Structured Task-Focused Occupational Therapy in the School Environment to Support Academic Performance: Fine Motor and Visual-Motor Skills

• Structured Task-Focused Occupational Therapy Program (Behavioral): The intervention consists of a 10-week structured task-focused occupational therapy program delivered in the school environment. Participants will receive two 30-minute sessions per week, for a total of 20 sessions. The program will include task-oriented activities targeting handwriting performance, fine motor skills, manual dexterity, visual-motor integration, visual perception, and motor coordination.

Primary outcomes

• Change in Handwriting Performance Assessed by the Minnesota Handwriting Test [Baseline and within 1 week after completion of the 10-week intervention (up to Week 11)]: Handwriting performance will be assessed using the Turkish version of the Minnesota Handwriting Test (MHT). The test includes 34 letters arranged in seven words and evaluates handwriting completion time, legibility, form, alignment, spacing, and size. Completion time is recorded in seconds, with shorter times indicating faster performance. Quality parameters are scored up to 34 points, with higher scores indicating better handwriting quality. Change from baseline to post-intervention will be compared between the intervention and control groups.

Secondary outcomes

• Change in Manual Dexterity Assessed by the Minnesota Manual Dexterity Test [Baseline and within 1 week after completion of the 10-week intervention (up to Week 11)]: Manual dexterity will be assessed using the Minnesota Manual Dexterity Test (MMDT). Completion times for the placing and turning tasks will be recorded in seconds. Shorter completion times indicate better manual dexterity.
• Change in Visual-Motor Performance Assessed by the Beery VMI [Baseline and within 1 week after completion of the 10-week intervention (up to Week 11)]: Visual-motor performance will be assessed using the Beery-Buktenica Developmental Test of Visual-Motor Integration. Outcomes will include the Visual-Motor Integration total score, Visual Perception subtest score, and Motor Coordination subtest score. Scores will be interpreted according to age-based normative values, with higher scores indicating better performance.
• Change in Academic Performance [Baseline and within 1 week after completion of the 10-week intervention (up to Week 11)]: Academic performance will be evaluated using official school grades in Turkish Language, Mathematics, and Life Sciences. Grades range from 1 to 4, with higher grades indicating better academic performance.

Other outcomes

• Change in Individualized Goal Attainment Assessed by Goal Attainment Scaling [Baseline and within 1 week after completion of the 10-week intervention (up to Week 11)]: Goal Attainment Scaling will be administered only to participants in the intervention group. Individualized SMART goals will be rated on a five-point scale ranging from -2 to +2, where -2 represents performance much lower than expected, 0 represents the expected level of achievement, and +2 represents performance much higher than expected. Higher scores indicate greater goal attainment.

Sex: All, ages: 7 Years to 9 Years

Inclusion Criteria:

* Being between 7 and 9 years of age
* Being enrolled in the second or third grade
* Demonstrating basic literacy skills
* Being identified as high risk for handwriting and/or manual dexterity difficulties based on standardized assessments and teacher observations
* Being expected to maintain regular school attendance throughout the study period
* Written informed consent provided by a parent or legal guardian

Exclusion Criteria:

* A diagnosed neurodevelopmental disorder, including autism spectrum disorder or attention-deficit/hyperactivity disorder
* Significant visual or hearing impairment
* An orthopedic or neurological condition affecting the upper extremity
* Current receipt of occupational therapy or special education services