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Kennedy Krieger Institute

New study reveals handwriting is real problem for children with autism

Kennedy Krieger researchers suggest improvements are possible by targeting letter formation, fine motor control training

November 9, 2009 (Baltimore, MD) – Handwriting skills are crucial for success in school, communication, and building children's self-esteem. The first study to examine handwriting quality in children with autism spectrum disorders (ASD) has uncovered a relationship between fine motor control and poor quality of handwriting in children with ASD, according to research published in the November 10, 2009, issue of Neurology®, the medical journal of the American Academy of Neurology. The study, conducted by researchers at the Kennedy Krieger Institute, compared handwriting samples, motor skills, and visuospatial abilities of children with ASD to typically developing children. The researchers found that overall, the handwriting of children with ASD was worse than typically developing children. Specifically, children with ASD had trouble with forming letters, however in other categories, such as size, alignment, and spacing, their handwriting was comparable to typically developing children. These findings build on previous studies examining motor skills and ASD conducted in 2009 by Kennedy Krieger researchers.

Parents of children with ASD are often the first ones to observe their child's poor handwriting quality. This study identifies fine motor control as a root source of the problem and demonstrates that children with ASD may not experience difficulties across all domains, just forming letters. By identifying handwriting as a legitimate impairment, parents, teachers and therapists will now be able to pursue techniques that will improve children's handwriting.

"The ability to keep up in classes and convey ideas through handwriting is fundamental to life," said Christina Fuentes, lead study author and researcher at the Kennedy Krieger Institute. "Knowing the causes of impairment allows us to strategically identify techniques that will help children with ASD improve their handwriting. 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."

About the study

Researchers administered a total of three tests to 14 children with ASD and 14 typically developing children. The handwriting samples were scored on legibility, form, alignment, size and spacing. The children's motor skills were then assessed using the Revised Physical and Neurological Examination for Subtle Sign (PANESS). The PANESS consisted of multiple categories such as gait tasks (heel walking), balance tasks (hopping on one foot) and timed movements (repetitive and patterned movements). Lastly, the children's visuospatial skills were assessed using the Block Design test in which they were timed to reconstruct large designs by properly assembling a set of blocks.

With no significant difference between the typically developing children and children with ASD groups in age, perceptual reasoning IQ, and the Block Design scores, a significant difference was found for performance on the PANESS, with the typically developing children performing better. Researchers found children with ASD's total handwriting scores were lower than typically developing children due to the quality of their letter formation. Researchers also found that motor ability, specifically for timed movements, was a strong predictor of handwriting performance in children with ASD as opposed to age, intelligence, and visuospatial abilities.

"Identifying this fine motor deficiency in handwriting provides important insight about ASD," said Dr. Amy Bastian, corresponding study author and Director of the Motion Analysis Laboratory at the Kennedy Krieger Institute. "It provides another example of motor skill problems that may give us cues for other deficits with socialization and communication. Furthermore, occupational therapists and teachers can now take the information from this study and apply it to the students they see on a daily basis."

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This study was sponsored by Autism Speaks and the National Institutes of Health.

About Autism

Autism spectrum disorders (ASD) is the nation's fastest growing developmental disorder, with current incidence rates estimated at 1 in 100 children. This year more children will be diagnosed with autism than AIDS, diabetes and cancer combined, yet profound gaps remain in our understanding of both the causes and cures of the disorder. Continued research and education about developmental disruptions in individuals with ASD is crucial, as early detection and intervention can lead to improved outcomes in individuals with ASD.

About the Kennedy Krieger Institute

Internationally recognized for improving the lives of children and adolescents with disorders and injuries of the brain and spinal cord, the Kennedy Krieger Institute in Baltimore, MD serves more than 13,000 individuals each year through inpatient and outpatient clinics, home and community services and school-based programs. Kennedy Krieger provides a wide range of services for children with developmental concerns mild to severe, and is home to a team of investigators who are contributing to the understanding of how disorders develop while pioneering new interventions and earlier diagnosis. For more information on Kennedy Krieger Institute, visit www.kennedykrieger.org.