Handwriting Without Tears ® : General Education Effectiveness Through a Consultative Approach

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Denise K. Donica; Handwriting Without Tears ® : General Education Effectiveness Through a Consultative Approach. Am J Occup Ther November/December 2015, Vol. 69(6), 6906180050p1–6906180050p8. doi: https://doi.org/10.5014/ajot.2015.018366

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OBJECTIVE. This study explores the effectiveness of the Handwriting Without Tears ® (HWT) kindergarten printing curriculum in general education through a consultative approach with occupational therapy.

METHOD. One cohort of students was the control ( n = 19), whereas two other cohorts were experimental groups learning printing through the HWT curriculum ( n = 20 each). The Test of Handwriting Skills–Revised (THS–R) was used to collect end-of-year legibility scores for all cohorts.

RESULTS. Both experimental groups individually and both experimental groups combined into one group outperformed the control group on all 10 of the THS–R subtests—scoring significantly higher ( p < .05 using analysis of covariance controlling for age and gender) on 6 of the subtests for the former and 7 for the latter—and on overall score. Large treatment effects were found for the standard score for each experimental group ( d = 0.81, 1.03, and 1.00).

CONCLUSION. This study supports the consultative role of occupational therapy with teachers in general education for handwriting curriculum implementation and the success of HWT for printing instruction.

The role of occupational therapy practitioners in the school system is evolving. The Individuals With Disabilities Education Improvement Act of 2004 (IDEA; Pub. L. 108–446) broadened the scope of the original legislation ( Individuals With Disabilities Education Act of 1990 ; Pub. L. 101–476) to focus on improving student outcomes, preventing problems, and setting expectations for students with disabilities to achieve high standards ( Jackson, 2007 ). Preventive strategies in the school systems are addressed through mechanisms such as early intervening services (EIS) and response to intervention (RtI; American Occupational Therapy Association [ AOTA], 2011 ; Jackson, 2007 ). IDEA allows occupational therapy practitioners to consult with and sometimes provide direct services for students in general education, especially for students struggling with learning or behavior. This expanded role for practitioners fosters both a consultative and collaborative environment between practitioners and teachers ( AOTA, 2011 ).

  • Occupational Therapy in General Education

Within general education, occupational therapy practitioners may be involved in EIS and RtI. EIS is a provision that allows schools to use some of their federal IDEA funding to provide training for teachers or to fund services for general education students. For example, practitioners may provide consultation regarding education concerns observed in general education students or may be asked to recommend a multisensory handwriting instruction approach to implement schoolwide ( Jackson, 2007 ).

RtI, an example of EIS, is a process that monitors the success of instructional strategies and services that are being implemented individually, in small groups, or classwide ( Jackson, 2007 ). RtI, although implemented differently by state, is typically a three-tiered model in which the first and foundational tier is focused on the effectiveness of education for all students, thus requiring evidence-based curricula and high-quality instruction ( AOTA, 2014 ). Through the RtI model, occupational therapy practitioners may be involved at any level of implementation ( AOTA, 2012 ). Because the importance of handwriting instruction and handwriting skills continues to be documented ( Puranik & Alotaiba, 2012 ), it is an important area of concern for school teachers and administrators that is often addressed by occupational therapy ( Asher, 2006 ; Case-Smith, 2002 ; Hoy, Egan, & Feder, 2011 ). Examples of the practitioner’s involvement in general education at Tier 1 include providing training for school personnel on handwriting strategies, assisting with handwriting screening, and suggesting research-based handwriting curricula ( AOTA, 2011 , 2012 , 2014 ).

When exploring current advancements in the roles of occupational therapy within an RtI model, a recent study of 276 school-based occupational therapists indicated that more than half had been involved in problem-solving teams, coaching and consultation, and one-on-one intervention. Other methods of involvement in RtI included identification of students needing extra support, in-services, progress monitoring, data collection, universal screening, program and curriculum development, and leadership or coleadership of groups ( Cahill, McGuire, Krumdick, & Lee, 2014 ). Occupational therapy practitioners also advocate for occupational therapy services to enhance student education under IDEA provisions ( AOTA, 2011 ).

  • Evidence-Based Practice in General Education

The implementation of EIS and RtI requires evidence to be used in decision making regarding educational practices and curriculum selections. Therefore, successful steps have been taken to ensure that school-based occupational therapy practitioners are equipped to use evidence-based practice in the school setting ( Cahill, Egan, Wallingford, Huber-Lee, & Dess-McGuire, 2015 ). Recent research includes studies that have involved the implementation of occupational therapy–based approaches aligning with RtI in general education. Although this area of research is in its infancy, studies have been published supporting the consultative and collaborative efforts of practitioners and teachers to address student skills in general education ( Howe, Roston, Sheu, & Hinojosa, 2013 ; Ohl et al., 2013 ). In addition, the Write Start program is a recent example of a coteaching model for handwriting skills involving a general education teacher and an occupational therapy practitioner. Multiple studies have documented the effectiveness of this model ( Case-Smith, Holland, & Bishop, 2011 ; Case-Smith, Holland, Lane, & White, 2012 ; Case-Smith, Weaver, & Holland, 2014 ).

Handwriting Without Tears ® (HWT), used in this study, is an established handwriting curriculum historically used by occupational therapy practitioners in traditional one-on-one service delivery but also designed for full-classroom implementation and instruction ( Olsen & Knapton, 2008 ). The purpose of this study was to explore the effectiveness of HWT in general education kindergarten classrooms through teacher-led implementation supported by occupational therapist consultation.

  • Handwriting Without Tears Evidence

Recognizing and incorporating evidence-based interventions are important not only to occupational therapy practitioners but also to other school personnel. Therefore, it is important to review existing evidence for HWT. Most of the published studies support its use in a variety of contexts. Studies have been done on HWT implementation in general education through full-class instruction or with students who have identified disabilities through individual or small-group instruction.

At the preschool level, the full preschool HWT curriculum was supported through full-class implementation with at-risk students in inclusion classrooms at a rural Head Start ( Donica, Goins, & Wagner, 2013 ; Lust & Donica, 2011 ). In addition, specific HWT techniques were supported for name writing and capital letter writing in full-class, small-group, and individual settings with preschool-age students ( Carlson, McLaughlin, Derby, & Blecher, 2009 ; Griffith, McLaughlin, Donica, Neyman, & Robison, 2013 ; LeBrun, McLaughlin, Derby, & McKenzie, 2012 ). Studies have also supported the use of HWT in general education first-grade classrooms ( Hape et al., 2014 ; Roberts, Derkach-Ferguson, Siever, & Rose, 2014 ; Salls, Benson, Hansen, Cole, & Pielielek, 2013 ). However, studies reviewing the use of HWT at the critical developmental grade of kindergarten are limited. Therefore, this study addresses this gap by asking the research question, Will students instructed using the kindergarten HWT curriculum at a private half-day kindergarten program have better end-of-year handwriting legibility scores than students in the same setting taught with teacher-developed lessons using the D’Nealian style of writing?

Research Design

This pilot study used a static group comparison. Because the elementary school administrative decision to implement HWT in the kindergarten classrooms was made near the end of an academic year, a control group was identified as the current students who had been receiving teacher-led handwriting instruction during that year. Therefore, a traditional pretest–posttest design could not be used. Additionally, the instrument used was not standardized for children under age 6 yr, so standard scores could not be calculated for a pretest–posttest comparison because the children were not yet 6 yr old during the pretest. Likewise, because the school administration decided to implement the HWT curriculum schoolwide, a traditional control versus experimental classroom approach was not possible. Instead, the control group was identified as the group of students in kindergarten the year before HWT implementation. The research study was approved by the head of the school and the university institutional review board. Parent permission was received for all study participants.

Participants

The participants were half-day kindergarten students in a private school (kindergarten to 8th grade) in rural eastern North Carolina. Although the school did not specifically use the RtI model, the consultative approach of the occupational therapist with the teachers mirrors a commonly identified expanded role of occupational therapy practice with general education students. All students enrolled in kindergarten during the last month of school were invited to participate in the study as the control cohort. Control students subsequently learned handwriting using HWT in first grade the year after they participated in the study. Likewise, all students in the first-year experimental group (HWT 1) and the second-year experimental group (HWT 2) were invited to participate, but students were not included if they did not have parent permission, withdrew from the school or joined the school during the academic year, or were under age 6 yr at the time of data collection. Therefore, the sample sizes were n = 19 (out of 25) for the control group, n = 20 (out of 29) for HWT 1, and n = 20 (out of 39) for HWT 2. Student demographics are presented in Table 1 .

Data collection occurred consecutively over 3 yr and included data from the control group and HWT 1 and 2. Data collection was completed using the Test of Handwriting Skills–Revised (THS–R; Milone, 2007 ), which was designed to assess a child’s neurosensory integration skill and is implemented to gather data on either manuscript (print) or cursive writing. For this study, the manuscript assessment was used. The test is standardized for children ages 6 yr 0 mo to 18 yr 11 mo and consists of 10 separate subtests. The activities in these subtests are described in Table 2 . The THS–R was administered to one class at a time and took about an hour per class.

