DOCUMENT RESUME

ED 452 998 PS 029 509

AUTHOR Marr, Deborah; Windsor, Mary-Margaret; Cermak, Sharon

TITLE Handwriting Readiness: Locatives and Visuomotor Skills in
the Kindergarten Year.
PUB DATE 2001-00-00
NOTE 17p.; In: Early Childhood Research & Practice: An Internet
Journal on the Development, Care, and Education of Young
Children, 2001; see PS 029 507.
PUB TYPE Journal Articles (080)
EDRS PRICE MF01/PC01 Plus Postage.
DESCRIPTORS Cognitive Development; *Handwriting; *Kindergarten Children;
Motor Development; Primary Education; Skill Development;
Spatial Ability; *Writing Readiness; Writing Skills
IDENTIFIERS *Graphomotor Skills; *Locatives; Visual Motor Functioning

ABSTRACT
Handwriting is an integral part of every child's school
experience. In order to provide the best program to children both with and
without handwriting problems, elementary educators need to understand the
factors underlying the skill of handwriting. This study investigated the
relationship between the cognitive understanding of locatives (e.g., words
used for spatial and temporal concepts, such as "up" or "next to") and the
graphomotor task of shape and letter copying in typically developing
kindergarten children. Additionally, changes in those skills during the
kindergarten year were examined. The Developmental Test of Visual-Motor
Integration, the Boehm Test of Basic Concepts, and the Scale of Children's
Readiness In PrinTing were administered to a sample of 138 children during
the first and second half of their kindergarten year. The findings showed a
significant increase in performance on all three measures from time one to
time two. The relationships among the three tests varied. A moderate positive
relationship between the visuomotor and handwriting test was found. This
result supports previous findings that link visuomotor skills to handwriting.
All other relationships were low. This study adds to a growing body of
knowledge about the prerequisite skills needed for handwriting. (Contains 51
references.) (Author/HTH)

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Spring 2001
Volume 3
Number 1 Table of Contents
It A cri CE.

Handwriting Readiness: Locatives and Visuomotor

Skills in the Kindergarten Year

Deborah Marr, Utica College of Syracuse University; Mary-Margaret

Windsor, Towson University; & Sharon Cermak, Boston University

Abstract
Handwriting is an integral part of every child's school experience. In order to provide the best program to
children both with and without handwriting problems, elementary educators need to understand the factors
underlying the skill of handwriting. This study investigated the relationship between the cognitive
understanding of locatives (e.g., words used for spatial and temporal concepts such as "up" or "next to")
and the graphomotor task of shape and letter copying in typically developing kindergarten children.
Additionally, changes in those skills during the kindergarten year were examined. The Developmental Test
.
of Visual-Motor Integration, the Boehm Test of Basic Concepts, and the Scale of Children's Readiness In
PrinTing were administered to a sample of 138 children during the first and second half of their
kindergarten year. The findings showed a significant increase in performance on all three measures from
time one to time two. The relationships among the three tests varied. A moderate positive relationship
between the visuomotor and handwriting test was found. This result supports previous findings that link
visuomotor skills to handwriting. All other relationships were low. This study adds to a growing body of
knowledge about the prerequisite skills needed for handwriting.

Introduction

Handwriting is an integral part of every child's school experience. Thirty to 60% of the
elementary school child's class time is spent in fine motor/writing activities, with writing
as the predominant task (McHale & Cermak, 1992). Some students have difficulty in the ,

production of legible handwriting. Factors that contribute to illegible writing are

incorrect letter formations or reversals, inconsistent size and height of letters, variable
slant and poor alignment, and irregular spacing between words and letters (Alston &
Taylor 1987; Tseng & Cermak, 1991; Ziviani & Elkins, 1984). Programs to address
handwriting problems have been varied and include visual perception and visuomotor
and letter formation training (Oliver, 1990; Lockhart & Law, 1994; Peterson, 1999). In
order to provide the best program to children both with and without handwriting

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problems, it is necessary for elementary educators to understand the factors underlying
the skill of handwriting.

