OTS 40: SBOT Journal Club - Autism, Hand Strength, & Handwriting Feat. Billy Hatridge
- Jayson Davies
- Oct 13, 2019
- 15 min read
Updated: May 29
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Welcome to the show notes for Episode 40 of the OT Schoolhouse Podcast.
In this episode, Jayson hosts the OT Dad, Billy Hatridge, to review an article titled "Hand Strength, Handwriting, and Functional Skills in Children With Autism" by Michele Alaniz, Eleanor Galit, Corina Isabel Necesito & Emily Rosario. This is a 2015 article from the American Journal of Occupational Therapy.
This podcast does not qualify as a Professional Development Podcast. You can learn more about how to earn professional development credits through the OTSH Podcast for your OT/COTA renewal certification here!
Links to Show References:
Visit Billy's website TheOTDad.com to see what he is up to. Be sure to check out his videos where he provides some quick handwriting tips using the Handwriting Without Tears methods.
Be sure to subscribe to the OT School House email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs.
Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com
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Episode Transcript
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Amazing Narrator
Hello and welcome to the OT schoolhouse podcast. Your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies, class is officially in session.
Jayson Davies
Hey everyone, and welcome to the OT school house podcast. My name is Jayson Davies, and I am your host now and forever. Of course, today we have reached episode 40. It's fantastic. I'm excited because, I mean, we're on episode 40 every time we kind of hit that milestone with a zero at the end, you know, 10s. It just feels really good. And so I'm happy to have all of you joining with me. I'm also excited today, because my wife and I, we went out and actually adopted a puppy. His name is TJ, because he's from Tijuana, I'll have to put a picture of him up on social media so you can all meet TJ. But he's been a handful getting to start training him and all that good stuff. So I've been a little lax on the OT school house, responding to emails a little bit. It's been a little crazy around here, but thank you for your patience, and I will have to introduce you all to him. You might be able to hear him walking around in the background. He's still a little anxious, so he's hovering around us. But anyways, today I am welcoming on a new friend of mine from Arkansas. His name is Billy hatridge, and he actually reached out to me with an article about handwriting and autism and how they go together. And you know, I thought you guys would probably like to hear it, so we're actually going to review that together today. The article is titled hand strength, handwriting and functional skills in children with autism. And so we're going to go over that here in a minute. But I do want to let you all know that Billy is a man of many hats, and today he is putting on his autism specialty hat, as well as his handwriting without tears certified hat, if you want to call it that. Billy is also the blogger behind The OT dad.com as he'll share a little bit more at the end of the episode. Just want to let you all know that you can go there. He has some actually pretty cool blogs. He kind of, well, you know what? I'm not going to share it. He does share with us a little bit about his story right up here front at the beginning of the episode. So have a listen. I hope you enjoy a little bit about the article. There's a link to the article. It is an Asia article. So if you're an A OTA member, you obviously have access to that. And there will be a link in the show notes. You can go to OT schoolhouse.com, forward slash, Episode 40. And yeah, it'll be really simple to pull up the actual article so you can read it for yourself, or just take a look at the charts and highlights. So without further ado, let me introduce to you Billy hatridge, occupational therapist from Arkansas. Hey there, Billy, how are you doing this afternoon?
Billy Hatridge
I'm doing good. Jayson, uh, thanks for having me.
Jayson Davies
Yeah, of course. You know, this is the first time that we're going to have a guest on today to share with us a little bit about a about a journal article. And so I'm happy to have you on so we can kind of do a little give and take about what we learned and what we liked or didn't like about this article, which is kind of cool thing that we get to do here on the podcast today. Yeah, I'm excited. Yeah. So before we jump into the article, why don't you go ahead and introduce a little bit about yourself in the OT world.
Billy Hatridge
Alright, my name is Billy hattridge. I'm an occupational therapist in the public schools of Arkansas. Been doing this for about six years now, 2015 I became a certified autism specialist to the International Board of continuing certification, continuing education standards. It's a mouthful, but then this year, I became a certified through handwritten about tears, and so I supervise a team of four OTs. We cover seven school districts which some of the secrets are real small. Might have like two or three kids in the whole district. We're talking about mountains in Arkansas, so it's a lot more driving than treatment some days. But yeah, it's good. I enjoy it. Wow. Okay,
Jayson Davies
so out here in California, we can actually only supervise it. Just got raised from two to three occupational therapy assistants. But I know from my experience, the more assistance you have, the more meetings you end up sitting in.