The THS–R was selected to measure differences in handwriting skills because it is standardized and allows for a variety of scores to be used for analysis. The overall standard score, scaled subtest scores for each of the 10 subtests, and subsequent percentile scores were determined. Scaled scores have a mean ( M ) of 10 and a standard deviation ( SD ) of 3, whereas standard scores have an M of 100 and an SD of 15. The test–retest reliability was .82 for the total test score, with interrater reliability ranging from .75 to .90 based on the authors of the assessment ( Milone, 2007 ). Unfortunately, no standardized handwriting assessments exist with standard scores for students under age 6 yr, which limits the ability to collect standard scores from the beginning of the kindergarten year. Because the use of standard scores is ideal for data analysis, students younger than age 6 yr (72 mo) at the time of data collection (end of the school year) were excluded from data analysis.

Intervention

Throughout the kindergarten year, the control group received teacher-developed instruction using the D’Nealian style of writing, and HWT 1 and 2 learned printing through the use of kindergarten HWT. At the end of the kindergarten year, the students completed the THS–R to determine the quality of their handwriting skills. The end-of-year scores for the control group were compared with the end-of-year scores for HWT 1 and 2 and with both experimental groups combined (HWT combined).

Intervention Description.

HWT 1 and 2 were instructed by their classroom teachers, who followed the lesson plans in the HWT Kindergarten Teacher’s Guide ( Olsen & Knapton, 2008 ). The kindergarten HWT curriculum included the following materials: wood pieces for capital letters with mat; slate chalkboards (one classroom used the stamp-and-see screens with similar teaching techniques as the slates because of the teacher’s aversion to chalk); Roll a Dough set; Rock, Rap, Tap, and Learn CD; and Letters and Numbers for Me student workbook ( Olsen, 2008 ).

The lesson plans ( Olsen & Knapton, 2008 ) required approximately 15 min per day of teacher instructional time, which was typically adhered to throughout the 2 yr. Each lesson was taught to the full class and typically began with a gross motor activity coordinated with a handwriting-related song on the Rock, Rap, Tap, and Learn CD. Next, the teaching guidelines ( Olsen & Knapton, 2008 ) were followed to implement a learning activity, which was either forming specific letters with multisensory manipulatives or writing in the Letters and Numbers for Me workbook ( Olsen, 2008 ). In addition to the formal handwriting instruction time, an occasional review activity, often using the manipulatives, was used as an independent morning work activity. A classroom assistant helped with materials in all classrooms throughout the 2 yr.

As part of the consultative role for this intervention, a registered occupational therapist (the author) or two occupational therapy graduate students were present in the classrooms during the handwriting lesson one time per week. This presence allowed the occupational therapy personnel to answer questions about the implementation of the curriculum and to provide occasional assistance to struggling writers. Lessons were implemented similarly for both HWT 1 and 2. Consultation by an occupational therapy practitioner with the teachers did not occur with the control group.

Interveners.

Three kindergarten teachers were involved in the study. Two teachers with 17 yr and 4 yr of teaching experience at the beginning of HWT 1 intervention participated in all three cohorts. The same two teachers who taught HWT 1 also taught the control group. After the control year, these two teachers attended a full-day printing and cursive training workshop on the HWT curriculum, which is recommended but not required of the program. The teachers worked together to develop their lesson plans based on the HWT Kindergarten Teacher’s Guide ( Olsen & Knapton, 2008 ).

After HWT 1 completed kindergarten, an additional kindergarten teacher with approximately 6 yr of experience was added. The new teacher attended the same HWT training as the other two teachers, but this training occurred after HWT 2's school year had started. She collaborated with the former teachers to create her lesson plans and understand the materials.

Intervention Fidelity.

To address fidelity to instruction, approximately one lesson per week of HWT 1 was observed by the author. The author consulted with the teachers and provided feedback on the teaching strategies, checked for proper use of handwriting activities and verbal cuing, and assisted as needed to address handwriting needs of specific students. This process helped establish consistency in instruction for both HWT 1 and 2. Weekly visits from the occupational therapist were unnecessary during the second year because the teachers indicated they understood how to implement the program, but the author did periodically check in with the teachers to answer questions if they arose.

Data Collection

The THS–R assessments were coded and scored semiblindly. Handwriting assessments for the three cohorts (control, HWT 1, and HWT 2) were scored by trained occupational therapy graduate students at different times, so the scorers were not blind to the cohort. However, this kindergarten study was part of a larger study that included first-grade THS–R assessments and two additional administrations of the THS–R throughout the year (approximately 4 mo apart) for the experimental groups. Therefore, even though the scorers were aware of which cohort assessments they were scoring, they were blind to the grade level and when during the academic year the assessment occurred. Scorers were trained by the author and by the DVD included in the THS–R assessment. They scored four sample handwriting assessments and discussed their differences in scoring for consistency before scoring the participants’ assessments, and they were randomly assigned assessments to score. However, interrater reliability was not established formally.

Data Analysis

The scaled scores, standard scores, and percentile scores of the THS–R were used for data analysis. Data analysis was completed using IBM SPSS Statistics (Version 22; IBM Corp., Armonk, NY). Descriptive statistics were calculated to determine the M scores and SD for each group on each of the subtests to identify specific skills and on the overall standard score for legibility. In addition, analysis of covariance (ANCOVA) was used to make statistical comparisons, controlling for age and gender because of documented differences in handwriting skills between boys and girls ( Graham, Berninger, Weintraub, & Schafer, 1998 ). Using ANCOVA, we compared the control group with HWT 1, HWT 2, and HWT combined. Treatment effect (Cohen’s d ) was calculated for each subtest comparison and for the overall score of the THS–R. This calculation serves as a frame of reference for the effect of the intervention on the outcomes and is valuable because of the small sample size. The effect size is considered small if 0.20 ≤ d ≤ 0.49, medium if 0.50 ≤ d ≤ 0.79, and large if d ≥ 0.80 ( Cohen, 1992 ; Thalheimer & Cook, 2002 ).

This study sought to determine whether students who completed kindergarten having learned handwriting skills from the HWT kindergarten printing curriculum would outperform students who learned printing from teacher-developed methods in D’Nealian-style writing in handwriting legibility skills. Table 2 includes the mean end-of-year THS–R scores for the control group compared with such scores for HWT 1, HWT 2, and HWT combined.

The experimental groups outscored the control group in all THS–R subtests and on overall score. ANCOVA showed that in 6 of the 10 subtests, both HWT 1 and HWT 2 scored significantly higher than the control group ( p < .05). In addition, ANCOVA showed that in 7 of the 10 subtests, HWT combined scored significantly higher than the control group ( p < .05). Figure 1 illustrates that the control group scored below the mean in 9 of the 10 subtests while almost all of the subtests for the experimental groups were above the mean (28 of 30). The control group performed at mean 36.63 percentile, whereas HWT 1 performed at mean 61.85 percentile and HWT 2 at mean 68.10 percentile. Refer to Table 2 for the specific results for scaled and standard scores.

Treatment effect (Cohen’s d) was calculated for each comparison. For all experimental groups (i.e., HWT 1, HWT 2, and HWT combined), a large treatment effect was found for 5–7 subtests and a medium treatment effect was found for 1–2 subtests. For HWT 2 and HWT combined, a small treatment effect was found for 2 subtests. In addition, for all experimental groups, a very large treatment effect was found for the overall standard score ( d = 0.81 for HWT 1, 1.03 for HWT 2, and 1.00 for HWT combined). The treatment effects for each subtest and overall standard scores are included in Table 2 .

The results from this pilot study show that the students who received handwriting instruction with HWT outperformed the control group consistently and across all skill areas. For uppercase letters, students in the HWT groups demonstrated a large treatment effect for printing the uppercase alphabet from memory (airplane), uppercase from dictation (butterfly), and copying selected uppercase letters (tree). These results are not surprising because the HWT curriculum begins with the students learning all uppercase letters before lowercase ones. The curriculum is diligent in instructing each uppercase letter individually in a developmental sequence through multiple multisensory mediums and in the workbook Letters and Numbers for Me ( Olsen, 2008 ).

Lowercase letters are taught in the HWT curriculum after all of the uppercase letters because of their complexity in line placement, stroke, and sequence. Each letter is instructed through multisensory techniques in a developmental sequence. The students in the HWT groups showed the largest treatment effects for printing lowercase from memory (bus). The experimental groups also demonstrated small to medium treatment effects for copying selected lowercase letters (horse) and medium to large treatment effects for copying words from a model (truck). Printing lowercase letters from dictation (frog) was not statistically significant but did demonstrate small treatment effects with the HWT 2 and HWT combined groups.

The formation of numbers from memory was also included in the THS–R (bicycle). Although the experimental groups demonstrated higher scores, differences were not statistically significant. The students began learning number formation early in the year through their math curriculum, which varied somewhat from the HWT number formations. Therefore, their introduction to this skill was not initially through the HWT curriculum.

The results for the skill level comparisons between individual upper- and lowercase letters were expected. However, large treatment effects were consistently seen for copying two sentences (book), and medium to large treatment effects were seen for writing words from dictation (lion). These effects were higher than expected because these skills are more complex than printing individual letters and are typically not well established at the end of kindergarten. Anecdotal teacher feedback supported these results, and teachers were pleased with the skills of the experimental groups.

