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Handwriting and Fine Motor Assessment Tools in School-based OT


An image showing an occupational therapist and child engaged in a play-based assessment

It is well established that fine motor skills are crucial in students' school activities and academic performance. In 2020, Caramia et al. established that "Students spent between 37.1% and 60.2% of the school day performing fine motor activities, with handwriting accounting for 3.4%–18.0% of the day." This data comes from a study where the researchers observed kindergarten, second, and fourth-grade classrooms. They also found that transitions accounted for about 20% of the day, but we'll save that for another time.


As school-based OT practitioners, we know that there is more to the occupation of education than handwriting, but it is also fair to say that fine motor and handwriting concerns make up a large part of our referrals.


Since there is such a high rate of referrals for fine motor and handwriting concerns, you will likely need a few assessment tools on hand to assess these skills. This blog post provides an overview of common fine motor assessment tools used by school-based OT practitioners, categorized into tools that assess handwriting skills and those with a broader focus on fine motor skills.


Let's start with handwriting-specific tools.


Fine Motor Assessment Tools for Handwriting


Assessing handwriting skills is a vital aspect of school-based occupational therapy, as proficient handwriting (or a reasonable and effective accommodation for handwriting) is essential for students' written expression and academic success. Several assessment tools have been specifically designed to evaluate handwriting skills, providing therapists with valuable insights into a student's legibility, speed, pencil grasp, and letter formation. The Minnesota Handwriting Assessment (MHA), Print Tool, Evaluation Tool of Children's Handwriting (ETCH), and Test of Handwriting Skills-Revised (THS-R) are widely recognized tools that assist OT practitioners in assessing and addressing handwriting difficulties in students.


Here are some of each tool's characteristics, along with some pros and cons of each tool.


Test of Handwriting Skills-Revised (THS-R):


  • Completion time: Approximately 25 minutes

  • Age range: 6 years to 18 years 11 months

  • Pros:

    • Assesses both manuscript and cursive handwriting skills (although I never used the cursive tool)

    • Provides norm-referenced scores for legibility, form, alignment, and size

    • Tests writing without lines so you can get an idea of the student's ability to maintain level writing

  • Cons:

    • Limited age range - may not be suitable for older students.

    • Does not assess fluency of handwriting

    • Scoring of each letter can be tedious until you understand the patterns (like gaps = a score of 1, and overshoots = a score of 2)

  • Pro Tip:

    • The THS-R is identified as a test of "neurosensory skills," not as an assessment of handwriting. However, it does function as a functional writing assessment and national norms for scoring.



Minnesota Handwriting Assessment (MHA):


  • Completion time: Around 15 minutes

  • Age range: Grades 1 and 2

  • Pros:

    • Norm-referenced tool

    • Evaluates letter formation, legibility, speed, and pencil grasp

    • Provides a comprehensive analysis of handwriting skills

  • Cons:

    • Extremely limited age range

    • Easy to administer, difficult and time-consuming to score

  • Pro Tip:

    • Check the desk height and other environmental factors prior to starting. That goes for all of these tools.


Print Tool:


  • Completion time: A few minutes to administer & 10 minutes to score

  • Age range: Preschool through 6th grade

  • Pros:

    • Assesses letter formation, sizing, spacing, and overall legibility

    • Provides a clear profile of a student's handwriting strengths and areas for improvement

    • Ties in with the Handwriting Without Tears writing curriculum

  • Cons:

    • Does not assess the speed or fluency of handwriting

  • Pro Tip:

    • Learning Without Tears offers free handwriting screening printouts on their website at LWTears.com



Evaluation Tool of Children's Handwriting (ETCH):


  • Completion time: Around 15 minutes

  • Age range: 6-12 years

  • Pros:

    • Evaluates multiple components of handwriting, including letter and number formation, alignment, spacing, and pencil grip

    • Offers specific guidelines for intervention based on identified areas of difficulty

    • No cost to purchase scoring handbooks - They allow you to make copies when you purchase the tool.

    • Assess both individual letter legibility AND word legibility

  • Cons:

    • Takes a moment to learn the scoring, but is on par with other handwriting assessment tools.

  • Pro Tip:

    • Jayson's preferred handwriting assessment



Fine Motor Assessment Tools with a Broader Focus

While handwriting is crucial, occupational therapists also recognize the importance of assessing overall fine motor skills beyond just handwriting proficiency. Fine motor skills encompass a range of abilities, including hand-eye coordination, dexterity, and motor planning, which significantly influence students' functional independence in various school-related tasks.


That is why I will often pair one of the handwriting tools above with one of the tools below. When I do that, I can draw more conclusions as to whether it is fine motor skills or something else impacting a student's handwriting.


Assessment tools such as the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI), Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2), Peabody Developmental Motor Scales, Second Edition (PDMS-2), and Miller Function & Participation Scales (M-FUN) provide a broader perspective on fine motor development and offer valuable insights into a student's fine motor skills and other skills such as gross motor skills, visual-motor integration, and motor planning abilities.


