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Am J Occup Ther. 2015 Nov-Dec;69(6):6906180050p1-8. doi: 10.5014/ajot.2015.018366.

Handwriting Without Tears(®): General Education Effectiveness Through a Consultative Approach.

Author information

Denise K. Donica, DHSc, OTR/L, BCP, is Associate Professor, Occupational Therapy Department, East Carolina University, Greenville, NC;



This study explores the effectiveness of the Handwriting Without Tears(®) (HWT) kindergarten printing curriculum in general education through a consultative approach with occupational therapy.


One cohort of students was the control (n = 19), whereas two other cohorts were experimental groups learning printing through the HWT curriculum (n = 20 each). The Test of Handwriting Skills-Revised (THS-R) was used to collect end-of-year legibility scores for all cohorts.


Both experimental groups individually and both experimental groups combined into one group outperformed the control group on all 10 of the THS-R subtests-scoring significantly higher (p < .05 using analysis of covariance controlling for age and gender) on 6 of the subtests for the former and 7 for the latter-and on overall score. Large treatment effects were found for the standard score for each experimental group (d = 0.81, 1.03, and 1.00).


This study supports the consultative role of occupational therapy with teachers in general education for handwriting curriculum implementation and the success of HWT for printing instruction.

[Indexed for MEDLINE]

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