Have you seen a child on your therapy caseload that writes with both hands? Writing with both hands can be a problem when it comes to handwriting legibility and efficiency. Have you ever wondered is my child a lefty or a righty? Or been asked if they are a lefty or righty and unable to answer? Have you noticed that your child seems to use both hands equally when writing? If so, your child may be experiencing mixed hand dominance patterns or cross-dominance, and this is why you are not sure if they are a lefty or a righty. Writing with both hands can have implications that affect handwriting. Read on for information on using both hands to write writing and what you need to know about mixed-handedness.
Here is more information on hand dominance and establishment of a preferred hand in functional activities.

Writing with Both Hands —Now What?
First, it’s important to understand what is happening when a student uses both hands to write. Let’s discuss mixed dominance to begin. Here is more information about hand dominance and activities to promote laterality.

What is Mixed Dominance?
Mixed dominance refers to when a child does not demonstrate a strong preference for either the left side or the right side of the body for completion of activities, or clearly utilizes both hands for specific sets of activities. For example, a kiddo might throw with his left hand, but write with his right hand.
It should also be noted that children with mixed dominance often utilize both sides of the body equally, but poorly. When they fatigue, this leads to confusion with if they are left-side dominant or right-side dominant.
When Does Dominance Develop?
Dominance of one side of the body or the other is not expected until 5 years of age. Before the age of 5 years old, use of both hands is expected to a moderate degree. However, most children are showing a strong preference for one hand or the other by 3.5-4 years of age.
Determining Mixed Dominance
Dominance is typically determined through observation of the eyes, hands and feet and which one the child uses for task completion. For example, a child who is demonstrating mixed dominance may be right eye dominant, and left hand/foot dominant or left eye dominant, right hand dominant and left foot dominant, or any combination of these characteristics.
Therapists may utilize the Jordan Left/Right Reversal Questionnaire or clinical observations to help them determine mixed dominance. In a vision screen, the therapist can have the child pretend to be a pirate, and see what eye they close when looking through a tube/rolled paper. The eye that the child closes is the non-dominant or “weak” eye and the dominant or “strong” eye is the open one. If the “strong” eye does not match the hand preference the child has been showing, this is mixed dominance in action.
Be sure to watch this space, because tomorrow we’ll cover more about writing with both hands, ambidexterity, and mixed dominance.
For more information on visual screening, check out our vision screening packet:
Occupational Therapy Vision Screening Tool
Mixed Dominance – Impact on Writing and Reading
Children who experience mixed dominance patterns are often delayed in reading and writing skills, along with poor left/right awareness.
Poor left/right awareness can affect their ability to accurately form letters and result in ‘dyslexia’ looking reversal patterns. The reversal patterns in letter formation and recognition may also lead to poor phonemic awareness, and later poor spelling, further delaying their reading and writing skills.
Reading left to right may also be a significant challenge as a result of poor eye teaming, as both sides of the brain are attempting to ‘dominate’ the skill. This struggle between the two sides of the brain results in poor organization of the information and retrieval of phonemic rules. Here is more information about visual processing and the skills that impact reading and learning.
Difficulties in these areas can be red flags of mixed dominance patterns that need to be addressed.
Final Notes on Mixed Dominance
Mixed dominance does not always seem like a big deal, but when left unaddressed your child may be left frustrated with their struggles in gross motor play, reading and writing. Struggles in these areas significantly impact a child’s self-esteem and desire to participate in age appropriate activities. Fortunately, mixed dominance can be easily addressed through therapy.
Try this pouring and scooping activity to refine hand dominance in functional tasks.
More visual processing activities
For even MORE information on eye-hand coordination and activities to use in your occupational therapy practice, you will want to join our free visual processing lab email series. It’s a 3-day series of emails that covers EVERYthing about visual processing. We take a closer look at visual skills and break things down, as well as covering the big picture of visual needs.
In the visual processing lab, you will discover how oculomotor skills like smooth pursuits make a big difference in higher level skills like learning and executive function. The best thing about this lab (besides all of the awesome info) is that it has a fun “lab” theme. I might have had too much fun with this one 🙂
Join us in visual processing Lab! Where you won’t need Bunsen burners or safety goggles!
Click here to learn more about Visual Processing Lab and to sign up.
