Handwriting process and product characteristics of children diagnosed with developmental coordination disorder

Deficits in handwriting performance limit the school participation of children with developmental coordination disorder (DCD). The aim of this study was to compare the handwriting process and product characteristics of children with DCD to those of typically developing (TD) children in order to determine the best means of differentiation between the groups. Participants were 40 children, from 7 to 10 years old. The experimental group consisted of 20 children who met the criteria of DCD, and the control group consisted of 20 age- and gender-matched controls. The children were asked to perform three graded writing tasks on an electronic tablet, which was part of a computerized handwriting evaluation system (ComPET), in order to obtain measures of their handwriting process. The children's handwriting product was then evaluated by the Hebrew Handwriting Evaluation (HHE). Results showed significant differences between the groups for the handwriting process measures (on-paper and in-air time, mean pressure) and for the handwriting product characteristics (global legibility, number of letters erased or overwritten, spatial arrangement, and number of letters written in the first minute). The discriminant analysis yielded a high significant discrimination (80-90%), with the 'number of letters erased or overwritten' variable as the most differentiating variable (-.67). We concluded that an evaluation of both handwriting process and product characteristics among children with DCD provides a more comprehensive picture of their deficits. Using this method may enable practitioners to focus on children's main deficits and to tailor intervention methods so as to prevent academic underachievement and its consequences on their emotional well-being.     

Assessing handwriting speed of children biliterate in English and Chinese

The assessment of multiliterate handwriting performance is rarely reported despite increased globalization. The present study describes the psychometric properties of a handwriting speed test developed for children who are biliterate in English and Chinese. This included interrater reliability, test-retest reliability, interitem correlation, construct validity, and concurrent validity. The test's reliabilities between two raters and over a 1-wk. interval were high with ICCs ranging from .89 to .99. Interitem correlation between the English and Chinese items was .87. The presence of age trends but not sex differences was a positive indicator of the test's validity. Correlations of .91 and 1.00 between the Chinese and the English items of the Handwriting Assessment Tool with the Chinese Handwriting Speed Test and Handwriting Speed Test, respectively, provided evidence of concurrent validity. These preliminary results showed the Handwriting Assessment Tool is reliable and is a potentially useful handwriting test for children biliterate in English and Chinese. The feasibility of assessing biliterate handwriting speed performance with the same set of scoring criteria for different writing systems was supported.     

Graphomotor skills in children with developmental coordination disorder (DCD): Handwriting and learning a new letter

The aim of the present study was to analyze handwriting difficulties in children with developmental coordination disorder (DCD) and investigate the hypothesis that a deficit in procedural learning could help to explain them. The experimental set-up was designed to compare the performances of children with DCD with those of a non-DCD group on tasks that rely on motor learning in different ways, namely handwriting and learning a new letter. Ten children with DCD and 10 non-DCD children, aged 8–10 years, were asked to perform handwriting tasks (letter/word/sentence; normal/fast), and a learning task (new letter) on a graphic tablet. The BHK concise assessment scale for children’s handwriting was used to evaluate their handwriting quality. Results showed that both the handwriting and learning tasks differentiated between the groups. Furthermore, when speed or length constraints were added, handwriting was more impaired in children with DCD than in non-DCD children. Greater intra-individual variability was observed in the group of children with DCD, arguing in favor of a deficit in motor pattern stabilization. The results of this study could support both the hypothesis of a deficit in procedural learning and the hypothesis of neuromotor noise in DCD.     

Do motor ability and handwriting kinematic measures predict organizational ability among children with Developmental Coordination Disorders?

Background and aimChildren with Developmental Coordination Disorders (DCD) exhibit deficient daily performance concealed in their perception–action mechanism. The aim of this study was to analyze behavior organization of children with DCD, in varied tasks that require generating and monitoring mental representations related to space and time inputs/requirements, for achieving better insight about their perception–action mechanism.MethodParticipants included 42 children aged 7–10, half of whom were defined with DCD and half were typically developing (TD). The children were matched for age, gender and school. They were evaluated using the Movement–ABC and performed three handwriting tasks on an electronic tablet that is part of a computerized system (ComPET – Computerized Penmanship Evaluation Tool). In addition, their teachers completed the Questionnaire for Assessing Students’ Organizational Abilities-Teachers (QASOA-T) to assess the children’s daily organizational ability.ResultsSignificant group differences (DCD versus controls) were found for all handwriting kinematic measures across the three handwriting tasks and for the children’s organizational abilities. Motor ability predicted a considerable percentage of the variance of the kinematic handwriting measures (30–37%), as well as a high percentage of the variance of their organizational abilities (67%). The coefficient of variance of the pen tilt added an additional 3% to the prediction of their organizational abilities.ConclusionsThe results of this study exhibited deficient ability among children with DCD in organizing their behavior in varied real-world tasks requiring generation and monitoring representation related to space and time. The significance of the results to understanding the performance mechanism and implication to the clinical field are discussed.     

