Running head: RESEARCH QUESTION
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Evidence Synthesis Based on Fieldwork Experience
Research question: For elementary age children with handwriting problems, is Handwriting
Without Tears (HWT) more effective than teacher-designed handwriting programs when used in
the classroom?
Johnny Rider
Touro University Nevada
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Research Question
For elementary age children with handwriting problems, is Handwriting Without Tears (HWT)
more effective than teacher-designed handwriting programs when used in the classroom? I chose
this question because I learned that a lot of occupational therapy services in the school districts
are of the consultative nature and I wanted to be prepared with which intervention would be
more effective if I were to educate and consult with a classroom teacher that had multiple
students struggling with handwriting.
APA Reference
Schneck, C., Shasby, S., Myers, C., & L. (2012). Handwriting Without Tears versus TeacherDesigned Handwriting Instruction in First Grade Classrooms. Journal Of Occupational
Therapy, Schools & Early Intervention, 5(1), 31-42. doi:10.1080/19411243.2012.675759
How does this study relate to your research question?
I chose this question because my fieldwork educator uses HWT in the clinic and also educates
classroom teachers on the program and I was curious if I were to work in a school, would it be
best for me to educate the teachers on the HWT program, or let them use whatever
program/curriculum they are most comfortable with? My fieldwork educator mentioned that
there are many good programs that classroom teachers have designed and I wondered which
would be more effective. I loved learning about the HWT program and thought it was a great
tool and wanted to learn more about having teachers implement it and serving in a consultative
role. I know that I would like to use HWT one-on-one with children, but I wanted to learn more
about the global affect handwriting programs could have on an entire class. I chose this article
out of the many articles I found because it was the most relevant to my question and the most
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current. This study compares Handwriting Without Tears and teacher-designed handwriting
instruction in first grade classrooms.
What is the purpose of the study?
Because the ability to write is one of the most fundamental occupations a child must master and
is important in order to succeed throughout their education, research was needed regarding
handwriting programs for the estimated 20% of children experiencing difficulty with
handwriting. Handwriting Without Tears has been adopted by 13 state boards of education and is
one of the most widely used approaches by occupational therapists. The purpose of this study is
to examine the effectiveness of the Handwriting Without Tears (HWT) program when delivered
through a consultative model in a first grade classroom compared to standard, teacher-designed
handwriting programs in eight different first grade classrooms.
What are the research questions/hypotheses?
Two research hypotheses were tested. First, general education students who receive HWT
instruction will have higher Minnesota Handwriting Assessment subtest scores after instruction
than students who receive teacher-designed handwriting instruction. Second, participants
receiving special education services and HWT instruction will have higher Minnesota
Handwriting Assessment subtest scores after instruction than special education students who
received teacher designed handwriting instruction.
Does the literature review justify the need for this study?
The literature review adequately justifies the need for this study. It describes the current issue of
handwriting difficulties with elementary students and how vital handwriting skills are for
education, social skills, and future occupations. Research is cited to explain how important
handwriting instruction is in classroom setting and the current concerns with teachers providing
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the instruction. The occupational therapy role is described in detail and HWT is illustrated as the
most widely used approach even though there has not been enough research. Additionally,
current research regarding HWT is cited as conflicting, therefore, more research is needed.
What is the study design/type of study? What is the level of evidence?
This was a quasi-experimental pretest/posttest control group design at the 3rd level of evidence.
How many participants all together and in each group if applicable?
148 first grade students who participated in both the pretest and posttest were included in the
study. 29 students were not included because they did not complete both tests. Of the 148 who
took both tests, 121 were in general education and 26 were in special education. In the general
education group, 54 students were in the control classrooms and 67 in the experimental
classrooms. One student’s data were removed from the control group as the statistician
determined it to be a significant outlier. More detailed information about the control and
experimental students listed by school and classroom is also available in the research article in
Table 1.
How were the participants recruited and selected?
The classrooms were selected from elementary schools in rural Kentucky. 177 first grade
students were enrolled in the 8 first grade classrooms that participated in this research project.
Teachers were recruited on the basis of who was actually interested and willing to attend the
HWT workshop and then after those teachers were selected, the therapist recruited teachers to
serve as a control class.
