The Relationship Objective.
The purpose of this study was to investigate the
Between the Evaluation
Tool of Children’s
Handwriting and
Teachers’ Perceptions of
Handwriting Legibility
Pimjai Sudsawad, Catherine A. Trombly,
Anne Henderson, Linda Tickle-Degnen
Key Words: education • measurement scales
• validity of tests
Pimjai Sudsawad, ScD, OTR, is Assistant Professor, Department
of Occupational Therapy, University of Wisconsin–Milwaukee,
PO Box 413, Milwaukee, Wisconsin 53201; pimjais@uwm.edu
Catherine A. Trombly, ScD, OTR, is Professor, Department of
Occupational Therapy, Sargent College of Health and
Rehabilitation Sciences, Boston University, Boston,
Massachusetts.
Anne Henderson, PhD, OTR, is Professor Emeritus, Department
of Occupational Therapy, Sargent College of Health and
Rehabilitation Sciences, Boston University, Boston,
Massachusetts.
Linda Tickle-Degnen, PhD, OTR, is Associate Professor,
Department of Occupational Therapy, Sargent College of
Health and Rehabilitation Sciences, Boston University, Boston,
Massachusetts.
This article was accepted for publication October 2, 2000.
518
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relationship between the Evaluation Tool of Children’s
Handwriting (ETCH) and teacher’s perception of hand-
writing legibility.
Methods. The ETCH was administered to 45 first-
grade students with illegible handwriting as reported by
their teachers. The teachers completed a teacher’s question-
naire at the same time to indicate the children’s level of
handwriting difficulties both in general and in specific tasks
that resemble the test tasks of the ETCH.
Results. There was no significant relationship between
the ETCH scores and the teacher questionnaire scores in
either general legibility or task-specific legibility.
Conclusion. The ecological validity of the ETCH, in
reference to the teachers’ perception of handwriting legibili-
ty, was not established. Further changes for scoring criteria
may be warranted before the ETCH can be used with con-
fidence that the scores obtained are meaningfully related to
actual performance in the classroom as determined by
teachers.
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, 518–523.
M
eaningful treatment outcome indicators are not
absolute measures but, rather, are related to
social norms and expectations (Keith, 1995). A
measurement of task performance in a contrived setting
using a specific measurement tool may not be sufficiently
meaningful to represent performance of that same task in
an actual context where social norms and expectations will
likely play a role in judging the level of performance. As
therapists and researchers, we need to understand the con-
nection between what is being measured in therapy and the
actual performance in real-life contexts, such as home or
school settings. We use standardized tests as a measure of
therapy or research outcome because of their objectivity
and concrete nature when compared with subjective evalu-
ations, such as opinions and judgment. However, validat-
ing the meaningfulness of the scores from such tests in
relation to day-to-day ability in real-life contexts is impor-
tant. Ecological validity—the functional and predictive
relationship between performance on a test and behaviors
in real-world setting (Sbordone, 1997)—has not been
widely investigated empirically in occupational therapy
research. Establishing ecological validity of tests may help
therapists and researchers to interpret more accurately and
use the scores with confidence as they reflect on the out-
come of interest in its social context.
Children’s handwriting performance in school is of par-
September/October 2001, Volume 55, Number 5
 ticular interest to parents, teachers, and occupational thera-
py practitioners because learning to write is a major occupa-
tion of childhood (Amundson, 1992), and children in early
education spend a considerable amount of time in writing
activities (McHale & Cermak, 1992). Nonfunctional hand-
writing is a common reason for referral for occupational
therapy services in school practice (Benbow, 1995), and sev-
eral assessments are available to measure children’s hand-
writing legibility (Alston, 1983; Amundson, 1995; Phelps
& Stempel, 1987; Reisman, 1993; Ziviani, 1984). Two
main approaches used in rating handwriting legibility are
rating of legibility components (e.g., slant, size, alignment)
and rating of global legibility (i.e., overall readability of writ-
ing sample). Examples of manuscript writing tests that rate
legibility components are those developed by Alston (1983),
Phelps and Stempel (1987), Reisman (1993), and Ziviani
(1984). The only test of manuscript writing that rates glob-
al legibility is the Evaluation Tool of Children’s Handwriting
(ETCH; Amundson, 1995). This test measures both overall
legibility and handwriting speed. Readability of letters,
words, and numerals is the primary criterion that deter-
mines global legibility.