Research supports the effectiveness of HWT in a full-class general education classroom ( Hape et al., 2014 ; LeBrun et al., 2012 ; Roberts et al., 2014 ; Salls et al., 2013 ); however, there is a gap in the literature for HWT use in kindergarten classrooms. This study was done in an effort to help bridge that gap while demonstrating how occupational therapy practitioners may serve as consultants to teachers in general education as supported by the current legislation.

  • Limitations and Future Research

Although this study has produced some important results, it has limitations that must be considered when interpreting its usefulness in evidence-based practice. First, because of the way the school administration chose to implement the curriculum, it was impossible to do a pretest–posttest comparison for each of the groups. However, pretests were done on each of the HWT groups to ensure that their scores at the beginning of the treatment year were not higher than those of the control group at the end of kindergarten. In addition, a confounding variable is that the THS–R was completed 3 times by each experimental group but only one time by the control group. However, approximately 4 mo passed between administrations to minimize learning effects.

Limitations also exist because interrater reliability was not formally established, and although some level of blinding occurred, it was not complete across all three data collection points. Lack of formal intervention fidelity monitoring is somewhat of a limitation. However, this study was designed to see whether the curriculum instructed by a teacher with collaboration from occupational therapy was effective. Therefore, it was important to let the teachers implement the curriculum as they saw fit using the guidelines provided by the curriculum as a guide.

Further research should include more involvement of occupational therapy practitioners, not only with individual students but also at the classroom and system level. To establish more evidence regarding best practices in handwriting instruction, further research should be done at the kindergarten level. However, before that research, the development of a psychometrically sound tool to measure handwriting legibility skills for the kindergarten population should be considered.

  • Implications for Occupational Therapy Practice

This study supports collaborative efforts between teachers and occupational therapy practitioners in teaching handwriting skills and gives occupational therapy practitioners more evidence on which to base recommendations in school problem-based teams and curriculum committees. The results have the following implications for occupational therapy practice:

Occupational therapy practitioners must continue to advocate for their involvement in general education problem-solving teams at the school level, which may include providing recommendations for handwriting curriculum.

Occupational therapy practitioner consultation with teachers can be successful in implementing handwriting curricula.

HWT is an evidence-based curriculum that can be recommended by occupational therapy practitioners for effective printing instruction at the classroom or institutional level.

  • Acknowledgments

The author thanks the students and teachers who were involved in this study and the East Carolina University master of science in occupational therapy graduates who assisted with data collection: Simone Barnes, Kristen Gibbs, Anne Thomas, and Caitlin Zawistowicz. In addition, Suzanne Hudson, associate professor at East Carolina University, consulted on the statistical analysis. The author also thanks HWT, which provided discounted trainings for the teachers and graduate students involved in the study.

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Data & Figures

Figure 1. Mean scaled scores on end-of-year Test of Handwriting Skills–Revised subtests. / Note. Dark horizontal line indicates mean scaled score of 10. HWT = Handwriting Without Tears.

Mean scaled scores on end-of-year Test of Handwriting Skills–Revised subtests.

Note . Dark horizontal line indicates mean scaled score of 10. HWT = Handwriting Without Tears.

Participant Demographic Characteristics ( N = 59)

Note. HWT = Handwriting Without Tears; M = mean; SD = standard deviation.

Comparison of THS–R Mean Scaled Scores Between Control and Experimental Groups

Note. For all results, p < .05 is significant. p values were calculated while controlling for age and gender. HWT = Handwriting Without Tears; LC = lowercase; M = mean; SD = standard deviation; THS–R = Test of Handwriting Skills–Revised; UC = uppercase.

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Handwriting Without Tears Letter Order

  • by victoria3515
  • November 2, 2023

Amazon affiliate links may be included in this blog post. As an Amazon Influencer, I earn from qualifying purchases.

In this blog post, we’re covering Handwriting Without Tears letter order, or the specific order to teach letter formation based on the handwriting curriculum, Handwriting Without Tears (Learning Without Tears). We’ve previously covered the cursive HWT order so this is a nice resource to have on hand.

Have you noticed most teachers teach letters in alphabetical order? The first thing they teach is name writing, then writing the alphabet. This seems like a logical progression, but is not the most effective or efficient method. There are several different handwriting programs out there to address this important skill. Many of them do not teach letters in order.

handwriting without tears occupational therapy

One program specifically is; Handwriting without Tears (now called Learning without Tears). The Handwriting without Tears letter order is vastly different than writing letters in sequential order.

handwriting without tears letter order

The Handwriting without Tears program is popular among therapists for good reasons:

  • It’s a research-backed curriculum
  • The program is designed to be easy to teach and easy to learn
  • Developmentally appropriate sequence
  • It uses explicit instruction combined with guided practice
  • Promotes handwriting automaticity
  • Multisensory learning to support a variety of learning styles, including kinesthetic learners , visual learners, and auditory learners
  • Uses hands-on tools and activities in handwriting lessons
  • Uses intuitive lesson booklets to promote learning

According to the folks at Learning without Tears, “Pre-K–5 students move through a developmentally appropriate teaching order from capital, to lowercase, and cursive letters. This design helps children master handwriting skills in the easiest, most efficient way. Instead of teaching 52 letter symbols with a mishmash of different sizes, positions, and confusing starting places, we divide and conquer.”

what is handwriting without tears letter order?

If you have used the HWT program, you may have noticed the letters are not in sequential order . In other words, the Handwriting Without Tears program does not teach letter formation in order from A-Z.

This sounds counter intuitive, as students are generally taught letters in order. Child development skills , as found in the Peabody Developmental Motor Scales , demonstrates the visual motor progression of fine motor skills . We cover some of this in our post on drawing milestones .

When developing writing skills, pre-writing lines emerge. This begins when the stages start at scribbling, vertical and horizontal lines, then circular forms. After these are mastered, more difficult designs such as a cross, square, and triangle are developed.

Learners who are still mastering the basics of writing lines, do not have the necessary skills to form more complex designs such as the letter A which relies on diagonal lines, or B which requires semicircles. Students often get stuck at this stage if they are unable to form these letters.

The Handwriting without Tears letter order promotes success, focusing on letters that use the preliminary pre-writing strokes. This is why letters with straight lines are taught first and in a group, known as letter families .

HWT Letter Order Groups

The Handwriting Without Tears letter order progresses like this:

  • L, F, E, H, T, I
  • U, C, O, Q, G, S, J, D, P, B, R
  • K, A, N, M, V, W, X, Y, Z

Handwriting Without Tears Straight Line Letters

The first letters are L, F, E, H, T, I. Notice all of these letters require only vertical and horizontal lines.

This is the first developmental skill mastered. Imagine the success of learning six letters right away, rather than struggling on A and B!

handwriting without tears Circular Letters

The second set of letters are circular: U, C, O, Q, G, S, J, D, P, B, R. The letters within each section progress in level of difficulty from U to R.

Notice that letter B is 16th on the list! This is vastly different than the traditional method of teaching it as letter number two.

While R, is a circular letter, it also contains a diagonal, which segues into the third uppercase letter formation group.

Grab our Letter B Worksheet for sensory motor practice to form the semicircles that make up this circular letter.

We also have a Letter C Worksheet for improving the circular motion of the pencil which carries over to other letters (Also known as magic c and is helpful for forming the lowercase letter counterparts).

Further down the list is letter D, and you can use our Letter D Worksheet to work on the straight line followed by a rotated semicircular motion that then carries over to the remaining letters with the same motor pattern: P, B, and R.

handwriting without tears Diagonal Letters

The third and final set of letters are the diagonals. Copying a triangle is one of the last basic shapes to learn as a developmental progression.

Forming diagonals is tricky. Not only are students crossing midline , they are doing so in a top to bottom fashion.

The letters in this series are: K, A, N, M, V, W, X, Y, Z. A is number 18 on the list. Now you can see why students struggle to learn the very first letters of the alphabet. They are not developmentally ready for this skill at the time we are insisting on teaching it.

Try using our Letter A Worksheet for sensory motor practice to form the diagonals and starting the letter in the middle.

Starting Position for handwriting without tears letters

An additional method HWT uses to group uppercase letters is their starting position. This is not my personal method of teaching, as I prefer the developmental sequence.

When focusing on the starting point for letters, Handwriting Without Tears groups the upper case letters into three catagories, depending on where the pencil starts:

  • Frog Jump Capital Letters – F, E, D, P, B, R, N, M
  • Corner Starting Capital Letters – H, K, L, U, V, W, X, Y, Z
  • Center Starting Capital Letters – C, O, Q, G, S, A, I, T, J

Take a look at the Frog Jump Capitals that start at the left corner (F, E, D, P, B, R, N, M). Notice several of these letters are more complex with diagonal lines. This can be a challenge for some students that struggle with the pre-writing lines, specifically diagonals. Additionally, this grouping of letters includes several different pencil stroke patterns, which can also be a challenge for some students.

Their second grouping is the starting corner capitals (H, K, L, U, V, W, X, Y, Z). This grouping of letters also includes a mix of straight line letters, diagonals, and curves.

