Date of Paper/Work


Type of Paper/Work

Doctoral Project

Degree Name

Doctor of Occupational Therapy


Occupational Science/Occupational Therapy

First Advisor

Julie D. Bass

Second Advisor

Kathleen Matuska


Doctor of Occupational Therapy


The National Handwriting Association or NHA (2019) explains that the act of handwriting is a symbolic and visual way for individuals to represent language and concepts in a physical and permanent format (NHA, 2019). The skill of handwriting is made up of multiple components including the domains of handwriting (such as tracing, near-point copying, writing from dictation or composition of sentences), legibility, speed, and ergonomic factors (Schneck & Case-Smith, 2015).

Current handwriting assessments, such as the Evaluation Tool of Children’s Handwriting (ETCH) or The Shore Handwriting Screening for Early Handwriting Development focus on assessment and intervention for early childhood and elementary when writing skills are developing. There are not handwriting assessment tools listed for adolescent students (Schneck & Case-Smith, 2015).

Handwriting intervention can take on a variety of forms depending on the identified needs of the individual. There are no national requirements for handwriting instruction in the United States and there is variety among states and school districts of possible handwriting instruction curriculums used (Schneck & Case-Smith, 2015). Resulting deficits may present in students for a variety of reasons. Intervention may include accommodating the deficits through the use of assistive technology (Schneck & Case-Smith, 2015). Intervention studies and research are limited to early childhood and elementary aged students or adolescent students with known disabilities (Schneck & Case-Smith, 2015).

Handwriting for adolescents in the school setting is a complex topic. The impact of difficulty with handwriting skills can be observed in a variety of ways and has potential to impact a student’s future and career (Miller et al., 2018). Current educational standards, or Common Core Standards, do not provide guidance for handwriting instruction beyond first grade, resulting in no expectations for direct handwriting instruction in secondary grades (Alstad et al., 2015). Intervention and assessment tools designed for younger students do not support improving writing skills in adolescents. Referrals for occupational therapy practitioners to address handwriting skills in the school setting are not limited to one age group.

Through three focused knowledge translation projects on this topic, it was found that occupational therapy practitioners and other stakeholders working with this population agreed with the importance of handwriting instruction in the school setting. Upon completion of the literature review a professional poster reviewing the main themes of the findings indicated the effects of Common Core standards on handwriting instruction. Through presentation of this evidence at an occupational therapy professional conference, occupational therapy practitioners indicated positive beliefs on the importance of this topic and the need for increased awareness.

Through a second knowledge translation project using the evidence found, an article was written to highlight the impacts of educational policy on occupational therapy practice in the school setting. This allowed for recognizing future opportunities and understanding a practitioner’s role in advocacy and education for stakeholders in the school setting.

The third knowledge translation format created was a formal slide presentation including the literature review process, review of evidence and exploration of the role of occupational therapy practitioners in advocating for change in the school setting. Following a practice presentation at an occupational therapy practitioner community of practice meeting, occupational therapy practitioners expressed similar practice dilemmas and recognized the strong evidence supporting handwriting instruction in the school setting. Completion of these knowledge translation projects allowed for increased awareness, educating on opportunities for advocacy and affirmed the importance of this topic for school-based occupational therapy practitioners and related stakeholders.

Further research is needed to understand the implications handwriting difficulties have on academic and non-academic outcomes in adolescents. Occupational therapy practitioners have a unique role to advocate for the importance of handwriting instruction in elementary grades and influence changes in educational policy through future research. Handwriting is an important occupation for students in secondary grades and more research is needed to understand how to develop and support success in this area.