The measurement of legibility using ratings of legibil-
ity components can be extremely time consuming and may
not provide a clear picture of the overall readability of a
child’s written work. Changes in slant, size, or alignment
may or may not indicate whether the child’s handwriting is
easier or harder to read. Often, these components are
judged against standard templates, which may not be
adaptable to variations in handwriting style. Evaluation of
global legibility, on the other hand, is quick and simple and
addresses the functional aspects of handwriting legibility
(Amundson, 1995). A person who reads the writing prod-
uct is more concerned with whether the handwriting can
be read with ease than with whether an exact correspon-
dence exists between a handwritten letter and a model let-
ter (Talbert-Johnson, Salva, Sweeney, & Cooper, 1991).
With its features and scoring guideline, the ETCH
seems to have high ecological validity because the assess-
ment tasks resemble the tasks in the classroom setting and
because it focuses on global legibility of manuscript writing.
However, the ecological validity of this assessment has not
yet been established. It is important to know whether agree-
ment exists between the ETCH score and the children’s level
of handwriting legibility as perceived by classroom teachers.
If the ETCH scores are in the very low range, does the
teacher necessarily agree that the child’s handwriting shows
a much-below-average legibility and vice versa?
The social comparison method (Kazdin, 1977) was cho-
sen for this study of the ecological validity of the ETCH.
With this method, a behavior is compared with that of “non-
deviant” peers. As Kazdin (1977) elaborated, the essential
feature of social comparison is to identify the person’s peers,
defined as individuals who are similar to the person in sub-
ject and demographic variables but differ in performance of
The American Journal of Occupational Therapy
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the target behavior. The evaluation of target behavior of all
persons in a given situation (or context) can be used to deter-
mine whose behavior is extreme and warrants intervention.
The level of behavior of the peers who do not warrant treat-
ment can serve as the criterion by which the success, or clin-
ical importance of treatment, is evaluated. On the basis of
this principle, a teacher’s questionnaire was developed for use
as a social comparison tool. The questionnaire was designed
to capture the teacher’s perception of the child’s level of legi-
ble handwriting. Teachers were asked to judge level of legi-
bility for children identified as having illegible handwriting
compared with other children in the same classroom and to
indicate how much these children’s handwriting legibility
deviated from the norms displayed by the other children.
The Method section of this article elaborates on the details
of this measurement tool.
Grace-Frederick (1998) investigated the validity of the
ETCH scores in relation to teachers’ judgments of chil-
dren’s handwriting legibility. The teacher’s rating scale con-
tained 5 choices: 1 = much less than average, 2 = less than
average, 3 = average, 4 = a little better than average, and
5 = much better than average. Grace-Frederick found that
children whom the teachers identified as having below-
average handwriting legibility (scores 1 and 2 combined)
had significantly lower scores on the ETCH than children
whose handwriting was identified as above average (scores
4 and 5 combined). However, the results from Grace-
Frederick’s study only showed the ability of the ETCH to
discriminate handwriting difficulties. The correspondence
of the children’s ranking on handwriting legibility between
the ETCH and teachers’ judgments was not investigated.
The correspondence of the two measurement tools in rank-
ing children’s handwriting legibility, specifically targeting
the children with handwriting difficulties as indicated by
their teachers, was investigated in this study.
The research question of this study, therefore, is: Does
a relationship exist between the ETCH scores and the level
of handwriting legibility in the classroom setting as identi-
fied by teachers? To establish ecological validity, the ETCH
needs to predict handwriting behaviors in the classroom
setting as ranked by teachers.