Driving Behaviour in Young Adults with Developmental Co-ordination Disorder

Between 30 and 70% of children with developmental co-ordination disorder (DCD) will have persistent daily functioning difficulties in adulthood (Cousins and Smyth 2003). However, few DCD studies have focussed specifically on the stage of emerging adulthood. Driving is an important rite of passage which marks the start of independence from parents. Delay, difficulty or avoidance in learning to drive may all have profound social, practical and psychological implications for the young adult with DCD. The driving experiences of 38 students with DCD and 77 typically developing students aged 17–25 years were examined using a semi-structured questionnaire. Quantitative measures indicate that fewer adults with DCD learn to drive compared to controls and that they show continuing difficulties with distance estimation and parking. Qualitative comments give a valuable insight into the learning and driving experiences of adults with DCD. Differences in the driving behaviour of adults with DCD and attention deficit hyperactivity disorder (ADHD) are discussed, as it is the need to consider guidance on driving skills when providing a package of care for young adults with DCD.     

Eye movements during the handwriting of words: Individually and within sentences

Handwriting, a complex motor process involves the coordination of both the upper limb and visual system. The gaze behavior that occurs during the handwriting process is an area that has been little studied. This study investigated the eye-movements of adults during writing and reading tasks. Eye and handwriting movements were recorded for six different words over three different tasks. The results compared reading and handwriting the same words, a between condition comparison and a comparison between the two handwriting tasks. Compared to reading, participants produced more fixations during handwriting tasks and the average fixation durations were longer. When reading fixations were found to be mostly around the center of word, whereas fixations when writing appear to be made for each letter in a written word and were located around the base of letters and flowed in a left to right direction. Between the two writing tasks more fixations were made when words were written individually compared to within sentences, yet fixation durations were no different. Correlation of the number of fixations made to kinematic variables revealed that horizontal size and road length held a strong correlation with the number of fixations made by participants.     

Developmental coordination impairments in adulthood

The aim of this study was to extend the understanding of Developmental Coordination Disorder (DCD) into adulthood. We recruited 19 adults aged between 18 and 65 who had received diagnoses of DCD or dyspraxia or who self-reported as having motor impairments consistent with a history of DCD, together with age- and gender-matched controls. Participants were given tests of manual dexterity, handwriting, construction, obstacle avoidance, dynamic balance, static balance, dual task performance, ball skills, reaction time, movement time and sequencing. As a group, adults with DCD performed more poorly than controls across all tasks. Slowness and variability of movement was a pervasive feature of their performance and many individuals had considerable problems with sequencing and with dual task performance. A discriminant function analysis conducted using six performance measures correctly classified participants as car drivers or non-drivers. Adults do retain motor difficulties and these can exclude them from important activities of daily living.     

Mental rotation performance in young adults with and without developmental coordination disorder

While there have been consistent behavioural reports of atypical hand rotation task (HRT) performance in adults with developmental coordination disorder (DCD), this study aimed to clarify whether this deficit could be attributed to specific difficulties in motor imagery (MI), as opposed to broad deficits in general mental rotation. Participants were 57 young adults aged 18–30 years with (n = 22) and without DCD (n = 35). Participants were compared on the HRT, a measure of MI, and the letter number rotation task (LNRT), a common visual imagery task. Only participants whose behavioural performance on the HRT suggested use of a MI strategy were included in group comparisons. Young adults with DCD were significantly less efficient compared to controls when completing the HRT yet showed comparable performance on the LNRT relative to adults with typical motor ability. Our data are consistent with the view that atypical HRT performance in adults with DCD is likely to be attributed to specific difficulties engaging in MI, as opposed to deficits in general mental rotation. Based on the theory that MI provides insight into the integrity of internal action representations, these findings offer further support for the internal modelling deficit hypothesis of DCD.     

