1. A Review of Handwriting Assessments
Presented by:
Rachel Kirk
Shannon Munford
Selena Mehr, BCABA
Caldwell College

2. Handwriting Why focus heavily on handwriting skills/remediation?
Record and communicate information
Compete in the regular education classroom
Personal use (class notes, shopping lists)
Written communication to others (letters, memos)
Writing related to seeking employment and job-related skills (applications)
To obtain information from others
(Stowitschek et. al., 1989)

3. Handwriting Poor Handwriting can “cause”:
Teachers place importance on clear, concise, good handwriting. Poor handwriting in the early grades linked to poor academic performance in the future. (Harvey and Henderson 1997)
Some develop mind-set that they cannot write and give up. (Berninger 1998)
Lack of confidence then leads to stress, poor self-esteem, poor career prospects. (Sassoon 1997)
Teachers place importance on clear, concise, good handwriting so when grading reports and essays, poor handwriting has a negative effect on a students grades.
Poor handwriting in the early grades has been shown to have a direct relationship to poor academic performance in the future.
Handwriting is so important that in addition to academic difficulties, poor handwriting can cause additional problems that become more complicated and difficult to resolve.

4. Handwriting Reason for Assessment:
Standardized or systematic procedures are seldom used
Poor letter formation skills are evident in the handwriting of many students
Few special or general educators have been trained to teach and remediate handwriting
Distinguish between student ability and actual handwriting performance
(Stowitschek et. al., 1989)

5. The Minnesota Handwriting
MHA
The Minnesota Handwriting
Assessment
Developed by:
Judith Reisman (1993)

6. Development of MHT: MHA is a way:
to assist school-based occupational therapists in the identification of children with writing difficulties/assess treatment.
A more sophisticated alternative to the “rating scales.”
MHA can determine:
Speed, accuracy, letter size, spacing, and can show where students difficulties are.
(Reisman 1993)
Occupational therapists working within School Health Support Services received increasing # of referrals of children who have handwriting difficulties.
Judith Reisman wanted to develop a reliable and easily administered test .

7. MHA Designed for: 1st and 2nd graders Age Range: (5 to 7 years)
Administration: Individual or Group- 5 to 10 minutes; 10 to 30 minutes to score
Test is used to identify how students are performing in relationship to their peers.
(Reisman 1993)

8. MHA: Materials Complete kit:
Includes manual, 1 manuscript and 1 D'Nealian Pad, 25 sheets
Additional copies of materials:
Manuscript Print Pads, pack of 4 pads (25 sheets per pad) D'Nealian Print Pads, pack of 4 pads (25 sheets per pad)

9. MHA: Format The total maximum point scored on the test is 170.
Rate score (writing speed): # of letters completed during the timed portion.
More time given:
Legibility
Form
Alignment
Size
Spacing
The total maximum point scored on the test is 170.
(Reisman 1993)
Scoring rules were developed from consultation with occupational therapists and teachers.
More time given to produce a complete sample for scoring the five quality categories

10. MHA Procedure: Sentence is given in jumbled form
Ex: “the quick brown fox jumped over the lazy dog”
Small triangles: starting point.
Write for a timed period (2 ½ minutes)
(Reisman 1991) used 2.5 minutes made after pilot test with 1st and 2nd graders
timed for 1.0, 1.5, 2.0, 2.5, 4.0 and 5.0 minutes.
67% of the 2nd graders finished at least 31 of the 34 sample letters in 2.5 minutes.
Stop and circle last letter written
Then finish the sentence
(Feder & Majnemer 2003)
Given in jumbled form was designed to eliminate partially the speed advantage that 2nd grade students and more fluent readers have by requiring all students to refer to each work before copying it.
Copying a complete and logically worded sentence would have given a favorable advantage to those with better reading and memory skills.
Author recognizes that the task is still not the same for all students, since some need to refer to every letter before copying while better spellers simply refer the each whole word
Students directed to copy the word found at the top of the page onto the lines below the preprinted sample
Small triangles are printed on the left side of each base line on the paper to help students find the starting point of each line.
The decision to use 2.5 minutes was made after piloting the test with 1st and 2nd graders who were timed for 1.0, 1.5, 2.0, 2.5, 4.0 and 5.0 minutes. 67% of the 2nd graders finished at least 31 of the 34 sample letters in 2.5 minutes.

11. MHA Legibility/Scoring:
Letter is recognizable out of context (dots on letters i/j)
Complete with all strokes present
Contains no reversals (letter k)
34 maximum points
Scoring is discontinued if the students writing is illegible.
This rule was adopted b/c:
It is impossible to obtain reliable measurements for the other categories if a letter is illegible
(Reisman 1993)
Scoring for legibility requires looking at each letter in isolation.
Legibility is weighted more heavily than the other categories b/c if a letter loses a point for legibility, then it warns a 0 in the other 4 categories.

