Objective: Children with ADHD often present with handwriting difficulties. However, the extent to which motor and attention skills influence performance in this group has not yet been explored. The objective of this study was to examine the factors associated with change in handwriting performance. Method: This study examines the factors associated with change in handwriting performance of 49 children newly diagnosed with ADHD (mean age = 8.4 [SD=1.3] years) prior to and 3 months following use of a stimulant medication. Results: Handwriting legibility and speed improved significantly at follow-up evaluation. However, most of the children with legibility difficulties at baseline continued to demonstrate difficulties when evaluated 3 months after initiation of medication. Change in handwriting legibility was best determined by improvements in visual-motor integration skills (β = 0.07-0.10; p < .001), while the change in speed did not appear to be consistently related to a single factor. Conclusion: Handwriting difficulties are common in children with ADHD, and medication alone is not sufficient to resolve these challenges.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. Washington, DC: Author.
2.
AmundsonS. J. (1995). Evaluation Tool of Children’s Handwriting: ETCH examiner’s manual. Homer, AK: O.T. KIDS.
3.
BartO.PodolyT.Bar-HaimY. (2010). A preliminary study on the effect of methylphenidate on motor performance in children with comorbid DCD and ADHD. Research in Developmental Disabilities, 31, 1443-1447.
4.
BeeryK. E.BuktenicaN. A.BeeryN. A. (2005). Beery-Buktenica Developmental Test of Visual-Motor Integration (5th ed.). Minneapolis, MN: NCS Pearson.
5.
Brossard-RacineM.MajnemerA.ShevellM.SniderL. (2008). Handwriting performance in children with attention deficit hyperactivity disorder (ADHD). Journal of Child Neurology, 23, 399-406.
6.
Brossard-RacineM.MajnemerA.ShevellM.SniderL.BélangerA. S. (2011). Handwriting capacity in children newly diagnosed with attention deficit hyperactivity disorder. Research in Developmental Disabilities, 32, 2927-2934.
7.
Brossard-RacineM.MazerB.JulienM.MajnemerA. (2012). Validating the use of the Evaluation Tool of Children’s Handwriting-Manuscript (ETCH-M) to identify handwriting difficulties and detect change in school-aged children. American Journal of Occupational Therapy, 66, 414-421.
8.
Brossard-RacineM.ShevellM.SniderL.BélangerA. S.MajnemerA. (2012). The motor skills in children newly diagnosed with Attention Deficit Hyperactivity Disorder prior to and following treatment with stimulant medication. Research in Developmental Disabilities, 33, 2080-2087.
9.
Canadian Attention Deficit Hyperactivity Disorder Resource Alliance. (2011). Canadian Attention Deficit Hyperactivity Disorder Resource Alliance (CADDRA): Canadian ADHD practice guidelines (3rd ed.). Toronto, Ontario, Canada: Author.
10.
ConnersC. K. (2001). Conner’s Rating Scales-Revised: Technical manual. North Tonawanda, NY: Multi-Health Systems.
11.
DiekemaS. M.DeitzJ.AmundsonS. J. (1998). Test-retest reliability of the Evaluation Tool of Children’s Handwriting-manuscript. American Journal of Occupational Therapy, 52, 248-255.
12.
DuffS.GoyenT. A. (2010). Reliability and validity of the Evaluation Tool of Children’s Handwriting-Cursive (ETCH-C) using the general scoring criteria [Validation Studies]. American Journal of Occupational Therapy, 64, 37-46.
13.
FederK. P.MajnemerA.BourbonnaisD.BlayneyM.MorinI. (2007). Handwriting performance on the ETCH-M of students in a grade one regular education program. Physical & Occupational Therapy in Pediatrics, 27, 43-62.
14.
FederK. P.MajnemerA.BourbonnaisD.PlattR.BlayneyM.SynnesA. (2005). Handwriting performance in preterm children compared with term peers at age 6 to 7 years. Developmental Medicine & Child Neurology, 47, 163-170.
15.