Because of its social relevance, teacher’s judgment of
handwriting legibility during regular classroom writing
tasks was used as a benchmark for ecological validity of the
ETCH. The teacher is usually the one who refers children
with handwriting difficulties for occupational therapy ser-
vices and determines whether the treatment outcome is sat-
isfactory within the classroom setting.
Method
Participants
Data used for this study were collected from 45 first-grade
students who were identified by their teachers as having
handwriting difficulties. These data were collected as part
of a larger study investigating the effectiveness of a treat-
519
 ment method to improve handwriting. The children’s char-
acteristics in the larger study were as follows: (a) identified
by their teachers as having below-average handwriting
compared with classmates, (b) had normal muscle tone and
full passive range of motion of both upper extremities, (c)
had kinesthetic deficits as determined by scoring on the
Kinesthetic Sensitivity Test (Laszlo & Bairstow, 1985) at or
below the 25th percentile, (d) had appropriate level of
attention span during classroom activities, and (e) were not
on medication intended to improve attention.
The children were recruited from 24 elementary
schools within 2 school districts in the Greater Boston area.
Their ages ranged from 6 years 2 months to 7 years 11
months (M = 6 years 11 months, SD = 5 months). The
median age was 7 years, whereas the mode age was 7 years
1 month. Thirty boys and 15 girls comprised the sample.
Instruments
The ETCH. Developed by Amundson (1995), the ETCH
is a standardized handwriting assessment designed for use
with 6-year-olds to 12-year-olds. The test assesses both
manuscript and cursive handwriting. Only the assessment
for manuscript handwriting was used in this study because
first graders only use manuscript writing during their edu-
cational activities. The ETCH was designed to measure
both legibility and speed of handwriting with six evaluation
tasks that resemble tasks required during classroom partic-
ipation. The six manuscript writing tasks are as follows:
1. Writing the alphabet from memory, where the child
is asked to write both lowercase and uppercase let-
ters in manuscript from memory
2. Writing numerals from memory, where the child is
asked to write the numerals 1 through 12 from
memory
3. Near-point copying, where the child is asked to
copy a five-word sentence from a nearby manu-
script model
4. Far-point copying, where the child is asked to copy
one sentence from a distant manuscript model
5. Dictation, where the child is asked to write two
five-letter nonsense words, and one five-number
zip code dictated letter by letter (or number by
number)
6. Sentence composition, where the child is asked to
compose and write a sentence that contains at least
five words.
The total scores of three aspects—letter legibility, word
legibility, and numeral legibility—were calculated for each
child. These scores came from all tasks combined and were
transformed into percentages on the basis of the number of
readable letters, words, and numbers against the possible
letters, words, and numbers, respectively. The test–retest
reliability coefficients for first-grade and second-grade chil-
dren are .63 for total numeral legibility, .77 for total letter
520
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legibility, and .71 for total word legibility (Diekema, Deitz,
& Amundson, 1998).
Teacher’s questionnaire. This measurement tool was
developed to obtain teachers’ judgments of the children’s
handwriting performance during classroom activities
when compared with other children in the same class.
Teachers were asked to answer six multiple-choice ques-
tions about the child’s overall handwriting legibility com-
pared with his or her peers. One question was aimed at the
children’s overall handwriting legibility, whereas the other
five were aimed at handwriting legibility during specific
classroom writing tasks. Those tasks were comparable to
the ETCH test tasks. These tasks included copying from a
near-point model, copying from a far-point model (e.g.,
the blackboard), dictation, free writing, and number legi-
bility during mathematics.
Each question contained the same seven choices to
describe the child’s level of handwriting legibility: much-
below average, below average, slightly below average, aver-
age, slightly above average, above average, and much-above
average. A score was assigned to each choice, ranging from
–3 for much-below average to +3 for much-above average.
A score of 0 was assigned for average.
