Hand Over Hand Or Hand Under Hand Prompting?

Therapists often use physical prompting in sessions to help support developing skills, with the goal of children developing and using targeted skills without adult support in the future. There are a range of possibilities for support, but there is ongoing discussion in the field about the appropriateness of Hand Over Hand or Hand Under Hand in different scenarios. When is it most appropriate to use one strategy or the other?

Hand Under Hand is characterized by an adult clinician allowing a child to manipulate the clinician's hand to complete an activity or goal, while Hand Over Hand is characterized by a clinician manipulating a child's hand to complete an activity.

Physical prompting is sometimes considered a strategy for children who have difficulty sitting or following directions for a variety of reasons. Before selecting physical prompting as a cueing strategy, which can be fairly direct, consider using other strategies and techniques. For example, try using visual breakdowns of activities and use set routines, with preferred activities initially and plenty of modeling. In general, the more engaging and visually stimulating an activity, the less support may be needed.

Because the goal of therapy is functionality and independence, physical prompting is often a last resort when a child is unable to engage in joint attention activities. As such, Hand Under Hand may be the least coercive method of physical prompting for children who are resistant to physical manipulation. This technique allows the clinician the possibility of waiting for the child to initiate action, as well as gradually pulling away the clinician's hand and allowing the child to directly manage an object. Overall, this allows the child to feel more in control. For example, a clinician prepares to use a marker to draw a design on paper but hesitates over the page, giving the child the opportunity to direct the action of the clinician's hand.

Hand Over Hand is considered a more coercive method of physical prompting because it involves an adult manipulating a child's hand(s) to complete an activity. This may be more appropriate as a child starts to feel more comfortable and leads during interactions; however, it is a more intrusive method.

Have questions about supportive techniques or other concerns? Reach out to a Sidekick therapist today!