant

3 pictures/comic strips3 pictures/comic strips Student’s Writing SheetStudent’s Writing Sheet Diagnostic Record Form Diagnostic Record Form

DRHPDRHPManual Content:Manual Content: Sections on Sections on direction usedirection use

Directions for Directions for ScoringScoring

Scorer trainingScorer training Single reliability Single reliability studystudy

Issues relative to Issues relative to the measurement of the measurement of handwritinghandwriting

Handwriting in Handwriting in left-handersleft-handers

Monitoring Monitoring handwriting handwriting standards in the standards in the classroomclassroom

Guidelines for Guidelines for remediationremediation

Remedial programsRemedial programs

DRHPDRHPCategories of AssessmentCategories of AssessmentPart 1. Faults of Concept and Style Part 1. Faults of Concept and Style

(poor teaching or failure to benefit from (poor teaching or failure to benefit from teaching)teaching)

Section A. Letters incorrectly formed Section A. Letters incorrectly formed and/or joinedand/or joined

Section B. Spacing ErrorsSection B. Spacing ErrorsSection C. Stylistic DistractorsSection C. Stylistic DistractorsSection D. SlurringSection D. Slurring

DRHPDRHPCategories of AssessmentCategories of AssessmentPart 2. Faults of Motor ControlPart 2. Faults of Motor Control

1.1. Inconsistency of slantInconsistency of slant2.2. Inconsistency of letter sizeInconsistency of letter size3.3. Irregular word alignmentIrregular word alignment4.4. Random Letter DistortionRandom Letter Distortion5.5. TremorTremor

DRHPDRHPCategories of AssessmentCategories of AssessmentPart 3. Concurrent ObservationsPart 3. Concurrent Observations

Section A. Posture of handling Section A. Posture of handling paper and penpaper and pen

Section B. Faulty ways of Section B. Faulty ways of addressing taskaddressing task

Section C. Physical Disadvantages Section C. Physical Disadvantages (poor motor control)(poor motor control)

DRHPDRHPAdministration:Administration: Individually or in a groupIndividually or in a group Student is given a comic book style Student is given a comic book style series of 3 pictures with word cues series of 3 pictures with word cues provided in “balloons” in each pictureprovided in “balloons” in each picture

Student is given “Student’s Writing Student is given “Student’s Writing Sheet” containing ten lines to write Sheet” containing ten lines to write onon

Test is not timed but authors suggest Test is not timed but authors suggest no more than 20 minutesno more than 20 minutes

DRHPDRHPScoring:Scoring: Only Part 1 and 2 are numerically scoredOnly Part 1 and 2 are numerically scored Quantitative measuresQuantitative measures

Scoring templates or mechanical aids for Scoring templates or mechanical aids for consistency of slant, spacing, and letter consistency of slant, spacing, and letter size difference are usedsize difference are used

These transparent diagnostic templates are These transparent diagnostic templates are applied to writing slant and alignment or applied to writing slant and alignment or deviation from the writing base linedeviation from the writing base line

Measurement of word spacing is taken but Measurement of word spacing is taken but dependent on the scorer’s accuracy and dependent on the scorer’s accuracy and decision when making numerical awardsdecision when making numerical awards

DRHPDRHPScoring:Scoring: Qualitative measuresQualitative measures

Examiner’s determination of whether Examiner’s determination of whether an error occurredan error occurred

When examiner judgment needed refer When examiner judgment needed refer to the operationally defined termsto the operationally defined terms

All of Section 3 (Observations)All of Section 3 (Observations) Higher Scores: high number of Higher Scores: high number of errors and higher writing errors and higher writing impairmentimpairment

DRHPDRHPScoring:Scoring: Use scores from part 1 & 2 with Use scores from part 1 & 2 with observations from part 3 (not scored) observations from part 3 (not scored) to provide basis for diagnostic to provide basis for diagnostic analysisanalysis

Overall score/sum were not intended Overall score/sum were not intended to be used but you can total the to be used but you can total the scores if needed for research scores if needed for research purposespurposes

Use of a two-scorer system provided Use of a two-scorer system provided for reliabilityfor reliability

DRHPDRHPLimitations:Limitations: Complex to ScoreComplex to Score

No scores or score range guidelines for No scores or score range guidelines for interpretation; necessary for development interpretation; necessary for development generalizabilitygeneralizability

IOA: 61-65% for 150 samples (Stott et. al., IOA: 61-65% for 150 samples (Stott et. al., 1987)1987) Scores are dependent on examiner’s accuracy and Scores are dependent on examiner’s accuracy and judgment judgment

No demographic information regarding the samplesNo demographic information regarding the samples No descriptive data for scorer reliability training No descriptive data for scorer reliability training provided in the study (Alston & Taylor, 87)provided in the study (Alston & Taylor, 87)

No validity studies doneNo validity studies done Authors do identify need for validity and further Authors do identify need for validity and further reliability studies (Alston & Taylor, 87)reliability studies (Alston & Taylor, 87)

DRHPDRHPLimitations:Limitations: Learner must have prerequisite of writing Learner must have prerequisite of writing complete sentences and writing/reading complete sentences and writing/reading comprehension.comprehension.