Lastly, the center starters (C, O, Q, G, S, A, I, T, J) are addressed. Again, this group of letters includes more curved lines, but again, a mix of straight lines, curved lines, and diagonals. Notice how many of the last letters are commonly used letters. This is another reason why this particular HWT letter order might be a challenge for some.

uppercase or lowercase letter order first?

There has been some discussion on whether it is better to teach upper or lowercase letter formation first. We cover the developmental reasons in our linked blog post.

The research has been inconclusive, as there are benefits to both.

  • While lowercase letters are everywhere, capital letters are the first introduced in toddler books and puzzles.
  • Lowercase letters will be used much more than capital, but uppercase letters are much easier to form due to the simple straight lines.
  • There is no retracing or letters that sit below the line in uppercase letters
  • B/D are not as confusing as lowercase b and d when writing capital letters
  • When reading, many agree that teaching letter sounds is more important than their names, therefore teaching lowercase letter sounds first, may be more beneficial than teaching the letter names
  • Consider the age of your learners – preschooler should write uppercase first, as that is their developmental progression stage. Kindergarten and later students may be able to start in alphabetical order, however for delayed students, this can cause frustration

handwriting without tears lowercase letter order

For the same reason we teach uppercase letters in a progressive order, Handwriting without Tears lowercase letter order is important also. These letters are formed in developmental progression as with the uppercase.

  • Just like their capital letters – c, o, s, v, w, t (just like uppercase only lower cross)
  • Magic C – these high frequency letters (a, g, d) start with a magic “c”. This helps differentiate between b and d. While “q” is a “magic c” letter, it is taught later to avoid confusion with g
  • The rest of the vowels – u, i, e
  • Familiar from capitals – l, k, y, j
  • Diving letters – these letters dive down (p, r, n, m, h, b)
  • Tricky leftovers – f has a tricky start, letter q is taught here to avoid confusion with g, x and z are familiar but infrequently used
  • Once these are learned, I add another group: the drop down letters. These are the most difficult to write correctly as all of the other letters sit on the line. When I am teaching correct letter formation, j, g, p, q, y are stressed as their own group, after the others have been learned

cursive handwriting letter order

As with upper and lowercase letter formation, cursive letters are formed in groups. While HWT has their way of presenting the cursive letters, I prefer (Amazon affiliate link) “ Loops and other Groups “.

This system groups the letters into the way they are formed. There are the clock climbers, kite strings, loop groups, then hills and valleys. Capital letters are taught last, as they are tricky and not used as frequently.

Here is an interesting post from the OT Toolbox about teaching cursive writing .

How to Teach Cursive Writing is another great resource.

resources to support handwriting without tears letter order

  • Learning Without Tears letter strategies uses a multisensory approach to learning letters , which includes creating letters out of clay or wooden blocks, singing songs about letters, to drawing on tiny chalkboards.
  • Cursive writing letter order teaches more specifics about writing in letter groups

Everyone is different, as are their learning styles. Ultimately the goal is success. Whether that means using the Handwriting Without Tears Letter Order, or another teaching method, whatever helps and motivates your student is the correct choice. Nothing we teach is one size fits all. That is what makes our job so exciting and dynamic!

handwriting without tears occupational therapy

Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

The Letters Fine Motor Kit is a supplement to any handwriting curriculum and uses hands-on, multisensory strategies to support letter formation.

Want printable handwriting and sensory motor activities to target the visual motor skills needed for letter writing? Grab a copy of our Letters! Fine Motor Kit . The printable PDF contains 100 pages of hands-on letter writing practice for multisensory handwriting!

Letters Fine Motor Kit

Inside the Letters Fine Motor Kit , you’ll find:

  • A-Z Multisensory Writing Pages:  Roll a ball of dough letters, ASL sign language letters, gross motor movement, small-scale letter box writing task, finger isolation letter trace, and writing practice area
  • Alphabet Fine Motor Clip Cards – Clip clothespins or paper clips to match letters with various fonts to strengthen the hands and focusing on eye-hand coordination, bilateral coordination, visual processing skills, and more.
  • Cut and place Fine Motor Mazes – Cut out the letter pieces and trace the maze with a finger to work on eye-hand coordination and finger isolation. Place a small letter on the letter spots to address in-hand manipulation and dexterity skills.
  • A-Z Cotton Swab Cards – Includes upper case and lower case letters. Dot the cards using a cotton swab or laminate the cards and use them over and over again.
  • A-Z Pattern Block Cards – These cards include a section for tracing with a finger tip for separation of the sides of the hand, eye-hand coordination, and finger isolation during letter formation. There is also a space to “finger write” the letter using the fingertip. This multisensory letter formation activity can be a great brain break during handwriting or literacy tasks. Learners can then form the letter using parquetry blocks.
  • Fine Motor Letter Geo-Cards – These geo board cards include A-Z in upper case forms. Users can copy the letter forms in a variety of multi-sensory strategies.
  • A-Z Color and Cut Letter Memory Cards – These upper case and lower case letter cards can be used to color for letter formation. Then use them in fine motor matching tasks or in sensory bins.
  • Color By Size Sheets – Help learners discriminate between tall letters, small letters, and tail letters. This visual perception activity invites learners to color small areas, using hand muscles for strengthening and handwriting endurance.
  • A-Z Building Block Cards – These LEGO block cards invite users to copy the cards to form letters using small building blocks. Users can place the blocks on the cards or copy the letter to address visual shift and visual memory. This activity set comes in upper case and lowercase letter forms.
  • A-Z Play Dough Letter Formation Cards – Print off these cards and laminate them to create play dough mats. Learners can form the letters using the arrows to correctly form letters with play dough while strengthening their hands and visual motor skills. Each card includes a space for practicing the letter formation, using a dry erase marker if the cards are laminated.
  • Graded Lines Box Writing Sheets – Users can trace and form letters in boxes to work on formation of letters, line awareness, starting points, and letter size.
  • Alphabet Roll and Write Sheets – Roll a dice and form the letter associated with the number of dots on the dice. This is a great way to work on letter formation skills using motivation. Which letter will reach the top first? This activity is easily integrated with a rainbow writing task to increase number or repetitions for letter practice.
  • Pencil Control Letter Scan – Use the letter bubble tracks to scan for letters. Users can fill in the letters of the alphabet to work on pencil control skills.
  • Color and Cut Puzzles – Color the pictures to work on hand strength and letter formation skills. Then cut out the puzzles and build visual perceptual skills.

Get your copy of the Letters Fine Motor Kit today!

"Handwriting Without Tears letter order" with letter K on a chalkboard and a small piece of chalk

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Many occupational therapists at Speech and Occupational Therapy Services of North Texas are trained in the Handwriting Without Tears method of teaching and remediating handwriting. Please visit www.hwtears.com for more information about Handwriting Without Tears.

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Curriculum-Based Handwriting Programs: A Systematic Review With Effect Sizes

Courtney engel.

Courtney Engel, MOT, OTR, is Occupational Therapist, Chicago, IL. At the time of the research, she was Master’s Student, Occupational Therapy Program, Department of Kinesiology, University of Wisconsin–Madison

Kristin Lillie

Kristin Lillie, MOT, OTR, is Occupational Therapist, Milwaukee, WI. At the time of the research, she was Master’s Student, Occupational Therapy Program, Department of Kinesiology, University of Wisconsin–Madison

Sarah Zurawski

Sarah Zurawski, MSE, OTR/L, is Lecturer, Occupational Therapy Program, Department of Kinesiology, University of Wisconsin–Madison

Brittany G. Travers

Brittany G. Travers, PhD, is Assistant Professor, Occupational Therapy Program, Department of Kinesiology, University of Wisconsin–Madison, and Assistant Professor, Waisman Center, University of Wisconsin–Madison; ude.csiw@srevartb

Associated Data

A systematic review of evidence for the effectiveness of curriculum-based handwriting interventions (preschool to second grade) found evidence for improvements in handwriting legibility but not in speed or fluency.

Challenges with handwriting can have a negative impact on academic performance, and these challenges are commonly addressed by occupational therapy practitioners in school settings. This systematic review examined the efficacy of curriculum-based interventions to address children’s handwriting difficulties in the classroom (preschool to second grade). We reviewed and computed effect sizes for 13 studies (11 Level II, 2 Level III) identified through a comprehensive database search. The evidence shows that curriculum-based handwriting interventions resulted in small- to medium-sized improvements in legibility, a commonly reported challenge in this age group. The evidence for whether these interventions improved speed is mixed, and the evidence for whether they improved fluency is insufficient. No clear support was found for one handwriting program over another. These results suggest that curriculum-based interventions can lead to improvements in handwriting legibility, but Level I research is needed to validate the efficacy of these curricula.