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If applicable, how were participants assigned to groups?
At each school, one first grade classroom participated in the control group and one in the
experimental group. The experimental classrooms were selected based on the teacher’s
willingness to attend an HWT workshop to learn how to instruct the children using HWT. The
control classrooms were selected based on teacher’s willingness to be a part of the study and
continue teaching their own handwriting curriculum that was not HWT.
How are the participants described – demographics?
The only demographics provided are that the schools are from rural Kentucky and the children
were all in first grade. Numbers are also provided for how many students were currently in
general or special education and those have been listed already. Gender of the students and
diagnoses were not provided in the study.
What are the variables? Independent and dependent if applicable.
The independent variable is the instruction that the students receive from their classroom
teachers, either HWT or a program designed by the teacher that is not HWT. The dependent
variable is the students’ scores on the MHA.
What measures were used?
The Minnesota Handwriting Assessment (MHA) was used to assess the children’s handwriting
abilities with a pretest and posttest. The MHA is a norm-referenced evaluation tool that
possesses recognized psychometric properties. It assesses manuscript handwriting for first and
second grade students with five quality categories of legibility, form, alignment, size, and
spacing. It also assesses the student’s rate of handwriting. It was used to determine students’
progress by comparing scores of both tests over time to show effectiveness of the two
instructional programs. The MHA was used as a pretest in August, at the beginning of school, to
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establish a baseline for comparison in April when the students were tested again, at the end of the
school year.
If applicable, what is the intervention?
The four classrooms implementing the HWT program were provided with materials and training
to implement HWT and the bimonthly consultation from an OT, all of whom participated in the
HWT workshop. These teachers were also provided with examples of activities to facilitate skill
development for handwriting and were specific to the underlying components of handwriting.
Teachers in the control classrooms continued to teach handwriting based on their preference of
styles, did not receive consultation from the OT to support HWT implementation, and did not
use the HWT program as their curriculum.
What statistical analyses were used?
The data were analyzed using SAS. Scaled MHA, legibility, form, alignment, size, and spacing
scores were used in the analysis. Two-sample student t-tests for unequal variances were used to
analyze mean differences between the pretest, posttest, and gain scores for both groups. Analysis
of covariance was used to analyze mean differences in posttest scores using a pretest variable as
the covariate. A significance level of 5% was used to determine statistically significant results.
What are the findings?
The mean pretest scores were not significantly different for the control and experimental groups
on any measure suggesting that the groups were similar in their handwriting ability prior to
intervention. For general education students, the mean gain MHA scores were significantly
higher in the control group than in the HWT group. The mean gain form scores and alignment
scores were significantly higher and no significant differences at the 5% significance level were
found in mean gain scores for legibility, size, and spacing for the two groups. All posttest mean
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scores were significantly higher in the control than in the HWT group for general education
students. With regards to the special education students, no significant differences at the 5%
significance level were found in the mean gain scores or mean posttest scores for each of the
measures for the two groups. For all HWT students using a two-sample t-test, the study showed
no difference in the gain scores for the MHA subtest scores for the HWT experimental group
when compared to the HWT group students with IEPs. With secondary analyses, at least 56% of
students in the control group and 42% of students in the HWT group improved in their legibility
performance scores by the end of the school year.
Do these findings support the hypothesis?
The findings did not support the hypothesis. They did demonstrate that both the HWT and
teacher-designed approaches resulted in overall improvements in handwriting during the first
grade school year which is valuable data.
How do the findings relate to previous research as described in the literature review?
Other studies investigating the effectiveness of HWT demonstrated a significant difference on
some quality categories of the MHA for the HWT group (Owens, 2004; Pontello, 1999; Wade,
2002). This study did not demonstrate any subtest on the MHA where the HWT students showed
significant improvement when compared to students in the traditional (control) classroom. The
findings of this research does not correlate with any of the other research presented in their
literature review.
Does the author state any clinical implications for findings?
The findings demonstrate that handwriting skills of students in both groups improved, thus
supporting the viability of using a multisensory handwriting approach, such as HWT, in the
classroom.
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What are the limitations that the author identifies?