Suggests no room for Suggests no room for individualization/modificationindividualization/modification Could change the pictures/balloons to accommodate Could change the pictures/balloons to accommodate the learners academic repetiorethe learners academic repetiore

Remedial materials and teacher education Remedial materials and teacher education aspects are limited to brief sections aspects are limited to brief sections

A brief review or introduction to an area is A brief review or introduction to an area is not sufficient information to plan and carry not sufficient information to plan and carry out handwriting programming (Daniels, 1988)out handwriting programming (Daniels, 1988)

Advantages:Advantages: Easy to administer (Daniels, 1988)Easy to administer (Daniels, 1988)

DRHPDRHPConclusion:Conclusion: Not a valid/reliable tool in assessing Not a valid/reliable tool in assessing handwriting problemshandwriting problems

With clarification in scoring methods With clarification in scoring methods DRHP could be…DRHP could be… Useful tool for occupational therapists and Useful tool for occupational therapists and behavioral therapists in assessing/teaching behavioral therapists in assessing/teaching handwriting problemshandwriting problems

Not a useful approach to assessing Not a useful approach to assessing handwriting for lower skilled handwriting for lower skilled individuals since there is a need for individuals since there is a need for writing/reading comprehension.writing/reading comprehension.

ETCHETCHEEvaluation valuation TTool of ool of

CChildren’s hildren’s HHandwritingandwriting

Author:Author: Susan J. Amudson Ph.D. OTR/L, FAOTASusan J. Amudson Ph.D. OTR/L, FAOTAPublication-1995Publication-1995

ETCHETCH

Who is using it?Who is using it?• Public Schools Public Schools • Pediatric occupational therapy Pediatric occupational therapy agencies agencies

• Children’s Hospitals Children’s Hospitals • Child SpecialistsChild Specialists

ETCHETCHPurpose:Purpose:

Evaluate:Evaluate:• Global legibility Global legibility • Speed Speed Target Population:Target Population:

• Mild developmental delaysMild developmental delays• Learning disabilities Learning disabilities • Mild muscular impairment Mild muscular impairment

ETCHETCHPrerequisite Skills:Prerequisite Skills:

• First or Second grade levelFirst or Second grade level• Composition Composition

ETCHETCHDesignDesign

Task 1- Alphabet Task 1- Alphabet Task 2- NumbersTask 2- NumbersTask 3- Near point Task 3- Near point Task 4- Far point Task 4- Far point Task 5- Dictation Task 5- Dictation Task 6- Sentence Task 6- Sentence

composition composition

ETCHETCHExample:Example:

ETCHETCHHow is the test scored?How is the test scored?Legibility Legibility • subtract the illegible letter, word subtract the illegible letter, word or numbers from the possible total.or numbers from the possible total.

Speed-Speed-TasksTasks 3, 4 &63, 4 &6• Minutes are divided by the number of Minutes are divided by the number of letters written within the time letters written within the time given.given.

ETCHETCHDiekema et al. (1998)Diekema et al. (1998)Test-retest reliability of the ETCH-MTest-retest reliability of the ETCH-M

• Examined the test-retest reliability with Examined the test-retest reliability with • 31 First and second graders31 First and second graders• Tested twice with one week between testing Tested twice with one week between testing Results:Results: total letter legibility =.77 total letter legibility =.77 total word legibility =.71total word legibility =.71Individual letter legibility ranged from .20-.76 Individual letter legibility ranged from .20-.76

ETCHETCHSudsawad et al. (2000)Sudsawad et al. (2000)

The Relationship Between the ETCH and The Relationship Between the ETCH and teachers’ perception of handwriting teachers’ perception of handwriting

LegibilityLegibility • 45 first grade students 45 first grade students • Teacher rated students Teacher rated students • ETCHETCH• Compared the ETCH scores to the teacher Compared the ETCH scores to the teacher

questionnairequestionnaire

Results:

Legability Legability Items:Items:

ETCHETCH Teacher Teacher Questionnaire Questionnaire

NumbersNumbers m=76.3m=76.3 m= -1.3m= -1.3Near Point Near Point m= 61.8m= 61.8 m= -1.8m= -1.8Far PointFar Point m=45.8m=45.8 m=-2.0m=-2.0Dictation Dictation m=42.2 m=42.2 m=1.7m=1.7

ETCHETCH

ETCHETCH

Pros:Pros:• Examiner is proficient Examiner is proficient • Scoring criteriaScoring criteria• Score sheets Score sheets • Includes diagramsIncludes diagrams• Total score reliabilityTotal score reliability• Tasks are relevantTasks are relevant• Cons:Cons:• Individual score reliability Individual score reliability • Insufficient validity studiesInsufficient validity studies• VariabilityVariability• Writing Quality Writing Quality

ETCHETCHLimitations:Limitations: SubjectiveSubjective Handwriting changes Handwriting changes Combined with other methods Combined with other methods Unable to account for the Unable to account for the differences in differences in

handwriting qualityhandwriting quality

ETCHETCHHow can this be modified?How can this be modified?Latency and durationLatency and durationOperational definitionOperational definitionlegibility legibility speedspeed

Pretest/Post-test Pretest/Post-test

ReferencesReferencesAlston, J., & Taylor, J. (1987). Alston, J., & Taylor, J. (1987). Handwriting: Theory, Handwriting: Theory,

research and practiceresearch and practice. London, UK: Croom Helm.. London, UK: Croom Helm.Berninger, V., & Graham, S. (1998). Language by hand: Berninger, V., & Graham, S. (1998). Language by hand: A synthesis of a decade of research on handwriting. A synthesis of a decade of research on handwriting. Handwriting ReviewHandwriting Review 12: 11-25. 12: 11-25.