Billy Hatridge
Right it is, you know, this, this career change happened for me about a year ago when I went into just a supervision role. So seeing how different therapists do different things, as far as their treatment, as far as their approaches, and then being able to be involved in plan care, that means students, but the end of the work week, it's a lot more just reading through documentation, meeting with OTs and being in those IEP meetings. So that takes a majority of my work week.
Jayson Davies
Yeah. Alright, so today, we're here to review an article. It's called hand strength, handwriting and functional skills and children with autism. And if I remember right, this was from 2015 And real quick, just to give them their credit, the authors are Michelle Allen, is Eleanor, galit Marina, Isabel necesito and Emily Rosario. So I'm sorry for any of you, if you're listening and I slightly mispronounce your name, but they are the primary authors on. This research that we're about to look at. So, Billy, what, what did you or what drew you to this article?
Billy Hatridge
Well, you know, I mentioned earlier, you know, the certified autism and handwriting specialist. So this was like, right in that niche for me, in terms of both of those areas, because a lot of times, in my clinical view, I kind of separate those two. You know, I have my Spectrum caseload here, then I have my handwriting here. And so to see these two combined and see kind of the correlations that they found within the study was that was pretty insightful.
Jayson Davies
Absolutely. And so I'm going to let you review a little bit. I mean, oftentimes when we talk about articles, we kind of look at that Pico. And so what kind of population do they have in this article? Well,
Billy Hatridge
the population is looking at, you know, kids between the age of four and 1024, of those being typically developing, and then 27 of those children being on the autism spectrum, and several of their their typically developed children, I do believe, came from children of the staff there at the facility, is that right?
Jayson Davies
Yeah, I believe so. And then the kids with autism were actually kids that they were treating at the clinic, very much a a population that they had access to.
Billy Hatridge
Right? And and I know that they're talking about how they they kind of excluded several kids on the spectrum due to limitations in comprehending the instructions and the communication and the ability to to participate in the testing protocols that they provided.
Jayson Davies
Absolutely. All right, so that's kind of the population that we're looking at. And so this study, we didn't actually look at an intervention, but we did look at comparisons, and if you'd like to talk a little bit about what what they're what they were comparing.
Billy Hatridge
So what they're looking at was the pinch and grip strength and its relationship to handwriting and functional skills between both typically developing children and children with autism, and trying to figure out if there is a correlation between things like grip and pinch strength, and then the ability to write legibly and to be independent in those activities of daily living.
Jayson Davies
Yeah. And, you know, looking at 2015 when this research was done, you would have thought that maybe they had some norms as far as pinch strength and grip strength by time you got to 2015 you know. But when it came to children that with autism, they really didn't find anything as far as consistent scores or norms for kids with autism. In fact, I think some of the articles that they mentioned, like everyone was using a whole different way to measure this, and so there was no consensus on even how to measure grip strength. So they did reference that, I'm not going to go into detail, but they use, they used, a consistent way of measuring the kids strength, both with the the dynamometer and the pinch mechanism that they use. So,
Billy Hatridge
right? And I think we see this trend a lot in especially our OT literature, right is there's not enough evidence to back up kind of what we're suspecting. And so more and more research like this needs to be done, because one of the things they said here was that there's not consistent, reliable information on pitch, pinch strength norms for children. That's crazy to think about it, right. Like for us as OTs, we do so much pinch activities in the schools. And for this one, say, look, there's not enough reliable information on even knowing what those norms are. You know, if I were to sit down and test a kid on their pitch drink, I wouldn't have a clue. Wouldn't have enough evidence to base that off of and that's not just autism.
Jayson Davies
That's just kids in general. Yeah, that's just kids in general. That was just a typical population.
Billy Hatridge
So that's kind of amazing to me that, you know, it's 20, this 2015 Now I'm curious what that you know how much has changed, but in 2015 you know, there just weren't pinch norms for children, typically developing children. So.