Tactile localization performance in children with developmental coordination disorder (DCD) corresponds to their motor skill and not their cognitive ability

When localizing touches to the hands, typically developing children and adults show a “crossed hands effect” whereby identifying which hand received a tactile stimulus is less accurate when the hands are crossed than uncrossed. This demonstrates the use of an external frame of reference for locating touches to one’s own body. Given that studies indicate that developmental vision plays a role in the emergence of external representations of touch, and reliance on vision for representing the body during action is atypical in developmental coordination disorder (DCD), we investigated external spatial representations of touch in children with DCD using the “crossed hands effect”. Nineteen children with DCD aged 7–11 years completed a tactile localization task in which posture (uncrossed, crossed) and view (hands seen, unseen) were varied systematically. Their performance was compared to that of 35 typically developing controls (19 of a similar age and cognitive ability, and 16 of a younger age but similar fine motor ability). Like controls, the DCD group exhibited a crossed hands effect, whilst their overall tactile localization performance was weaker than their peers of similar age and cognitive ability, but in line with younger controls of similar motor ability. For children with movement difficulties, these findings indicate tactile localization impairments in relation to age expectations, but apparently typical use of an external reference frame for localizing touch.     

Reliance on visual feedback from ocular accommodation on motor skills in children with developmental coordination disorder and typically developing controls

Children with developmental coordination disorder (DCD) present with marked impairments in motor skills, including visual-motor integration. Oculomotor anomalies are more prevalent in children with DCD than typically developing children. Children with DCD further demonstrate altered use of visual feedback compared to typically developing controls. We investigated whether the accommodation system, a key component of the oculomotor system, contributes to visual feedback during fine and gross motor skills performance; and whether children with DCD demonstrate differences in reliance on visual feedback from accommodation. Minus dioptre lenses were used to maximally induce accommodation and impede accommodation dynamics. Children with DCD and typically developing controls performed motor skills tests assessing balance, upper limb coordination, visual-motor performance, gross and fine dexterity. Motor skills performance in controls was significantly affected by impeded accommodation in all tasks. Children with DCD demonstrated reliance on accommodation feedback in upper limb and visual-motor tasks only. Children with DCD may be less reliant on visual feedback obtained from accommodation due to adaptive mechanisms to overcome faulty information in the presence of oculomotor anomalies. These results strengthen our previous findings that accommodation anomalies contribute to motor skills impairment, and suggest that performance on these motor tasks is heavily reliant on visual feedback from accommodation.     

Visual perceptual and handwriting skills in children with Developmental Coordination Disorder

ObjectiveChildren with Developmental Coordination Disorder demonstrate a lack of automaticity in handwriting as measured by pauses during writing. Deficits in visual perception have been proposed in the literature as underlying mechanisms of handwriting difficulties in children with DCD. The aim of this study was to examine whether correlations exist between measures of visual perception and visual motor integration with measures of the handwriting product and process in children with DCD.MethodThe performance of twenty-eight 8–14 year-old children who met the DSM-5 criteria for DCD was compared with 28 typically developing (TD) age and gender-matched controls. The children completed the Developmental Test of Visual Motor Integration (VMI) and the Test of Visual Perceptual Skills (TVPS). Group comparisons were made, correlations were conducted between the visual perceptual measures and handwriting measures and the sensitivity and specificity examined.ResultsThe DCD group performed below the TD group on the VMI and TVPS. There were no significant correlations between the VMI or TVPS and any of the handwriting measures in the DCD group. In addition, both tests demonstrated low sensitivity.ConclusionClinicians should execute caution in using visual perceptual measures to inform them about handwriting skill in children with DCD.     

Gaze behaviour during walking in young adults with developmental coordination disorder

