Evaluation Tool of Children's Handwriting

Last Updated

April 23, 2017

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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

Instrument Details

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.

Pediatric Disorders

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

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

15-30 minutes

Required Training

Reading an Article/Manual

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.

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	.71^a	Adequate
Total Word	.77^b	Excellent
Total Word, Excluding VI	.63^a	Adequate
Ia. Alphabet Lowercase	.64^a	Adequate
Ib. Alphabet Uppercase	.76^b	Excellent
II. Numerals	.63^a	Adequate
III. Near-point Copying	.20^a	Poor
IV. Far-point Copying	.63^a	Adequate
V. Dictation	.68^a	Adequate
VI. Sentence Composition	.33^a	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	Pearson^a	Pearson^b	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	Pearson^a	Pearson^b	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.