Issues Related to Handwriting

Many studies have addressed the underlying factors related to handwriting. These factors
can be categorized into external and internal factors. Examples of external factors are
instructional procedures and materials used during writing (Alston, 1985; Carlson &
Cunningham, 1990; Pasternicki, 1987; Rubin & Henderson, 1982; Zaner-Bloser, 1994;
Ziviani, 1987). Internal factors are abilities found within the student: visuomotor skills,
visual perception, motor planning (i.e., the ability to plan new motor behavior), in-hand
manipulation, and kinesthetic awareness (Berninger & Rutberg, 1992; Case-Smith &
Pehoski, 1992; Laszlo & Bairstow, 1984; Maeland, 1992; Sclmeck, 1991; Tseng, 1991;
Tseng & Murray, 1994; Weil & Amundson, 1994; Ziviani, Hayes, & Chant, 1990;
Ziviani, 1995). The internal factor of cognition and its relationship to handwriting has
not been extensively studied. Several authors (Brown & Donnenwirth, 1990; Chu, 1997;
Exner, 1990; Exner & Henderson, 1995; Moore & Law, 1990; Naka, 1998) have
discussed the link between various aspects of cognitionparticularly attention, memory,
and languageand handwriting skill. It is suggested that success in handwriting can be
optimized when the internal factors are at age-appropriate levels, making the student
ready to benefit from classroom instruction.

Writing Readiness

Readiness is a term that describes foundation skills present before the child learns a new
task (Slavin, Karweit, & Wasik, 1994). Sovik (1975) described writing readiness as
having the needed characteristics to "profit satisfactorily from the instruction given in
the teaching of handwriting at different stages through elementary school" (p. 54).
Writing readiness skills have been further specified by several authors. Lamme (1979)
outlined six prerequisites for handwriting: small muscle development, eye-hand
coordination, utensil or tool manipulation, basic stroke formation, alphabet letter
recognition, and orientation to written language. Benbow, Hanft, and Marsh (1992)
listed four prerequisite areas: dominant hand use, midline crossing with the dominant
hand, proper posture and pencil grip, and ability to copy the first nine shapes of the
Developmental Test of Visual-Motor Integration (Beery & Buktenica, 1989). Other
authors have identified kinesthetic readiness as an important precursor to handwriting
instruction (Benbow, 1995; Laszlo & Bairstow, 1985; Levine, 1998). A foundation in
kinesthesia allows reception of ongoing error information from handwriting efforts: this
necessary information is stored in memory to be recalled when the movement is
repeated. While younger children may substitute visual for kinesthetic feedback in the
early elementary years, the switch to kinesthetic feedback should be made eventually to
produce faster handwriting. If this switch is not made, the increasing demand for writing
production in the later elementary years may result in academic productivity problems.

Cognitive readiness could affect handwriting performance. Several authors have

suggested that a certain level of cognitive/language ability needs to exist before
handwriting performance is optimal. Exner and Henderson (1995) stated that cognitive
skills including attention, memory, perception, and language affect the learning of motor

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skills, but that the role of cognition diminishes once the skill is learned and skill
refinement is in progress. Chu (1997) recommended evaluation of the cognitive
components of attention, memory, language comprehension, and reasoning when a child
has handwriting difficulties. Sandler et al. (1992) found that three of the four patterns of
writing disorders identified in 9- to15-year-olds had links to either cognitive or
visual-perceptual function. These included expressive language, rapid naming, picture
naming, attention, and memory. While many authors recognize that cognition/language
plays an important role in handwriting, the question of what constitutes critical cognitive
readiness is not clearly answered.

The Kindergarten Year

Formal handwriting instruction may begin as early as the kindergarten year

(Zaner-Bloser, 1994). The verbal directions used in handwriting instruction assume
children understand spatial and temporal concepts. Terms such as "on top of the line,"
"above the line," or "between the lines" are used in handwriting curriculum (Benbow,
1995). An ability to understand these terms is acquired in a developmental sequence.
Johnston (1988) summarized 19 studies on the acquisition of spatial location terms. The
age at which the average child begins to understand the locative "in" is 2 years.
Additional locatives are learned as the child increases in age, with the most challenging
locative, "back/front," attained by the average child at 4 years 8 months. Examining
children's understanding of spatial and temporal concepts would influence handwriting
curriculum as well as intervention strategies used in the classroom.

