Apr 15 / Kelli Fetter, M.S., OTR/L

If Not Us, Then Who? Reclaiming Occupational Therapy’s Role in Handwriting

photo Abby Waters

Welcome to guest blogger!

Kelli Fetter, M.S., OTR/L

Aspire OT is always excited to celebrate OTs, OTAs, and students who make an impact. Kelli Fetter is an occupational therapist, entrepreneur, Certified Handwriting Specialist and Aspire OT Instructor.  

Walk into almost any school-based occupational therapy discussion about handwriting and you will hear some version of the following statements:
“I’m not a handwriting teacher.”
“Their fine motor scores are average, so they don’t qualify.”
“The school doesn’t have a handwriting curriculum, so there isn’t much we can do.”
These statements are incredibly common… and incredibly concerning.
Handwriting is one of the most frequent reasons children are referred to occupational therapy in schools. Yet many OTPs feel uncertain about their role in addressing it. Over time, a narrative has quietly taken hold that handwriting instruction belongs to teachers, while OTPs should focus only on underlying or (GASP) only fine motor skills.
But handwriting is NOT just an academic skill. It is not just a motor skill. It is an occupation.
And if occupational therapist practitioners step back from supporting it, we leave many students, especially those with dysgraphia and other specific learning disabilities, without the support they need to fully participate in school.
So it’s time to address a few persistent myths.


Myth #1: “OT Practitioners Aren’t Handwriting Teachers”

Many school-based OTPs hesitate to directly address handwriting because they believe teaching letter formation or writing mechanics crosses into the teacher’s role.
But handwriting sits at the intersection of motor learning, cognitive processes, and educational participation, exactly where occupational therapy lives.
Handwriting requires the integration of:
* Motor planning
* Visual–motor integration
* Kinesthetic feedback
* Postural stability
* Bilateral coordination
* Working memory
* Orthographic mapping
Teachers are responsible for literacy instruction, yes! Occupational therapy practitioners support the motor, sensory, and cognitive processes that allow students to physically produce written language.
In other words: teachers teach what to write (text generation). OTPs help students develop the ability to write it (text transcription).
When a student struggles to produce letters efficiently, legibly, or automatically, the barrier is often occupational performance, not simply lack of instruction. And if it IS a lack of instruction, then your role is to ADVOCATE at the Tier 1 and 2 level.

Myth #2: “If Fine Motor Scores Are Average, There’s No OT Need”

Another common misconception is that handwriting difficulties must be accompanied by low fine motor test scores to justify OT involvement. But standardized fine motor assessments were never designed to fully capture handwriting performance.
A child may score within average ranges on measures of:
* grip strength
* pegboard tasks
* visual–motor integration
* fine motor precision
…and still struggle significantly with:
* letter formation
* writing speed
* spacing and alignment
* fatigue with writing tasks
* written expression
Why?
Because handwriting is far more complex than isolated fine motor tasks. It involves motor learning, automaticity, orthographic retrieval, and cognitive load management.
When letter formation is not automatic, the brain must allocate working memory to the mechanics of writing. This reduces cognitive resources available for spelling, sentence generation, and idea expression.
The result is often a student whose written output does not reflect their true knowledge.
Occupational therapy practitioners are uniquely positioned to identify and address this gap between ability and performance.

Myth #3: “If the School Doesn’t Use a Handwriting Curriculum, OT Shouldn’t Intervene”

Some OTPs feel limited by the instructional structures in their school. If handwriting instruction is inconsistent or absent, therapists may assume their role is limited.
But this is precisely where occupational therapy leadership becomes critical.
When handwriting instruction is missing or insufficient, students who struggle will fall further behind. Waiting for a formal curriculum to exist before intervening means waiting while students accumulate frustration, avoidance, and academic barriers.
School-based OTPs can support handwriting through multiple levels of service delivery:
* collaboration with teachers
* classroom strategies
* small-group intervention
* targeted individual therapy when needed
Rather than viewing handwriting as outside the OT role, we can help schools build stronger systems of support.