Handwriting difficulties are observed in 10%–30% of school-age children with and without identified disabilities ( Feder & Majnemer, 2007 ). Children experiencing handwriting impairments tend to have lower achievement in mathematics, lower verbal IQ, and greater attention difficulties than their peers without impairments ( Sandler et al., 1992 ), resulting in decreased ability to interact and engage in classroom settings. Poor handwriting can also lead to limited compositional fluency ( Graham, Berninger, Weintraub, & Schafer, 1998 ), issues with taking legible notes and reading them later, and more time needed to finish assignments ( Graham, 1992 ). Moreover, handwriting impairments have been linked to reduced working memory capacity and lower reading and spelling scores ( McCarney, Peters, Jackson, Thomas, & Kirby, 2013 ), suggesting that handwriting challenges early in life may have cascading negative effects on learning and academic performance.

To address handwriting difficulties, several curriculum-based handwriting programs have been developed. These programs are taught within the classroom setting and are geared toward improving handwriting in all children, not just those exhibiting difficulties. Occupational therapy practitioners in the schools often facilitate these interventions; handwriting deficiencies are one of the primary causes for referral to occupational therapy among school-age children ( Barnes, Beck, Vogel, Grice, & Murphy, 2003 ).

Handwriting Without Tears (HWT; Olsen & Knapton, 2008 ), a developmentally and multisensory-based handwriting curriculum, can be implemented in the classroom by both teachers and occupational therapy practitioners. The Write Start program ( Case-Smith, Holland, & Bishop, 2011 ; Case-Smith, Holland, Lane, & White, 2012 ), another cotaught classroom-embedded intervention, is aimed at promoting writing fluency in grade school children of all ability levels. These and other curriculum-based programs (see Table 1 ) target handwriting performance in children’s classroom setting. The curriculum-based approach aligns with the Every Student Succeeds Act of 2015 (Pub. L. 114-95) , a reauthorization of the No Child Left Behind Act of 2001 (Pub. L. 107-110) , which allows schools to address the needs of all students but particularly focuses on children who are not meeting academic standards. Aligning handwriting interventions with classroom curricula is thought to promote greater generalization of skills to handwriting-based activities within the classroom.

Handwriting Curriculum-Based Interventions Examined in the Reviewed Studies

Despite the availability of curriculum-based programs, little research has been conducted on the efficacy of these interventions in improving handwriting performance. A previous systematic review found that handwriting interventions (a blend of both curriculum-based and non–curriculum-based programs) were effective when they provided sufficient time for handwriting practice ( Hoy, Egan, & Feder, 2011 ). However, this review did not specifically evaluate curriculum-based handwriting interventions, and the majority of the literature on curriculum-based programs has been published since the review.

Therefore, the objective of the current study was to systematically review the efficacy of curriculum-based handwriting programs in improving handwriting in classroom activities for children with and without identified disabilities. Combining our systematic review with effect size calculations from each study, we specifically aimed to examine (1) whether curriculum-based handwriting interventions in general made meaningful changes to children’s handwriting legibility, speed, and fluency; (2) whether specific curricula rendered the largest treatment effects; and (3) whether specific characteristics of curricula (e.g., age at intervention, length of intervention) led to more substantial treatment effects.

Search Strategy

We conducted a systematic search of the literature to identify curriculum-based handwriting interventions for children. The previous systematic review of handwriting interventions covered December 1978 to January 2010 ( Hoy et al., 2011 ). The current review included studies of curriculum-based handwriting interventions published from January 2006 to December 2015. Figure 1 shows the number of studies identified, screened, eligible for, and included in the systematic review. With the help of a medical librarian, our team systematically searched the following databases: PubMed, EBSCOhost (including Academic Search Premier), CINAHL Plus With Full Text, Education Full Text, ERIC, MEDLINE, PsycINFO, Social Sciences Full Text, SocINDEX with full text, and OTseeker. For PubMed, key terms included child * and handwrit * and (intervention or therapy or program). For EBSCOhost, terms included child * (and handwrit * intervention or handwrit * program). For OTseeker, the broad term “handwriting” was used to encompass a wide range of articles. The searches were further narrowed by the use of filters, including peer-reviewed journal articles, publication within the past 10 yr, and clinical trials.

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Flow diagram of articles identified, screened, eligible for, and included in the systematic review.

Figure format from “Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement,” by D. Moher, A. Liberati, J. Tetzlaff, and D. G. Altman; PRISMA Group, 2009, PLoS Medicine, 6 (6), e1000097. https://doi.org/10.1371/journal.pmed.1000097

The search terms were developed to capture relevant articles and to ensure that the terms relevant to the specific thesaurus of each database were included. Additionally, the American Journal of Occupational Therapy was hand searched to ensure that all appropriate articles were included.

Selection Criteria

Articles selected for review included those that had used handwriting interventions and curriculum-based programs for children in preschool through fifth grade. We chose to exclude articles addressing children above the fifth-grade level to focus on the years when children typically learn handwriting fundamentals. We included studies of curriculum-based handwriting programs used for children both with and without identified disabilities, who together form the target population of these interventions. Other inclusion criteria were interventions that took place in a general education classroom, interventions longer than one session, and interventions with a clear beginning and end. Specific exclusion criteria were studies with adult participants, interventions implemented outside the classroom setting, and studies that lacked a distinguishable intervention. The studies used in our review were assessed for outcomes related to overall handwriting performance, such as legibility, writing speed, and fluency.

Effect Size Computations

Using the reported means and standard deviations published in each study, we calculated Hedge’s g using the compute.es package ( Del Re, 2013 ) in R ( R Core Team, 2015 ). Hedge’s g is an effect size measure that permits comparison of the size of the intervention effect across studies and measures. A Hedge’s g of 0.20 is considered a small effect, 0.50 is considered a medium effect, and 0.80 or greater is considered a large effect. Compared with Cohen’s d, Hedge’s g may provide a better estimate of effect size in small samples ( Grissom & Kim, 2005 ). In the case of repeated measures analyses, we followed the recommendations of Morris (2008) by calculating Hedge’s g for the pre–post change in each group and then subtracting the Hedge’s g for the control group from the Hedge’s g for the treatment group. Because this procedure did not account for repeated measures, it may have led to decreased estimates of effect sizes for these analyses. Positive effect sizes represent the size of effect in the expected direction (i.e., faster, more fluent, or more legible handwriting), whereas negative effect sizes represent the size of the effect in the unexpected direction (i.e., slower, less fluent, and less legible handwriting).

From the original search, we identified 252 studies matching our search terms. Of these studies, 99 were excluded because the titles did not include handwriting or children in preschool through fifth grade. Abstracts of the remaining 153 were screened, and 121 were excluded because of the absence of an explicit handwriting intervention or program (see Figure 1 ).

Supplemental Table 1 (available online at http://otjournal.net ; navigate to this article, and click on “Supplemental”) summarizes the 13 included studies. Levels of evidence were assigned on the basis of AOTA guidelines ( Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996 ). There were 0 Level I studies, 10 Level II studies, 2 Level III studies, and 1 study we classified as Level II–III because it had two distinct intervention groups but no control. Several curricula were examined by the 13 studies, including Write Start ( Case-Smith, Holland, & Bishop, 2011 ), HWT ( Olsen, 2003 ; Olsen & Knapton, 2008 ), HWT–Get Set for School ( Olsen & Knapton, 2008 ), Peterson Directed Handwriting Curriculum ( Nelson, 2006 ), the Fine Motor and Early Writing Pre-K curriculum, the Size Matters Handwriting Program (SMHP; Moskowitz, 2009 ), Write Direction ( Taras, Brennan, Gilbert, & Eck Reed, 2011 ), and Handwriting Clubs ( Howe, Roston, Sheu, & Hinojosa, 2013 ). Table 1 presents a brief description of each curriculum.

Risk of Bias

Because the studies under review were nonrandomized, we assessed risk of bias according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Moher et al., 2009 ) guidelines using ROBINS–I ( Sterne et al., 2016 ). As seen in Supplemental Table 2 (available online), the majority of studies had low risk of bias across domains.

Effects of Level II Versus Level III Studies

Because Level III studies, by definition, do not have a control group, pre–post treatment effect sizes may be overestimated because they likely reflect not only improvements from the intervention but also maturation effects and benefits from completing the same or a similar measure twice. To examine whether the difference in effect sizes between the 10 Level II studies and the 3 Level III studies (including the Level II–III study) was robust, we contrasted the average effect sizes of the analyses. Level II studies had an average effect size of 0.32 (small to medium effect; range = −0.90 to 1.96), whereas Level III studies had an average effect size of 2.69 (very large effect; range = −0.19 to 9.98). The Level III effect sizes were on average eight times larger than the Level II effect sizes, suggesting that maturation effects play a large role in curriculum-based handwriting intervention research. Because of this large discrepancy, we report findings from all studies but effect sizes of only the Level II studies.

Effects of Curriculum-Based Handwriting Interventions

Handwriting legibility..

Handwriting legibility was measured as an outcome in 12 of the 13 studies. Quality was considered a proxy for handwriting legibility. Because letter formation is a main component of legibility ( Hammerschmidt & Sudsawad, 2004 ), letter formation was interpreted as legibility. Eight studies showed significant improvements in at least one component of legibility. Therefore, moderate evidence exists for improved handwriting legibility after curriculum-based handwriting programs. The reviewed interventions had an average effect size of 0.39 (range = 0.02 to 1.05), suggesting small to medium effects on legibility.

Handwriting Speed.

