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Evaluation Tool of Children's Handwriting

Evaluation Tool of Children's Handwriting

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Purpose

The ETCH assesses a child's legibility and speed of handwriting as well as the child's pencil management related to writing tasks that are commonly done in a classroom setting (Amundson, 1995).

Link to Instrument

Acronym ETCH

Area of Assessment

Occupational Performance
Upper Extremity Function

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$200.00

Cost Description

Cost includes the ETCH kit.

Key Descriptions

  • The ETCH measures an individual's manuscript and cursive handwriting. It is a paper-based tool administered and scored by educators and allied health professionals.
  • The manuscript measure is called the ETCH-M, and it includes 6 tasks:
    1) Alphabet writing: 26 lower-case letter items & 26 upper-case letter items
    2) Numeral writing: 12 numeral items
    3) Near-point copying: 5 word items & 18 letter items
    4) Far-point copying: 5 word items & 18 letter items
    5) Dictation: 2 word items, 10 letter items, & 5 numeral items
    6) Sentence composition: variable depending on sentence chosen by child

    ETCH-M Score Distribution:
    Word: 0 to 12
    Letters: 0 to 98
    Numeral: 0 to 34
    Totals: 0 to 144

    Legibility distribution: 0 to 100% for word, letter, and numeral scores
  • The cursive measure is called the ETCH-C, and it includes 7 tasks:
    1) Alphabet writing: 26 lower-case letter items & 26 upper-case letter items
    2) Numeral writing: 20 numeral items
    3) Near-point copying: 5 word items & 31 letter items
    4) Fair-point copying: 7 word items & 29 letter items
    5) Manuscript-to-cursive: 6 word items & 31 letter items
    6) Dictation: 3 word items, 15 letter items, & 5 numeral items
    7) Sentence composition: variable depending on sentence chosen by child
  • Score distribution for ETCH-C:
    A) Word: 0 to 21
    B) Letters: 0 to 158
    C) Numeral: 0 to 25
    D) Totals: 0 to 204
  • Legibility distribution: 0 to 100% for word, letter, and numeral scores

Number of Items

13

Equipment Required

  • Examiner's manual
  • Master response booklet
  • Master score sheets
  • Task sheets
  • Wall charts
  • Quick reference sheets
  • Scoring card
  • Table
  • Chair
  • Stopwatch
  • 2 no. 2 pencils

Time to Administer

15-30 minutes

Required Training

Reading an Article/Manual

Age Ranges

Child

6 - 12

years

Instrument Reviewers

Initially reviewed by University of Illinois at Chicago Master of Science in Occupational Therapy students Sara Brumm, Jasmine Brown, and Jazmin Landa.

Body Part

Upper Extremity

ICF Domain

Activity

Measurement Domain

Motor
Cognition

Professional Association Recommendation

No professional association recommendations have been made.

Considerations

The ETCH can be used with any child that is having handwriting challenges with the following diagnoses: mild developmental delays, learning disabilities, and mild neuromuscular impairments.

Children with "severe involvement of mental retardation, emotional disturbances, or cerebral palsy may not be appropriate candidates as handwriting may not be a feasible means of written communication" (Amundson, 1995).

ETCH can be used to gather descriptive information on writing skills from older clients. However, it should be noted that the content may not be age- or content-appropriate for clients over 12 years, 5 months.

Pediatric Disorders

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Minimally Clinically Important Difference (MCID)

Children in Grades 2 and 3 with Attention Deficit Hyperactivity Disorder: (Brossard-Racine, Mazer, Julien, & Majnemer, 2012; n = 26)

  • In the ETCH-M, clinicians should not consider a change in scores over time as clinically significant if that change corresponds to less? than 6.0% for total letter legibility and less than 10.0% for total word legibility.

Cut-Off Scores

Children Aged 7 to 9 Years in Grades 2 and 3 with Writing Dysfunction: ?(Diekema, Deitz, & Amundson, 1998; n = 31)

  • Cut-off scores of 75.0% for total word legibility and 76.0% for total letter legibility were found to provide excellent levels of accuracy

Children in Grades 2 and 3 with Attention Deficit Hyperactivity Disorder: ?(Brossard-Racine, Mazer, Julien, & Majnemer, 2012)

  • 75% total word legibility and 76.0% total letter legibility on the ETCH-M are suggested as teh cut-off values to discriminate between children with handwriting legibility difficulties who should be seen in rehabilitation for evaluation and treatment from those who have no such difficulties.

Children in Grades 6 and 7 with and without Writing Difficulties: (Duff & Goyen, 2010, n = 48)

  • Cut-off score of 92 for total letter was determined to be the best to discriminate between case and control participants (sensitivity = .88 and specificity = .83).

  • Cut-off score of 85 for total word was determined the best to discriminate between case and control participants (sensitivity = .71 and specificity = .75).

  • Cut-off score of 95 for total numeral was determined the best to discriminate between case and control participants (sensitivity = .42 and specificity = .88).

Test/Retest Reliability

ETCH-Manuscript

First and Second Grade Students: (Diekema, Deitz, & Amundson, 1998)

Total/Task

Reliability Coefficient (ICC/Spearman Rank Order Correlation Coefficient)

Strength of ICC

Total Letter, Excluding VI

.11/1.00

 

Total Letter

.00/1.00

 

Total Numeral

.71a

Adequate

Total Word

.77b

Excellent

Total Word, Excluding VI

.63a

Adequate

Ia. Alphabet Lowercase

.64a

Adequate

Ib. Alphabet Uppercase

.76b

Excellent

II. Numerals

.63a

Adequate

III. Near-point Copying

.20a

Poor

IV. Far-point Copying

.63a

Adequate

V. Dictation

.68a

Adequate

VI. Sentence Composition

.33a

Poor

Notes: aSpearman rank order correlation coefficient; bIntraclass correlation coefficient

"Total legibility percentage scores were more reliable than individual task scores, so the researchers recommended that the therapists use total legibility percentage scores when evaluating progress and making intervention decisions" (Koziatek & Powell, 2002).