While many studies examine handwriting of the older child (second grade and higher),
fewer have researched the early years of beginning writing. Tan-Lin (1981),
Tolchinsky-Landsman and Levin (1985), and Gombert and Fayol (1992) looked at
handwriting samples of children in the 3- to 6-year-old range. These studies found a
developmental sequence beginning in the younger ages with drawing and scribbling, and
concluding in the older age groups with an ability to write legible letters. Tan-Lin (1981)
found that at least one-third of 4- to 6-year-olds could print up to five simple words from
memory. Common words written by this age group were MOM, DAD, DOG, CAT, and
STOP.

Tan-Lin (1981) identified the quality changes in handwriting in 4- to 6-year-olds. She

noted that such factors as size, quantity, proportion, and spacing improve with age.
Additional studies of older children have examined size and proportion.
Smits-Engelsman and Van Galen (1997) found that dysgraphic children (i.e., children
with writing deficits) 7 to 11 years old showed more variability in letter size than
nondysgraphic children. Windsor (1995), studying handwriting legibility, developed the
concept of "letter form width." This composite measure determined from letter sizes
allows comparison of relative size/form of letters between handwriting samples. She
found that 8- to 11-year-old boys with attention deficit/hyperactivity disorder (ADHD)
wrote larger letters than typical boys of the same age. Hamstra-Bletz and Blote (1993),
in a longitudinal study of dysgraphic handwriting from grades two to six, found that
inconsistent letter size was a common feature in dysgraphic writing.

Weil and Amundson (1994) examined the relationship between the kindergartner's
ability to copy letter forms and geometric shapes. They analyzed performance on the

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Developmental Test of Visual-Motor Integration (VMI) and the Scale of Children's
Readiness In PrinTing (SCRIPT). A Pearson product-moment correlation coefficient
revealed a moderate correlation (r = .47,p < .001). Students at the end of the first
semester of kindergarten were, on average, able to copy 78% of the letters presented.
Additionally, 88% were able to copy the first nine forms of the VMI. They concluded
from the results "...that most children in kindergarten will be ready for beginning
handwriting instruction during the latter half of the kindergarten school year" (Weil &
Amundson, 1994, p. 987).

Although some aspects of handwriting in the kindergartner have been investigated, the
relationship between the cognitive ability of understanding spatial and temporal
concepts and handwriting has not been explored. Specifically, this study investigated the
relationship between the cognitive understanding of spatial and temporal locatives and
graphomotor production, including shape and letter copying, at two points in the
kindergarten year. It was hypothesized that there is a positive, moderate correlation
between the scores on the Boehm Test of Basic Concepts (Boehm, 1986), the
Developmental Test of Visual-Motor Integration (Beery, 1997), and the Scale of
Children's Readiness In PrinTing (Amundson & Weil, 1996) for both test sessions.
Further, it was hypothesized that despite the fact that formal handwriting instruction
does not occur in kindergarten, scores on all measures will increase from the first half of
the year to the second half of the year.

Method

Participants
The participants for this study included 61 boys and 77 girls, with 120 right-handed
students and 18 left-handed students. Ages at the first session ranged from 4 years 11
months to 6 years 7 months, with a mean age of 5 years 7 months (standard deviation 3.9
months). This convenience sample of typically developing children represents the
majority of the kindergarten students in a middle-income, suburban community in
upstate New York. A student was considered typically developing if there was no
Individualized Education Plan (IEP) in place, he or she had not been retained in
kindergarten, and he or she had English as the primary language. Six percent of the
district's students are in families below the poverty level, with 10% using the
free/reduced lunch program. Racial distribution of the participants was 93% white, 2%
black, 1% Asian, and 4% other.

