Children with autism show specific handwriting impairments

Abstract

Background: Handwriting skills, which are crucial for success in school, communication, and building children's self-esteem, have been observed to be poor in individuals with autism. Little information exists on the handwriting of children with autism, without delineation of specific features that can contribute to impairments. As a result, the specific aspects of handwriting in which individuals with autism demonstrate difficulty remain unknown.

Methods: A case-control study of handwriting samples from children with and without autism spectrum disorders (ASD) was performed using the Minnesota Handwriting Assessment. Samples were scored on an individual letter basis in 5 categories: legibility, form, alignment, size, and spacing. Subjects were also tested on the Wechsler Intelligence Scale for Children-IV and the Physical and Neurological Examination for Subtle (Motor) Signs.

Results: We found that children with ASD do indeed show overall worse performance on a handwriting task than do age- and intelligence-matched controls. More specifically, children with ASD show worse quality of forming letters but do not show differences in their ability to correctly size, align, and space their letters. Within the ASD group, motor skills were significantly predictive of handwriting performance, whereas age, gender, IQ, and visuospatial abilities were not.

Conclusions: We addressed how different elements of handwriting contribute to impairments observed in children with autism. Our results suggest that training targeting letter formation, in combination with general training of fine motor control, may be the best direction for improving handwriting performance in children with autism.

Figures

Figure 1 Handwriting samples from subjects with autism spectrum disorders (ASD) Subjects copied the top sample (A). The ASD group consisted of children with a range of handwriting skills. Samples are from one of the lower scoring subjects with ASD (B) and from a higher scoring subject from the ASD group (C).

Figure 2 Average total and form handwriting scores across groups The control group averaged significantly higher total (A) and form (B) handwriting scores than did the autism spectrum disorders (ASD) group. Error bars represent standard error (*p < 0.02, **p < 0.01).

Figure 3 Examples of autism spectrum disorders (ASD) form errors Examples of common form errors demonstrated by subjects with ASD and well-formed corresponding letters by control subjects (CTL). Some featured errors included sharp points in sections that should be curved (o and s), extensions greater than 1/16 of an inch (b), and generally poor quality (k).

Figure 4 Physical and Neurological Examination for Subtle (Motor) Signs (PANESS) scores predict overall handwriting scores in subjects with autism spectrum disorders (ASD) Only within the ASD group, PANESS timed movement scores predicted total handwriting scores (R2 = 0.56, p = 0.002). Higher handwriting scores represent better performance, while higher PANESS scores represent worse performance. Solid line represents ASD group’s least squares fit; dashed line represents control group’s fit. CTL = controls.