Students from grades 2nd to 4th were identified as having poor handwriting due to problems with letter formation, alignments, letter sizing, and space. These students did not have any diagnosed medical conditions and no problems with vision or hearing. Students that received direct OT services for 30 minutes/week demonstrated overall improvement with letter legibility, increasing an average of 14%. Handwriting practice or activities directly focusing on Improving handwriting were implemented 77% of the time during direct OT services. 

Various types of OT interventions (visual, motor, sensory, specific handwriting programs, etc.) have a positive impact on handwriting for children with challenges with motor coordination. It was found that intervention should be incorporated Into meaningful occupations of children, such as school curriculum) for increased benefits of students who have difficulty with handwriting. Ideally, interventions should be a collaborative effort with teachers, parents, and other professionals to enhance effectiveness. Additional outcomes from OT interventions that demonstrated a positive impact on handwriting skills include child motivation, involvement of parents, child behavior, and child participation.

Sensory integration In the school system has demonstrated to enhance performance and participation In the school. Comprehensive evaluations are critical to identify why challenges occur. This can include interviews, record review, observations, and assessments. OT intervention involving sensory integration in this instance focused on self-regulation, fine motor skills, and social skills. Intervention methods included yoga, collaborating/educating teacher, and prepatory activities (e.g. squeezing stress ball prior to fine motor activities). 

Ongoing education with teachers for sensory processing and collaboration can have a positive impact on children's skills. Activities collaborated with teachers included vestibular, tactile, and proprioceptive input throughout the day. Sensory rich environments with structured sensory activities demonstrate the ability to improve play skills in preschool aged children with autism.