The teachers sent consent forms to all 180 registered kindergarten students. There were
177 consent forms returned. Eight students were on IEPs and were not included in the
study. Additionally, 31 children were not included due to absence on one of the test
dates or incomplete tests.

Instruments
The Developmental Test of Visual-Motor Integration (VMI) (Beery, 1997) is a widely
used test of visuomotor skills. The student copies a series of shapes in a test booklet, and
the graphic responses are scored using the criterion listed in the manual. Each shape is

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awarded either a 1 for passing or a 0 for failing. Scoring is discontinued after the student
has earned three consecutive Os. The maximum score possible is 18. This test was
recently revised in 1997. Test-retest reliability is reported as .87, and inter-scorer
reliability is reported as .94. Additional detailed information on the reliability and
validity is cited in the test manual. Inter-coder agreement was examined for this study
using a Pearson correlation. Resulting correlation between the first author and an
experienced occupational therapist on a set of 10 student tests was .97.

The Boehm Test of Basic Concepts (BTBC) (Boehm, 1986) is a standardized,

norm-referenced test designed to assess children's mastery of basic concepts. Each child
has a booklet with pages containing several rows of three pictures. The examiner cues
the child to a row and reads a question, and the child responds by marking the correct
picture within the row. The test consists of 50 questions. Examples include "Mark the
dog that is at the end of the line" and "Mark the animal that is at the bottom."
Administration can be done in a group or individually. For a kindergarten sample,
split-half reliability is reported to be .81, and test-retest reliability for tests given one
week apart was .85. More detailed information on reliability and validity is given in the
test manual (Boehm, 1986). For the present study, inter-coder agreement was established
using a Pearson correlation. Correlation results between the first author and an
occupational therapy research assistant on a set of 10 tests was found to be .97.

The Scale of Children's Readiness In PrinTing (SCRIPT) is a letter form copying

research test developed by Weil (Weil & Amundson, 1994). The test booklet consists of
five pages with a maximum of eight letters per page using the Zaner-Bloser manuscript
alphabet. All 26 lowercase letters are included, as are the following eight uppercase
letters: A, K, M, N, V, W, Y, Z. In total, the student copies 34 letters. The student sees
the stimulus letter printed in the center of a square and is asked to copy the letter in the
blank square space located directly below the stimulus letter. The test developer
provided scoring criteria. Point-by-point reliability was reported at 90% to 100%. This
level of reliability was not achieved during the initial scoring for the present study.
Therefore, the decision was made to investigate reliability of scoring for this test. More
refined parameters, which included criterion from the Test of Copied and Dictated
Writing, were developed (see Figure 1) (Windsor, 1995). Similar to the original scoring
of the SCRIPT, each letter was scored as pass/fail, but unlike the SCRIPT, each letter
was judged by more specifically defined criteria, which allowed for more discriminate
judging of each letter. Using the refined parameters and a Pearson correlation, an
inter-coder agreement on a set of 10 tests was found to be .95 between the first and third
author.

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 The letter is.quickly and easily recognized as itself and no other
symbol using the "peek hole" method; no gross errors in proportion
are present..Case (upper or lower) is correct.

.:::The letter.has no missing parts and no extra parts. This includes the
need to have the "stick" on a lower case "n."

3. No lines extend beyond the intersection by more than 2 mm.

Baselines and toplines must be parallel to the horizontal boundary

lines of the blank stimulus box within :3 mm. Top lines and bottom
boundary lines are not used, for the letters "a," "b," "d," "q," "g," "r,"
"p," and the bottom of nu."

5. Upstrokes and downstrokes must be parallel to the vertical

boundaries within 3 mm. The capital letter "M" and the dots on "i"
and "j" are not included in this criterion. The side points of "z," " ,
"x," "k," and "c" must fall within a 3-mm space of each other,
which is perpendicular to the horizontal boundaries.

6. Letter fonns must be closed correctly with no more than a 2-mm gap.
For "k," this means the intersection of the two angled lines can be no
more than 2 mm apart.

