Here’s How I Write–Hebrew: Psychometric Properties And .

MethodParticipantsParticipants comprised a convenience sample of 58 Israelichildren in Grades 2–5 attending a mainstream educational program in central Israel. They included 44 boys(75.9%) and 14 girls (24.1%) between the ages of 7.1and 10.10 yr (mean [M] age 5 8.4 yr, standard deviation[SD] 5 0.87). Participants with dysgraphia were recruited by 10 pediatric occupational therapists experienced in handwriting intervention from their area ofresidence. The therapists evaluated the handwriting ofchildren referred to them by teachers or parents. Theyidentified 29 children with dysgraphia based on scores³15 on the Brief Assessment Tool for Handwriting(BATH; Lifshitz & Parush, 1999) and scores ³1 SDbelow the mean scores on the Hebrew HandwritingEvaluation (HHE; Erez & Parush, 1999), an objective,standardized Hebrew handwriting evaluation. The control group (n 5 29) was matched on age range andgender and determined to be proficient at handwriting(BATH scores below the cutoff [M 5 7.41, SD 5 3.17],and normative performance on the HHE) by the thirdauthor (Renana Yefet). Exclusion criteria for both groupswere significant neurological and primary sensory impairments or chronic diseases.InstrumentsThe BATH is a 16-item questionnaire designed by expertoccupational therapists to identify schoolchildren withhandwriting difficulties. It is completed by an occupationaltherapist familiar with the child or by the child’s teacher. Itencompasses aspects of handwriting function including legibility, the writing process and performance, andquestions targeting the emotional aspects of writing. Eachitem is rated on a 4-point Likert scale ranging from0 (never) to 3 (always), with higher scores indicating poorerperformance. The total score ranges from 0 to 64, and thecutoff score for the existence of handwriting problems is15. The tool underwent an expert-validation process, andthe final items were selected based on ³80% agreementbetween 14 handwriting experts. Internal reliability is high(a 5 .9). The validation process included significantcorrelations between scores on the BATH and the HHE(r 5 .46–.65, p .01), and significant differences betweenthe scores of children with and without dysgraphia (n 5189), t(58) 5 20.78, p 5 .00, supporting its known-groupvalidity (Lifshitz & Parush, 1999).HHIW–HE is a pictorial self-assessment and goalsetting tool for children in Grades 2–5 designed to helpchildren evaluate their handwriting strengths and weaknesses and to determine, together with an occupationaltherapist, their handwriting intervention goals. The toolconsists of 24 item cards plus 1 demonstration card (i.e.,totaling 25 cards) and a goal-setting form. One side ofeach card contains a statement and matching picture depicting a child with proficiency regarding a certain aspectof handwriting. The card’s flip side contains a statementand a picture depicting a child with difficulty regarding thatsame aspect of handwriting (Figure 1). For each of the24 cards, the examiner shows the child both sides and thenasks the child, “Which is more like you?” The child responds by selecting a side (positive vs. negative handwritingattribute) and then qualifies his or her response as “all ofthe time” or “some of the time.” A negative handwritingattribute is scored as either 4 points (all of the time) or 3points (some of the time). A positive handwriting attributeis scored as either 2 points (some of the time) or 1 point (allof the time). The total scores range from 24 to 96, withlower total scores indicating more positive self-perceptionsof handwriting abilities than higher total scores.The HHIW–HE is administered after the child andtherapist have established a therapeutic relationship, thechild’s teacher reports on his or her perceptions of thechild’s handwriting, and a formal handwriting evaluationis administered. After the self-assessment stage of theHHIW–HE process, the therapist helps the child definehis or her treatment goals in a child-centered manner(Goldstand & Gevir, 2012).Content validity was supported by the results of anexpert-validation process involving nine experienced pediatricoccupational therapists with a minimum of 10 yr of expertisein handwriting intervention. The final items were selected onthe basis of 80%–90% agreement among the experts (Ayre& Scally, 2014). In a pilot study, HaLevi (2009) found75%–80% agreement between children’s responses on theHHIW–HE and therapist scores on the HHE (Erez &Parush, 1999) among 10 Israeli children (ages 7.5–10.3 yr,M 5 8.5) with handwriting difficulties attending a regulareducation program. These findings support the ability oftypical children in this age range to self-report on theirhandwriting ability. In addition, the HHIW–HE test–retestreliability was performed over a 2-wk interval with 14members of the control group and was been found to beacceptable (r 5 .65–1.00, p .05; Yefet, 2012).ProcedureAfter obtaining approval from the Hebrew Universityethics committee, the researchers contacted 10 pediatricoccupational therapists (³8 yr of experience) from central Israel to recruit participants for the research group.The American Journal of Occupational TherapyDownloaded From: http://ajot.aota.org/ on 09/04/2018 Terms of Use: http://AOTA.org/terms7205205060p3