Jayson Davies
Yeah, surprise, surprise. So going a little bit deeper, what other outcomes did they use to kind of look at the correlation between pinching and grasp, as well as the handwriting legibility.
Billy Hatridge
So, like I mentioned earlier, with the strength, they use the Preston Jamar hand and not dynamometer, and then the pinch meter, you know, those are the Patterson medical brand stuff there that was just to get their measurements. And then they use the VMI motor coordination sub test to look at the pencil control. And I think that was kind of the big, you know, standardized norm referenced paper protocol that they used. And then they used the etch the evaluation of children's handwriting for the handwriting legibility. And then they had created a questionnaire to get the ratings on the ADLs.
Jayson Davies
Which that was a parent completed in house, created parent questionnaire, basically.
Billy Hatridge
And said 27 items on that. And I kind of wish they had described that a little more in detail, since it wasn't that they made in house, just. Kind of know what that looked like specifically.
Jayson Davies
But yes, I agree. And maybe, maybe after this podcast, someone will reach out to us and say, hey, I can share that with you. We'll see. But if that happens, we'll be sure to get it out as easy as as easily as we can, if possible. So let's talk about a little bit of the outcomes then. So when it comes to strength, we already dipped into that just a little bit. But what else did they find?
Billy Hatridge
So one of the big things for me that was shocking in terms of their their out outcomes, was that the pinch strength did not have a correlation with pencil control, that it was the grip strength that had a bigger impact on writing legibility and pencil control than the pinch did, and that was for both the typically developing and then the children with autism. And I think that for us at school, OTs fall into that trap of when we're working on that pressure, we use so many pinch based activities. And you know, their study here is kind of showing that it's a lot more based on just that whole hand grip strength in terms of that pencil control, and that was my big takeaway from that, just in terms of what I do on a daily basis.
Jayson Davies
Yeah. And I believe that was on the VMI, right?
Billy Hatridge
Yes. That was on the motor coordination on the VMI. That's where they found that, yeah.
Jayson Davies
And if I remember right on the edge, they found that grip strength overall correlated with the edge scores. And they looked at the upper case, lower case, and numbers on that those sub tests, but they found they in just the group with autism, that grip strength did not correlate with the legibility of writing. And so again, same thing, like you're kind of talking about a little bit of inconsistencies between whether or not it correlated with typical kids versus kids with autism.
Billy Hatridge
They made quite a bit of mention when they talked about the limitations of the study, about how complex both handwriting and autism are, because, you know, as we know, OTs handwriting is not just motor there's so many more elements to that there's a sensory elements, just visual elements, and so they're only able to Look at those that one specific category with the handwriting. And so the fact that grip strength correlated with the typical peers, but not with those with autism, definitely shows that, you know, there's a lot more things influencing that handwriting when it comes to to autism, as far as the the eligibility of the writing.
Jayson Davies
And you know, that kind of goes with the whole As occupational therapists, we have, you know, this PEO model, we have other ecological models that take so many factors into place. And we can't just look at grip strength, or just look at their pincer grasp or something, you know, there's so many other factors that come into play. Cognition, you know, is a huge factor. And they tried, if I remember, right, they tried to account for that as much as possible by making a cut off, or, if you want to say exclusion criteria. But even then, I think I remember the limitations, that there was still a correlation between understanding of the task and and overall grip strength. And so you just see the kids, of course, you know, if they don't understand how to do this, how to use the dynamometer, then you know, is their strength really going to be right? It should be.
Billy Hatridge
And that was one of the big things they had mentioned right was, was the children's inability to follow the directions to the T and that impact on especially the getting those grip and pinch strength.
Jayson Davies
Yeah, one thing that really stood out to me, and as far as the strength, was that the hand and pinch strength patterns were similar in the sense that, you know, kids with autism, as well as typical, typically developing kids both increase their strength as they got older. However, the kids with autism were always lower at the same age. And they were also very inconsistent. You know, they were doing the average of three scores when it came to grip strength. And the kids with autism were just like all over the place as far as their inconsistent ability to provide a similar score each time that they were tested. And so that's, that's pretty, you know, influential.
Billy Hatridge
And I think that's one of the tricky parts about, you know, doing any kind of study with children on the spectrum. And anyone who's worked in that population knows that minute by minute, it can be a very different kid that you're working with. You know, consistency in these kinds of tasks can be very tricky when working with those, those types of kiddos. So, yeah, yeah.
