Why “Hand-Over-Hand” Assistance Works Poorly With So Many Special Needs Children

This method of teaching fine motor skills has never worked well for me in Early Intervention.  In my professional experience, it has been a popular technique for many special educators.  But they aren’t always getting the results they want.  Very often, the scenario is as follows:  I get a call from a concerned parent, telling me that the teacher is wondering if their child has sensory aversion, since he or she resists the teachers’ touch during sessions.

Sometimes that is indeed the case.  More of the time it is not.  The true reason why “hand-over-hand” assistance is not accepted or working well is a little more complicated.  Here are the two situations in which sensory aversion is not the biggest problem, but there are less obvious reasons for the failure of this method of training:

  1. Children with low muscle tone.  Holding a child’s hand and guiding them, even moving their hand and arm, limits the necessary proprioceptive and kinesthetic information that is required for a child to learn effective hand control.  The tactile sensation and the imposed movement from an adult’s hand masks this subtle information.  The brain cannot process and learn if it isn’t receiving correct and useful information.  One strategy that works for me is using the weight of my hand to create “drag”; I am giving the child more proprioceptive/kinesthetic information as the child moves intentionally to accomplish a task.  It cannot be too much drag, restricting their movements, and it cannot be too little movement or contact, which the brain interprets as offensive light touch.  And it has to follow their general movement, not passively bringing a child’s hand to the toy.  This takes practice to learn, and it helps if you are good at perceiving your own subtle movements.  Think Feldenkrais or Tai Chi.
  2. Children with cognitive and/or communication delays.  A child that doesn’t realize that “hand-over-hand’ assistance is intended to help them perform a task, or a child that doesn’t want to perform that task, will almost always resist the physical contact of an adult.  Imagine if the person sitting next to you suddenly grabbed your partially paralyzed hand and pulled  it off the table.  You would jerk it back.  If you knew that a spider was crawling toward your hand, you would be grateful, not resentful.  It’s dependent on your awareness of the person’s intent, and your agreement that this is the way you want assistance to move your hand!!   If a child is unaware or uninterested, it makes sense for them to resist physical intervention.  So many globally-delayed children are handled all day long without their full awareness or even their consent.  They may have no interest in stacking blocks or scribbling.  There are other ways to assist them.  Creativity and excellent observations of a child’s motivation to move are the keys to improving their participation.

I hope this clarifies why I rarely use this method of assistance with my clients.  It can work, but usually it works better with older special needs children, and children without sensory processing issues.  Unfortunately, that population is rarely on my Early Intervention caseload!

Looking for more information about how to help a special needs child at school?  Check out Help Your Special Needs Toddler Make The Transition To School Routines and Is is Sensory Or Is It Behavior? Before 3, The Answer Is Usually “Yes!” for some ideas that really work!

 

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