Children With ASD Have Specific Handwriting Impairments

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Children With ASD Have Specific Handwriting Impairments

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November 27, 2009 — Results of a case–control study show that children with

autism spectrum disorders (ASD) have particular problems with handwriting that

may respond to more training in letter formation and strategies to improve fine

motor control, the researchers say.

" The ability to keep up in classes and convey ideas through handwriting is

fundamental to life, " lead author T. Fuentes, BS, from the Kennedy

Krieger Institute, Baltimore, land, said in a statement. " Our study suggests

that teaching children how to form letters, in combination with general training

of fine motor control through techniques that include stabilizing the arm and

the use of proper writing utensils, may be the best direction for improving

handwriting performance. "

The findings were published in the November 10 issue of Neurology.

Handwriting a Challenge in ASD

Poor handwriting was noted in the original description of Asperger syndrome, the

researchers point out, and it has since been shown that children with ASD have

impairments in several domains that contribute to handwriting, including fine

and gross motor function and the ability to sense the position of their limbs in

space. They also tend visually to focus more on details than whole or global

features, and this may affect how the shapes of letters are perceived and

subsequently reproduced, the authors add.

In this study, they write, " we asked whether, consistent with common

observations, children with ASD show overall handwriting impairments, and if so,

whether these impairments are in specific qualitative categories. "

Using a case–control design, the researchers assessed handwriting samples using

the Minnesota Handwriting Assessment from children with and without ASD.

Handwriting samples from 14 children with ASD and 14 typically developing

control children were scored on the basis of legibility, form, alignment, size,

and spacing. In addition, participants were tested using the Wechsler

Intelligence Scale for Children–IV, and the Physical and Neurological

Examination for Subtle (Motor) Signs.

The children with ASD were found to have worse overall performance in

handwriting than their age- and intelligence-matched counterparts in the control

group. In particular, those with ASD had a more difficult time forming letters,

but they did not show differences in the ability to align, size, or space the

letters relative to the sample they were copying.

Motor skills were significantly predictive of handwriting performance, the

authors note, but not age, sex, IQ, or visuospatial abilities.

Compensatory Strategies

A previous study of adults with ASD showed they tended to write larger than

control patients, but this was not the case here, the authors point out.

However, the instruction in this test was to match the letter size in the

sample. It may have been that in the adult study, where the size of letters was

not specified, subjects had learned to draw their letters larger to compensate

for difficulties with fine motor control.

Although the children in this study were unable to use a compensatory sizing

strategy, some ASD subjects used other such strategies, the authors note.

" For example, 2 of the highest scoring subjects with ASD gripped their dominant

forearms with their nondominant hands to help steady their movements, a strategy

they were taught in school, " they write. " These observations, in combination

with the result that motor abilities strongly predict handwriting performance,

suggest that therapies targeting motor control are the best approach to

improving handwriting in individuals with autism. "

The study was supported by an Autism Speaks Pre-Doctoral Fellowship and a grant

from the National Institutes of Health. Ms. Fuentes has disclosed no relevant

financial relationships. Disclosures for coauthors appear in the article.

Neurology. 2009;73:1532–1537. Abstract

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Authors and Disclosures

Journalist

is the news editor for Medscape Neurology & Neurosurgery.

has been writing principally for physician audiences for nearly 20 years. Most

recently, she was news editor for thekidney.org and also wrote for theheart.org;

both of these Web sites have been acquired by WebMD. Prior to that, she spent 10

years covering neurology topics for a Canadian newspaper for physicians. She can

be contacted at S@....

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