Nine of the 13 studies assessed handwriting speed or rate. Five of these studies found significant improvements in speed. However, 3 studies found no difference in speed, and Pfeiffer, Rai, Murray, and Brusilovskiy (2015) found that the intervention group became significantly slower after training than the control group. Therefore, the evidence is mixed regarding whether curriculum-based interventions enhance handwriting speed. The reviewed interventions had an average (mean) effect size on speed of 0.13 (range = −0.90 to 0.77). Because of the large range, we also calculated the median (0.22). Therefore, the intervention effects on handwriting speed were variable and, when averaged, were small to very small.

Handwriting Fluency.

Only 4 of the 13 studies assessed fluency, and all 4 investigated the Write Start program. Only 3 of these studies found significant differences in fluency at posttest. Because of the similarity of the studies and some inconsistencies in posttests, the evidence is insufficient for curriculum-based handwriting programs to improve fluency. Given the discrepancy in effect sizes of the 2 Level II studies that assessed fluency (range = −0.08 to 0.74), we did not calculate an average effect size.

Effects of Specific Curricula

We compared effect sizes for legibility and speed across the different curricula (see Figure 2 ). For legibility, an explicit handwriting program ( Kaiser, Albaret, & Doudin, 2011 ) had the largest effect size, but this study was the only one to use this intervention. SMHP ( Pfeiffer et al., 2015 ) and Write Start ( Case-Smith, Holland, & White, 2014 ; Case-Smith, Weaver, & Holland, 2014 ) on average had medium to large effects on legibility. The Fine Motor and Early Writing Pre-K Curriculum ( Donica, Goins, & Wagner, 2013 ), HWT ( Donica, 2015 ; Donica et al., 2013 ; Lust & Donica, 2011 ; Roberts, Derkach-Ferguson, Siever, & Rose, 2014 ; Salls, Benson, Hansen, Cole, & Pielielek, 2013 ), Write Direction ( Taras, Brennan, Gilbert, & Eck Reed, 2011 ), and intensive handwriting practice ( Howe, Roston, Sheu, & Hinojosa, 2013 ) all had small or very small effects on legibility. However, many of these studies used active and rigorous control conditions, which might have diminished the size of these effects.

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Effect sizes (Hedge’s g ) for legibility and speed, by curriculum.

Note. Effect sizes are interpreted as follows: 0.20 = small effect, 0.50 = medium effect, 0.80 = large effect. Negative effect sizes reflect intervention changes in the opposite-than-expected direction (i.e., slower handwriting after the intervention). HWT = Handwriting Without Tears; HWT–GSS = Handwriting Without Tears–Get Set for School; Pre-K = prekindergarten; VPM = visual–perceptual–motor training.

For speed, the explicit handwriting program ( Kaiser et al., 2011 ) had the largest effect size. Write Start ( Case-Smith et al., 2011 , 2012 ; Case-Smith, Holland, & White, 2014 ; Case-Smith, Weaver, & Holland, 2014 ) and intensive handwriting practice ( Howe et al., 2013 ) had small to medium effect sizes. Intriguingly, SMHP ( Pfeiffer et al., 2015 ) had a small to medium effect size but in the opposite direction, suggesting that this curriculum significantly enhanced legibility while promoting slower writing.

Effects of Specific Characteristics of Curricula

Age at instruction..

Effect sizes for legibility (17 effect sizes) and speed (8 effect sizes) were examined as a function of the grade at which the intervention took place (interventions that took place in Grades 1 and 2 were coded as 1.5). Legibility effects showed a medium-sized but not significant correlation with age at instruction, r = .33, p = .25. Speed effects did not vary according to age at instruction, r = −.06, p = .89.

Instruction Length.

The length of intervention varied across studies; however, all interventions lasted a minimum of 6 wk. The majority of handwriting programs lasted ≥12 wk and yielded handwriting improvements in at least one of the specified outcome areas. Given the variability in session time and frequency across interventions, we calculated an estimate of the total number of hours of intervention for each of the studies. Total hours of intervention ranged from 6 hr ( Donica et al., 2013 ) to 90 hr ( Donica, 2015 ), with the latter occurring over a 2-yr time span. Omitting the 90-hr intervention outlier, total intervention hours were not correlated with the effect sizes for legibility, r = .27, p = .37, or speed, r = −.11, p = .79.

This systematic review aimed to examine the evidence for curriculum-based handwriting interventions to improve handwriting legibility, speed, and fluency. From our extensive literature search, 13 curriculum-based handwriting studies met inclusion criteria for review (10 Level II studies and 3 Level III studies). Conspicuously, there were no randomized controlled trials (Level I evidence). Our systematic review rendered two major findings: (1) Curriculum-based handwriting interventions in general demonstrated small to medium effects in improving legibility, and (2) although certain programs may be better suited for targeting speed versus legibility, other characteristics of the programs (i.e., age at intervention and hours of intervention) did not appear to influence efficacy.

Efficacy of Curriculum-Based Handwriting Interventions

The findings suggest that curriculum-based handwriting interventions can successfully elicit small- to medium-sized improvements in legibility. Although the size of these effects was not large, even small gains in legibility may be important because poor handwriting legibility can greatly compromise a child’s functioning in school and lead to lower grades ( Graham, Harris, & Fink, 2000 ; Schneck & Amundson, 2010 ). These effect sizes may have been smaller than expected because many of the reviewed studies implemented active control groups (handwriting was taught, but in a different way) rather than passive control groups. Using an active control group is more rigorous but may result in underestimation of the size of the intervention effect.

In contrast, curriculum-based interventions did not appear to enhance handwriting speed. Speed effect sizes varied greatly, and the average speed effect size was small. One possible explanation is that when legibility and form are emphasized in a curriculum, slower handwriting production may result. Indeed, several studies demonstrated that when legibility improved, speed declined or showed no improvement ( Howe et al., 2013 ; Roberts, Siever, & Mair, 2010 ; Weintraub & Graham, 1998 ). Another possible explanation is that improvements in letter quality may be observed before improvements in speed because of the additional practice time needed for speed to develop ( Hoy et al., 2011 ). Consequently, speed effects may not be as evident in studies that focus on young learners.

Writing fluency was a variable of interest because the end goal of efficient handwriting is to allow children to focus on higher order aspects of writing. However, not enough studies measured fluency to be able to draw conclusions. This is a critical gap in the literature and a key avenue for future research because writing fluency likely reflects the more functional aspects of handwriting ability.

Program Characteristics That Demonstrated the Highest Efficacy

We calculated effect sizes for all studies in the systematic review to supplement our interpretation of the literature. This allowed us not only to estimate effect sizes across the whole body of evidence but also to compare effects across different curricula, ages, and lengths of intervention.

An important question has been whether one type of curriculum-based handwriting intervention outperforms the others. In other words, does it matter which curriculum a school uses? From our comparison of effect sizes, no one handwriting program appeared to outperform the other programs across all domains. Intriguingly, the Write Start program and the explicit handwriting program from Kaiser et al. (2011) were the only programs to have non–small effects on both legibility and speed. However, other programs had medium to large effect sizes in each of those domains (just not consistently across domains). Therefore, different programs may excel at targeting different outcomes.

In an ideal situation, the needs of the children in the classroom would dictate which curriculum is used. For example, our results suggest that SMHP may be best for classrooms for which the primary goal is legibility but not speed. Alternatively, for classrooms for which the primary goal is handwriting speed, the explicit handwriting program from Kaiser et al. (2011) , Write Start, or the intensive handwriting program from Howe et al. (2013) might be best suited.

We also used the effect sizes to examine the ideal length of intervention, and we found that more intervention hours did not appear to lead to substantially larger handwriting improvements. This finding suggests that 6 wk of intervention may be sufficient, even though a previous review of curriculum-based and non-curriculum-based handwriting interventions suggested that handwriting interventions should occur at least two times per week for a minimum of 20 sessions to be effective ( Hoy et al., 2011 ).

Interestingly, we found that the grade at which the intervention occurred had a nonsignificant but medium to large relation to how big the intervention-based legibility effects were, which suggests a trend for older grades to be associated with larger effects. Although this association was not statistically significant and should be interpreted with extreme caution, the size of the effects for different ages and grades might be useful in designing future research.

Limitations

A limitation of this review is that no Level I studies met inclusion criteria, restricting our ability to draw firm conclusions on the efficacy of curriculum-based handwriting interventions. The lack of Level I studies may be attributable to the fact that curriculum-based interventions, by definition, take place in the classroom, preventing random assignment of students to one condition or another. However, a large-scale study that randomly assigns different classrooms to the intervention or control condition would provide higher levels of evidence in support of curriculum-based interventions.

Another limitation is that our calculation of effect sizes did not account for repeated measures, which may have led to decreased estimates of effect sizes. We chose this as a conservative approach, but some of the effects may be underestimated. Other limitations include inconsistency in definitions of handwriting components (e.g., legibility), limited descriptions of participants, and lack of long-term follow-up in the studies reviewed.