12. MHA Alignment/Scoring: Position of the letters on the line.
Form/Scoring:
Measures letter quality
Lines: curved or pointed in certain parts of the letter.
no gaps or overlaps greater than 1/16” between letter parts
Maximum 34 points
Alignment/Scoring:
Position of the letters on the line.
Letters within 1/16” of the solid baseline.
Maximum 34 points
Gaps or line extensions grater than 1/16 inch cannot be presented.
Alignment relates to the position of the letters on the line.
Letter will earn an error point if it does not rest within 1/16 of an inch above or below the bottom line

13. MHA
Size/Scoring:
Measures all other parts of the letter to the midline, upper and lower lines.
Maximum points 34
Spacing/Scoring:
Correct letter and word spacing
“daylight” between letters.
Maximum points 34
Each letter is judged in size in reference to the solid top line, the dotted line, or the lower dotted line.
In order to receive a point, the letter must be within 1/16 of the lines that should be touched by the letters.
Spacing category includes letter and word spacing.
A ruler is used to judge specific criteria for too narrow or too wide spacing
Requires “daylight” b/w letters but no more than ¼” between words. Enough space should be allowed so that letters do not overlap but not so much that a single word looks like 2.
Also enough space should be present between words so that 2 words do not “run into” each other and look like 1 word.

14. Research 6 raters trained in 3 sessions
Reisman, J.E., (1993). Development and Reliability of the Research Version of the Minnesota Handwriting Test. Physical and Occupational Therapy in Pediatrics, 13(2),
6 raters trained in 3 sessions
1st session: Brief explanation of the scoring rules.
Took an average of 2 hours to score
After 1st session: discussion b/w Reisman and the raters.
2nd session: repeated the process.
After 2nd session: errors made raters was very small.
3rd session: repeated the process.
Took an average of 25 minutes to score
Reliability increased to 95%.
Manual for the MHA: 3 sets of 10 handwriting samples, can be compared to Reismans grading of the samples.
Explains scoring procedure as in the study.
In order to determine the effectiveness of the MHA Reisman did a reliability study.
The raters were given a brief explanation of the scoring and then each rater scored 10 of the students samples independently. These were compared with Reismans scoring of the same 10 samples.
After 1st session: a discussion b/w Reisman and the raters where they looked, explained and answered questions about misinterpreted rules.
2nd session: this time the number of errors made by the raters in the scoring process was very small.
Because of this reliability study, the manual for the MHA includes 3 sets of 10 handwriting samples which can be compared to Reismans grading of the samples and explains scoring procedure as in the study.
As the raters become more experienced (over 100 samples scored), the time needed to score 1 test paper averages 3 minutes

15. Research con’t:
Cornhill, H., Case-Smith, J. (1996). Factors that relate to good and poor handwriting. American Journal of Occupational Therapy, 56(3),
48 typical 1st graders identified as either good or poor handwriters.
Motor accuracy test, visual-motor integration test and 2 in-hand manipulation tests.
All test scores significantly higher for students with good handwriting.
Then given the MHA.
Results:
Eye-hand coordination, visual-motor integration and in-hand manipulation have a direct association to handwriting skills
MHA is a valid tool that accurately shows a students current handwriting skills
Then given the MHA, all students who did well on the initial tests did well on the MHA and the students who did poorly did not do well on the MHA.

16. Research con’t:
Owens, L.L (2004). The Effects of the Handwriting Without Tears Program on the Handwriting of Students in Inclusion Classrooms. Master’s Thesis. Virginia Commonwealth University, Richmond, Virginia.
2 Experimental groups(41 students)- received HWT method
2 Comparison groups(40 students)- general handwriting instruction.
Handwriting performance measured using MHA.
Pretest scores: no difference b/w both groups
Posttest scores: experimental classes showed improvement in the areas of size (.008) and spacing (.014).
4 children identified with special education needs were included in each group.
Students who received the HWT instruction had higher mean MHT posttest scores then students who did not receive the HWT instruction.
Pretest scores: no statistically significant difference b/w experimental and comparison groups.
Posttest scores: experimental classes showed statistically significant improvement in the areas of size (.008) and spacing (.014) compared to the classes receiving traditional handwriting.

17. MHA: Individualization/Modification
The initial MHA evaluation shows handwriting illegibility.
The teacher could customizes the MHA test by:
Teaching specific commonly used letters.
Example: e, a, h, f, t, i, r, d, s, y.
Combining these letters into words.
Example: “The first day.”
Practice writing these words.
Take MHA using the learned letters, words and phrases.
Contriving this procedure until all the letters have been used and evaluated.
Having the student practice writing these words.
Have the student take the MHA using the learned letters, words and phrases.
Contriving this procedure until all the letters have been used and evaluated.