BackgroundIndividuals with Developmental Coordination Disorder (DCD) experience difficulty with motor coordination and this affects their daily functioning. Research indicated inferior visuospatial processing and oculomotor control in DCD. As visual information is essential for locomotor control, more insight in the gaze behaviour of this population during walking is required and crucial for gaze training interventions as a possible means to improve daily functioning of children and adults with DCD.AimThis study explored differences and similarities in gaze behaviour during walking between typically developing young adults and those with DCD.Methods and proceduresTen young adults with DCD (age: 22.13 ± 0.64) and ten typically developing individuals (age: 22.00 ± 1.05) completed a walking task in which they had to place their feet on irregularly placed targets wearing eye tracking glasses.Outcomes and resultsIndividuals with DCD walked slower and demonstrated a different gaze strategy compared to their neurotypical peers as they fixated almost each and every target sequentially. Typically developing individuals, on the other hand, directed gaze further along the path and often fixated areas around the targets.Conclusions and implicationsDespite adequate walking performance in daily situations in young adults with DCD, fundamental control deficits persist into adulthood.What this paper adds?This paper is the first to demonstrate differences in gaze behaviour between young adults with DCD and typically developing individuals in a task that resembles a task of daily living, as previous research focused on laboratory tasks. This is a valuable finding as DCD has a clear impact on the daily life. Furthermore, this study demonstrated that the fundamental control deficits of DCD persist into adulthood despite frequent performance and practice of these daily tasks. Lastly, these findings might contribute to the therapeutic potential of gaze training interventions to improve the daily functioning of children and adults with DCD.     

Adapting to the surface: A comparison of handwriting measures when writing on a tablet computer and on paper

Our study addresses the following research questions: Are there differences between handwriting movements on paper and on a tablet computer? Can experienced writers, such as most adults, adapt their graphomotor execution during writing to a rather unfamiliar surface for instance a tablet computer?We examined the handwriting performance of adults in three tasks with different complexity: (a) graphomotor abilities, (b) visuomotor abilities and (c) handwriting. Each participant performed each task twice, once on paper and once on a tablet computer with a pen.We tested 25 participants by measuring their writing duration, in air time, number of pen lifts, writing velocity and number of inversions in velocity. The data were analyzed using linear mixed-effects modeling with repeated measures.Our results reveal differences between writing on paper and on a tablet computer which were partly task-dependent. Our findings also show that participants were able to adapt their graphomotor execution to the smoother surface of the tablet computer during the tasks.     

Development of motor imagery ability in children with developmental coordination disorder – A goal-directed pointing task

Children with developmental coordination disorder (DCD) have difficulties with the predictive control of movements. This was shown in studies that target motor imagery and motor planning, and appears to become particularly evident with increases in task complexity. In this study, we used a complex mental chronometry paradigm to examine the development of motor imagery ability in children with DCD, using a longitudinal design. Thirty children were included in the DCD group (aged 6–11 years) and age- and gender-matched to 30 controls. The DCD group had a Movement Assessment Battery for Children-2 score ≤16th percentile and the control group ≥25th percentile. Results of this study showed that children with DCD indeed had a significantly lower correlation between executed and imagined movements. Importantly, the increase in the correlation and linear fit during subsequent measurements was comparable for the DCD and control group. Together, these findings suggest a delayed developmental onset of motor imagery ability in DCD, but a similar rate of development over time compared to the control group. Based on these results, it seems likely that explicit motor imagery instructions can be used to improve predictive control in children with DCD.     

The effect of a motor skills training program in the improvement of practiced and non-practiced tasks performance in children with developmental coordination disorder (DCD)

The purpose of the present study was to examine the effect of a group-based task oriented skills training program on motor and physical ability for children with DCD. It was also investigated if there was an effect on fine motor and handwriting tasks that were not specifically practiced during the training program. Forty-one children aged 6–10 years took part in this study. Children were assigned to three groups: an experimental training group consisting of 14 children with DCD, a control non-training group consisted of 13 children with DCD and a control non-training group consisting of 14 typically developed children. The measurements included were, the Movement Assessment Battery for Children (MABC), the Modified Agility Test (MAT), the Triple Hop Distance (THD), the 5 Jump-test (5JT) and the Handwriting Performance Test. All measures were administered pre and post an 8-week training program. The results showed that 10 children of the DCD training-group improved their performance in MABC test, attaining a score above the 15th percentile after their participation in the training program. DCD training-group showed a significant improvement on all cluster scores (manual dexterity (t (13) = 5.3, p < .001), ball skills (t (13) = 2.73, p < .05) and balance (t (13) = 5.13, p < .001). Significant performance improvements were also found in MAT, THD, 5JT (t (13) = –4.55; p < .01), handwriting quality (t (12) = –2.73; p < .05) and speed (t (12) = –4.2; p < .01) after the training program. In conclusion, improvement in both practiced and non-practiced skills, in the training program, may reflect improvement in motor skill but also transfer to other skills.     