Because of the confidential coding of the studies assessments, the researchers were not aware of
the diagnosis and/or service provided to the special education students. Students who received
occupational therapy in the special education program may have received additional handwriting
instruction that was not accounted for. Small sample size is also a limitation. HWT may not have
been a good match for the teachers’ style or classroom schedule. The HWT curriculum was an
additional burden on an already crowded daily schedule and could be another reason HWT was
not as successful as hypothesized. HWT teachers were not consistent in implementing the
lessons when the school day was altered due to assemblies or activities. Training for the HWT
was limited and their acceptance and incorporation of the outcomes was another concern. The
control teachers may have worked harder on handwriting as they knew they were being
compared to an established handwriting program, thus creating a Hawthorne effect. Additional
limitations stem from the assessments selected to measure handwriting outcomes. The MHA
may have not been appropriate for the experimental students who practiced their handwriting on
HWT paper which is two-lined and then were tested on three-lined paper.
Does the author discuss implications for future research?
The author only discusses that additional research is necessary and recommends that future
research should address the limitations discussed in this study. Specifically, the author
recommends including a teacher log to document what handwriting instruction was actually done
in the classroom.
What would you say about the sample size? Do you think it was adequate?
I think the sample size was adequate for this study. If the researcher wanted to identify
significant results with the general education and special education students separately, the
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sample size for special education students should have been larger. 26 students was not an
adequate sample size for analyzing data within special education students only.
If the researcher did not find a significant difference between the groups, is it possible that
his is due to a Type II error? If so, why do you think so?
After reading this article and reviewing the data collection, analysis and limitations, I do not
think the lack of a significant difference between groups could be due to a Type II error.
Is there a control or comparison group? If so, is the control or comparison group
comparable to the experimental group on key features?
The control group consisted of one classroom from each school with the teacher providing
handwriting instruction designed and utilized by them. The teachers in the control classrooms
continued to teach handwriting based on their preference of styles and did not receive
consultation from the occupational therapists. They did not use the HWT program as their
curriculum. Their curriculum was not controlled in any way other than not using the HWT
program. Each teacher could theoretically have a completely different handwriting curriculum
and classroom instruction was not monitored individually.
Are those administering the outcome measures blind to the group assignment?
The teachers were not blind to the study. This is discussed in the limitations and could have led
to a Hawthorne/Observer effect. All of the assessment measures were scored by the same
occupational therapist enrolled in graduate school and employed as a graduate assistant by the
Eastern Kentucky Occupational Therapy Department. The scorer was blinded to the school or
group (experimental or control).
Are the participants blind to group assignment?
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The author does not state whether or not the all of the participants were blind to the group
assignment. The teachers were aware of which group assignment they were a part of which has
been previously mentioned. However, the students understanding of the research was not
addressed in the article.
Does the researcher account for drop-outs in the study? Could drop-outs have influenced
the outcomes?
The drop-outs (29 students) were the students who did not complete both the pretest and the
posttest and they were not included in the study. They are clearly listed in the Participants
section of the study. They were excluded from the study and could not have influenced the
outcomes.
Does the researcher report reliability and validity of the outcomes measures? Are there
questions about the outcome measures chosen?
The author references Roston and colleagues (2008) and their research which concluded that the
MHA is a reliable and valid instrument for assessing handwriting in typical first and second
graders in a general education classroom. I have questions about the outcome measures chosen
because according to the only source that they cite, the MHA is only stated as reliable and valid
for typical, general education students. However, this study was performed on both typical and
non-typical students in general and special education. Reports on reliability and validity of
outcome measures for non-typical and/or special education students should be included in the
article.
What confounding factors could contribute to or influence the study outcomes?
1. How much education/consultation was given to the teachers using HWT. They were
given a workshop, materials, and bimonthly OT consultation. For some teachers that are
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comfortable with handwriting programs and maybe familiar with HWT, this may have
been enough to competently instruct students using HWT. For other teachers it may have
not been enough. There was no assessment as to whether the teachers felt or were
prepared adequately to teach the HWT curriculum. The variance in teacher skill level
could affect the study outcomes and could be a factor in why the hypothesis was not
supported even though additional research did support it. Would the outcomes be
different if the classroom teachers had more instruction and time to practice?
2. The teachers that designed their own programs (control group) did not provide any data
on how, what, when, where, and length of instruction. There are too many variables here
and the preference of the teachers could be vastly different in each class.