FlapperB. C. T.HouwenS.SchoemakerM. M. (2006). Fine motor skills and effects of methylphenidate in children with attention deficit-hyperactivity disorder and developmental coordination disorder. Developmental Medicine & Child Neurology, 48, 165-169.
16.
HarrellF. E. (2001). Regression modeling strategies. New York, NY: Springer.
17.
HendersonS. E.SugdenD. A. (1992). Movement Assessment Battery for Children: Manual. London, England: The Psychological Corporation.
18.
HoyM. M.EganM. Y.FederK. P. (2011). A systematic review of interventions to improve handwriting. Canadian Journal of Occupational Therapy, 78, 13-25.
19.
KaplanB. J.WilsonB. N.DeweyD.CrawfordS. G. (1998). DCDmaynot be a discrete disorder. Human Movement Science, 17, 471-790.
20.
KoziatekS. M.PowellN. J. (2002). A validity study of the Evaluation Tool of Children’s Handwriting-Cursive. American Journal of Occupational Therapy, 56, 446-453.
21.
LererR. J.LererM. P.ArtnerJ. (1977). The effects of methylphenidate on the handwriting of children with minimal brain dysfunction. Journal of Pediatrics, 91, 127-132.
22.
LufiD.GaiE. (2007). The effect of methylphenidate and placebo on eye-hand coordination functioning and handwriting of children with attention deficit hyperactivity disorder. Neurocase, 13, 334-341.
23.
MaelandA. F. (1992). Handwriting and perceptual motor skills in clumsy, dysgraphic, and normal children. Perceptual & Motor Skills, 75, 1207-1217.
24.
Malloy-MillerT.PolatajkoH. J.AnstettB. (1995). Handwriting error patterns of children with mild motor difficulties. Canadian Journal of Occupational Therapy, 62, 258-267.
25.
MiyaharaM.MobsI.Doll-TepperG. (2001). Severity of hyperactivity and the comorbidity of hyperactivity with clumsiness in three sample sources: School, support group and hospital. Child: Care, Health and Development, 27, 413-424.
26.
PitcherT. M.PiekJ. P.HayD. A. (2003). Fine and gross motor ability in males with ADHD. Developmental Medicine & Child Neurology, 45, 525-535.
27.
RosenblumS.EpszteinL.JosmanN. (2008). Handwriting performance of children with attention deficit hyperactive disorders: A pilot study. Physical & Occupational Therapy in Pediatrics, 28, 219-234.
28.
SantoshP. J. (2007). Pharmacotherapy in ADHD. In TaylorE. (Ed.), People with hyperactivity: Understanding and managing their problems (pp. 118-133). London, England: Mac Keith Press.
29.
Smith-EngelsmanB. C. M.NiemeijerA. S.van GalenG. P. (2001). Fine motor deficiencies in children diagnoses as DCD based on poor grapho-motor ability. Human Movement Science, 20, 161-182.
30.
TuchaO.LangeK. W. (2001). Effects of methylphenidate on kinematic aspects of handwriting in hyperactive boys. Journal of Abnormal Child Psychology, 29, 351-356.
31.
Van HoornJ. F.MaathuisC. G.PetersL. H.Hadders-AlgraM. (2010). Handwriting, visuomotor integration, and neurological condition at school age. Developmental Medicine & Child Neurology, 52, 941-947. doi:10.1111/j.1469-8749.2010.03715.x
32.
VolmanM. J. M.van SchendelB.JongmansM. J. (2006). Handwriting difficulties in primary school children: A search for underlying mechanisms. American Journal of Occupational Therapy, 60, 451-460.
33.
WatembergN.WaiserbergN.ZukL.Lerman-SagieT. (2007). Developmental coordination disorder in children with attention-deficit-hyperactivity disorder and physical therapy intervention. Developmental Medicine & Child Neurology, 49, 920-925.
34.
WechslerD. (1999). Wechsler Abbreviated Scale of Intelligence. San Antonio, TX: Psychological Corporation.
35.
WhalenC. K.HenkerB.FinckD. (1981). Medication effects in the classroom: Three naturalistic indicators. Journal of Abnormal Child Psychology, 9, 419-433.
