Hand over Hand Techniques VS Hand Under Hand Support

Hand Over Hand Support

The use of physical prompts which includes hand over hand technique and hand under hand is widespread and accepted practice. This includes but is not limited to, pupils with a range of disabilities including PMLD, SLD, and visual impairment.  Described by VanDijk (1966) as forming part of a set of teaching strategies for supporting deaf-blind children that he describes as “Co-active movement”. Hand over hand techniques or hand under hand can be part of a taxonomy of development. A way to progress the pupil’s development. The initial idea is that the physical prompt will elicit a response from the child that indicates they want to continue with the activity. This should lead to the child developing the desired skill. With the aim that the child will duplicate the movement without adult support.  

Hand Over Hand Techniques: Physical Support

With pupils who do not have complex physical or visual needs, there are other types of instruction, verbal, pictorial, modelled that can be used. Only when these have proven ineffective should a physical prompt be used. This may be as a prompt to attend to the task, or a full task completed with physical support.

There are ethical considerations to the coercive practice of hand over hand techniques, especially if used when a pupil can’t or won’t follow instructions. It is worth considering that autistic pupils will quickly become used to that task being completed with Hand-over-hand support. This routine may be hard to move away from (Prompt fade). It is likely that the child is not learning how to do something but just aware their hand is being manipulated. If you constantly initiate an activity physically the child is not learning how to start, undertake or complete the task. You are. We must not teach our pupils that they must comply with the physical manipulation of adults. This directly contravenes our safeguarding systems and RSE curriculum intent.

Choosing an appropriate prompt strategy

When choosing the strategy to use it is essential to identify the problem we are trying to solve and decide our plan and how to implement it including outlining both the pupil and adult’s roles. 

Suggestions to try before physical prompting.

• Receptive language barrier to instructions – Simple visual breakdown of steps. For a colour sorting activity use an image of the completed activity. Build a tower – three images adding a block each time. Use the blue peter “here’s one I made earlier” approach. Show a completed tower or jigsaw.
• Starting an activity – Initiate the activity by making sure the task and expectations are clear. For mark-making have the paper on the table and hand the child the pencil. You can fade the prompt over time until the child picks up the pencil. If they have a favourite colour use that pencil. If they find a pencil too thin to hold, adapt it with putty or foam.
• Pupil won’t engage with a planned learning task – Use their interests. If a pupil likes cars then attach a crayon to the car and drive it around the paper. If they are motivated by water play use a container of water to drop tokens in when counting.
• Pupil will not sit – I have found that pupils are more likely to sit if the adults are sitting. There are a range of cushions and wedges that make the seat more comfortable. Regular movement breaks are important for those who have energy to spare. 

Levels of Support

This model by Layton et al (2013) reinforces the appropriate level of support to allow children with multi-sensory impairments to access their environments.

• Anticipation – the use of routines to allow children to anticipate events
• Co-Active Movement – Hand over/under hand can provide stimulus for a child to explore when child and adult conduct a task together. i.e washing hands. 
• Deferred imitation – This is when the child imitates an adults movements after a period of time.
• Natural gestures – spontaneous communication i.e pulling an adult, taping arm for attention.

With pupils who do not physically need this level of support it might be more appropriate to initially use the strategies outlined by Wheeler (1997).  The first stage of this is creating a predictable routine that allows for anticipation of a sequence of events. We would reinforce this both through consistent practice every day and visual reinforcement through a tangible visual schedule. 

Hand over hand Vs Hand Under Hand and the development of trust

The development of trust through positive touch (known as resonance activities) is the base of this – this should be appropriate and take into account the pupil’s sensory profile but could include a touch on the arm or shoulder, a hug if they are upset. This moves onto coactive movements, this may mean the adult and child sharing an activity, in playing with toy cars the adult models how to push the car, the key element is interacting with the environment together. We are assisting the pupil to interact with their environment with the aim of developing independence. Unless pupils are visually impaired or cannot attend to a joint attention activity there should be no need for physical touch. An adult modeling an activity or gesture should be attempted first. This may include holding a hand out flat when a child wants something or wants to give them something.

Hand over Hand Guidance involves the adult manipulating the child’s hands. In the example below the adult is guiding the child to mark-make. Hand-under-hand may be more appropriate who resist this level of manipulation or are tactile defensive. In this approach, the child experiences the activity through you. This has the benefit of allowing the child to feel more in control, for our pupils the ethos of creating a nurturing environment with positive relationships will over time create a more effective route to independence than a coercive environment.

Levels of support and fading physical support

Chen et al (2000) outline three approaches to the methods of guidance:

1. The adult may rest a hand underneath the child and wait for the child to initiate an interaction.
2. Place the child’s hand on the adults while the adult manipulates an object.
3. The adult gradually withdraws their hand until the child’s fingers touch the object.

Depending on the purpose of the support we may change our approach throughout the activity. Hand under hand moves to hand over hand as the child starts to leads the interaction. Hand next to hand may be used if the pupil can imitate. The more motivating the activity the less support will be required. McInnes and Treffry (In McLinden et all 2016) summarise the adult role during each stage of interaction. The purpose of adult support here is to minimise barriers to learning. Again the basis of this is a positive relationship where the pupil feels comfortable with adult interactions

Our aim is to use the least amount of support through adapting our approach, environment, and resources rather than relying on physical assistance. This is to reduce the number of adult interactions, demands, and verbal instructions in the classroom. This should increase the time allowed for the pupil to process and practice the task. Routine reduces stress for all by reducing the cognitive load for staff and pupils. The table below from Cook et al (2016) gives a range of examples of adaptations around snack and lunch that can be applied in any classroom. 

To sum up we should use hand under hand whenever possible as it is more respectful to the pupil and builds trust. It is less intrusive and coercive. We ensure the pupil maintains control and provides autonomy leading to more effective learning. 

References Linked T Hand Over Hand Technique

Chen, D., & Haney, M. (1999). Promoting Learning through Active Interaction. Project PLAI. Final Report. Online

Cook, R. E., Richardson-Gibbs, A. M., Nielsen, L. (2016). Strategies for Including Children with Special Needs in Early Childhood Settings. United States: Cengage Learning.

Layton, L., Tilstone, C., Williams, A., Morgan, J., Anderson, A., Gerrish, R. (2013). Child Development and Teaching Pupils with Special Educational Needs. United Kingdom: Taylor & Francis.

Mccall, S., Mclinden, M. (2016). Learning Through Touch: Supporting Children with Visual Impairments and Additional Difficulties. United Kingdom: Taylor & Francis.

Wheeler, L., & Griffin, H. (1997). A Movement-Based Approach to Language Development in Children Who are Deaf-Blind. American Annals of the Deaf, 142(5), 387-390. Retrieved July 6, 2021, from http://www.jstor.org/stable/44392539