Susan Little, OTR/L provided a fabulous seminar as part of Therapro’s Saturday Seminar Series on November 10th entitled: Handwriting Without Tears: Strategies for Success. She gave attendees a close look at a developmentally based curriculum for students from Pre-K through 5th grade and beyond, that uses a multisensory, fun approach to teaching skills for both printing and cursive. It includes three programs: Pre-K Early Learning, Handwriting Without Tears, and Keyboarding Without Tears (digital program). The program keeps expanding with additional products and trainings. The Pre-K program and elementary grade level programs include workbooks, journals, and Teacher’s Guides. Multisensory materials offer kinesthetic learning experiences for printing and cursive letter formation.

Susan is an experienced occupational therapist who has provided services to children aged birth through 21 years old in a variety of settings including school systems, early intervention, inpatient/outpatient rehabilitation, and neonatal intensive care units. As a certified handwriting specialist, she has worked extensively with children on penmanship instruction and remediation. She was first introduced to Handwriting Without Tears (HWT) as an OT student and found it to be a unique and targeted approach that meets the diverse learning styles of all students. Susan began working for Learning Without Tears in 2003 and now serves as Channel Sales Manager for the company. Her passion for educating others on the benefits of using the Learning Without Tears programs was evident in her presentation today.

The handwriting process was described in sequential stages beginning with pre-writing and finally handwriting. Susan identified the stages as follows: controlled scribbles; discrete lines, dots, or symbols; straight-line or circular letters; uppercase letters; lowercase letters. She focused primarily on early stages of handwriting, but also touched on the development of cursive and keyboarding skills using multi-sensory learning experiences.

The Print Tool is a comprehensive evaluation for students from kindergarten through grade 5 that includes student and school information, a review of school papers, and careful observation of the child’s physical approach and fine motor skills. Administered individually, the Print Tool evaluates uppercase letters, numbers, lowercase letters, and seven specific handwriting components: memory, orientation, placement, size, start, sequence, and word spacing.

A preschool student who is exposed to the Pre-K Learning program learns the readiness skills for handwriting (includes both letters and numbers). It consists of three components: 1.) Language and Literacy; 2.) Readiness and Writing; and 3). Numbers and Math. Susan identified some common struggles that occur at this level such as letter and number memory difficulties that might manifest themselves as omitting a letter, interchanging upper and lower case letters, or spelling phonetically. Another struggle a child at this early level may exhibit are letter and number formation problems including letter reversals, spacing, and sizing issues. Pencil grip is another area she discussed that may require simple modifications of posture or paper placement to build success. A fun fact Susan offered is that 50% of all 3 year olds have the ability to grasp a crayon correctly. LWT uses this fact by utilizing very small tools like pieces of chalk or Flip Crayons to facilitate development of the intrinsic muscles of the hands. Susan demonstrated a number of strategies and sequential activities to engage students as they transition to letter formation. The use of songs can help develop the motor plan for pencil/crayon use. Here’s an example:

Pencil Song
Pick up a pencil, Pick up a pencil
This is easy to do
Pick up a pencil, Pick up a Pencil,
I just tell my fingers what to do
My thumb is bent,
Pointer points to the tip, Tall man uses his side
I tuck my last two fingers in
And take them for a ride.

Now I’m holding it just right,
But not too tight,
Every finger knows what to do
And now I have a big surprise,
A big surprise for you
Let’s drop it and do it again!

Susan demonstrated a number of products that can be used in a variety of creative ways, including Capital Letter Kit to form letters in the correct order and position through teacher-directed play. It includes wood pieces and laminated cards that show the image of a letter on one side and activities on the flip side to help teach letter awareness and same/different discrimination. Roll-A-Dough Letters is a great companion to the HWT curriculum because it includes a multi-sensory tray that can be used to make letters in sand or shaving cream. Laminated letter and number cards and 12 oz. of modeling dough are included. The child learns the skills of size discrimination and visual integration. The Stamp and See Screen is a magnetic screen in a sturdy plastic frame. It includes 4 plastic magnetic letters to allow a child to stamp upper case letters. A tool that resembles chalk is used to trace or write letters. It can be used over and over because the slide eraser clears the board in one sweep. Blackboard with Double Lines helps teach placement on lines and spacing for uppercase and lowercase letters, and numbers. With repetition, a motor plan develops.

