Curriculum-Based Handwriting Programs: A Systematic Review

The Paper
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.

The Problem

If you don’t work in a school setting it may come as a surprise that handwriting issues are one of the main reasons for OT referrals.

Handwriting is an important activity for young children that still plays an integral role in learning.  It’s suggested that up to 30% of kids show difficulties with writing that affect their academic performance.

Several formalized handwriting programs have been developed and used by OTs over the years, and new ones are steadily being developed and marketed to OTs. Still, not much research has been done to see if these programs are effective.

Some handwriting programs include (in no particular order):

  • Handwriting without tears

  • Write start

  • Peterson directed handwriting program

  • Explicit Handwriting Program

  • Size Matters (LOL!)

  • Write direction

  • Fine Motor and Early Writing Pre-K curriculum

  • Handwriting clubs

  • Printing like a Pro

  • Living Letters


Study Details
Researchers sought to answer 3 questions with this systematic review:
 

  1. Can curriculum based handwriting systems make meaningful change for writing  legibility, speed and fluency?

  2. Do certain programs have a greater effect?

  3. What parts of a program lead to a greater effect?

They looked at curriculum based handwriting programs for students k-5 from 2006-2015 and focused on interventions provided within a general classroom setting for students (with and without labelled disabilities).

Thirteen studies were included in total. Most (10) were Level II evidence. There were no Level I studies found.


Results
Do curriculum based handwriting programs work in general?

Based on the studies selected it appears curriculum based programs may have a small positive effect for legibility.  Effective sizes for speed and writing fluency were tough to pin down because of small sample sizes and large discrepancy between studies.  For example, many studies found no change in writing speed and one even found that students got slower.
 

Are some curriculums more effective than others?

The authors summarized results for speed and legibility in a handy chart (above).  The dashed lines here represent no effect (0.0) or small (0.2), medium (0.5) and large (0.8) effect sizes.  The further right the point, the more effective.  Programs that had been studied a few times show up as a range.

There is no perfect handwriting curriculum; based on the programs studied, no one outperformed all others (in all domains).  The Write Start program and the explicit handwriting program were the only programs to have non–small effects on both legibility and speed.

Statistics nerd side note: This review used Hedge’s g as the measure of effective size - which (if you remember our discussion a few weeks ago) is similar to Cohen’s d.  Effect sizes are an important measure to figure out if things are actually working in an intervention - but they can also be misleading. For example, with a small positive effect size you might need to treat 10-20 kids with an intervention before just one of them improves.


Key Takeaways

  • Handwriting legibility can be improved.  Small effect sizes for legibility might still be meaningful because it could translate to improved academic performance overall.

  • Speed is not always improved by these interventions.

  • Doesn’t matter what age you start with (it can still be effective).

  • 6 weeks of intervention appears to be sufficient.

  • There is no perfect handwriting curriculum so schools (and OTs) should choose a writing program pragmatically.