Autism Hand Dominance


Guest Post: Linda Keogh OT – Hand Dominance Strategies and Activities

A huge thank you to Occupational Therapist Linda Keogh for her guest post as part of the Little Puddins’ “Autism 101” series; where essentially parents of Autistic children, get to “Ask the Expert”, for help and guidance.

Linda is our first guest blogger as part of the Autism 101 series and I am so thankful she has taken time out of her busy schedule to impart vital information for parents and professionals.

At the end of this post there is a FREE PDF DOWNLOAD of all Linda’s Guest Post so you can read it when off line or file with your other OT Resources.


Occupational Therapy for Autistic Children

Occupational therapy for kids? Isn’t that just for adults? Kids don’t have jobs, right? Well, kids do have very important occupations. It is their job to play, learn and become independent throughout their childhood.

An Occupational Therapist (OT) can evaluate a child’s skills with playing, school performance, and daily activities. They will then use these findings to develop goals with parents around meaningful occupational treatments that the child needs to develop further. Therapy can come in many forms and shapes but it should always be rooted in play.

Now that you have an idea of what an OT does, let’s get into our blog. When I was thinking about what topic to discuss for I decided to stop and look at my therapy sessions over a number of days.

Right or Left Handed

I looked for a common theme and sure enough there was one “I don’t know If he is left or right handed” “she is swapping her hands a lot” “ I think he might be ambidextrous”. 

Children who don’t have a strongly dominant left or right hand for a specific task or who switch hands when a specialised hand is required, may struggle to carry out fine motor tasks that require automatic, learned movements, such as cutting neatly on a line with scissors, or handwriting.


Hand Dominance

Hand dominance is the term used to describe the hand a person uses spontaneously during skilled tasks such as snipping with scissors, using a crayon or brushing teeth. It is the hand a child will prefer to use because it is more efficient. This then leaves the other hand in the role of stabiliser or for those who have attended therapy with me know fondly as “the helper’s hand”.

The development of hand dominance is a beautiful sign that your little one’s brain is maturing and that brain lateralisation is occurring.

Hand dominance for unilateral tasks such as reaching for a block will develop first and you can see signs of this preference in your young toddler but it is typically established around 3 to 4 years.

Hand dominance with bilateral tasks , (e.g. using a scissor) can take a little longer but is typically well established around 5 years.

So why do some children have difficulty with hand dominance? 

For some,  the difficulties with hand dominance can be linked with weaker upper limb muscles causing a child to tire quickly and swap hands in the middle of the activity. Some children’s reduced upper limb strength can be due to low muscle tone, developmental delay or neurological condition. But more often this is commonly seen with those kids who skipped the crawling stage.  


Activities which help with the development of strength involve weight bearing or resistance. My top ten favourite activities to build strength in hands and arms are:

1.    Wheelbarrow races

2.    Animal walks

3.    Crawling games

4.    Scooter board games

5.    Playing games laying over a therapy ball.

6.    Outdoor chalk on walls and pavements.

7.    Squishing squeezing poking and manipulating therapy putty.

8.    Using thongs and tweeters

9.    Clothing pegs

10. Water spray bottles

Linda Keogh OT

Crossing the Midline

For other children, their difficultly with hand dominance may be caused by difficulties with “crossing the midline”. This is the ability to reach across the middle of the body with the arms and legs. The midline is an imaginary line drawn vertically dividing the body into two equal parts.

It allows children to cross over their body to perform a task on the opposite side. If your child is consistently swapping hands then they will end up having two average hands rather than one highly proficient hand.

My favourite activities for midline crossing:

Drawing rainbows

Have your child sit crossed legged on the floor with a roll of paper in front of them. Encourage them to start at the left side with their dominant hand and draw a large rainbow all the way to the right side. Do this with all the colours of the rainbow.  

Playing giggle wiggle

Placing a bowl with the balls on the right side and the game on the left, encourage your child to pick up the ball in their right hand and place the ball into the game on the left side. Then when cleaning up, encourage the child to use their left hand to place the balls back into the bowl on the right-hand side.  This same idea can be done with tasks like peg boards, form boards and pop up pirate.


Using large (adult size) paint brushes let your child paint the sides of the house with water. Encourage using one hand at a time.


Using a spray bottle and towel, have your child wash the windows in your house or on a flat surface such as the table.

Toe Taps

Reach both hands up into the air and then reaching down with one hand to tap the opposite toes then repeat on the other side. Make this extra fun by adding in some music to make it a little dance off.


Draw a large figure eight (the number eight facing side to side, not top to bottom) with outdoor chalk and have them walk the figure eight OR draw the infinity sign and have your child trace it with the finger of their more dominant hand. I love to stick this sign on the wall and have them do this exercise here to also build upper limb strength.

That’s all for this weeks post. We hoped you enjoyed it and can’t wait to share our blog post with you. Remember these activities are a guide and if you are concerned about your child it is recommended to make a visit to your local OT service. If you are unsure about how to do this in your area we suggest asking your GP. For private OT services you can find a list of those in your area on the AOTI


Thank you so much to Linda for her fantastic Guest Blog post. If you would like to get in contact with Linda, go to her website HERE or find her on Instagram HERE.

You can DOWNLOAD a FREE PDF of Linda’s Guest Post HERE.

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