Jayson Davies
So that kind of sums up the article. I think. Going forward, what are you taking from this article and implementing as your role, either as an occupational therapist, providing the therapy, or even when you're working with your assistants?
Billy Hatridge
Can I stop you there real quick? There was something I want to jump on in the limitations, that they had mentioned, and they had said here that they did not complete any visual perceptual testing. And so they know that they're limited in their interpretation of the the handwriting part because they didn't do any visual testing. And I was wondering why they didn't go ahead at least do the visual perception subtest. You know, it's two minutes. It's not going to take that much extra time. They're already doing the motor coordination test. And so, you know, one of the the writers is listening in, I would definitely like to know, you know, Shirley had talked about it and why they had left that out, just to kind of be able to get, get those numbers on the on the visual perception part.
Jayson Davies
Yeah, and you know, that also talks to what we do going forward. And you know, we need to make sure that we're doing a visual perceptual test with with the kids. And of course, they also didn't do the visual integration part of the actual test. They did the motor coordination, but not the actual part to see if kids can copy, you know, overlapping circles and all the good stuff that isn't that one, for those of you who aren't as familiar with the VMI coordination. What that is, it's almost kind of like tracing or staying within the lines or something. So it's very all the material is right there for you. All they were really testing was, is that that really pencil control and they stay within the lines? So, yeah, definitely, I see what you're saying there. It would be nice to know a little more visual perceptual skills and visual motor tasks for these kiddos.
Billy Hatridge
So moving ahead for our OT practice, I think the takeaway for this study has more to do with the handwriting interventions than it does with the autism. The study found that there wasn't as big of a correlation with students with autism when it comes to grip and pinch strength, there's a lot more factors to focus on there. And, you know, with autism, there's so much in the grand scheme of things that you addressing. But when it comes to the handwriting, you know, we have more and more and more kids are coming to our caseload who that's the that's the point of what we're doing with OT, it's going to be kind of backing away a lot from those pinch activities, the fingertip activities, and working more on just building up that general hand strength, I think, because I'm looking at their implications here, and it's, you know, grip strength correlates with pencil control, grip strength correlates with hand ability. Grip strength correlates with functional abilities. And so it all comes back to this, the strength of the hands. And so definitely gonna get my kids out there monkey bars a lot more, I think, in terms of the handwriting instruction, those kinds of activities.
Jayson Davies
So definitely I love it some of those more, more child friendly occupations, you know, not just sitting at the table, working on pinch and working on just handwriting, handwriting, more handwriting. So, right, yeah, I definitely think you're right about that. Alrighty, man. Well, I think that kind of sums up what we're talking about today. Before I let you go, I want to give you a chance to let people know if they have any questions for you, specifically where they can get in touch with you.
Billy Hatridge
Yeah, so the OT dad is my social media handle, and that's for, you know, Instagram, Pinterest, Facebook, the whole shebang. I have a website or blog, more specifically, the OT dad.com and, you know, I found working in the schools, our communication with parents is very limited, and so I kind of created up the Facebook page to help share resources and links and articles with my parents, and then it kind of grew from there. And so, yeah, if anybody wants to reach out to me and see what I'm doing over there, they're more than welcome to I said handwriting and autism is kind of my, my passion project, so I love talking about it.
Jayson Davies
Awesome, man. Well, thank you again, so much for coming on and sharing this article with us. We really appreciate it, and I hope to see you again soon. All right. Well, thank you, Jayson. Talk to you later. All right. Well, thank you everyone for listening to Episode 40 of the OT school house podcast and a special thank you to Billy hatridge for coming on this show. Again, he is from the OT dad.com and he's actually the one who reached out with this article to me, and it was great to have it. I hope you all enjoyed and learned a little bit about handwriting and autism and hand strength. So it was great. I hope you're enjoying this little Journal series that we're doing here on the OT school house podcast. And yeah, take care. Have a great week, and we'll see you next time on the podcast. Bye.
Amazing Narrator
Bye. Thank you for listening to the OT schoolhouse podcast for more ways to help you and your students succeed right now, head on over to otschoolhouse.com Until next time class is dismissed.
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