What is the Hand Under Hand? Should We Stop Hand Over Hand?

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.  We might also consider if a child or adult is requesting assistance and desires help in this way.  That would be different than an adult grabbing hands without consent.  

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  

Tips and Tricks 

1) Ask for Permission First

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