Date Presented 04/02/2022

The research in the OT literature documenting the dosage (intensity, frequency, duration) of interventions commonly used by the OT profession is limited. This study provides novel information related to the dosage of handwriting curricula and is meaningful to OTs and OT assistants working among pediatric populations.

Primary Author and Speaker: Bryan M. Gee

Additional Authors and Speakers: Jane Ewoniuk, Kimberly Lloyd

INTRODUCTION/RATIONALE: There is limited research in the occupational therapy literature that documents the dosage (intensity, frequency, and duration) of interventions commonly used by occupational therapy professions. This is especially true with handwriting curriculum’s used to increase participation and performance in pertinent educational occupations. The purpose of this study was to explore the parameters of dosages of published outcome studies that reported handwriting curriculum effectiveness among small groups or classroom populations.

METHOD/APPROACH: This study utilized a content analysis approach analyzing the dosage parameters and other pertinent information related to how handwriting curricula are used in the occupational therapy literature. The literature review yielded 27 peer-reviewed publications that were included in the content analysis. Two raters reviewed the method/finding sections and reported the content related to dosage. The parameters related to dosage were tracked by a comprehensive spreadsheet and then measures of central tendency and frequency distribution were applied to the data.

RESULTS: The findings revealed that of the studies that used formal handwriting curricula had dosage parameters for the categories of number of weeks (M = 14.72, SD = 9.61), number of sessions (M = 37.42, SD = 35.31), sessions per week (M = 3.32, SD = 1.54), and total intervention hours (M = 97.12, SD = 388.04). The mean sample size across the studies was 52.35 participants, with 19% in classrooms where the average age was 5. Most of the studies used the Handwriting Without Tears (37%) handwriting curriculum.

CONCLUSION: This study provides novel information related to the dosage of handwriting curricula and is meaningful to occupational therapists and occupational therapy assistants working among pediatric populations. Specifically, the findings from the study may guide occupational therapists with the type of curricula dosage for various settings (schools or summer camps) and populations (neurotypical or atypical).


Schneck, C. & O’Brien, S. (2020). Assessment and treatment of educational performance in Case-Smith’s Occupational Therapy for Children and Adolescents by O’Brien, J. & Kuhaneck, H. (Eds). Elsevier.

Gee, B., Gerber, D., Butikofer, R., Covington, N., & Lloyd, K. (2018). Frequency, Intensity, and Duration of CIMT: A Content Analysis. NeuroRehablitation, 42(2), 167-172.

Donica, D. (2010). A historical journey through the development of handwriting instruction (part 1): The historical foundation. Journal of Occupational Therapy, Schools, & Early Intervention, 3(1), 11-31.