Hand-Over-Hand: Why It’s Unethical — and Ineffective — for Autistic Students

My First-Grade Memory (and Why it Still Unsettles Me)

I remember the way the room felt in first grade — the sounds of kids breathing and shifting in their chairs, the buzz of the fluorescent lights, the hum of the heater at the back of the classroom - I grew up in cold, Montreal winters!

I adored my teacher. She was warm and kind, the sort of adult you wanted to please. She believed that getting close to children — a hand on a shoulder, leaning in at a desk, giving a hug at the end of the day — showed care.

But my Autistic nervous system didn’t experience it that way.

Even as a young child, I struggled with personal space. When she leaned in too close, or when the sleeve of her sweater brushed my arm, I felt my chest tighten as if my body wanted to shrink back. I didn’t have words for it, but my body told me: too close.

Sometimes I think how lucky I was that my handwriting came easily. Because if my teacher had ever tried to place her hand over mine — or under it — to guide my pencil, the very thing meant to help would have unsettled me.

It wasn’t her kindness that calmed me; it was simply the steadiness of her being nearby.

It wasn’t her touch that soothed me; in fact, it would have made me less able to focus.

I loved her as my teacher. I trusted her. But her closeness was not regulating to me.

This is why I say that good intentions don’t cancel out an Autistic nervous system’s need for space and agency.

The Sensory Science

Research confirms that Autistic people often experience heightened responsiveness to sensory input — especially touch and proximity.

For example, MacLennan, O’Brien, & Tavassoli (2022) found that Autistic adults reported significantly higher tactile and olfactory sensitivity than non-Autistic peers, shaping how they experienced ordinary interactions.

Sensory sensitivity is not a preference. It’s a nervous-system fact. When we cross a child’s sensory boundary — even gently — we can unintentionally create discomfort or dysregulation, which makes learning harder.

Why Hand-Over-Hand (and Often Hand-Under-Hand) Doesn’t Belong

Hand-over-hand instruction involves placing an adult’s hand directly over or under the child’s, moving their hand through a task. It’s often well-intentioned, but for many Autistic students it is:

• A violation of personal space - having another person’s hand over or under theirs is simply too close.

• A sensory intrusion. Adult touch (and their smell) can overwhelm a student and even drown out the child’s own ability to feel proprioceptive feedback, making it harder to sense their own movement.

• Counter-productive for motor learning. Motor skills grow through exploration, trial and error, and self-generated movement — not by being physically moved!

• A source of dysregulation. Feeling crowded or controlled can tip the nervous system toward fight, flight, or freeze — which shuts down learning.

• A consent problem. Even with gentle intentions, the adult’s action can teach the child that their hesitation or “no” doesn’t matter.

Some professionals suggest hand-under-hand as a softer alternative. But it can still be uncomfortable for many Autistic students for the same reasons: sensory sensitivities and unease with close proximity.

If you, as the adult supporting an Autistic child, feel you “need” to use hand-over-hand or hand-under-hand, pause. Rethink the task you are attempting to achieve and scaffold it so that the demand is lessened and the child can participate without having their personal space intruded upon.

What We Should Be Doing Instead

Autistic motor development often follows a different path. Rather than trying to force typical movement patterns, we can support authentic skill growth by breaking tasks into smaller steps and scaffolding each piece.

Scaffold, Don’t Override: Instead of positioning a child’s fingers into a “correct” pencil grasp, we can encourage grasp development through playful, hands-on fine-motor activities:

• Stringing beads

• Poking pipe cleaners into a colander

• Using tweezers, tongs, or clothespins with varied resistance

Model and Play with Writing Strokes:

• Make down strokes as “rain” on a vertical chalkboard or window

• Sweeping side-to-side strokes as “wind”

• Form shapes in sand, shaving cream, or finger paint

• Drawing big, loose strokes in the air before shrinking them down and building them up again!

The adult can model beside the student instead of touching their hand.

We start with big, playful movements before asking for precise pencil work.

The Crucial Takeaway

If an adult feels compelled to use hand-over-hand — or even hand-under-hand — it’s a signal that the task itself needs to be re-examined.

Perhaps we are asking for a skill the Autistic child is not ready for yet, or we have not scaffolded the steps enough. Forcing proximity does not teach the skill; it risks dysregulation. And dysregulation is the enemy of learning.

Have you ever reconsidered using hand-over-hand?

How have you scaffolded tasks in ways that honored a child’s sensory and personal-space needs?

Share your reflections in the comments!

More from Dr. Lisa Marnell and Kids Master Skills . . .

This fall Dr. Lisa launched an AOTA-approved professional development entitled, "Insight to Autism for School-Based OTs"!

This self-paced, online course provides 8 AOTA Contact Hours (0.8 AOTA CEUs) and walks OTPs through a process to bettter understand their Autistic students, support them in schools in ways that align with their Autistic neurobiology (enabling them to feel less stress and experience better quality of life), and show them how to optimize Autistic students' learning while also guiding teachers, staff, and admin to adopt neuroaffirming practices!

Check out Dr. Lisa's professional development at this picture link!

And if you are a parent, teacher, or other school professional, you can take Dr. Lisa's course tailored for you! Learn more about a course for you at this picture link!

If you want to learn more ways to support your autistic students, watch my FREE MasterClass that offers you proactive supports for sensory sensitive children and teens.

Register and watch it HERE: https://www.kidsmasterskills.com/ 

Also, do you have my 10 Neurodiversity-Affirming posters? Download them HERE! 

As always, feel welcome to touch base with me by e-mail at KidsMasterSkills@gmail.com

I would love to hear about your successes, your struggles, your feedback, and any questions or comments you have! Let me know if this post was helpful.

References:

MacLennan, K., O’Brien, S., & Tavassoli, T. (2022). Sensory reactivity differences in autistic adults: An examination across modalities. Journal of Autism and Developmental Disorders, 52(8), 3445–3457. https://doi.org/10.1007/s10803-021-05186-3