Cornhill, H., & Case-Smith, J. (1996). Factors that Cornhill, H., & Case-Smith, J. (1996). Factors that relate to good and poor handwriting. relate to good and poor handwriting. American Journal of American Journal of Occupational Therapy, 56(3),Occupational Therapy, 56(3), 305-312. 305-312.

Daniels, L.E. (1988). The diagnosis and remediation Daniels, L.E. (1988). The diagnosis and remediation of handwriting problems: An analysis. of handwriting problems: An analysis. Physical & Physical & Occupational Therapy in PediatricsOccupational Therapy in Pediatrics, 8(1), 61-67., 8(1), 61-67.

Diekema, S.M., Deitz, L., & Amundson, S.J. (1998). Test-retest reliability of the Evaluation Tool of Children’sHandwrting-Manuscript. American Journal of Occupational Therapy, 52, 248-255.

Feder, K., & Majnemer, A. (2003). Children’s Feder, K., & Majnemer, A. (2003). Children’s Handwriting Evaluation Tools and Their Psychometric Handwriting Evaluation Tools and Their Psychometric Properties. Properties. Physical and Occupational Therapy in Pediatrics, Physical and Occupational Therapy in Pediatrics, 23(323(3), 65-83.), 65-83.

ReferencesReferencesHarvey, C. & Henderson, S. (1997). Children’s Harvey, C. & Henderson, S. (1997). Children’s handwriting in the first three years of school: handwriting in the first three years of school: Consistency over time and its relationship to Consistency over time and its relationship to academic achievement. academic achievement. Handwriting ReviewHandwriting Review 11: 8-25. 11: 8-25.

Owens, L.L (2004). The Effects of the Handwriting Owens, L.L (2004). The Effects of the Handwriting Without Tears Program on the Handwriting of Without Tears Program on the Handwriting of Students in Inclusion Classrooms. Students in Inclusion Classrooms. Master’s ThesisMaster’s Thesis. . Virginia Commonwealth University, Richmond, Virginia Commonwealth University, Richmond, Virginia. Virginia.

Reisman, J.E., (1991). Reisman, J.E., (1991). Poor handwriting: Who is referred? Poor handwriting: Who is referred? American Journal of Occupational Therapy, 45American Journal of Occupational Therapy, 45, 849-852., 849-852.

Reisman, J.E., (1993). Development and Reisman, J.E., (1993). Development and Reliability of the Research Version of the Reliability of the Research Version of the Minnesota Handwriting TestMinnesota Handwriting Test .. Physical and Occupational Physical and Occupational Therapy in Pediatrics, 13Therapy in Pediatrics, 13(2), 41-55.(2), 41-55.

Sassoon, R. (1997). Dealing with adult Sassoon, R. (1997). Dealing with adult handwriting problems. handwriting problems. Handwriting ReviewHandwriting Review 11: 69- 11: 69-74.74.

ReferencesReferencesStott, D.H., Henderson, S.E., & Moyes, F.A. (1987). Stott, D.H., Henderson, S.E., & Moyes, F.A. (1987). Diagnosis and remediation of handwriting Diagnosis and remediation of handwriting problems. problems. Adapted Physical Education QuarterlyAdapted Physical Education Quarterly, 4, 134-, 4, 134-147.147.

Stott, D.H., Moyes, F.A., & Henderson, S.E. (1985). Stott, D.H., Moyes, F.A., & Henderson, S.E. (1985). Diagnosis and Remediation of Handwriting ProblemsDiagnosis and Remediation of Handwriting Problems. . Fairwater, Cardiff, Whales. DRAKE Educational Fairwater, Cardiff, Whales. DRAKE Educational Associates.Associates.

Stowitschek, C.E., Stowitschek, J.J., Hendrickson, Stowitschek, C.E., Stowitschek, J.J., Hendrickson, J.M., Gable, R.A. (1989). Diagnosis and J.M., Gable, R.A. (1989). Diagnosis and remediation of handwriting errors. remediation of handwriting errors. Multidisciplinary Multidisciplinary Diagnostic and Training Program,Diagnostic and Training Program, 22. 22.

Sudsawad, P.,Trombly, C.A., Henderson, A., Tickle-Degnen, L (2000). The relationship between the Evaluation Tool of Children’s Handwriting and teachers perceptions of handwriting legibility. American Journal of Occupational Therapy, 55 518-523.