Marie Brossard-Racine, Barbara Mazer, Marilyse Julien, Annette Majnemer; Validating the Use of the Evaluation Tool of Children’s Handwriting–Manuscript to Identify Handwriting Difficulties and Detect Change in School-Age Children. Am J Occup Ther 2012;66(4):414-421. doi: 10.5014/ajot.2012.003558.
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© 2019 American Occupational Therapy Association
In this study we sought to validate the discriminant ability of the Evaluation Tool of Children’s Handwriting–Manuscript 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.
Preliminary cutoff values of 75.0% for total word legibility and of 76.0% for total letter legibility on the ETCH–M are suggested to discriminate between children in Grades 2 and 3 who present with handwriting difficulties and those who do not.
These quantitative cutoff values can support clinicians in justifying need for intervention.
Change in handwriting scores <6.0% for total letter legibility and <10.0% for total word legibility should not be considered clinically important.
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