What is Hand Under Hand?

July 12, 2021 No Comments

What is Hand UNDER Hand?

First: let’s discuss Hand OVER Hand.   

Hand OVER Hand: a therapy technique often taught in undergraduate and graduate programs as a way to “help” students complete tasks.  

Recently, autistic adovcates have pointed out that this may be a harmful technique. An article in the ASHA Leader from October of 2020 explains why this practice should change and offers ideas for alternatives.  It was compiled by Autistic SLPs Rachel Dorsey, Hillary Crow, and Caroline Gaddy.  Be sure to check out Putting Autistic Voices at the Forefront of Care.


The article highlights the importance of Autonomy: 

By respecting our clients’ choices, we foster mutual trust and rapport,
value their freedom to express themselves, protect them from potential
abuse, encourage independence, and support self-determination. When we
validate our clients’ self-advocacy, we recognize their humanity.

Are there any cases that are acceptable for using Hand OVER hand?   Yes: Safety.  Parents teaching and cuing skills within the home setting.  

What do I do for children who have motor delays or are required to do certain things, but refuse (example: washing hands at school)?  Try to model alongside the child.  Add visuals and use social stories and videos to teach skills without forcing the child to comply physically. 

Hand UNDER Hand: a therapy technique that places the student’s hand on top of the therapist or helper.  This allows the student to move their hand at will and remove their hand if uncomfortable. It is suggested that this type of movement is more effective at teaching the student what the movement feels like than grabbing the student’s hand and moving it for them. 


This article teaches the application of Hand UNDER Hand.  Hand-Under-Hand Prompting by C.J. Fields  

Video Demonstrations

If you’re like me, you may need more help to understand what all of this means.  I consider myself a kinesthetic learner: I need to try something before I “get it”.  I’ve put together two videos that demonstrate use of this technique.  

Disclaimer: this is my own child.  In the first video, I didn’t ask for his consent prior to initiating the technique.   I was learning. 



Tips and Tricks 

1) Ask for Permission First

2) Make Sure the Student’s Hand is on Top

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    Elizabeth has been a Speech Language Pathologist since 2005. She has special interests in Autism and ADHD. Some of Elizabeth's experience comes from years of development and training in pediatric private practice, but the majority has come from raising her four children. Her household includes neurodiverse family members. Elizabeth enjoys supporting families and professionals with her experience from both sides of the table. Learning to merge the "normal" and "autistic" worlds has led to the most success, both professionally and at home. Read More

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      Prior Speaking Experiences

      -Guilford Child Development: Autism in the Early Childhood Setting
      -Cheshire Speech and Voice: Effective Tools for increasing Sensory Integration for Speech/Language Intervention; Autism
      -Caldwell Community College and Technical Institute: Autism
      -CHIPS Greensboro: Autism for Professionals
      -NCSHLA: Teletherapy (Including the Parent Perspective)
      -Telepractice Today: Podcast (Parent and SLP Perspectives)
      -UNC Chapel Hill: Guest Lecture
      -Abled Not Labeled: Presenter (Intro to Neurodiversity)