计算机时代的书写心理学

计算机的普及使人们阅读及书写的能力降低, 这引发了社会对书写的关注。书写涉及大量高级神经活动, 与认知、人格、疾病等均有关联, 对个体发展也具有重要作用。现代书写心理学通过使用书写板等设备, 实现了对书写过程及结果的量化研究, 发现了书写速度、压力、握笔等指标与智力、认知负荷等的一些关联。未来对书写过程的研究可以进一步深入; 测量方面的研究成果可以应用到日常人机交互及教学、司法等实践中; 还可以研究用书写促进个体认知及人格发展的具体途径。     

Inferring Gender from Handwriting in Urdu and English

Abstract

Handwriting samples in both English and Urdu from 30 donors were judged for masculinity-femininity by 25 judges (both judges and donors were adult Pakistanis, bilingual and literate in both Urdu and English). Inferences about gender were made reliably and accurately in both Urdu and English. Levels of accuracy (about 68%) were similar to those reported in studies of handwriting in English. Judged gender of handwriting was significantly stable across the two languages studied. These effects are relevant for the study of gender roles and gender stereotyping in assessment.     

Fine motor deficiencies in children diagnosed as DCD based on poor grapho-motor ability

A sample of 125 children from grades 4 and 5 of two normal Dutch primary schools were investigated regarding the incidence of handwriting problems and other fine motor disabilities. Handwriting quality was assessed with the concise assessment method for children's handwriting (BHK) and the school questionnaire for teachers (SQT). Two groups of 12 children each were formed, one group of good writers and a group of poor writers selected from the lower performance range. The latter group was investigated in depth by assessing general and fine motor ability using the Movement Assessment Battery for Children (M-ABC test) and the Motor Performance School Readiness Test (MSRT). We hypothesised that poor handwriting is part of a wider neuromotor condition characterised by faster and cruder movements, lack of inhibition of co-movements and poor co-ordination of fine motor skills. To test the theory kinematic measures of drawing movements were collected on the flower-trail-drawing item of the M-ABC test. Moreover, the experimental group of poor writers received physiotherapy during a three-month period and was tested for handwriting proficiency after therapy and again nine months later. The results revealed that 34% of the group of 125 children displayed handwriting problems. The analysis confirmed that serious handwriting problems are accompanied by fine motor deficits. We suggest that in these children an enhanced level of neuromotor noise is compensated for by enhanced phasic stiffness of the limb system. This results in higher movement velocity and fewer velocity peaks. In the children who received physiotherapy the quality of handwriting improved.     

Motor and cognitive control in a normative sample of 7‐year‐olds

The aim of the present study was to explore the relationship between cognitive and motor control by correlating individual performance on a variety of complex tasks in a normative sample of over 100 7‐year‐olds. While there are a few studies including children with specific developmental disorders (i.e. ADHD and DCD) showing that they share similar comorbid deficits, it is still unclear whether control processes share variance in normative samples. Results presented here reveal on the one hand that some aspects of cognitive and motor control are significantly interrelated, even when controlling for age. On the other hand, individuals’ ability to efficiently respond to the speed and accuracy demands of any of the included tasks appeared to constitute an important aspect of executive functioning.     

Effect of dual tasking on a dynamic balance task in children with and without DCD

The purpose of this study was to compare performance of children with Developmental Coordination Disorder (DCD) and typically developing (TD) children in a dual task paradigm with a dynamic balance task on the Wii Fit as primary task and a concurrent cognitive (counting) or a concurrent bimanual fine motor task as secondary tasks.Using a cross-sectional design, 25 children with DCD and 38 TD children were assessed with the Movement Assessment Battery for Children, 2nd edition (MABC-2) and Divided Attention (DA) task of the KiTAP. Next, the single- and dual-tasks were performed and the level of interference or facilitation of the dual tasks was calculated. Regression analysis determined the predictive value of the DA and MABC-2 component balance outcomes on the dual task performance. On the motor and attentional tasks, the group of children with DCD scored significantly below the level of the TD children. The dual task effect showed similar interference and facilitation of tasks in the different dual-task conditions in both groups.In the dual task-cognitive condition, the divided attention abilities and the MABC-2 balance score predicted 25% of the Wii Fit dynamic balance task performance, whereas in the dual task-motor condition this was higher (31.6%). In both conditions, DA was a stronger predictor than MABC balance score and appears to be an important factor to consider when developing motor task training for children with DCD.