Ambidextrous or Just Undecided? Understanding Hand Preference in Children

As an Occupational Therapist who recently underwent a reverse shoulder replacement on my dominant side, I’ve been living a personal experiment in "forced ambidexterity." It's highlighted just how deeply wired our motor habits are and how much we rely on having a clear dominant side. Tasks that once felt automatic now require conscious planning, extra effort, and a lot of patience.

This experience has also reignited a question I often encounter in my work with children:
Is being ambidextrous a strength, or can it actually present challenges, especially for neurodivergent children?

Let’s unpack this topic.

What Is Ambidexterity, Really?

Ambidexterity is the ability to use both hands with equal skill. True ambidexterity is rare, occurring in fewer than 1% of the population. More commonly, we see mixed-handedness when different hands are used for different tasks, or delayed hand dominance, particularly in young children or those with neurological differences.

Hand dominance typically emerges between 2.5 and 5 years of age, as the brain begins to establish lateralisation, specialising certain functions to one hemisphere. Most people naturally develop a preference for one hand, which supports the development of automaticity in fine motor tasks such as writing, using scissors, and brushing teeth.

Why Is Dominance Important?

From an OT perspective, establishing a clear and consistent dominant hand is crucial for:

• Developing fine motor precision

• Increasing speed and fluency in academic tasks like writing and cutting

• Supporting neural efficiency in the motor cortex

• Reducing cognitive load, requiring fewer brain resources, when movement patterns are automatic

Children without a dominant hand often show:

• Slower task performance, initiation and completion

• Immature pencil grasp

• Messy or inconsistent handwriting that sometimes include letter or number reversals

• Fatigue during fine motor tasks

• Poor bilateral coordination, such as stabilising paper while writing

Ambidexterity and Neurodivergence

Parents often proudly share that their child is ambidextrous. But when I dig a little deeper, I often find:

• Sensory processing challenges

• Dyspraxia or developmental coordination disorder (DCD)

• Autism Spectrum Disorder (ASD)

• ADHD or executive functioning differences

For neurodivergent children, mixed-handedness or ambidexterity may reflect an underlying difficulty with motor planning, body awareness, or interhemispheric communication rather than a true strength.

For example:

• A child who switches hands may be doing so because neither hand feels “right”, a red flag for sensory-motor integration issues

• Others may lack postural stability or have poor proprioception, which limits their ability to refine motor skills on one side

Research Insight:
A 2020 study by Gonzalez and Nelson (in Neuropsychologia) found that children with mixed-handedness performed lower on academic and executive functioning tasks compared to their right- or left-handed peers.

The Myth of the “Gifted Ambidextrous Child”

The idea that being ambidextrous is a sign of high intelligence, creativity, or genius is a persistent myth. While some creative individuals, like Leonardo da Vinci, were reportedly ambidextrous, most cognitive and motor development theories, like Ayres' Sensory Integration Theory, support the benefits of cerebral lateralisation and hand dominance.

Occupational Therapy Perspective:
In our clinical lens, ambidexterity without a clear reason, such as trauma or surgery, often raises flags. We see it as an indicator to further assess the child’s:

• Postural stability

• Core strength and proximal control

• Bilateral coordination and crossing midline

• Visual-motor integration

• Fine motor planning (praxis)

What Should Parents Look For?

✅ Healthy signs of dominance:

• Your child consistently uses one hand for skilled tasks by age 5

• The preferred hand is used for writing, feeding, drawing, and brushing teeth

• The other hand is used to stabilise or assist, like holding paper still

🚩 Potential concerns:

• Switching hands mid-task or mid-word

• Inconsistent grasp or pencil pressure

• Difficulty crossing midline or using the left hand only on the left side of the body

• Fatigue or frustration with fine motor tasks

• Poor pencil control, reversals, or awkward pencil grasp

What Can Be Done?

As OTs, we can support children by:

• Observing for natural preference through play and self-care routines

• Using bilateral activities such as threading, cutting, ball games, to encourage the integration of both sides of the body

• Promoting core and shoulder stability to support fine motor control

• Offering hand dominance activities, practising with one hand while the other stabilises

• Consulting standardised tools like:

• BOT-2 (Bruininks-Oseretsky Test of Motor Proficiency)

• Beery VMI

• Sensory Integration and Praxis Tests (SIPT) or 

• Clinical Observations of Motor and Postural Skills (COMPS)

If dominance hasn’t emerged by school entry age (or is inconsistent), it’s worth a full OT assessment.

Final Thoughts: Respecting Neurodiversity While Supporting Function

In a neuroaffirming world, we value and support all kinds of brain wiring, including motor differences. Being "ambidextrous" may be how some children naturally show up in the world, and it’s not something to pathologise, but it does require a closer look to ensure they’re functionally successful and not experiencing hidden barriers to learning.

Our goal as OTs isn’t to force a dominant side, but to promote efficient, coordinated, and confident movement for everyday success, whether that means encouraging more consistency, building foundational strength, or simply helping a child feel good about how their body works.

Recommended Resources

• Ayres, A. J. (2005). Sensory Integration and the Child.

• Case-Smith, J., & O'Brien, J. C. (2015). Occupational Therapy for Children and Adolescents (7th ed.)

• Gonzalez, C. L. R., & Nelson, E. L. (2020). “Handedness and Academic Skills in Children: A Review.” Neuropsychologia, 147, 107585.

• www.understood.org – for parent-friendly articles on sensory and motor development

• www.spdstar.org – resources on sensory processing disorder and motor planning