Point vs nib of a pencil.
Letter size vs A4 size copy paper. 
Slant board vs slope board. 

Sometimes when I speak to my American colleagues, it feels like we are speaking a different language. 

MTSS is a phrase that I've heard but I've had to learn what it actually means, what it might mean for pencil grasp and handwriting, how it translates into the Australian context and how it affects me as a solo private practitioner. 

It prompted me to think ... "What do we do at a universal level to support handwriting development and what additional support might some students need?" While the education systems in the US and Australia are different (they aren't even identical across the Australian states), the underlying principles are transferable and relatable. 
​
What is MTSS (Multi-tiered system of supports)? 
A multi-tierd system of supports is a framework for organising increasingly targeted support according to student need.  The commonly used three-tier structure  includes:

Tier 1: Universal - for 80 % of all students.  Instruction and environmental supports are provided across the classroom or school. 
Tier 2: Targeted - for 15 % of students.  Students who need more than the universal supports receive additioanl, targeted intervention (often in small groups).
Tier 3: Intensive - for 5 % students with more significant or pesistent needs. Support becomes individualised and intensive. 

Students more between the tiers based on their response to intervention. Collaboration between teachers, families and professionals include screening, progress monitoring, data collection and problem-solving so that students receive the right level of support at the right time. 

So how do we apply this to pencil grasp and handwriting? 

Tier 1: What does every child need in order to have the best chance of developing functional handwriting skills? 
An OT might contribute to:
​• Evidence-based handwriting curriculum
• School-wide PD on fine motor development
• Classroom push-in support
• Environmental modifications
• Teacher training on grasp pattems
• Whole-class fine motor warm-ups
• Universal design for leaming
• Progress monitoring quarterly
• Pencil grip cues posted in classroom
• Fine motor centers
• Regular movement breaks
• Developmental skill checklists
• Parent education resources
• Screening for at-risk students
• Proper seating/desk positioning
• Age-appropriate writing tools

Tier 2: What about the students who need more support?
This might include OT support such as:
• Small group instruction
• Fine motor skill stations
• Pencil grip progression activities
• Handwriting practice groups
• Teacher consultation weekly
• Modified writing tools/grips
• Visual motor skill activities
• Progress monitoring 

Tier 3: When individualised supprot is needed.
An OT might provide: 
• Direct 1:1 OT services 
• Specialized adaptive equipment
• Sensory integration techniques
• Custom therapeutic exercises
• Home program development
• Progress monitoring weekly
• IEP goal development
• Assistive technology evaluation

Australian Context
​MTSS is well established in the USe education system, but Australia does not have one nationally mandated MTSS framework used by every school.  Australian states, territories and education sectors (public, private, catholic) use a range of frameworks and terminology.  However, the underlying concept of "universal -> targeted -> individualised support" is present in Australian education. 

Another key difference is that in Australia there is not a single national model for school-based OT, and not every Australian school employs an OT. Not every Australian school allow therapists on-site to work with students. 

An OT working in Australia might be:

• ​employed directly by a school
• employed by an education system
• working across several schools
• contracted by a school working for an external allied health provider
• a private practitioner supporting individual students
• employed by community or public health 

Personally, as a sole private practitioner, how does this apply to me (or you, if you are in a similar position)?
​The MTSS framework provides a way of thinking where we can consider a student's context.  At tier 1, I can consider that what I share for my particular student may also benefit the whole class.  A pencil warm up activity may be demonstrated so that the teacher can instruct the whole class.  A poster or resource could be used to support all the students.   At tier 2, I can collaborate with the teacher to develop additional writing opportunities, targeted practice or a fine-motor station.  At tier 3, I might provide individualised support for the student and consider how can intervention carry over into everyday school life?

Do you work from the MTSS framework or similar? I would love to hear your perspective. 

​We've providing you with a free resource to reference the "Multi-Tiered System of Supports (MTSS) approach for pencil grasp and handwriting development". This practical visual framework outlines universal, targeted and intensive supports, helping OTs and educators consider how to support all students from whole-class strategies through to individualised intervention.

