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OT and PT Support for Literacy in Schools

OT and PT Support for Literacy in Schools
Jean Polichino, MS, OTR, FAOTA
April 27, 2017

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ean: Thank you very much and good morning. It's a pleasure to be with all of you this morning and to share with you current research as well as my own experiences in school-based practice with students who struggle with literacy issues. The agenda for today's seminar is as follows:

  • Our National Focus on Literacy – What and Why?
  • How Literacy Develops
  • Including Literacy in OT and PT Evaluation
  • OT and PT Interventions to Support Literacy 

National Focus on Literacy

Because the context of our practice is within schools, where reading and writing are given significant focus, that will be our focus today. To begin, let's look at literacy from a national perspective. The definition of literacy is more inclusive than you might expect (UNESCO, 2004):

Literacy is the ability to read, write, listen, speak clearly and think critically using print and digital materials across all disciplines.
Literacy involves a continuum of learning, enabling individuals to achieve their goals, to develop their knowledge and potential, and to participate fully in their community and wider society. 

The National Center for Education Statistics (NCES) publishes outcome data based on student performance on the National Assessment of Educational Performance (NAEP). The NAEP is a group of academic assessments administered periodically across the country to determine what America students know and can do. The NAEP is the largest nationally representative and continuing assessment in the United States. The reading assessment is given to fourth and eighth graders every two years. The writing assessment is given periodically to eighth and 12th graders. The NAEP is sometimes referred to as the nation's report card.

In 2015, the NCES compared results for reading proficiency at fourth and eighth grade levels (Figure 1). 

Table of 2015 National Statistics of Reading Proficiency for all students and students with disabilities

Figure 1. 2015 National reading proficiency stats.

In fourth grade, 36% of all students (including those with disabilities) achieved grade level proficiency on the NAEP. Only 12% of students with disabilities achieved grade level proficiency. Among eighth graders, 34% achieved grade level proficiency, as compared to only 8% of students with disabilities. Stated another way, 64% of all fourth graders and 66% of all eighth graders included in the 2015 data were reading below grade level. For children with disabilities, 88% of fourth graders and 92% of eighth graders were reading below grade level.

According to NAEP trend data, between the years 1998 and 2011, there was a reading proficiency increase of only four points at the fourth grade level and only two points at the eighth grade level, for students with disabilibies. This is despite the national effort to improve reading scores among all students. 


According to the most recent NAEP assessment data, 25% of all students, with and without disabilities, in eighth and 12th grades scored at or above the proficient level in writing (NCES, 2012). This abysmal writing outcome underscores the seriousness of the writing challenge for all of the nation's students. For students ages 9-14 with learning disabilities, writing is considered their most common problem, more so even than reading (Cobb-Morocco, Dalton & Tivnan, 1992). Approximately 80% of children with learning disabilities struggle with written language (Morris et al., 2009).

The Writing-Reading Connection

For those of us who have worked in schools with young learners, we have observed a relationship between reading and writing. Let's take a look at what recent studies have found about a reading-writing connection. In 2011, Graham and Hebert published the results of a meta analysis seeking to identify whether and how writing impacts children's reading abilities. As you may know, a meta analysis looks across a topic or topics in the literature seeking commonalities among the findings of various research studies. In their meta analysis, these authors looked at 95 studies of students in grades one and two. Their findings include the following:

  • Writing about material read enhances reading comprehension
  • Writing about reading has a positive impact on the comprehension of weaker readers and writers
  • Writing instruction enhances student's reading
  • Increasing writing improves reading comprehension
  • More writing instruction produce greater reading gains than less writing instruction

In another study published in 2012, Karin James looked at brain images to identify a reading-writing connection. She found that children who drew a letter freehand from a model showed increased brain activities in areas of the brain that activate during reading and writing; what she characterize as, "a recognition by mental stimulation of the brain." This was not the case for children who typed or traced the letter, but only for children who drew a letter freehand.

Many of you may be aware of the work of Virginia Beringer. Her name has become one that's frequently cited by instructional personnel and also therapists who are looking to find insights in how to help with reading and writing. Her body of research, published over a period of years beginning in 1990, has yielded conclusions that make the case for handwriting, including cursive writing, in efforts to improve reading and writing skills. In her studies, children produced more words more quickly and expressed more ideas when composing by hand, versus using a keyboard. When asked to come up with ideas for a composition, children with better hand writing exhibited greater neural activations in areas associated with working memory and increased overall activation in reading and writing networks. Finally, Berninger found that cursive writing may assist in facilitating motor control of letter formation and preventing the reversal and inversion of letters. Many of us have seen that in our practice, particularly with kids who are dyspraxic.

In an interesting study of college students in 2014, Mueller and Oppenheimer found that students learn better when they take notes by hand than when they type on a computer. Now, this study was based on older students, but it is informative nonetheless. This finding suggests that writing by hand allows the student to process a lecture's contents and reframe it, a process of reflection and manipulation that appears to lead to better understanding and encoding. It is ironic, as Graham and and Hebert noted in their 2011 conclusions, that "despite the importance of writing to reading, learning, communicating self-expression, self-exploration, and future employment...students at school write infrequently, and little time is devoted to writing instruction beyond the primary grades."

Impact of Assistive Technology

Given the evidence for the importance of handwriting to both writing and reading, what impact does assistive technology have on literacy efforts for children with disabilities? In 2012, Dunst and Colleagues conducted their own meta-analysis. They reviewed a total of 36 studies, involving almost 700 children with disabilities or delay. They looked at both speech generative devices and various computer software devices. In their results, looking across these studies, they found both speech generative devices and various software devices were effective in promoting communication and literacy-related behavior, regardless of disability or delay. While handwriting might be the most effective way to imprint reading and writing, there is also benefit to using speech generative devices and various computer software devices.

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jean polichino

Jean Polichino, MS, OTR, FAOTA

Jean E. Polichino, OTR, MS, FAOTA has 26 years of experience managing and administering early intervention and related services for school districts and charter schools in the greater Houston area. She is a former chairperson of the Early Intervention and Schools Special Interest Section for the American Occupational Therapy Association, Inc. and continues to be an active contributor to professional publications on issues related to school practice. She is currently working as a consultant to Texas school districts offering assistance with management of therapy services as well as professional development for school therapists.   

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