Procedure
Children whose parents consented to participate were
taken from the classroom for ETCH testing. Testing was
conducted individually in a quiet and, if possible, secluded
place within each school (e.g., unoccupied cafeteria, the
library, an unoccupied office). Most children were seated
on regular child-sized chairs at child-sized tables. If the
chair and table sizes were not exactly suitable, appropriate
adjustments were made to ensure proper positioning.
Teachers were given the teacher’s questionnaire the same
day of or the next day after the ETCH testing.
A single scorer blind to the children’s identities scored the
ETCH. Before scoring, the scorer completed two quizzes pro-
vided in the test manual and showed satisfactory competency
in scoring on the basis of the competency criterion. The scor-
er’s competency was maintained throughout the scoring peri-
od by retaking the same quizzes after every 9 or 10 scorings
to minimize deviations from the scoring criteria. The compe-
tency was satisfactory in all recalibrations. Scoring was carried
out within a period of approximately 2 weeks.
Results
Table 1 presents detailed information of the ETCH and
teacher’s questionnaire scores. The correlation coefficients
between the teacher’s questionnaire general legibility scores
(an item in the questionnaire that indicated the teacher’s
perception of the child’s overall legibility) and the ETCH
total word legibility (r = –.03, p = .81), total letter legibili-
ty (r = .09, p = .54), and total numeral legibility (r = –.12,
p = 41) were low and not significant.
September/October 2001, Volume 55, Number 5
 Table 1 children were identified as having problems with hand-
Detailed Information of the ETCH and Teacher’s
Questionnaire Scores writing legibility.
Variable n M SD Minimum Maximum Several interpretations of these findings are possible.
ETCH First, the lack of significant relationship between the ETCH
Total word 45 51.1 25.5 0.0 94.7
Total letter 45 65.6 13.3 38.9 89.8
score and the teacher’s questionnaire score may indicate that
Total numeral 45 72.4 17.7 17.6 100.0 the performance identified by the ETCH does not corre-
Number 45 76.3 18.2 0.0 100.0 spond to the handwriting skills as judged by the teachers.
Near-point (word) 45 61.8 34.1 0.0 100.0
Near-point (letter) 45 72.5 18.9 27.7 94.4 The children who had lower scores on the ETCH were sel-
Far-point (word) 45 45.8 34.3 0.0 100.0 dom the children whom the teachers judged to have a lower
Far-point (letter) 45 66.3 17.4 5.5 94.4
Dictation (unit) 45 42.2 31.3 0.0 100.0 level of handwriting legibility in the classroom setting.
Dictation (letter) 45 61.6 16.0 26.6 93.3 Graham (1986) asserted that the construct of legibility has
Sentence composition
(word) 43a 53.7 27.4 0.0 100.0 been defined by its general characteristics rather than by a
Sentence composition unitary characteristic, making the definition imprecise.
(letter) 43a 70.6 19.0 23.0 100.0
Teacher’s questionnaire
Graham and Miller (1980) indicated that legibility is a com-
General 45 –1.9 0.7 –3.0 0.0 posite of simpler elements that are interrelated. Those ele-
Numeral 45 –1.3 0.8 –3.0 0.0 ments include neatness; uniformity; words and letter
Near-point 45 –1.8 0.8 –3.0 1.0
Far-point 45 –2.0 0.8 –3.0 0.0 proportions, alignment, and formation; consistent slant; and
Dictation 45 –1.7 0.8 –3.0 0.0 line quality. Graham stated that the meanings of these
Free writing 45 –2.0 0.7 –3.0 0.0
Note. ETCH = Evaluation Tool of Children’s Handwriting.
descriptions of handwriting legibility are not adequately
a
Two children could not form a sentence for this task; therefore scoring was established, and it is not clear what degree of each factor or
omitted and total scores adjusted. combination of factors constitutes legible handwriting. As
Correlation analyses were also performed to examine Graham concluded, the ambiguity of these criterion vari-
the relationship between each ETCH subtask score and its ables can be a source of variability in handwriting evaluation.
