This randomized controlled trial will evaluate the effects of a structured, task-focused occupational therapy program delivered in the school environment on handwriting performance, fine motor skills, visual-motor integration, and academic performance in primary school children. Second- and third-grade students identified as being at risk for handwriting and manual dexterity difficulties will be randomly assigned to an intervention group or a control group. The intervention group will receive a 10-week school-based occupational therapy program consisting of two 30-minute sessions per week, for a total of 20 sessions. The control group will continue routine classroom activities without therapist-led occupational therapy. Handwriting, manual dexterity, visual-motor integration, visual perception, and motor coordination will be assessed at baseline and after the intervention. Academic grades will also be recorded, and individualized goal attainment will be evaluated in the intervention group.
Being between 7 and 9 years of age
Being enrolled in the second or third grade
Demonstrating basic literacy skills
Being identified as high risk for handwriting and/or manual dexterity difficulties based on standardized assessments and teacher observations
A diagnosed neurodevelopmental disorder, including autism spectrum disorder or attention-deficit/hyperactivity disorder
Significant visual or hearing impairment
An orthopedic or neurological condition affecting the upper extremity
Current receipt of occupational therapy or special education services
Parallel
Structured Task-Focused Occupational Therapy Program
BehavioralThe intervention consists of a 10-week structured task-focused occupational therapy program delivered in the school environment. Participants will receive two 30-minute sessions per week, for a total of 20 sessions. The program will include task-oriented activities targeting handwriting performance, fine motor skills, manual dexterity, visual-motor integration, visual perception, and motor coordination.
Change in Handwriting Performance Assessed by the Minnesota Handwriting Test
Handwriting performance will be assessed using the Turkish version of the Minnesota Handwriting Test (MHT). The test includes 34 letters arranged in seven words and evaluates handwriting completion time, legibility, form, alignment, spacing, and size. Completion time is recorded in seconds, with shorter times indicating faster performance. Quality parameters are scored up to 34 points, with higher scores indicating better handwriting quality. Change from baseline to post-intervention will be compared between the intervention and control groups.
Change in Manual Dexterity Assessed by the Minnesota Manual Dexterity Test
Manual dexterity will be assessed using the Minnesota Manual Dexterity Test (MMDT). Completion times for the placing and turning tasks will be recorded in seconds. Shorter completion times indicate better manual dexterity.
Change in Visual-Motor Performance Assessed by the Beery VMI
Visual-motor performance will be assessed using the Beery-Buktenica Developmental Test of Visual-Motor Integration. Outcomes will include the Visual-Motor Integration total score, Visual Perception subtest score, and Motor Coordination subtest score. Scores will be interpreted according to age-based normative values, with higher scores indicating better performance.
Change in Academic Performance
Academic performance will be evaluated using official school grades in Turkish Language, Mathematics, and Life Sciences. Grades range from 1 to 4, with higher grades indicating better academic performance.
Change in Individualized Goal Attainment Assessed by Goal Attainment Scaling
Goal Attainment Scaling will be administered only to participants in the intervention group. Individualized SMART goals will be rated on a five-point scale ranging from -2 to +2, where -2 represents performance much lower than expected, 0 represents the expected level of achievement, and +2 represents performance much higher than expected. Higher scores indicate greater goal attainment.
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