Interrater/Intrarater Reliability

ETCH-Manuscript

Children from Grades 1, 2, and 3 Receiving Occupational Therapy or Had Been Referred for Occupational Therapy Services: (Amundson, 1995)

Total/Task

Pearsona

Pearsonb

ICC

Strength of ICC

Total Letters

.92

.90

.84

Excellent

Total Numbers

.85

.87

.82

Excellent

Total Words

.85

.75

.48

Adequate

Ia. Lower-case Letters

.87

.85

.68

Adequate

Ib. Upper-case Letters

.92

.91

.88

Excellent

II. Numerals

.76

.78

.70

Adequate

III. Near-point Copying (Letters)

.80

.76

.51

Adequate

III. Near-point Copying (Words)

.91

.71

.55

Adequate

IV. Far-point Copying (Letters)

.64

.74

.47

Adequate

IV. Far-point Copying (Words)

.76

.77

.58

Adequate

V. Dictation (Letters)

.90

.86

.79

Excellent

V. Dictation (Units)

.88

.69

.69

Excellent

VI. Sentence Composition (Letters)

.94

.85

.86

Excellent

VI. Sentence Composition (Words)

.80

.63

.42

Adequate

Notes: aSpearman rank order correlation coefficient; bIntraclass correlation coefficient.

 

ETCH-Cursive

Children from Grades 4, 5, and 6 Receiving Occupational Therapy or Had Been Referred for Occupational Therapy Services: (Amundson, 1995)

Total/Task

Pearsona

Pearsonb

ICC

Strength of ICC

Total Letters

.97

.97

.89

Excellent

Total Numbers

.53

.70

.53

Adequate

Total Words

.90

.98

.94

Excellent

Ia. Lower-case Letters

.90

.90

.86

Excellent

Ib. Upper-case Letters

.97

.96

.86

Excellent

II. Numerals

.77

.86

.53

Adequate

III. Near-point Copying (Letters)

.91

.91

.77

Excellent

III. Near-point Copying (Words)

.76

.77

.49

Adequate

IV. Far-point Copying (Letters)

.94

.93

.91

Excellent

IV. Far-point Copying (Words)

.75

.64

.34

Poor

V. Manuscript-to-Cursive (Letters)

.94

.94

.92

Excellent

V. Manuscript-to-Cursive (Words)

.78

.75

.57

Adequate

VI. Dictation (Letters)

.94

.96

.94

Excellent

VI. Dictation (Units)

.74

.81

.62

Adequate

VII. Sentence Composition (Words)

.93

.96

.88

Excellent

VII. Sentence Composition (Letters)

.95

.88

.74

Adequate

Notes: aSpearman rank order correlation coefficient; bIntraclass correlation coefficient.

Criterion Validity (Predictive/Concurrent)

ETCH-C (Concurrent)

Children in Grade 4: (Koziatek & Powell, 2002; n = 101)

Variable

Validity Coefficients of Teachers Grades for Worksheets

Strength of Validity Coefficients

ETCH-C Words

.61

Adequate

ETCH-C Letters

.65

Adequate

Worksheet Words

.76

Excellent

Worksheet Letters

.78

Excellent

Construct Validity

Construct Validity: Discriminative

Children in Grades 6 and 7 with and without Writing Difficulties: (Duff & Goyen, 2010; n = 48)

  • Total Letter ROC curve indicates adequate discriminant validity (area under the curve = .86; 95% confidence interval [CI] = (.75, .98)

  • Total Word ROC curve indicates adequate discriminant validity (area under the curve = .85; 95% CI = (.47, .96)

  • Total Letter ROC curve indicates adequate discriminant validity (area under the curve = .76; 95% CI = (.63, .90)

Bibliography

Amundson, S. (1995). Evaluation Tool of Children's Handwriting. Homer, AL: OT KIDS.

Brossard-Racine, M., Mazer, B., Julien, M., & Majnemer, A. (2012). Validating the use of the Evaluation Tool of Children's Handwriting-Manuscript to identify handwriting difficulties and detect change in school-age children. American Journal of Occupational Therapy, 66(4), 414-421.

Diekema, S.M., Deitz, J., & Amundson, S.J. (1998). Test-retest reliability of the Evaluation Tool of Children's Handwriting-Manuscript. American Journal of Occupational Therapy, 52(4), 248-255.

Duff, S. & Goyen, T.A. (2010). Reliability and validity of the Evaluation Tool of Children's Handwriting-Cursive using the general scoring criteria. American Journal of Occupational Therapy, 64(1), 37-46.

Koziatek, S.M. & Powell, N.J. (2002). A validity study of the Evaluation Tool of Children's Handwriting-Cursive. American Journal of Occupational Therapy, 56(4), 446-453.

Sudsawad, P., Trombly, C.A., Henderson, A., & Tickle-Degnen, L. (2001). The relationship between the Evaluation Tool of Children's Handwriting and teachers' perceptions of handwriting legibility. American Journal of Occupational Therapy 55(5), 518-523.