Handwriting Without Tears aims to maximize writing success for all students! This resource is fun and engages students as soon as it is introduced by providing the building blocks that are essential for handwriting in sequential steps. It is a rich program that takes into consideration the many components of learning handwriting skills throughout the school years and uses creative, engaging sensory activities. Be sure to check out the Learning Without Tears website for what Susan calls a “treasure trove” of free resources that includes screening and assessment tools: https://www.lwtears.com

Attendees had rave reviews about Susan’s seminar:

“As an OT student, I walked in with a limited knowledge of the topic. Walking out, I feel much more comfortable teaching handwriting skills and I am confident in the additional resources that were presented to me.” – Elizabeth W., OT Grad Student

“After 40 years of practicing OT, I wanted to be aware of other options I will try.” – Anonymous, Occupational Therapist

“I would recommend this seminar to a colleague because it provides the participant with the importance of the development of underlying components. Handwriting Without Tears is fun and brings back the joy of learning. It allows children to marinate in the learning process!” – Tara G., Occupational Therapist

“Lots of valuable information. Easy for students and teachers.” – Jenna R., Teacher

“I am an OTS and I believe this should be a required seminar. It was very informative and I feel as if I have a great resource to go to once I am an OTR.” – Tabitha C., OT Grad Student

Thank you, Susan!

Filomena Connor, MS, OTR/L
November 10, 2018

Therapro’s October 13th Saturday Seminar featured Margaret (Peggy) Morris, OTD, OTR/L, BCP, who presented her seminar, Pediatric Occupation-Based Assessment. Her review of a variety of pediatric assessment tools was comprehensive and enlightening.

Peggy has had a distinguished career as a pediatric occupational therapist, practicing in schools and private practice. Currently she is a faculty member in Tufts University’s Graduate Occupational Therapy Department. In addition, she is has presented workshops nationally and has been a Certified National Presenter for Handwriting without Tears.

Peggy contends that “occupational therapists have, at the heart and soul of their being, a focus on participation in meaningful occupations.” She distinguished between two assessment frameworks that current assessments occupy: International Classification of Function (ICF) and OT Practice Framework, 3rd ed. (OTPF3). Interestingly, assessments that are in the ICF category may not be occupational therapist designed, and focus on assessment of body function and structures that may limit function. The assessments in the OTPF3 category are occupation-based tools that assess function in “wanted and needed” occupations, and are being developed or have been developed by occupational therapists. The occupation-based tools have the added advantage that they can be used to determine progress versus only improved scores. Peggy noted that the very first occupation-based tool that requires clinic reasoning was the School Function Assessment. It appears that the OTPF3 group includes the important feature of attaining the student’s view of what he/she would like to focus on, i.e. student’s goal. Peggy pointed out commonalities between the two assessment categories to be considered when selecting an assessment tool. She mentioned the GOAL, Goal Oriented Assessment of Life Skills and Miller Function and Participation Scales (M-FUN) as hybrid tools.

A number of assessment tools were discussed that have empirical data associated with them. An interesting study highlighted the tools that therapists choose. The Beery VMI and the BOT-2 were at the top of the list. The Beery is a “bottom up” assessment that looks at student factors like body structures and function. On the other hand, a “top down” assessment tool offers an occupation-based way to provide services. A highly recommended tool was the COPM, Canadian Occupational Performance Measure, which was designed as an outcome tool.

Peggy discussed making an important distinction between “clinical reasoning” and “contextual or environmental observation” when evaluating a student. Clinical reasoning tells what you observe, i.e. convergence of the eyes, whereas contextual/environmental observation refers to observation of function in the classroom. She suggested that in the therapist’s assessment report that contextual/environmental observations be listed and discussed as the first tool used in the assessment to highlight its importance.

To gradually shift our focus to occupation-based and participation-based measures for assessments, versus only performance-based measures, Peggy suggested we review assessment results with parents and teachers by discussing qualitative results first, and then the scores the child received. With more occupation-based tools emerging, we can provide more meaningful evaluation of a student’s school function, and plan therapy that is also meaningful to the student!

Take a look at some of the extremely positive comments from attendees:

“This presentation reminds me of why I became an OT! This brings back the importance of connection & what is truly meaningful. Thank you.” – Tara G., Occupational Therapist

“It helped me to think more broadly about how to assess the students I work with. It also helped to think about keeping the student’s desires in perspective and a priority.” – Cindy M., COTA

“Fascinating to hear about new resources, (new/old?) ways to approach how we think and can change our practice! Thanks so much!” – Beth B., Occupational Therapist

“Well presented. Made me think about questions that I didn’t know I had.” – Trisha L., Occupational Therapist

“It brings our practice forward into a more function-based orientation by challenging old mind set.” – Marion S., Occupational Therapist

Thank you, Peg!

Filomena Connor, MS, OTR/L
October 13, 2018