Graduation Date


Document Type

Master's Thesis (Campus only Access)

Degree Name

Master of Science in Occupational Therapy

Department or Program

Occupational Therapy

Department or Program Chair

Ruth Ramsey, EdD, OTR/L

First Reader

Melisa Kaye, MS, OTR/L

Second Reader

Joann Figone, MS, OTR/L


The majority of school-based occupational therapy (OT) referrals are for handwriting. In fact, fine motor and handwriting concerns affecting educational performance make up 80-85% of OT referrals in schools. Occupational therapists use an abundance of interventions for remediating handwriting difficulties, but there is scant evidence of why specific strategies or combinations of strategies are effective.

Cognitive interventions have shown to be successful in the treatment of handwriting. Metacognitive skill, a component of cognition, allows a child to self-monitor and self-reflect on his or her handwriting skills to correct mistakes and generate goals for improvement. Therefore, a child’s ability to self-reflect on handwriting is likely an important factor when strengthening the learning and use of handwriting. Having insight into a child’s reflection of his or her handwriting abilities will also assist occupational therapists in creating an appropriate and effective handwriting intervention. This study aims to contribute to the evidence regarding the development and treatment of handwriting skill in elementary school-aged children.

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