Curved lines must be curved, and straight lines must be able to fit
within a 24nm space:These:criteria inClude any extension lines that
may be present..

8. Angles must be present.

9. There is no rotation of more than 45 degrees in any part of the letter;

no reversals are present.

10. Each side of the horizontal line in "t" and "f' must be within 2-mm
length of the other; the bottom portion of the vertical line of the "t"
must be at least 2 mm longer then the top side.

11. Oblique lines cannot be perpendicular to the outer boundary lines

ttytt).

Figure 1. Criteria for scoring the Scale of Children's Readiness In PrinTing (SCRIPT).

Letter and word size may indicate maturity of a student's writing. Various authors have
noted that large and variable-sized letters are markers of poor handwriting (Alston &
Taylor, 1987; Hamstra-Bletz & Blote, 1993; Tseng & Cermak, 1991; Windsor, 1995;
Ziviani & Elkins, 1984). An index of letter/word size called Word Form Width (WFW)
was developed for this study. The students were asked to write five words from dictation
on unlined paper. Words (MOM, DAD, DOG, CAT, and STOP) were chosen from a

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study by Tan-Lin (1981) that identified words frequently written by 4- to 6-year-olds.
The words were spoken and spelled. The first word produced, MOM, was used to
determine Word Form Width. See Figure 2 for measurement criteria. Inter-coder
agreement between the first and second author on 10 samples was established at .94
using a Pearson correlation.

1. Measure the word only if it contains all letters, is in a relatively

straight line, contains no reversals, is located in the large white space
at the bottom of the page, and is generally recognizable.

2. Measure the distance in millimeters at baseline from the far left outer
edge of the word to the right outer edge of the word.

3. Round the millimeter to the nearest whole centimeter.

Figure 2. Criteria for scoring Word Form Width.

Procedure

Prior to testing, the teachers were surveyed regarding their teaching experience and
training in handwriting instruction. Nine of the ten teachers responded to the survey. The
average number of years in teaching was 19.8, with a range of 7 to 30 years. The average
number of years teaching kindergarten was 7.6, with a range of 0 to 20 years. None of
the teachers reported having any training in handwriting instruction either as
undergraduates or in workshops. While a specific handwriting curriculum is not used at
the kindergarten level, the average time devoted per week to handwriting instruction in
the classroom was 55 minutes, with a range of 40-90 minutes. Teaching techniques
included demonstration and verbal cueing for letter formation.

There are 10 full-day kindergarten classes in this district. The participants were tested in
their classrooms using group procedures. The first author administered all tests. Test
sessions were scheduled in collaboration with the teachers. The sequence of tests was
counterbalanced across the classrooms to control for fatigue and order effects. Testing
occurred in November (Session 1) and April (Session 2). The tests were given in two
separate time periods on the same day. The VMI and SCRIPT were administered in one
15-minute time period. The BTBC was administered in a 30-minute time period. The
two time periods were separated by a range of 30 minutes to 3 hours based on the
schedule of each class.

The VMI and the BTBC were administered according to standard group procedures from
the manual. Before beginning the SCRIPT, students were asked to write the following
dictated words on the open space provided on the cover sheet: MOM, DAD, DOG,
CAT, STOP. Each word was spoken and spelled.

The directions for the SCRIPT were as follows:

Please copy the letters you see in the box below each letter. When you are
done with one page, go on to the next page until you have done all the

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 pages. When you are done, please put your pencil down in front of you on
the desk.

Results

Directional paired t-tests were calculated, and as hypothesized, increased performance

on the VMI, SCRIPT, and the BTBC was significant over the course of the kindergarten
year (see Table 1). There was no significant change in the scores for Word Form Width.

Table 1

Total Scores for Sessions 1 and 2 on Graphomotor and Locative Measures

Session 1 Session 2

Effect
Test N M SD I SD t-Test i Size
I

VMI 138 12.6 2 14 1.8 7.8* i 0.7

SCRIPT 138 15.3 5.7 19.1 5.4 7.7* 0.7

BTBC 138 43.1 14.9 44.6 i 4.1 4.6* 0.4

1

WFW 114 6.4 2.9 : 6.2 2.8 0.6 0.1

r

Note:.VMI = Developmental Test of Visual-Motor Integration; SCRIPT Scale

of Children's Readiness In PrinTing; BTBC = Boehm Test of Basic Concepts;
WFW = Word Form Width.
'Pp < .05.