18. MHA Pros Reinforce/teach hand dexterity (kinesthetic)
knowledge (cognitive) is motivational
Helps with perception/motor skills
Easy to score
Easy to administer
Clear, easy to understand manual
Reisman: “MHA can be administered to children with a variety of disabilities.”

19. MHA Cons Test is relatively new
No extensive clinical trials or research
Children who can not read are at a disadvantage in the timing portion.
Write letter by letter
Some pre-req: hold a pencil, see, concentrate and understand.
Can be difficult for many developmentally disabled children

20. The Diagnosis and Remediation of
DRHP
The Diagnosis and Remediation of
Handwriting Problems
Authors:
Denis H. Stott, Fred A. Moyes, and
Sheila E. Henderson (1985)

21. DRHP According to Stott et. al. (1987)… Purpose:
Systematically identify and classify handwriting problems
To be used as a clinical tool
Advance research in handwriting
Provide remedial materials for teacher education

22. DRHP According to Stott et. al. (1987)… Population Intended to Assess:
Children with two years experience handwriting
(3rd grade)
Adults who have loss skill of handwriting due to brain injury

23. DRHP Materials Manual Scoring templates for size and slant
3 pictures/comic strips
Student’s Writing Sheet
Diagnostic Record Form

24. DRHP Manual Content: Handwriting in left-handers
Sections on direction use
Directions for Scoring
Scorer training
Single reliability study
Issues relative to the measurement of handwriting
Handwriting in left-handers
Monitoring handwriting standards in the classroom
Guidelines for remediation
Remedial programs

25. DRHP Categories of Assessment Part 1. Faults of Concept and Style
(poor teaching or failure to benefit from teaching)
Section A. Letters incorrectly formed and/or joined
Section B. Spacing Errors
Section C. Stylistic Distractors
Section D. Slurring

26. DRHP Categories of Assessment Part 2. Faults of Motor Control
Inconsistency of slant
Inconsistency of letter size
Irregular word alignment
Random Letter Distortion
Tremor

27. DRHP Categories of Assessment Part 3. Concurrent Observations
Section A. Posture of handling paper and pen
Section B. Faulty ways of addressing task
Section C. Physical Disadvantages
(poor motor control)

28. DRHP Administration: Individually or in a group
Student is given a comic book style series of 3 pictures with word cues provided in “balloons” in each picture
Student is given “Student’s Writing Sheet” containing ten lines to write on
Test is not timed but authors suggest no more than 20 minutes

29. DRHP Scoring: Only Part 1 and 2 are numerically scored
Quantitative measures
Scoring templates or mechanical aids for consistency of slant, spacing, and letter size difference are used
These transparent diagnostic templates are applied to writing slant and alignment or deviation from the writing base line
Measurement of word spacing is taken but dependent on the scorer’s accuracy and decision when making numerical awards

30. DRHP Scoring: Qualitative measures
Examiner’s determination of whether an error occurred
When examiner judgment needed refer to the operationally defined terms
All of Section 3 (Observations)
Higher Scores: high number of errors and higher writing impairment

31. DRHP
Scoring:
Use scores from part 1 & 2 with observations from part 3 (not scored) to provide basis for diagnostic analysis
Overall score/sum were not intended to be used but you can total the scores if needed for research purposes
Use of a two-scorer system provided for reliability

32. DRHP Limitations: Complex to Score
No scores or score range guidelines for interpretation; necessary for development generalizability
IOA: 61-65% for 150 samples (Stott et. al., 1987)
Scores are dependent on examiner’s accuracy and judgment
No demographic information regarding the samples
No descriptive data for scorer reliability training provided in the study (Alston & Taylor, 87)
No validity studies done
Authors do identify need for validity and further reliability studies (Alston & Taylor, 87)

33. DRHP
Limitations:
Learner must have prerequisite of writing complete sentences and writing/reading comprehension.
Suggests no room for individualization/modification
Could change the pictures/balloons to accommodate the learners academic repetiore
Remedial materials and teacher education aspects are limited to brief sections
A brief review or introduction to an area is not sufficient information to plan and carry out handwriting programming (Daniels, 1988)
Advantages:
Easy to administer (Daniels, 1988)

34. DRHP
Conclusion:
Not a valid/reliable tool in assessing handwriting problems
With clarification in scoring methods DRHP could be…
Useful tool for occupational therapists and behavioral therapists in assessing/teaching handwriting problems
Not a useful approach to assessing handwriting for lower skilled individuals since there is a need for writing/reading comprehension.