3. Outside influences were not accounted for. For example, data was not collected on
whether or not students were receiving additional handwriting instruction such as after
school programs or occupational therapy services. If students were receiving additional
instruction with other programs the study outcomes could have been influenced
positively or negatively.
What are the major strengths of this study? (list 3)
1. Sample size was large compared to some of the similar studies I found. One of the
reasons I chose this was the sample size.
2. The intervention was very pragmatic and related to real life situations. Many times
classroom teachers have good curriculum for handwriting but OT’s also have great
programs like HWT and there should be research to see if one is better than the other?
This research question was very applicable to real life and provides easy application
for OT’s, classroom teachers, parents, and the elementary education system.
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3. The Secondary Analysis was very informative. I have not seen many secondary
analyses in my limited reading of research but I appreciated another way to look at
the data and break it down with different variables and categories to see if there was
significance individually and with different categories of the participants.
4. The literature review and discussion provided was very well thought, organized
clearly and succinctly, and informative. I felt up to date on current research and all of
my thoughts and more were brought up in the discussion section.
What are the major weaknesses of the study? (list3)
1. The first weakness I saw was using both general and special education students but not
taking into account the outcome measures and different instruction provided.
2. Not providing any diagnoses poses an issue for therapists and teachers wanting
information for specific children with specific diagnoses.
3. Not recording any data for how the classroom instruction was actually given leaves many
variables unknown and a lot of possibility that outcomes were due to chance or unknown
factors.
4. The MHA assessment selected to measure handwriting outcomes was not properly
supported in the study as valid and reliable for both student groups nor was the idea that
some students may have been taught using two-lined paper but tested with three-lined
paper on the MHA.
5. Without any comparison to classrooms that were not teaching handwriting skills we have
no way of knowing that the improvements on the MHA were not simply due to a school
year full of writing assignments and art projects. The simple act of just being in school
and completing assignments could be the real reason there was an improvement in MHA
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scores. Additional data should have been collected from classrooms without specific
handwriting curriculum to eliminate the possibility of school work being a factor.
How would you use this article as a therapist?
I would refer to this article as a therapist first as evidence that multisensory approaches to
teaching handwriting are effective. I would also use it as evidence that HWT does improve
handwriting skills with elementary aged children. I would also use this to educate classroom
teachers about the efficacy or their efforts within the classroom to teach and improve
handwriting skills of their students. This article could be used as a basis to provide trainings to
classroom teachers so they can implement handwriting curriculum in their classroom if they do
not already have one established. I would use it to justify consulting with teachers regarding in
class handwriting programs.
How does this article support/not support participation in occupation and the field of
occupational therapy?
This article supports the continued efforts of classroom teachers and occupational therapists to
provide multisensory handwriting intervention for students struggling with the fundamental
occupation of handwriting. The article includes literature stating that children in kindergarten
spend 42% of their fine-motor time on paper-and-pencil activities and an estimated 20% of
children in elementary school experience difficulty with acquisition of the skills required for
handwriting. It reinforces the knowledge that the ability to write is one of the most fundamental
occupations a child must master and is a vital support to school success as well as future
employment. Even though we have seen technological advances, handwriting is still the
predominant method utilized by students to show academic learning. This article supports the
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student’s engagement in handwriting occupations in order to help them engage and succeed in
the education system.
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References
Owens, L. L. (2004). The effects of the Handwriting Without Tears program on the handwriting of
students in inclusion classrooms (Unpublished master’s thesis). Virginia Commonwealth
University, Richmond, Virginia.
Pontello, K. M. (1999). The effectiveness of a structure handwriting program (Unpublished master’s
thesis). Lakehaed University, Ontario, Canada.
Schneck, C., Shasby, S., Myers, C., & L. (2012). Handwriting Without Tears versus Teacher-Designed
Handwriting Instruction in First Grade Classrooms. Journal of Occupational Therapy, Schools &
Early Intervention, 5(1), 31-42. doi:10.1080/19411243.2012.675759
Wade, R., (2002). The effects of the HWT writing program on writing performance in kindergarten
(Unpublished master’s thesis). Eastern Kentucky University, Richmond, Kentucky.