When Should School-Based OTs Be Concerned About Hand Dominance?

Is hand dominance important in school-based OT? As a school-based therapist, one common challenge you might find is the issue of students switching hands while learning to write or complete other fine motor tasks. This phenomenon, where young children frequently switch between their dominant and non-dominant hands during writing tasks, can be a source of concern for parents, teachers, and occupational therapists alike. In this blog, we will explore the research on this topic, examining the reasons behind hand-switching behavior and providing practical strategies for school-based OTs to address this issue effectively.

Understanding Hand Dominance

Hand dominance refers to the consistent use of one hand over the other for skilled tasks. It typically emerges during early childhood and may show up as soon as age 2. However, it is still common for children to switch hands during these stages, and some researchers note that children may not have a clear preference until age 6 (Bryden et al., 2000). So, if you’re working with a young student who is not yet displaying consistent hand dominance, there may be no cause for concern. Before deciding to intervene, make sure the behavior you’re observing isn’t within typical limits. 

But beyond this age, while the majority of students naturally develop a clear hand dominance (either left or right-handed), a small percentage of children exhibit hand-switching behaviors

Reasons for Hand-Switching Behavior

In most preschool and kindergarten students, hand-switching is a typical part of the developmental process as they explore and experiment with their fine motor skills. It may stem from the child’s curiosity and desire to test their abilities using both hands. This behavior is perfectly fine and shouldn’t be discouraged.

For older children, some may struggle to establish a dominant hand due to various factors, such as limited exposure to activities that promote hand preference, lack of hand-strengthening experiences, or insufficient practice with fine motor tasks. If you are working with a student who had limited exposure to school and fine motor skills, they may simply need more practice and exposure before feeling comfortable with a dominant hand. 

Hand-switching can also occur when a child faces difficulties with bilateral coordination, which refers to the ability to use both sides of the body together in a coordinated manner. Children with poor bilateral coordination may switch hands to compensate for challenges in maintaining stability or control during fine motor tasks. Other motor deficits, such as motor planning challenges, may come into play here too. 

hand dominance school-based OT

Research on Hand Dominance and School-Based OT

So why should school-based OTs care about hand-switching? Hand dominance plays a significant role in children’s early writing skills. A meta-analysis conducted by Papadatou-Pastou et al. (2019) found a strong relationship between hand preference and performance in early writing tasks. Their findings emphasized the importance of considering hand dominance when addressing writing difficulties in young children. School-based OTs play a vital role in identifying these challenges and providing appropriate interventions to support children’s handwriting skills.

A lack of hand dominance can be an early warning sign for other conditions. Zwicker, Missiuna, and Harris (2012) conducted a review on developmental coordination disorder (DCD) and highlighted the relationship between DCD and hand preference. School-based OTs can help identify these missed milestones and provide early intervening services for children who are at risk of further delay. 

Practical Strategies for School-Based OTs to Increase Hand Dominance

When you suspect a student’s lack of hand dominance is no longer within typical development, it’s important to investigate further. Begin by placing tools at the midline to see which hand the student naturally chooses to pick up the items. Observe the child’s handwriting patterns and note the frequency and circumstances of hand-switching. Assess the child’s other fine motor skills, including hand strength, grasp, and bilateral coordination, to identify potential areas of weakness or delay.

You should also take time to observe how they perform with other tools such as scissors, buttons, or zippers to see if one hand seems to be more preferred. This may not be cut and dry – you may find you have a student who prefers to use their right hand to write but their left hand to hold scissors. But hopefully, you will be able to emerge from this investigation with an idea that one hand is slightly more preferred. 

After your evaluation, encourage activities that promote hand preference, such as drawing, coloring, cutting, and self-care tasks. Provide opportunities for the child to practice using their seemingly preferred hand while incorporating engaging and purposeful activities. At this point in the process, it’s okay if your student is still switching hands between different tasks. My personal rule is that the student should finish an individual task with the hand they started with that way they’re not switching simply due to hand fatigue/lack of practice. But if I present a new activity, I’m okay if they want to attempt that one with their other hand. Keep in mind that this part of the process may take a lot of time and practice. 

Other Areas School-Based OTs Should Check When Working on Hand Dominance

It’s also a great idea to include bilateral coordination activities in therapy sessions to improve the child’s ability to coordinate both hands effectively. Activities like playing with manipulatives, puzzles, and stringing beads can help develop bilateral skills. Try to work these activities into the student’s daily classroom routine when possible. 

One other important area to check during this process is the student’s positioning. You may need to make adjustments to the student’s writing environment to provide adequate support. Ensure the child sits in a properly sized chair with their feet fully able to rest on the floor, and at a desk that allows their arms to rest comfortably on top of it without reaching or stretching. This will ensure that if there are other underlying strength issues your student will be best set up for success. 

hand dominance school-based OT

Finally, as a school-based OT, it’s so important to maintain open lines of communication with teachers and families to ensure consistency in supporting the child’s hand development. Make sure the activities and strategies you’re recommending are being carried over in the classroom and at home when possible. 

While hand dominance in school-based OT can be a source of concern, it is important to approach it with a comprehensive understanding of the underlying factors, including when it’s necessary to intervene. By implementing appropriate strategies and interventions, school-based OTs can help children establish hand dominance, enhance their fine motor skills, and ultimately improve their handwriting abilities.

And if you’re looking for even more support with your school-based practice, be sure to check out The Dynamic School OT Course. There’s a huge module on intervention strategies like the ones discussed here as well as support with evaluation and collaboration. Can’t wait to see you there!

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