Pearson product-moment correlations were calculated between the VMI, SCRIPT,

BTBC, and Word Form Width. For Session I (see Table 2), a moderate correlation was
found between the SCRIPT and the VMI (r = .39), and the SCRIPT and the BTBC (r =
.30). The remaining correlations were low (r < .25). As expected, a negative relationship
existed between WFW and the SCRIPT (r = -.21) because as children get older, they
write more legibly and smaller.

Table 2

Pearson Product-Moment Correlations between Measures for Session 1

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89
cognitive understanding of spatial and temporal concepts, visuomotor skills, and
graphomotor production in the kindergarten child. Considering the first purpose, three of
the four measures demonstrated statistically significant improvements over the course of
the kindergarten year. Changes in WFW were not significant. Change would be expected
due to maturity and classroom training as skill is improving for this age group. The lack
of significant change in WFW scores may reflect the measure used. Children were given
a large space on which to write their words. The use of lined paper may have prevented
them from using more of the page than they might otherwise have done. Additionally,
WFW may not be an appropriate measure of a student's writing maturity for this age
group because writing skill may still be variable.

Benbow, Hanft, and Marsh (1992) have suggested that children are ready for
handwriting instruction once they can copy the first nine forms of the VMI. Only two
subjects received a score of less than 9 on the VMI at Session 1. The SCRIPT scores for
these two children were between 1 and 2 standard deviations below the mean. No child
received a VMI score of less than 10 at Session 2. The two subjects with low VMI
scores at Session 1 had SCRIPT scores of 1 standard deviation below the mean in
Session 2. According to Benbow's criteria, all children in this sample were ready for
handwriting instruction at Session 2. Weil and Amundson (1994) also concluded that
most children would be ready for handwriting instruction in the latter half of their
kindergarten year.

Results related to the second purpose indicated that a moderate relationship exists
between visuomotor and graphomotor skills. Tseng and Murray (1994), studying
children in grades three to five, found correlations consistent with the present study. In
their study, a sample of poor handwriters had a correlation of r = .31 between
handwriting and the VMI, while a sample of good handwriters had a correlation of r =
.33. Four teachers rating legibility of a copied textbook paragraph measured
handwriting. The relationship between graphomotor production and visuomotor skill
was not as strong as that seen in some other studies. Weil and Amundson (1994),
examining typical children using the same measures and the same age group, found the
correlation to be moderate (r = .47). Their scoring criteria for the SCRIPT was more
lenient than that used in the present study and resulted in a mean score of 26.2 out of 34
in the second half of the kindergarten year, compared with the 19.1 out of 34 in Session
2 of the present study. Maeland (1992) examined the relationship of the VMI with
handwriting of 10-year-old students and found a correlation similar to Weil and
Amundson (1994) (r = .43). Independent judges rating legibility of six dictated
sentences on a 7-point scale measured handwriting. The different methods used to
measure handwriting may contribute to the range of correlations seen.

The relationship between cognitive skills and handwriting has not been extensively
studied. However, several authors have stated the importance of cognition in any skilled
motor task (Brown & Donnenwirth, 1990; Chu, 1997; Exner, 1990; Exner & Henderson,
1995; Henderson & Pehoski, 1995; Meulenbroek & Van Galen, 1990; Sandler et al.,
1992). Understanding spatial and temporal concepts had a low relationship to
visuomotor or graphomotor skills in the present study. Because this sample primarily
included typically developing, middle and upper socioeconomic children, spatial and
temporal concepts needed for writing may already be understood. The BTBC manual
indicates that 98% of kindergarten children understand the word "top," 90% understand
the word "between," and 85% understand the word "above" (Boehm, 1986). Because
these words are used during handwriting instruction, the variations in graphomotor
production may be due to factors not related to these measured concepts. This finding
may not be the case for children from different socioeconomic backgrounds or cultures.

