The purpose of this study was to compare the effect of cognitive versus multisensory interventions on handwriting legibility of elementary school students referred to occupational therapy for handwriting difficulties. In this randomized controlled trial, 72 first- and second-grade students were assigned to either a cognitive intervention, multisensory intervention, or control (no intervention) group. Letter legibility was measured using the Evaluation Tool for Children's Handwriting before and after 10 weeks of intervention. Analysis of variance of change scores showed no statistically significant difference across the three groups. First-grade students improved with or without intervention, but second-grade students showed sizeable improvement with cognitive intervention compared to multisensory intervention (d = 1.09) or no intervention (d = .92). These results challenge current occupational therapy practice of using a multisensory approach for remediation of handwriting difficulties for students in second grade. A cognitive approach to handwriting intervention shows greater promise and is worthy of further investigation.
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