Implications for Occupational Therapy Practice

The results of this study have the following implications for occupational therapy practice:

  • Curriculum-based handwriting programs, in general, appear to successfully target legibility in preschool, kindergarten, and young school-age children.
  • Specific curriculum-based handwriting programs may be better at targeting speed than legibility (or vice versa) and ideally should be selected on the basis of whether the primary need of the classroom is handwriting speed or legibility.
  • For the majority of children, 6 wk (∼15 hr) was enough to make gains in legibility. However, children with handwriting challenges may need more time. Future research is needed to determine the ideal length of curriculum-based handwriting programs.
  • A key need exists for future Level I research to examine curriculum-based handwriting.

Supplementary Material

Supplemental material, acknowledgments.

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Grant U54 HD090256 to the Waisman Center), the Brain and Behavior Research Foundation (NARSAD Young Investigator Award to B.G.T.), and the Hartwell Foundation (to B.G.T.). We thank Karla Ausderau and Lauren Bishop-Fitzpatrick for their insights and help with this systematic review. We also thank Michael Venner for his expertise and assistance with our database search.

* Indicates articles included in the systematic review.

Contributor Information

Courtney Engel, Courtney Engel, MOT, OTR, is Occupational Therapist, Chicago, IL. At the time of the research, she was Master’s Student, Occupational Therapy Program, Department of Kinesiology, University of Wisconsin–Madison.

Kristin Lillie, Kristin Lillie, MOT, OTR, is Occupational Therapist, Milwaukee, WI. At the time of the research, she was Master’s Student, Occupational Therapy Program, Department of Kinesiology, University of Wisconsin–Madison.

Sarah Zurawski, Sarah Zurawski, MSE, OTR/L, is Lecturer, Occupational Therapy Program, Department of Kinesiology, University of Wisconsin–Madison.

Brittany G. Travers, Brittany G. Travers, PhD, is Assistant Professor, Occupational Therapy Program, Department of Kinesiology, University of Wisconsin–Madison, and Assistant Professor, Waisman Center, University of Wisconsin–Madison; ude.csiw@srevartb .

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What is Handwriting Without Tears?

Curative Care Blogs

February 14, 2022

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Handwriting Without Tears (HWT) is a multi-sensory approach to teach K-5 writing. There is also a Pre-K portion of the program that focuses on prewriting skills required for Kindergarten readiness. HWT targets to incorporate fun, engaging and developmentally appropriate techniques into practice. It incorporates music, movement, letter play, wooden pieces, and Playdoh/putty to develop gross motor and fine motor skills along with providing a sensory enriching experience. HWT utilizes specific and unique letter formation and style to allow for better obtainment of writing skills. The program uses a vertical print style as is easiest for the child to write and what they are most familiar within their environments. The program begins with uppercase letter formation and then once mastered, progresses to lowercase letter formation and if applicable, cursive writing.

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Handwriting Without Tears

“Handwriting Without Tears” is a MUST HAVE program designed by Occupational Therapists to improve fine motor, visual perception, and eye-hand coordination skills which impact a child’s handwriting abilities.

This program is a simple, proven successful, user-friendly resource which WILL improve your child’s letter formation, speed, neatness and legibility in handwriting skills.

This program uses a consistent, easy to follow, multi-sensory approach and is very successful with the 2-lined method to teach proper letter formation.

It is an easy and fun way to learn the skills that often frustrate our children, parents, and teachers. The program is also designed to use with left-handed children and includes easy steps for pre-writing skills, and learning printing and cursive handwriting for children of all ages and developmental levels.

This fantastic handwriting program includes multiple resources for children, parents, therapists, and teachers. You will have the supplies you need to help your child learn and improve their handwriting skills.

For more information on Handwriting Without Tears, please contact us , or visit the Handwriting Without Tears website.

Your Therapy Source

Curriculum-Based Handwriting Programs – What Does the Research Say?

The American Journal Of Occupational Therapy recently published a systemic review of curriculum-based handwriting programs for students in preschool through second grade.  Challenges with handwriting in school can have a negative impact on academic performance, Occupational therapy practitioners frequently help students improve handwriting legibility, speed, and fluency.

After reviewing 13 studies, the researchers identified the following:

  • curriculum-based handwriting interventions resulted in small- to medium-sized improvements in legibility.
  • mixed evidence for improvements in handwriting speed.
  • insufficient evidence for improved fluency.
  • after review of 9 handwriting curriculums, no clear support was found for one handwriting program over another.
  • 6 wk of intervention (about 15 hours) may be sufficient to improve legibility.

Certain handwriting programs provided greater benefits with regards to legibility or speed.  For example,  the Size Matters Handwriting Program may be the best choice for classrooms for which the primary goal is legibility but not speed.   If the primary goal is handwriting speed, the research indicated that the explicit handwriting program (from Kaiser et. al), Write Start, or the intensive handwriting program from (Howe et al.) might be the best choice.

The researchers recommended that Level I research is needed to validate the efficacy of these curricula.

Reference:  Engel, C., Lillie, K., Zurawski, S., & Travers, B. G. (2018). Curriculum-Based Handwriting Programs: A Systematic Review With Effect Sizes. American Journal of Occupational Therapy, 72(3), 7203205010p1-7203205010p8.

Read more about another Occupational Therapy Handwriting Study here.

handwriting without tears occupational therapy

This  Handwriting Bundle  for PreK-5th Graders is created by school-based Occupational Therapist, Thia Triggs of Print Path. This Handwriting Without Tears© -style letter font, uses 3-lines to best support your students. There are Go-Dots, Gray-Boxes, and Simple Arrows that inform rather than confuse learners. Best practices include research-based methods incorporating application of developmental and motor learning theories to benefit your struggling learners.  Get 10 of the best handwriting instruction downloads for your multi-leveled interventions! FIND OUT MORE .

Curriculum-Based Handwriting Programs - What Does the Research Say?

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Handwriting Without Tears

handwriting without tears occupational therapy

Handwriting Without Tears (HWT) is a structured curriculum for teaching handwriting to children. The program is used regularly in Occupational Therapy treatment sessions. During the summer we offer HWT summer camps at both NTS locations. The camp is developmentally based and appropriate for children with pre-kindergarten level skills through 5th grade. This curriculum has proven to be very effective for children with special handwriting needs. The lessons follow a multi-sensory and developmentally appropriate approach to meet the needs associated with different learning styles. Camps are taught by an HWT-trained Occupational Therapist. Groups typically consist of 3-5 children per camp.

Learning to print and later to write in cursive, requires a detailed set of skills that include appropriate stability, hand and finger strength, visual motor skills, and visual perceptual ability. Difficulty forming letters, becoming fatigued with lengthy writing tasks, trouble with spacing &/or placement on the writing line, are all addressed both by identifying and remediating underlying component parts of writing ability, and well as practice during sessions and at home.

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OC Hand Writing

Oc handwriting - about.

Employs Handwriting Without Tears® certified handwriting specialists. These skilled and experienced individuals are passionate about teaching your child good handwriting habits.

Kathryn Majewicz, owner of OC Handwriting is a Certified Handwriting Specialist in Orange County, California. She has received her training and certification in the Handwriting Without Tears ® Pre-K through 5th Grade curriculum as well as in the administration of the Print Tool™ Assessment. Kathryn is a retired occupational therapy assistant and a former member of The American Occupational Therapy Association and The California Board of Occupational Therapy. Kathryn has successfully worked in Orange County for over 15 years with children, teens, and adults with special needs and learning disabilities. In addition to working in various school districts and colleges she was featured on KTLA News discussing the importance of legible handwriting for life-long success, and in The OC Family magazine and The Newport Beach Daily Pilot .

Contact (714) 875-2474 or use our contact form for further information. OC Handwriting uses the award winning Handwriting Without Tears® curriculum helping children and adults in handwriting throughout Southern California.

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In 1977, Jan Olsen set out on a mission to make handwriting easier to learn for her son John.

TEARS OVER HANDWRITING

Responding to John’s tears over handwriting in first grade , Jan used her occupational therapy training and background to develop strategies to facilitate his handwriting skills.

handwriting without tears occupational therapy

SOLUTION FOR HANDWRITING

John’s teacher noticed his progress and asked Jan to help other students in the class. Soon, Jan became known in the area as the tutoring solution for handwriting, and her ideas became the basis for the first therapist’s guide, Handwriting Without Tears.

In 1977, Jan Olsen set out on a mission to make handwriting easier to learn for her son John. Responding to John’s tears over handwriting in first grade, Jan used her occupational therapy training and background to develop strategies to facilitate his handwriting skills.

handwriting without tears occupational therapy

K-5 CURRICULUM

This guide expanded into a full, multisensory K–5 curriculum, including student editions, assessments, music, and engaging manipulatives that are integrated directly into the lessons—instead of being added into instruction as an afterthought.

DESIGNED WITH CHILDREN IN MIND

Designed with children in mind, the developmentally appropriate, hands-on instruction is simple and effective for all children and teachers. Jan even developed the Handwriting Without Tears style of cursive, simple and vertical instead of slanted, for children in grades 2–5+ to master tricky letter connections easily.

handwriting without tears occupational therapy

From there, we added a kindergarten readiness program, Get Set for School, so early numbers and letter sounds could dance across Pre-K classrooms around the country. We even introduced our favorite letter-learning hero, Mat Man, a loveable classroom character for teaching with music, building, playing, and storytelling. 