Here is some info on each of those:




Miller Function & Participation Scales (M-FUN):


  • Completion time: Approximately 30-45 minutes

  • Age range: 2 years through 7 years 11 months

  • Pros: (Jayson's preferred tool for this age range)

    • Assesses fine motor skills, visual perception, visual-motor integration, and motor planning

    • Provides a comprehensive profile of a child's functional motor abilities

    • Scoring tools that help you guide treatment planning.

  • Cons:

    • Limited age range

    • Longer administration (and set-up) time compared to some other assessment tools

    • The test books and scoring books can get expensive

  • Pro Tip

    • Make lots of copies of the origami fish and dog

    • The pros outweigh the cons, in my opinion

 

Want to hear why I prefer the M-FUN over the BOT-2?


 


Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2):


  • Completion time: Varies depending on the subtests administered

  • Age range: 4 through 21 years

  • Pros:

    • Evaluates fine motor skills along with other motor abilities

    • Provides a comprehensive assessment of fine motor proficiency

  • Cons:

    • Lengthy administration time for the complete test

  • Pro Tips:

    • The recommended minimum interval for reassessment is three months.

    • I typically administer the Fine Motor Precision, Fine Motor Integration, Manual Dexterity, and Bilateral Coordination subtests. The Upper-Limb Coordination subtest can also be helpful at times.



Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI):


  • Completion time: 10-15 minutes

  • Age range: 2 years through adulthood

  • Pros:

    • Assesses the integration of visual and motor skills

    • Provides norm-referenced scores for visual-motor integration abilities

  • Cons:

    • Has been shown to not necessarily correlate with handwriting skills

  • Pro Tip:

    • The VMI is sometimes used by non-OT professionals, so ask your school psychologist if they are using the VMI before you both attend the IEP with the same assessment.


Peabody Developmental Motor Scales, Second Edition (PDMS-2):

  • Completion time: Varies depending on the age of the child and the areas being assessed

  • Age range: Birth through 5 years

  • Pros:

    • Assesses fine and gross motor skills

    • Provides a comprehensive assessment of fine motor skills, including grasping, manipulation, and visual-motor integration

    • Offers both standardized scores and age equivalents

  • Cons:

    • Limited to the age range of birth through 5 years

    • Will soon need to upgrade to the Third Edition

  • Pro Tip:

    • Take some time to familiarize yourself with the scoring booklet and tasks.

    • There are many materials, and it takes some time to get used to knowing which task to start with due to the need to find the student's baseline.

 
You've assessed the student. Now what?

Sign up for the A-Z School-Based OT Course to help you better understand how to complete an OT evaluation. You'll get access to my evaluation document template to improve your evaluation write-ups!

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Assessing Beyond Fine Motor Skill


While fine motor skills are an essential focus of school-based occupational therapy, it's important to note that occupational therapists address a wide range of areas that contribute to students' overall success and participation in the school environment. While the previously discussed assessment tools provide valuable insights into fine motor development, they do not capture the full scope of an OT's expertise and intervention strategies. Here are a few additional areas in which school-based OTs assess and intervene:

  1. Sensory Processing: Evaluating how students perceive and respond to sensory information to develop strategies for managing sensory challenges and promoting engagement in school activities.

  2. Self-Care and Independence: Assessing students' ability to perform daily living tasks, such as dressing and grooming, to enhance independence and functional participation.

  3. Visual Perception and Visual-Motor Skills: Evaluating how students interpret and use visual information for motor planning and coordination, supporting academic performance.

  4. Executive Functioning: Assessing skills related to organization, time management, planning, and self-regulation to address challenges that impact task initiation, focus, time management, and assignment completion.

  5. Social-Emotional Skills: Assessing students' social interactions, emotional regulation, self-awareness, and coping strategies to enhance social skills, self-esteem, and emotional well-being, fostering positive relationships and school engagement.

By considering these additional areas and employing comprehensive assessment approaches, school-based OT practitioners can address the diverse needs of students and support their holistic development, functional participation, and overall well-being in the school environment. We will soon post blogs about tools you can use to assess these other areas in school-based OT, so stay tuned.


The Final Word


These fine motor assessment tools are important resources for school-based OT practitioners to evaluate and address students' fine motor skill needs. Using the standardized assessment tools mentioned above, practitioners can obtain valuable information about students' handwriting and fine motor abilities.


It is always important to note that standardized assessment tools only give you a snapshot of data in a controlled environment. Always pair standardized assessment tools with observations and other assessment data to form a comprehensive evaluation and treatment plan.


What are your preferred fine motor and handwriting assessment tools?


Share this post on social media, and let me know which assessment tools you prefer to use when assessing students with fine motor concerns.


See ya next time,


👋 Jayson

 
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References:


Occupational Therapy Practice Framework: Domain and Process—Fourth Edition. Am J Occup Ther August 2020, Vol. 74(Supplement_2), 7412410010p1–7412410010p87. doi: https://doi.org/10.5014/ajot.2020.74S2001


Sierra Caramia, Amanpreet Gill, Alisha Ohl, David Schelly; Fine Motor Activities in Elementary School Children: A Replication Study. Am J Occup Ther March/April 2020, Vol. 74(2), 7402345010p1–7402345010p7. doi: https://doi.org/10.5014/ajot.2020.035014











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