Implications for Practice

Educators are concerned about a young student's readiness for handwriting instruction.
The results of this study add to the growing conclusion that typical students in the latter
half of kindergarten have the foundation skills needed to begin formal handwriting
instruction. Kindergarten teachers should consider available curricula that offer
beginning handwriting training and are motivational for this age group.

Early identification of children with the potential for handwriting problems is another
concern for the kindergarten teacher. The results of the present study point out an area
that may assist in early identification: the relationship between visuomotor skills and
handwriting. Evaluating visuomotor skills may help pinpoint children who need close
monitoring or specific interventions to prevent the development of handwriting
problems. Future research needs to investigate whether training in visuomotor skills will
increase handwriting performance.

Limitations

The first limitation of the present study relates to the use of group administration of the
measures. Although group administration of the measures is described in the manuals,
the teachers felt that many of the students rushed to keep pace with their classmates. It
was also noted that some children looked to their peers for correct answers or models of
writing despite the efforts of the examiner to discourage such behavior. Classroom
teachers reported feeling their students were capable of higher performance if the tests
had been given individually.

The subjects used for this study were homogeneous, generally from a higher
socioeconomic level, and had no identified disabilities. These characteristics may have
resulted in less variability in scores and less representation of kindergarten children as a
whole and may limit generalizability of the results to children with low socioeconomic
status or atypical abilities.

Implications for Future Research

The present study examined typically developing children and has supported the
importance of visuomotor skills in handwriting for the kindergarten child. Examining
this relationship within populations at risk for handwriting problems would be valuable.
If the relationship is stronger with these children, handwriting teaching strategies using
locative concepts may need to be adapted.

Acknowledgments

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[11 This study was supported in part by a grant to Sargent College Health and Rehabilitation Sciences, Boston
University, from the U.S. Department of Health and Human Services, Health Resources and Services
h
Administration, Maternal and Child Health Bureau (MCJ-000-901) and MCH grant #MCJ 08941301. This
article was written in partial fulfillment of the first author's requirements for the degree of Doctor of
Science in Therapeutic Studies at Boston University. The authors would like to thank the New Hartford
School District for their help and cooperation in this study.

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Author Information

Deborah Marr, MS, OTR/L, is an assistant professor of occupational therapy at Utica College of Syracuse
University focusing on courses related to pediatrics and research. She also is a doctoral student at Boston
University's Department of Occupational Therapy. Her research interests include the fine motor and
sensory processing skills of preschool and early elementary children, and current clinical work involves
consultation to the Head Start program.

Deborah Marr

15
6
 Utica College of Syracuse University
1600 Burrstone Rd.
Utica, NY 13502
Telephone: 315-792-3101
Email: dmarr@utica.ucsu.edu

Mary-Margaret Windsor is a former clinical assistant professor, Department of Occupational Therapy at

Boston University. She received a BSOT (1968) and an MEd (1976) from the University of New
Hampshire. She earned a Doctor of Science Degree in Therapeutic Studies (1995) from Boston University.
Currently she is an instructor in sensory integration for Western Psychological Services, a visiting assistant
professor at Towson University, Department of Occupational Therapy and Occupational Science, and is
involved in humanitarian work and occupational therapy practice internationally.

Sharon A. Cermak, EdD, OTR/L, FAOTA, is professor of occupational therapy at Boston University and
project director of an occupational therapy doctoral leadership training grant from the Maternal and Child
Health Bureau, Health Resources and Services Administration. Dr. Cermak is director of occupational
therapy training at the interdisciplinary Leadership in Education in Neurodevelopmental Disabilities
(LEND) program at Children's Hospital, Boston. She is a former Fulbright scholar and a recipient of the
R.K. Gray award. Dr. Cermak's research includes examination of (1) motor planning deficits in children,
and (2) sensory processing, emotional regulation, and development in post-institutionalized children.
74

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