We occasionally come across young students (K-1st) who have yet to establish hand dominance.  They typically switch during hand use.  Is it best to observe for the more skilled hand and promote its use or check for dominance in the eye or foot?  At what age should there be intervention for this?  Any input from experienced peds/school-based OT's is appreciated.

 

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INOTR

i am currently a non-pediatric setting OTR but my 2+years experience with pediatric OT from my previous job may validate my 2cents.

from how i can recall, in terms of age, laterality begins:

at 2-3 years old where it is somewhat deceiving since a child may look ambidextrous for the most part and is termed "preference"

at 5 years old, it's the child's "dominant" side - now, one may distinguish frequent use of one side, apparent during reaching activities/test; 

by the age of 7, it is considered concrete and thus, termed "handedness." Moreover, handedness may have something to do with the brain dominance (whether left or right hemisphere-dominant)...so if that is established, that it - that's the "strong" side that influences your intellectual capacity as well.

points to ponder:

if a child has no known medical condition/s affecting physical (motor), mental (cognitive, sensori-perceptual, cognitive d/o) and/or combination of both then, i could say that the parameters mentioned above can be used as the "normal" parameters to validate the appropriate intervention.

*** to answer you question using these parameters, normal children who belong to groups of Kinder to 1st grade would be in the age-range of 5 to 7 y/o (i might be wrong), you may be able to strengthen the side that the child practically uses often to improve and establish your plan of intervention.

if there is an identified condition, the "age" parameters should be viewed in correlation to the developmental maturity (mental-cognitive) in synchrony with the parameters of growth (physical). you might want to contemplate on qualifying your evaluation not by just "age" per-se but by assessing chronological age versus mental age.

there's a good reference about growth and development that discuses the evolution of handedness...but i failed to recall the title nor the author.

i hope this helps.

 

Hi, Usually we do observe the most dominant for a while but if the dominance appears to be equal we use some standardized tests like the placing coins in the movement assessment battery or parts of the Bruininks-Oseretsky Test of Motor Proficiency.  we consider intervention when the children are expected to write at school which is different for us becase i live in europe and also when we find that at school the tutors are emphasising the use of one hand. Intervention is also indicated when the child starts writing letters and numbers. HAving said that we do find children with mixed dominace writing with one hand and doing other things with the other.  

on www.otexchange.com there are articles for review.  There is one entitled hand dominance by Deana Iris Sava that has helpful information.  I am recently finding students who MAY BE dyslexic having issues and have found 2 students that used to start with their left and switch midline and go to their right that were then forced to become lefties which may have caused issues leading to their recent OT referrals.  I hope you find something useful.

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mp

In my experience, the best intervention is to work on using both hands together, particularly in activities involving trunk rotation and  crossing midline.  In addition, help the child use both hands at midline and see which hand tends to be used more as a helper hand.  This may take some time and may be inconsistent. Remember, that lefties may have a weaker hand preference and may develop a preference later.   Encourage drawing across midline, or moving cars across midline and similar activities.   The child may also have difficulty with visual maturity- eyes working together effectively and midline can be an issue there, as well. Until a child demonstrates a significant preference, I allow him/her to experiment with use of each hand until he/she works out a preference. However, I do discourage switching hands at midline, such as writing with left hand on left side of page and switching to the right hand after hitting the middle, encouraging instead that they finish with the hand with which they began.