Make sure to also download the previous free resources if you haven't already:
* School Readiness Skills
* The Developmental Progression of Pencil Grasp
* Check your grasp
* How to Size a Desk
These resources are part of Gripipedia — a practical guide to pencil grasp evaluation and intervention. More details coming VERY soon!
​

When a child struggles with handwriting, we often look first at the pencil grasp, the pencil, or the handwriting itself.

But sometimes the problem is much closer to the child’s body.

Is the furniture the right fit?

A desk and chair that are too high, too low, too deep or otherwise poorly matched to a child can change the way they sit, position their arms, hold their pencil and use their hands for writing.
Before we start teaching a new pencil grasp or changing the way a child writes, it is worth taking a moment to look at the whole writing set-up.

Furniture is part of the environment that supports function.

The goal of a good workstation isn't to make a child sit perfectly still in one "correct" position. It is to provide enough support and stability for the child to use their hands effectively, while still allowing them to move.

In the previous article "The why and how of vertical surfaces" we looked at proximal to distal stability of the upper body.  The principle continues to apply when the child is seated at a table.  When the body has a supportive base, the upper limbs have greater freedom to move. When the furniture doesn't fit, a child may use extra effort to stabilise themselves, leaving less capacity for the fine motor demands of writing. 

This is why furniture fit matters for function.

What does a good writing position look like?
There isn't one perfect posture that every child needs to maintain.

Children naturally shift, lean, move their feet and change position while working. Movement is normal and often helpful.

Instead of looking for a rigid "correct" posture, look for a position that allows the child to be:

• comfortable
• supported
• stable enough for the task
• able to move their arms freely
• able to see and reach their work
• able to change position when needed

Consider the relationship between the feet, chair, desk and child.
Feet: Create a stable base
Ideally, a child's feet should be supported on the floor or on a stable footrest. When feet are dangling, children may compensate by swinging them, wrapping them around chair legs or hooking them underneath the chair.  They may even choose to sit crosslegged on their chair.  One of my previous students was referred to me as they were squatting on their chair! Foot support provides a stable base for the body but it doesn't mean feet have to remain completely still.

Chair: Support the body
The chair should allow the child to sit comfortably with their pelvis and trunk supported. A backrest can provide useful support, particularly during longer writing tasks. The child should be able to sit back into the chair rather than constantly perching on the edge or using their legs to create stability. The chair also needs to work with the desk height. A chair that is too low or too high can change the child's entire position at the desk.

Some children benefit from movement with a wobble chair or alternate seating. A balance cushion to sit on or a cushion behind the child's back can also provide additional support. 

Desk: Writing surface function.
The writing surface should allow the child's arms to rest comfortably while keeping their shoulders relaxed. The writing surface can sit approximately 2 inches (5 cm) above the child's bent elbow when they are sitting comfortably. This is a guide and some children may benefit from a slope (slant board) for forearm and wrist support. 

Look for:

• relaxed shoulders
• comfortable elbow positioning
• forearms that can rest or move freely
• enough space to move the writing arm
• the ability to reach and reposition the paper

What happens when the furniture doesn't fit?
Children are excellent compensators.
If something in their environment isn't working, they often find their own solution.
You might see a child:

• slumping forward
• sitting on their legs
• swinging or wrapping their feet
• leaning heavily on the desk
• raising their shoulders
• sitting very close to the page
• standing at the desk
• moving constantly
• changing their pencil grasp
• using their whole arm or trunk to compensate for limited hand movement

"Does this position support what this child is trying to do?"
A quick furniture fit check can provide valuable information about a child's positioning and posture.  The goal is furniture fit for function.

We've created a free How to Size a Desk resource to help you quickly check a child's desk and chair set-up.
It provides a visual guide to:

• desk height
• chair support
• foot positioning
• sitting position
• posture
• signs that it may be time to check the desk size

It's designed to be an easy reference for OTs, teachers and families; whether you're checking a classroom workstation, therapy space or homework desk at home.
​
Download your free copy and check whether the furniture is fit for function.