Figure 1. Sample cards from Here’s How I Write–Hebrew: A Child’s Self-Assessment of Handwriting and Goal Setting Tool.Note. Row 1 (from left to right): “I like to write” and “I do not like to write.” Row 2 (from left to right): “I hold the page with my other hand when I write” and “I donot hold the page with my other hand when I write.” From Kach Ani Kotev [Here’s How I Write–HE], by S. Goldstand and D. Gevir, Jerusalem: Authors. Copyright 2012 by the authors. Reprinted with permission.Control group participants were recruited with a snowball procedure and matched to the research group according to age range and gender. Consenting parents ofboth study groups signed an informed consent, and thechildren provided assent. The BATH and the HHE copytask were administered to the control group to confirmhandwriting proficiency, and the children were then ratedon the HHIW–HE items on the basis of the objectiveassessment results. The recruiting therapists identifiedchildren with dysgraphia based on the BATH and HHEscores. The third author (Renana Yefet) reviewed theadministration protocol delineated in the HHIW–HE7205205060p4Downloaded From: http://ajot.aota.org/ on 09/04/2018 Terms of Use: http://AOTA.org/termsSeptember/October 2018, Volume 72, Number 5

manual (Goldstand & Gevir, 2009) with the therapists,after which they scored 21 of 24 of the HHIW–HE items(excluding 3 items relating to children’s feelings abouthandwriting, such as “I like to write”). Next, all participants completed the HHIW–HE, and the scores of theresearch and control groups were compared to determinethe tool’s known-group validity.Data AnalysesStatistical analyses were conducted using IBM SPSSStatistics (Version 19; IBM Corp., Armonk, NY). Giventhe non-normal distribution of the HHIW–HE scores,nonparametric statistical analyses were conducted. Independent samples Mann–Whitney U test was used tocompare the total score and the 24 item scores of theHHIW–HE between the study groups; the Bonferronicorrection for multiple comparisons was then used (p 5.05 for the 24 cards). Internal consistency was computedusing Cronbach’s a. Nonparametric effect size r wascomputed for between-group comparisons (Fritz et al.,2012).The construct of self-awareness was operationallydefined as the percentage of child–therapist agreementin HHIW–HE ratings. Each rating was first categorizeddichotomously; that is, items scored as 4 (always) or 3(some of the time), reflecting negative perceptions, werecategorized as negative statements, whereas items scoredas 2 (some of the time) or 1 (all of the time), reflectingpositive perceptions, were grouped as positive statements. If both the child’s and the therapist’s ratingswere in the positive or negative statement category,agreement was surmised. Items that children ratedpositively and that the therapist rated negatively werecategorized as overrated by the child, and in the opposite condition, as underrated by the child. Spearman’s correlations were computed to examine thecorrelation between the children’s and the therapists’ratings on the HHIW–HE items and between thetherapist’s scores on the BATH and the child’s HHIW–HE total scores. The percentage of child–therapist agreement on the tool’s items between the groups was comparedusing t tests.ResultsThe children in the research group scored in the dysgraphic range on the BATH (16–32; M 5 22.69, SD 53.91), whereas children in the control group receivedscores indicating no dysgraphia (1–14; M 5 7.41, SD 53.17). Internal consistency, determined using Cronbach’sa for all 24 items, was good (a 5 .884), and removal ofany of the items was not found to substantially change thesize of the coefficient (range 5 .875–.884). For knowngroup comparisons, the calculation of between-groupHHIW–HE scores revealed that children with dysgraphiarated themselves as significantly more impaired thanchildren without dysgraphia on the total HHIW–HWscores and on 6 of the 24 items. Analysis of group differences in self-ratings revealed moderate to large effectsizes (Table 1).For between-group child–therapist agreement anddisagreement (i.e., self-awareness), the mean percentageof items that children and therapists agreed on was significantly higher for the control group (M 5 84.88, SD 510.72) than for the research group (M 5 71.25, SD 513.43), as confirmed by an independent sample t test,t(56) 5 4.268, p 5 .000. However, when comparing thepercentage of disagreement between child and therapist,Table 2 shows a clear pattern whereby overrating wasfar more frequent among children with dysgraphia thanamong the controls. In addition, a significant moderatecorrelation was found between the total HHIW–HE andtotal BATH scores of the control group (r 5 .457, p 5.013), whereas no significant correlation was found in theresearch group (r 5 .171, p 5 .374).DiscussionThe current study was performed to examine the psychometric properties of a new client-centered handwritingself-assessment tool for schoolchildren in Grades 2–5. Thetool was also used to examine the degree of handwritingskill self-awareness among children with and withoutdysgraphia.Psychometric PropertiesData analysis of the tool revealed a Cronbach’s a of .884,indicating that the tool’s items are related to each otherand support its internal consistency. Significant differences were found between the groups on the totalHHIW–HE scores, with moderate to large effect sizes,reflecting the tool’s abil

handwriting difficulties than did controls; however, they tended to overestimate their handwriting abilities. Goldstand, S., Gevir, D., Yefet, R., & Maeir, A. (2018). Here’s How I Write–Hebrew: Psychometric properties and handwriting self-awareness among schoolchildren with and without dysgraphia. American Journal of Occupational