Validating the Use of the Evaluation Tool of Children’s Handwriting–Manuscript to Identify Handwriting Difficulties and Detect Change in School-Age Children

Abstract

In this study we sought to validate the discriminant ability of the Evaluation Tool of Children's HandwritingManuscript in identifying children in Grades 2-3 with handwriting difficulties and to determine the percentage of change in handwriting scores that is consistently detected by occupational therapists. Thirty-four therapists judged and compared 35 pairs of handwriting samples. Receiver operating characteristic (ROC) analyses were performed to determine (1) the optimal cutoff values for word and letter legibility scores that identify children with handwriting difficulties who should be seen in rehabilitation and (2) the minimal clinically important difference (MCID) in handwriting scores. Cutoff scores of 75.0% for total word legibility and 76.0% for total letter legibility were found to provide excellent levels of accuracy. A difference of 10.0%-12.5% for total word legibility and 6.0%-7.0% for total letter legibility were found as the MCID. Study findings enable therapists to quantitatively support clinical judgment when evaluating handwriting. Brossard-Racine, M., Mazer, B., Julien, M., & Majnemer, A. (2012). Validating the use of the Evaluation Tool of Children's Handwriting-Manuscript to identify handwriting difficulties and detect change in school-age children. American Journal of Occupational Therapy, 66, 414-421. http://dx

Development and Validity of the Persian Handwriting Assessment Tool for Primary School-Aged Children

“…CFA confirmed the accuracy of the three-dimensional structure that was designated through EFA. According to the literature, speed and legibility are components of handwriting, but their scores are reported separately (3,4,29,36). The results of our study are in accordance with the literature and the opinions of the expert panel.…”

Handwriting Performance of Typical Second-Grade Students as Measured by the Evaluation Tool of Children's Handwriting - Manuscript and Teacher Perceptions of Legibility

“…Discussion The results suggest that students in the second grade in the first half of the academic year achieve mean scores on the ETCH-M of high 80 percentages for total legibility of words and numerals, and in the mid 80 percentages for total legibility of letters. As expected, the mean scores were higher than those reported elsewhere for first-grade students (Feder et al, 2007) and for the mean legibility scores for students in Grades 2 and 3 who had ADHD (Brossard-Racine et al, 2012). The study offers cautious support for the premise that the ETCH-M discriminates adequately between students in different grade levels in comparison to previous reports and that typical students perform better than those with ADHD.…”

“…Brossard-Racine, Mazer, Julien, and Majnemer (2012) reported cutoff scores on the ETCH-M for 26 second-grade and third-grade students diagnosed with ADHD based on occupational therapists' perceptions (yes or no) of the need for occupational therapy services after viewing the ETCH-M samples. Total word legibility scores of 75% and total letter legibility scores of 76% were deemed appropriate cutoff scores for referral for occupational therapy services and changes of more than 10% and 6%, respectively, were suggested as minimally clinically important differences (Brossard-Racine et al, 2012).…”

Graphomotor skills in children with prenatal alcohol exposure and fetal alcohol spectrum disorder: A population‐based study in remote Australia

“…In a study of 31 children in Grade 1 in the United States, an average of 78–80% letter legibility was found when writing a sentence (Diekema, Deitz & Amundson, ). Similarly, a study evaluating 26 children in Grades 2 and 3 in Canada found a mean letter legibility of 73.3% and word legibility of 70.6% (Brossard‐Racine, Mazer, Julien & Majnemer, ). Both these studies reported much higher letter legibility rates than for the children in the Lililwan Project (62.9%).…”

“…This study provides evidence that many children in the region, regardless of PAE, have graphomotor impairment which could interfere with academic performance and participation in cultural and recreational activities, and may benefit from occupational therapy input. Letter legibility rates of less than 76.0%, and word legibility rates of less than 75.0%, indicate the need for therapeutic treatment (Brossard‐Racine et al ., ). This recommendation is based on younger children (Grades 2 and 3) than those in the Lililwan Project, but nevertheless indicates that 37.6% (based on word legibility) to 68.3% (based on letter legibility) of children may benefit from handwriting intervention.…”