Make sure to also download the previous free resources if you haven't already:
* School Readiness Skills
* The Developmental Progression of Pencil Grasp
* Check your grasp
These resources are part of Gripipedia — a practical guide to pencil grasp evaluation and intervention. More details coming soon!

Cindy is a registered occupational therapist practising in Sydney, Australia.  She has two growing children who are a constant source of inspiration and learning.  Cindy loves working creatively to help children to reach their potential, finding opportunities in everyday living and making learning fun. She is also addicted to making printables (even when they take a long time to complete).  Cindy is the author of the Occupational Therapy blog Your Kids OT.  Read more articles from Your Kids OT at https://www.yourkidsot.com/blog

Cindy is a contributing author of the Functional Skills for Kids Therapy Team.  They have together published THE HANDWRITING BOOK, THE SCISSORS SKILLS BOOK and THE TOILETING BOOK.

​The information on this site is general in nature. The activities are safe for most children, however, you should consult an Occupational Therapist or health professional to address specific movement, sensory or other medical conditions. Affiliate links are used throughout this website to promote recommended products. Your Kids OT receives a small commission if any purchases are made through these links. Please see my disclosure policy for more details. ​​​
YKOT shop:  https://www.yourkidsot.com/store/c1/Featured_Products.html
Teachers Pay Teachers: https://www.teacherspayteachers.com/Store/Your-Kids-Ot
You Tube Channel: https://www.youtube.com/channel/UCZUz_5nYEOCkj32DiOCQo4Q/featured
Facebook: https://www.facebook.com/yourkidsot
Instagram: https://www.instagram.com/yourkidsot/
Pinterest: https://www.pinterest.com.au/yourkidsot/
​

Have you ever suggested that a child draw on a window, write on a whiteboard or paint on an easel?

There is something deceptively simple about working on a vertical surface. It can look like “just another way to draw,” but changing the position of the work surface changes the way the whole upper limb has to work.

For children developing fine motor skills, this can provide an opportunity to work on proximal stability, upper-limb strength, wrist stability and distal hand control — all important foundations for activities such as drawing, handwriting, cutting, dressing and manipulating small objects.

If you're thinking about school readiness, vertical surface activities are also part of the bigger picture. In my recent article, [School Readiness Skills with Free Printable], I include drawing and painting on a vertical surface as one of the activities that can help children develop the physical foundations needed for school participation. School readiness isn't just about sitting at a desk and holding a pencil but about developing the physical, cognitive, fine motor and self-help skills that support participation across the school day.

Why does proximal stability matter? Think about the upper limb as a chain.
Trunk → shoulder → elbow → wrist → hand → fingers
The parts closer to the body are described as proximal, while the hand and fingers are distal. This is where the familiar OT principle was developed. Proximal stability provides a foundation for distal mobility.

During handwriting, for example, the shoulder and arm need to provide enough stability so that the wrist and fingers can make the smaller, more precise movements required to control the pencil.
We want to give children opportunities to experience and practise stability and controlled movement throughout the upper limb. This is where vertical surfaces can be useful.

What changes when we work vertically?
When a child works at a vertical surface, gravity and the position of the arm change the demands of the task. Instead of resting the forearm on a table, the child has to support the arm against gravity.

Depending on the activity and the child's position, this can encourage:

• shoulder and upper-arm activation
• scapular stability
• wrist extension
• bilateral coordination
• crossing the midline
• controlled arm movements
• hand and finger strength
• visual-motor coordination
• greater stability for the hand and fingers to move

Vertical work can therefore provide a nice progression from large proximal movements towards smaller distal movements.

One of the commonly discussed benefits of vertical work is the tendency for the wrist to move into extension when the hand is raised to work on the surface. A stable, extended wrist can provide a useful foundation for finger movement and manipulation. Vertical and inclined writing surfaces have been described in occupational therapy literature as ways of supporting wrist extension and stability during functional tool use including pre-writing and handwriting activities.

