Visual-Motor Skills: A Research-Based Overview for School-Based OT
Irene Hannam, MS OTR/L
What Are Visual-Motor Skills?
Visual–motor integration (VMI) is the ability to coordinate visual perception with fine-motor movement—seeing a shape, letter, or pattern and accurately reproducing it with a pencil, scissors, or a manipulative. VMI underpins handwriting, drawing, cutting, and efficient device access (mouse/trackpad/keyboard) (Beery & Beery, 2010; Lu et al., 2024; Hernandez et al., 2024).
Why They Matter in Schools:
Large syntheses show VMI relates meaningfully to academic skills. Meta-analyses report significant, non-trivial associations between VMI and handwriting legibility and spelling/reading outcomes, with the strongest effects in early grades (Lu et al., 2024; Khatib et al., 2022). These needs continue into upper elementary and secondary school, where OTs often weigh handwriting remediation versus alternative access for note-taking and digital tasks (Nightingale et al., 2022; Hernandez et al., 2024).
Developmental & Special Populations:
Children with developmental disabilities and autistic youth often present complex VMI/visual-perceptual (VP)/motor profiles (Carsone et al., 2021; Faber et al., 2022). A recent randomized crossover study suggests spatially structured handwriting instruction can improve outcomes for autistic children (Le Pong et al., 2025). Best practice is to combine standardized measures (e.g., Beery-VMI) with functional writing tasks for decision-making (Vico-Quesada et al., 2023).
What the Evidence Says About Intervention:
- Classroom-embedded programs help. Systematic review shows curriculum-based handwriting programs yield small to moderate improvements in legibility, especially when practice is explicit and frequent (Engel et al., 2018). School-delivered psycho-educational activities also improved VMI and pre-writing skills (Taverna et al., 2020).
- Motor-learning principles matter. A pilot RCT found brief, structured pre-writing lessons (clear stroke sequences, high-frequency practice, feedback) produced promising gains in early letter formation and readiness (Johnston et al., 2025).
- Different skills drive legibility vs. speed. Studies show VMI/letter formation relates more to legibility, while attention/automaticity/manual dexterity contribute more to fluency/speed (Downing & Caravolas, 2023; Maurer et al., 2024).
- Technology doesn’t remove the need for VMI. Evidence reviews emphasize that VMI supports accurate cursor control and typing—critical in 1:1 device classrooms (Hernandez et al., 2024).
Implications for School-Based OT:
1. Screen Early and Broadly. In kindergarten and first grade, include VMI/VP, fine-motor, and attention measures; evidence links K skills to Grade-1 handwriting legibility and speed (Hwang et al., 2024; Maurer et al., 2024).
2. Use Tiered Supports.
o Tier-1 (whole class): 5–10 minutes/day of tracing, mazes, dot-to-dot, vertical surfaces, and explicit letter-stroke review embedded in ELA (Engel et al., 2018; Taverna et al., 2020).
o Tier-2/3 (targeted/individual): Add focused VMI + fine-motor practice and feedback; the SHINE model illustrates a feasible school-led approach (Shire et al., 2021).
3. Integrate with Letter-Formation Instruction. Pair VMI activities with explicit, consistent stroke routines and frequent, short practice (Johnston et al., 2025; Engel et al., 2018).
4. Assess Across Tasks. Evaluate copying and composing; VMI predicts copying legibility more strongly, and legibility varies by task demands—so include both (Fogel et al., 2022).
5. Address Special Populations. For autistic students or those with learning differences, combine VMI/VP training with fine-motor work, sensory-motor foundations, and motivational supports (Faber et al., 2022; Le Pong et al., 2025).
6. Monitor Outcomes Functionally. Track standardized VMI when indicated and real-world indicators—legibility, speed, endurance, classroom independence (Vico-Quesada et al., 2023).
Bottom Line:
VMI is a cornerstone of school participation. Evidence from 2018–2025 supports early screening, classroom-embedded practice, and OT-led interventions grounded in motor-learning principles and matched to the specific performance target (legibility vs. speed). Systematically targeting and monitoring VMI can meaningfully enhance students’ academic readiness and success.
References (after 2018):
· Beery, K. E., & Beery, N. A. (2010). Beery–Buktenica Developmental Test of Visual–Motor Integration: Administration, scoring, and teaching manual (6th ed.). NCS Pearson.
· Carsone, B., Green, K., Torrence, W., & Henry, B. (2021). Systematic review of visual motor integration in children with developmental disabilities. Occupational Therapy International, 2021, 1801196.