counterpart of the children’s handwriting legibility in the According to the ETCH scoring criteria, as long as the
same task as judged by teachers. No significant relation- letters, words, or numbers themselves are readable, differ-
ships were found (see Table 2). ences between two handwriting samples in these elements
will not be reflected in the ETCH scores. On the contrary, it
Discussion is conceivable that teachers will notice these qualitative dif-
Almost no relationship was found between the standard- ferences and judge the samples to be different. The ETCH’s
ized handwriting measurement (ETCH) and the teachers’ inability to reflect differences in writing quality may be one
perceptions of the children’s level of handwriting legibility of the reasons for the disagreement between the ETCH and
in the classroom. The lack of agreement between the teacher’s questionnaire scores as seen in this study.
ETCH and the teachers’ perceptions was observed both in The findings seem to indicate that the percentages of
general and in specific writing tasks. On closer examina- handwriting legibility alone, as used for the ETCH scoring
tion, the ETCH high and low scores were scattered within procedure, may not be adequate to reflect children’s handwrit-
each level of handwriting difficulty as identified by the ing legibility in the classroom setting. On the basis of this first
teachers (slightly below average, below average, much- interpretation, qualitative factors, such as uniformity, word
below average). Some children whom teachers identified as and letter proportions and alignment, consistency of slant, and
having much-below-average handwriting legibility in the line quality, may need to be incorporated into the ETCH’s
classroom received moderate to high scores on the ETCH. scoring system for it to reflect more closely children’s hand-
On the other hand, some children whom teachers indicat- writing ability in the classroom as judged by their teachers.
ed as only having slightly below-average handwriting legi- In a previous study, Grace-Frederick (1998) found that
bility did poorly on the ETCH. The ETCH legibility the ETCH scores of the children whom teachers judged to
scores varied widely from 0% to 100%, although all the have below-average handwriting legibility were significantly

Table 2
Correlation Coefficients and p Values of the Relationship Between Specific Legibility Items of the ETCH and Teacher’s
Questionnaire
ETCH
Teacher’s Number Near-Point Far-Point Dictation Sentence Composition
Questionnaire Numeral Word Letter Word Letter Unit Letter Word Letter
Numeral .21 (.18) — — — — — — — —
Near-point — –.02 (.92) .24 (.12) — — — — — —
Far-point — — — .27 (.07) .22 (.14) — — — —
Dictation — — — — — –.02 (.88) .09 (.56) — —
Free writing — — — — — — — .07 (.65) .19 (.23)
Note. ETCH = Evaluation Tool of Children’s Handwriting.

The American Journal of Occupational Therapy 521

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 different from those of the children whom the teachers judged
to have above-average handwriting legibility, indicating dis-
criminant validity of the ETCH. In Grace-Frederick’s study,
children from entire classrooms were included as participants.
Therefore, handwriting legibility ranged from much-below
average to much-above average. In the present study, all chil-
dren were below average in their handwriting legibility in their
teachers’ opinions. Although scores on the ETCH can distin-
guish the children whose handwriting is below average from
those whose handwriting is above average, it may not distin-
guish the more severe from the less severe.
The second interpretation of these findings is that teach-
ers may have judged severity of handwriting problems on the
basis of other components in addition to handwriting legibil-
ity. Some of the possible factors that may contribute to these
judgments include the child’s attention to writing details and
the child’s attitude toward writing. Although these factors
might have affected the teachers’ judgment of the children’s
handwriting quality, they would not have influenced the
administration or scoring of the ETCH because only the
handwriting product was examined. This speculation is based
on comments from the teachers that how much the children
paid attention to the writing task and whether they liked to
write had an impact on how they wrote. This speculation,
however, is not substantiated by empirical data. One might
infer on the basis of this interpretation that a teacher’s per-
ception is not a valid indication of a child’s severity of hand-
writing problems because of other factors, such as those
indicated previously, that can influence that perception.
