1 International Journal of Therapy and Rehabilitation | 2021 | https://doi.org/10.12968/ijtr.2020.0007 RESEARCH © 2021 MA Healthcare Ltd Introduction Handwriting, as a visible form of spoken language, is an essential skill for learning and using knowledge (Athenes et al, 2004; World Health Organization, 2007). This psychomotor skill is a means of communication and an important skill for some occupations, such as teaching, writing, being a student and leisure activities that require writing (Feder and Majnemer, 2007). More than 30–60% of a child’s school activities are related to fne motor tasks, with handwriting taking up the majority of this time (McHale and Cermak, 1992). The prevalence of handwriting issues in typically developing children ranges from 10–30%, and is signifcantly higher (at least 50%) in children with developmental and learning disabilities (Karlsdottir and Stefansson, 2002). Poor handwriting abilities affect children’s performance in school activities. Failure to obtain handwriting competency in school also has long-term negative effects on a student’s self-esteem, self-effcacy, and participation (Feder and Majnemer, 2007; Havaei et al, 2016a). Handwriting diffculties are the primary reason for referral to school-based occupational therapy (Feder et al, 2000). The occupational therapy practitioner’s role for handwriting remediation is to assist both the teacher and the student by consulting with the teacher, making adaptations to the educational environment, and providing direct services to the student for skill acquisition (Feder et al, 2000). In this regard and for providing effective services, therapists should have suffcient information about handwriting components and the handwriting status of clients (Hammerschmidt and Sudsawad, 2004). Owing to a lack of evidence on the handwriting status of students in Iran, there are no appropriate criteria and a complete view for studying and comparing students with handwriting diffculties (Havaei et al, 2016a; 2016b). Some of the fndings in previous studies in other countries and other languages also are not applicable because handwriting is a language and culture-dependent skill (Hamstra-Bletz and Blotte, 1993; Erez and How to cite this article: Havaei N, Mahmodzadeh M, Azad A et al. Handwriting status among Iranian primary school students: a cross- sectional study. Int J Ther Rehabil. 2021. https://doi. org/10.12968/ijtr.2020.0007 Handwriting status among Iranian primary school students: a cross-sectional study Naser Havaei 1 Mahdieh Mahmodzadeh 1 Akram Azad 2 Mahsa Meimandi 2 Mandana Rezaei 2 Mina Ahmadi Kahjoogh 1 Ahmad Mohammadi 1 Author details can be found at the end of this article Correspondence to: Ahmad Mohammadi; aram_mohammadi25@ yahoo.com Abstract Background/Aims Handwriting diffculties among school students are the primary reason for referral to school-based occupational therapy. Appropriate criteria and a complete view of the students’ handwriting status are lacking in Iran. The purpose of this study was to gather comprehensive information about handwriting issues for therapists and related disciplines in Iran. Methods In this cross-sectional study, the handwriting status of 1262 Persian-language elementary school students (grades 2 and 3) from governmental schools was surveyed using the Persian handwriting assessment tool. Results There were statistically signifcant differences in handwriting components between second and third grade students except for word size and text slant. Handwriting components were different between boys and girls, and between right- and left-handed writers. Regression analysis revealed a positive relationships between age and grade and most of the handwriting components. Conclusions The results of this study have implications for teachers, therapists and other specialists who work and research on handwriting status of typically healthy students and students who are disabled in Iran. Handwriting skills are improved over time and it seems that girls and right-handed writers are better writers. Key words: Handwriting, Students, Survey Received: 22 January 2020; accepted following double-blind peer review: 7 May 2020