Moving Toward a Tiered Approach

Handwriting challenges are rarely isolated to one or two students. In many classrooms, a significant number of students struggle with legibility, speed, or writing endurance.
A tiered model allows occupational therapist practitioners to support students more effectively.
Tier 1: Universal Support
OTs collaborate with teachers to strengthen classroom handwriting instruction and writing readiness.
Examples include:
* recommending evidence-informed handwriting programs
* supporting developmentally appropriate expectations
* providing classroom strategies for posture, paper positioning, and pencil grasp
* embedding motor learning principles into handwriting instruction
Tier 2: Targeted Small Groups
Students showing early signs of handwriting difficulty benefit from small-group intervention focused on:
* letter formation
* writing fluency
* spacing and alignment
* motor planning for writing
Short, structured practice sessions with consistent feedback can dramatically improve skill acquisition.
Tier 3: Individualized Intervention
Students with persistent handwriting difficulties, including those with dysgraphia or other learning disabilities, may require individualized support addressing:
* motor planning and automaticity
* writing endurance
* strategy instruction
* assistive technology when appropriate
This tiered approach allows OTPs to support handwriting proactively rather than reactively.

Supporting Students with Dysgraphia and Other Learning Disabilities

For some students, handwriting difficulties are not simply developmental delays but part of a broader learning profile.
Students with dysgraphia, dyslexia, ADHD, and other neurodevelopmental conditions often experience significant barriers to written output.
Without appropriate support, these students may:
* avoid writing tasks
* produce minimal written work
* struggle to demonstrate knowledge on assessments
* experience increasing academic frustration
Occupational therapy can play a crucial role in helping these students develop efficient and functional writing strategies while collaborating with educators addressing literacy.

Reclaiming the Occupation of Handwriting

Handwriting remains one of the most fundamental tools students use to participate in school. Despite advances in technology, written work continues to be required across nearly every academic subject.
As occupational therapist practitioners, we cannot afford to step away from this area of practice.
Supporting handwriting is not about replacing teachers or delivering isolated handwriting drills. It is about addressing the occupational performance demands of written communication.
It is about helping students access their education.
And perhaps most importantly, it is about recognizing that when handwriting becomes a barrier to learning, occupational therapy has a role to play.
Because if we step back from supporting the occupation of handwriting, we must ask ourselves an important question: If not us, then who?
Instructor bio
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Click the logo to view Kelli's handwriting program
Click here for more information
about Handwriting Solutions
Kelli L. Fetter, M.S., OTR/L
Aspire OT Instructor

Kelli Fetter is a Certified Handwriting Specialist and the founder of Handwriting Solutions, LLC, a global provider of handwriting, reading, and spelling tutoring. Her practice is known for its top-tier assessment process, individualized remediation plans, and innovative virtual 1:1 intervention as well as small group camps that engage students while accelerating progress. Through her work, Kelli partners with families worldwide to unlock children’s potential in literacy, handwriting, and written expression.

In addition to direct services, Kelli is a sought-after speaker and educator for teachers, therapists, and parents. She has presented at national and international conferences, sharing evidence-based strategies for supporting children with dysgraphia, dyslexia, and related learning differences. Kelli is also co-authoring a forthcoming textbook for occupational therapists on dysgraphia, further cementing her role as a leader in advancing the field.

Before founding Handwriting Solutions, Kelli practiced as an occupational therapist in pediatric outpatient care, early intervention, preschools, and private schools, as well as serving as an adjunct professor in pediatrics and kinesiology. She brings extensive advanced training in handwriting, dyslexia, and dysgraphia, along with a deep commitment to translating research into practice.

Kelli’s passion is deeply personal, fueled by her own daughter’s journey with dyslexia and dysgraphia. This lived experience drives her mission to empower parents, educators, and therapists with the tools and confidence they need to unlock every child’s potential.

DISCLOSURES 
Financial: Kelli is compensated as an Aspire OT instructor. Kelli is the owner/operator of Handwriting Solutions
Non Financial: There are no disclosures.
check out Kelli's self paced course

OT's Role in Dysgraphia & Specific Learning Disabilities in Handwriting

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