INNOVATIVE TECHNOLOGY

To meet growing needs for innovative technology instruction in schools, Handwriting Without Tears added Keyboarding Without Tears, a web-based curriculum for grades K–5 that teaches typing, general computer readiness, digital citizenship, and online test prep. ISTE-approved and winner of a CODiE and a Teacher’s Choice Award, Keyboarding Without Tears offers a technology solution that blends digital literacy into instruction in a fun and engaging way to build successful digital communicators.

handwriting without tears occupational therapy

To unify our three programs and reach more teachers and students, we rebranded in 2018 to Learning Without Tears! Learning Without Tears now includes Get Set for School, Handwriting Without Tears, and Keyboarding Without Tears. Our company has grown to make sure all children (over 30 million to date!) have all the tools they need to express their thoughts, step by step and letter by letter.

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  1. Living and Learning: Reflections on Pediatric Occupational Therapy

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  2. "Happy Occupational Therapy Month from Handwriting Without Tears

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  3. Handwriting Without Tears

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  4. 𝐎𝐜𝐜𝐮𝐩𝐚𝐭𝐢𝐨𝐧𝐚𝐥 𝐓𝐡𝐞𝐫𝐚𝐩𝐲-𝐇𝐚𝐧𝐝𝐰𝐫𝐢𝐭𝐢𝐧𝐠 𝐖𝐢𝐭𝐡𝐨𝐮𝐭 𝐓𝐞𝐚𝐫𝐬; 𝗩𝗶𝘀𝘂𝗮𝗹 𝗣𝗲𝗿𝗰𝗲𝗽𝘁𝗶𝗼𝗻

    handwriting without tears occupational therapy

  5. Pin by Amanda Phillips on preschool

    handwriting without tears occupational therapy

  6. Handwriting Without Tears Lessons in Action

    handwriting without tears occupational therapy

VIDEO

  1. Hand writing ✍️

  2. OCCUPATIONAL THERAPY HANDWRITING TIPS FOR BACK TO SCHOOL

  3. Letters Q and G

  4. Activities to Promote Handwriting Skills

  5. Learn to write Lower Case c

COMMENTS

  1. Handwriting Without Tears

    Because the importance of handwriting instruction and handwriting skills continues to be documented ( Puranik & Alotaiba, 2012 ), it is an important area of concern for school teachers and administrators that is often addressed by occupational therapy ( Asher, 2006; Case-Smith, 2002; Hoy, Egan, & Feder, 2011 ).

  2. Handwriting Specialist Certification

    Requirement 1) Must have a Bachelor's degree (or equivalent) or be a Certified Occupational Therapy Assistant (COTA) 2) Attend all four of the handwriting workshops (in their entirety) • Readiness & Writing for Pre-K • Handwriting Without Tears Print (K-2) • Handwriting Without Tears Cursive (2-5) • Handwriting Assessment

  3. Handwriting Without Tears: The "Write" Way to Learn Handwriting

    At Lumiere Children's Therapy, our Occupational Therapists use Handwriting without Tears® to help kids improve their handwriting skills. This program helps improve fine motor skills, body awareness and letter formation. In this article, we talk about common challenges that can lead to handwriting issues and how Handwriting without Tears® can help!

  4. Handwriting Without Tears Letter Order

    The Handwriting without Tears letter order promotes success, focusing on letters that use the preliminary pre-writing strokes. ... Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU ...

  5. Handwriting Without Tears®

    Intuitive, Effective Design HWT Delivers Success Shop now! Get started with our literacy solutions Start off your handwriting literacy journey today! Browse our shop and find our classroom kits and materials-designed for Pre-K-5 students. Shop Now Need support for Handwriting Without Tears? We're here to help! Get Support

  6. Handwriting Without Tears

    Many occupational therapists at Speech and Occupational Therapy Services of North Texas are trained in the Handwriting Without Tears method of teaching and remediating handwriting. Please visit www.hwtears.com for more information about Handwriting Without Tears.

  7. Find a Handwriting Specialist

    The Level 1 Certification directory helps you find an occupational therapist, teacher or other qualified individual who specializes in helping children succeed with handwriting.

  8. Curriculum-Based Handwriting Programs: A Systematic Review With Effect

    Handwriting Without Tears (HWT; Olsen & Knapton, 2008 ), a developmentally and multisensory-based handwriting curriculum, can be implemented in the classroom by both teachers and occupational therapy practitioners.

  9. To Develop an Occupational Therapy Kit for Handwriting Skill... : The

    pencil grip, letter formation, and body posture. Handwriting Without Tears Methodology™ (HWT) is an established handwriting curriculum created by Jan Olsen and is used by occupational therapy (OT) practitioners in traditional one-on-one service delivery. It is also designed for full classroom implementation and instruction and is used in thousands of Mainstream and Special Schools across the ...

  10. What is Handwriting Without Tears?

    Handwriting Without Tears (HWT) is a multi-sensory approach to teach K-5 writing. There is also a Pre-K portion of the program that focuses on prewriting skills required for Kindergarten readiness. HWT targets to incorporate fun, engaging and developmentally appropriate techniques into practice. It incorporates music, movement, letter play ...

  11. Handwriting Without Tears

    Developed by Jan Olsen, an occupational therapist, Handwriting Without Tears ® is a developmentally based program designed to progress a child's fine motor skills along with visual skills through fun and interactive activities. The program is offered by the Center for Independence at UPMC Children's Hospital of Pittsburgh.

  12. Learning Without Tears History

    In 1977, Jan Olsen set out on a mission to make handwriting easier to learn for her son John. Responding to John's tears over handwriting in first grade, Jan used her occupational therapy training and background to develop strategies to facilitate his handwriting skills. John's teacher noticed his progress and asked Jan to help other ...

  13. Collaborative instruction and Handwriting Without Tears®: A strong

    Occupational therapists are uniquely positioned to assist teachers and students in the occupational task of handwriting. This intervention combined a collaborative teaching model and the use of Handwriting Without Tears ® to teach lower case letter writing to two classrooms of kindergarteners.

  14. Handwriting Without Tears

    Handwriting Without Tears. "Handwriting Without Tears" is a MUST HAVE program designed by Occupational Therapists to improve fine motor, visual perception, and eye-hand coordination skills which impact a child's handwriting abilities. This program is a simple, proven successful, user-friendly resource which WILL improve your child's ...

  15. Handwriting without tears

    At Children's Therapy Solution's we offer handwriting instruction by an occupational therapist trained in the Handwriting Without Tears (HWT) program. This award-winning program was developed by Occupational Therapists and it is the only developmentally-based curriculum on the market.

  16. Curriculum-Based Handwriting Programs

    The American Journal Of Occupational Therapy recently published a systemic review of curriculum-based handwriting programs for students in preschool through second grade. ... This Handwriting Without Tears© -style letter font, uses 3-lines to best support your students. There are Go-Dots, Gray-Boxes, and Simple Arrows that inform rather than ...

  17. Handwriting Without Tears

    Our Team Faq Blog Contact Us x Free Consultation Handwriting Without Tears HomeServiceHandwriting Without Tears Handwriting Without Tears Handwriting Without Tears (HWT) is a structured curriculum for teaching handwriting to children. The program is used regularly in Occupational Therapy treatment sessions.

  18. Kathryn Majewicz, Certified Handwriting Specialist

    Kathryn Majewicz, owner of OC Handwriting is a Certified Handwriting Specialist in Orange County, California. She has received her training and certification in the Handwriting Without Tears ® Pre-K through 5th Grade curriculum as well as in the administration of the Print Tool™ Assessment. Kathryn is a retired occupational therapy assistant ...

  19. Our History

    1977. In 1977, Jan Olsen set out on a mission to make handwriting easier to learn for her son John. Responding to John's tears over handwriting in first grade, Jan used her occupational therapy training and background to develop strategies to facilitate his handwriting skills.

  20. Online CEUs for Occupational Therapists

    Online continuing education for occupational therapy. Earn CEUs online. 600+ evidence-based courses. Live webinar, video, text, & audio formats. New courses added weekly. AOTA Approved Provider CE, NBCOT® Professional Development Provider. Course completion certificates provided. unlimited ceu access | $99/year.

  21. A Full Guide to Occupational Therapy Shadowing

    Occupational therapists focus is on developing fine motor skills, visual-perception skills, cognitive skills and sensory-processing deficits. They help patients to fully engage with daily activities such as eating and driving. Along with shadowing in settings, such as a hospital or clinic, it's also beneficial to see OTs at work in other areas.

  22. Home

    Infinity Rehab offers physical therapy, occupational therapy, and speech-language therapy to SNFs, home health agencies, and assisted living. A Leading Provider in Therapy Services Infinity Rehab is leading a post-acute care revolution, offering an unparalleled experience for our patients.

  23. Hand Therapy Certification Commission

    Contact Us. 180 Promenade Circle Suite 300 #41 Sacramento, CA 95834. Toll Free: 800-860-7097 Local: 916-566-1140 FAX: 866-308-6433 Local: 916-922-0210 Follow Us