35. Evaluation Tool of Children’s Handwriting
ETCH
Evaluation Tool of Children’s Handwriting
Author:
Susan J. Amudson Ph.D. OTR/L, FAOTA
Publication-1995

36. ETCH Who is using it? Public Schools
Pediatric occupational therapy agencies
Children’s Hospitals
Child Specialists

37. ETCH Purpose: Evaluate: Target Population: Global legibility Speed
Mild developmental delays
Learning disabilities
Mild muscular impairment

38. ETCH
Prerequisite Skills:
First or Second grade level
Composition

39. ETCH Design Task 1- Alphabet Task 2- Numbers Task 3- Near point
Task 4- Far point
Task 5- Dictation
Task 6- Sentence composition

40. ETCH
Example:

41. ETCH How is the test scored? Legibility Speed-Tasks 3, 4 &6
subtract the illegible letter, word or numbers from the possible total.
Speed-Tasks 3, 4 &6
Minutes are divided by the number of letters written within the time given.

42. Test-retest reliability of the ETCH-M
Diekema et al. (1998)
Test-retest reliability of the ETCH-M
Examined the test-retest reliability with
31 First and second graders
Tested twice with one week between testing
Results:
total letter legibility =.77
total word legibility =.71
Individual letter legibility ranged from

43. ETCH Sudsawad et al. (2000) The Relationship Between the ETCH and
teachers’ perception of handwriting
Legibility
45 first grade students
Teacher rated students
ETCH
Compared the ETCH scores to the teacher questionnaire

44. ETCH Results: Legability Items: ETCH Teacher Questionnaire Numbers
Near Point
m= 61.8
m= -1.8
Far Point
m=45.8
m=-2.0
Dictation
m=42.2
m=1.7

45. ETCH Pros: Cons: Examiner is proficient Scoring criteria Score sheets
Includes diagrams
Total score reliability
Tasks are relevant
Cons:
Individual score reliability
Insufficient validity studies
Variability
Writing Quality

46. ETCH Limitations: Subjective Handwriting changes
Combined with other methods
Unable to account for the differences in
handwriting quality

47. ETCH How can this be modified? Latency and duration
Operational definition
legibility
speed
Pretest/Post-test

48. References
Alston, J., & Taylor, J. (1987). Handwriting: Theory, research and practice. London, UK: Croom Helm.
Berninger, V., & Graham, S. (1998). Language by hand: A synthesis of a decade of research on handwriting. Handwriting Review 12:
Cornhill, H., & Case-Smith, J. (1996). Factors that relate to good and poor handwriting. American Journal of Occupational Therapy, 56(3),
Daniels, L.E. (1988). The diagnosis and remediation of handwriting problems: An analysis. Physical & Occupational Therapy in Pediatrics, 8(1),
Diekema, S.M., Deitz, L., & Amundson, S.J. (1998). Test-retest reliability of the Evaluation Tool of Children’sHandwrting-Manuscript. American Journal of Occupational Therapy, 52,
Feder, K., & Majnemer, A. (2003). Children’s Handwriting Evaluation Tools and Their Psychometric Properties. Physical and Occupational Therapy in Pediatrics, 23(3),

49. References
Harvey, C. & Henderson, S. (1997). Children’s handwriting in the first three years of school: Consistency over time and its relationship to academic achievement. Handwriting Review 11: 8-25.
Owens, L.L (2004). The Effects of the Handwriting Without Tears Program on the Handwriting of Students in Inclusion Classrooms. Master’s Thesis. Virginia Commonwealth University, Richmond, Virginia.
Reisman, J.E., (1991). Poor handwriting: Who is referred? American Journal of Occupational Therapy, 45,
Reisman, J.E., (1993). Development and Reliability of the Research Version of the Minnesota Handwriting Test. Physical and Occupational Therapy in Pediatrics, 13(2),
Sassoon, R. (1997). Dealing with adult handwriting problems. Handwriting Review 11:

50. References
Stott, D.H., Henderson, S.E., & Moyes, F.A. (1987). Diagnosis and remediation of handwriting problems. Adapted Physical Education Quarterly, 4,
Stott, D.H., Moyes, F.A., & Henderson, S.E. (1985). Diagnosis and Remediation of Handwriting Problems. Fairwater, Cardiff, Whales. DRAKE Educational Associates.
Stowitschek, C.E., Stowitschek, J.J., Hendrickson, J.M., Gable, R.A. (1989). Diagnosis and remediation of handwriting errors. Multidisciplinary Diagnostic and Training Program, 22.
Sudsawad, P.,Trombly, C.A., Henderson, A., Tickle-Degnen, L (2000). The relationship between the Evaluation Tool of Children’s Handwriting and teachers perceptions of handwriting legibility. American Journal of Occupational Therapy,