Nevertheless, teacher’s judgments are important in the social
context. Whether the child will be referred for handwriting
evaluation and treatment is almost solely based on the
teacher’s perception of the child’s level of performance.
Although direct evidence is not available to support the
notion that teachers’ judgments of handwriting legibility
may be influenced by other factors, it is well established that
many factors can significantly influence teachers’ judgments
when they evaluate student performances. Briggs (1970,
1980) and Markham (1976) found that the format of an
essay presentation significantly affected how the essay would
be graded. Teachers tended to give a better grade to the essay
that was rendered in better handwriting than the same essay
presented less attractively. Chase (1986) found complex
interactions among different factors such as a student’s race
and gender, penmanship, and a teacher’s level of expectation.
These interactions differentially affected teachers’ essay scor-
ing even when the essays were identical in both content and
presentation. For example, African-American students with
good penmanship whose papers were read under high expec-
tations were given relatively high scores compared with
Caucasian students with good penmanship and the same
high expectations. The relationship, however, was reversed
for students for whom readers had low expectations. African-
American students with good penmanship whose papers
522
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were read under low expectations received relatively low
scores compared with Caucasian students with good pen-
manship, whose papers were read under the same condition.
The researcher concluded that variables such as these in mul-
tiple combinations differentially influence the reader.
Possibly, the teachers in the present study were influenced by
factors other than handwriting when assessing level of hand-
writing legibility.
A third possible interpretation is that the ETCH score
represents a one-time observation of handwriting legibility,
whereas the teacher’s questionnaire score represents a general
observation of the skills over time. Handwriting perfor-
mance on a single occasion and in an artificial testing envi-
ronment may not be an accurate reflection of the student’s
ability. Health factors, motivation, personal problems, or dis-
tractions (Graham, 1986) may affect how the student writes
on a particular day, resulting in handwriting performance
that is different from his or her usual or average level of
handwriting legibility as determined by the teacher.
This study needs replication in order to verify the results.
Further investigation should be done for the total range of
children’s handwriting legibility from much-below average to
much-above average as judged by teachers so that a complete
picture of the ecological validity can be obtained. Different
types of teacher ratings of handwriting performance may be
used as benchmarks for ecological validity. Additionally, fur-
ther investigation needs to determine whether the qualitative
factors (i.e., uniformity, word and letter proportions and
alignment, consistency of slant, line quality) actually con-
tribute to teachers’ judgments of handwriting legibility in the
classroom setting. Another handwriting measurement tool
that assesses these factors may be studied and compared with
the ETCH for its relationship with teachers’ judgments. The
results may help to direct future instrument development that
is appropriate for predicting or representing actual perfor-
mance of handwriting in the classroom setting.
If objective, standardized tools are to identify children’s
levels of performance or capture meaningful changes in
performance after treatment, they need to provide results
consistent with performance in the social context.
Otherwise, “improvement” as identified by an objective,
standardized tool measuring either therapeutic outcome or
research outcome may not be valid and may mislead and
generate inaccurate information. More studies should be
conducted to investigate the relationship between other
standardized test scores and performance in a natural set-
ting so that the meaningfulness and usefulness of those test
scores may be established. ▲
Acknowledgments
We thank the administrators, staff, and students of the Malden and
Medford school districts of the Greater Boston area for their generous
help, accommodations, and commitment during the study. This study
was partially funded by the Dudley Allen Sargent Research Fund of
Sargent College of Health and Rehabilitation Sciences, Boston
University, and the National Center for Medical Rehabilitation Research
September/October 2001, Volume 55, Number 5
 of the National Institutes of Health (National Institute of Child Health
and Development), grant #T32HD07462. This study is based on the
first author’s doctoral dissertation.
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BK-114

of three children who have encountered problems learning to print or write in cursive.

Order #1979 • $40 AOTA members • $50 nonmembers

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The American Journal of Occupational Therapy 523

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