Open access: https://pmc.ncbi.nlm.nih.gov/articles/PMC8321716/
· Downing, C., & Caravolas, M. (2023). Relations between handwriting legibility and fluency and their patterns of association with spelling, graphomotor, and attention skills. Journal of Experimental Child Psychology, 236,105756.
· Engel, C., Lillie, K., Zurawski, S., & Travers, B. G. (2018). Curriculum-based handwriting programs: A systematic review with effect sizes. American Journal of Occupational Therapy, 72(3), 7203205010p1–7203205010p8.
· Faber, L., van den Bos, N., Houwen, S., Schoemaker, M. M., & Rosenblum, S. (2022). Motor skills, visual perception, and visual–motor integration in children and youth with autism spectrum disorder. Research in Autism Spectrum Disorders, 96, 101998. https://doi.org/10.1016/j.rasd.2022.101998
· Fogel, Y., Rosenblum, S., & Barnett, A. L. (2022). Handwriting legibility across different writing tasks in school-aged children. International Journal of Occupational Safety and Ergonomics, 28(4), 1984–1994.
· Hernandez, A., Lay, J., Jolley, S., & Siebers, A. (2024). Visual–motor integration is also relevant for computer use. American Journal of Occupational Therapy, 78(5), 7805205010.
· Hwang, Y. S., Hsiao, Y.-L., Su, P.-F., Hung, J.-Y., & Tsai, W.-H. (2024). Kindergarten visual–perceptual and motor skills and behavioral traits predict first-grade Chinese handwriting legibility and speed. American Journal of Occupational Therapy, 78(1), 7801205170. https://doi.org/10.5014/ajot.2024.050425
· Johnston, B., Ryan, B., Hatfield, M., Calder, S. D., & Claessen, M. (2025). Efficacy of a prewriting intervention: A pilot randomised controlled trial. Australian Occupational Therapy Journal, 72(4), e70043.
· Khatib, L., Li, Y., Geary, D. C., & Popov, V. (2022). Meta-analysis on the relation between visuomotor integration and academic achievement: Role of educational stage and disability. Educational Research Review, 35, 100412.
· Le Pong, J., Howe, T.-H., Chen, H.-L., Weng, Z.-C., & Wang, T.-N. (2025). Enhancing handwriting performance in autistic children: A randomized crossover study on the effectiveness of a spatial-structured handwriting intervention program. Autism Research. Advance online publication. https://doi.org/10.1002/aur.70102
PubMed: https://pubmed.ncbi.nlm.nih.gov/40778466/
· Lu, H., Zhang, Y., & Chan, S. (2024). A meta-analysis on the relation between handwriting and visual-motor integration. Learning and Individual Differences, 109, 102494. https://doi.org/10.1016/j.lindif.2023.102404
· Maurer, M. N., Fischer, U., Jirout, J., & Booth, J. R. (2024). Correlates of early handwriting: Differential patterns for legibility, fluency, and time. Early Education and Development, 35(4), 843–858.
· Nightingale, R., Sumner, E., Prunty, M., & Barnett, A. L. (2022). Handwriting and typing: Occupational therapy practice when supporting adolescents with handwriting difficulties. British Journal of Occupational Therapy, 85(11), 891–899.
Open access: https://pmc.ncbi.nlm.nih.gov/articles/PMC12033838/
· Shire, K. A., English, A. A., & Hopfenbeck, M. (2021). Developing and implementing a school-led motor and handwriting intervention: Helping Handwriting SHINE. Journal of Occupational Therapy, Schools, & Early Intervention, 14(3), 274–290. https://doi.org/10.1080/19411243.2020.1837047
· Taverna, L., Tremolada, M., Tosetto, B., Dozza, L., & Zanin-Scaratti, R. (2020). Impact of psycho-educational activities on visual-motor integration, fine motor skills, and name writing among first graders: A kinematic pilot study. Children, 7(4), 27. https://doi.org/10.3390/children7040027
Open access: https://pmc.ncbi.nlm.nih.gov/articles/PMC7231227/
· Vico-Quesada, M., González, B., & Martín-Martín, J. (2023). Functional assessment of handwriting among children: A systematic review of the psychometric properties. American Journal of Occupational Therapy, 77(5), 7705205050.
Disclaimer
I am an occupational therapist providing information intended to support academic success in students. This resource is designed for teachers, parents, and occupational therapy professionals as a general guide. It is not medical advice, diagnosis, or treatment, and should not be used as a substitute for individualized medical care. Please consult appropriate professionals for individual medical or therapeutic concerns.