Vertical Surface Ideas
1. Window  activities - A window provides an interesting visual experience because the child can see through the surface. 
Try:

• use washable window markers to draw
• paint with water
• use reuseable stickers or decals on the windows
• "clean a window" with a spray bottle, cloth or sponge 
• make a suncatcher with cellophane in different colours
• use sucker toys on the window

You can also fix paper onto a window surface temporarily with masking tape or blue tack. 

2. Use a whiteboard or chalkboard
Whiteboards and chalkboards are fantastic because they allow children to make large movements without worrying about paper.  Whiteboards provide an opportunity for lighter pressure and chalkboards encourage more pressure. This is a great contrast for children to try both experiences.  Here is a fun idea using a whiteboard with a ball and Squigz.

3. Paint at an easel
Try:

• large paintbrushes
• rollers
• sponges
• cotton buds/Q Tips
• water painting
• chalk paint
• painting with both hands

4. Use magnets
A magnetic whiteboard or fridge are wonderful vertical surfaces to use a variety of magnetic toys.
Try:

• magnetic letters
• small magnetic shapes
• building pictures
• matching games
• moving magnets through a maze

5. Tabletop vertical surface opportunities
Try:

• A "put in/posting" box  - cardboard box with holes placed in a vertical plane (Check out how we feed monsters here with sensory snakes and here with playdough and cutlery)
• Book stand / cookbook holder — place paper, a whiteboard or laminated activity on it.
• Tablet stand — a sturdy tablet holder can hold a small whiteboard or acrylic sheet.
• Acrylic photo frame — slide a piece of paper inside and let the child draw on the surface with whiteboard markers.
• Slanted file organiser — some sturdy desktop organisers can hold paper or a small board almost vertically.
• Small tabletop easel — the obvious one, but inexpensive and easy to use.
• LEGO/Duplo baseplate mounted or placed vertically — great for building rather than drawing.
• Pegboard — place it upright on a table and use pegs, rubber bands, hooks or small objects.
• Slope board/Slant board - draw or paint.​

What are your favourite vertical surface activities? 
​​​​

​To celebrate the launch of Gripipedia, we’re giving away a copy of our book plus a rolling bag full of occupational therapy supplies! Total worth over $400 Aus Dollars. 
To enter: Find the details on the YKOT Facebook Post. 

Winner announced on September 18th, 2026. Gripipedia is coming! Register for the free webinar and launch with bit.ly/Gripipedialaunch

Open to Australian residents only. American OTPs, head over to Instagram where Miss Jaime will be offering you the same giveaway!

Enter the giveway HERE!

Cindy is a registered occupational therapist practising in Sydney, Australia.  She has two growing children who are a constant source of inspiration and learning.  Cindy loves working creatively to help children to reach their potential, finding opportunities in everyday living and making learning fun. She is also addicted to making printables (even when they take a long time to complete).  Cindy is the author of the Occupational Therapy blog Your Kids OT.  Read more articles from Your Kids OT at https://www.yourkidsot.com/blog

Cindy is a contributing author of the Functional Skills for Kids Therapy Team.  They have together published THE HANDWRITING BOOK, THE SCISSORS SKILLS BOOK and THE TOILETING BOOK.

​The information on this site is general in nature. The activities are safe for most children, however, you should consult an Occupational Therapist or health professional to address specific movement, sensory or other medical conditions. Affiliate links are used throughout this website to promote recommended products. Your Kids OT receives a small commission if any purchases are made through these links. Please see my disclosure policy for more details. ​​​
YKOT shop:  https://www.yourkidsot.com/store/c1/Featured_Products.html
Teachers Pay Teachers: https://www.teacherspayteachers.com/Store/Your-Kids-Ot
You Tube Channel: https://www.youtube.com/channel/UCZUz_5nYEOCkj32DiOCQo4Q/featured
Facebook: https://www.facebook.com/yourkidsot
Instagram: https://www.instagram.com/yourkidsot/
Pinterest: https://www.pinterest.com.au/yourkidsot/