Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Handwriting difficulties (HD) are a top reason for referral to OT. Executive function (EF) was described as an underlying mechanism of daily functioning and HD. This study found differences between handwriting of adolescents with HD and their peers with other daily function difficulties but no relation between EFs and legibility. The Handwriting Legibility Scale is suggested for evaluation of legibility in adolescents.
Primary Author and Speaker: Liat Hen-Herbst
PURPOSE: The aim of this study was to address the knowledge gap regarding characteristics of adolescents with handwriting difficulties and suggest insights to improve diagnosis of dysgraphia by occupational therapists (OTs). A sensitive tool to evaluate legibility among adolescents is proposed. Despite technology, handwriting is still required for self-expression, communication, and academic skills. An estimated 7%–15% of school-age children exhibit handwriting deficits. As known so far, handwriting difficulties may be divided into written product (less legible and organized; more erasures and corrections) and handwriting process (fewer letters produced per minute; more pressure applied) features. Previous studies suggested associations between handwriting and daily functioning tasks with executive function (EF) components as an underlying mechanism. Due to date, little attention was paid to handwriting difficulties among adolescents. Adolescents who do not develop proficient handwriting risk low grades, severe academic difficulties, and low self-esteem. Sustained research in this field is crucial to not only advance knowledge of underlying deficits in adolescents with handwriting difficulties, but also improve diagnosis of dysgraphia and treatment. We compared adolescents with self-reported handwriting difficulties to peers with self-reported difficulties in other daily activities. Based on previous studies, we expected both groups to present difficulties in EF. The characteristics of each group were examined in terms of handwriting process, legibility, and EF, and correlations between handwriting measures and EF were evaluated.
DESIGN: This cross-sectional study was based on a sample of 81 adolescents aged 10 to 18 years. They were divided into two groups based on their main reason for referral to OT: Group 1, adolescents aged 13–18 years with self-reported handwriting difficulties (n = 40; M = 15.60 years, SD = 1.34); Group 2, adolescents aged 10–15 years, with self-reported difficulties in daily functions (n = 41; M = 13.83 years, SD = 2.19).
METHOD: Adolescents completed the Behavior Rating Inventory of Executive Function-Self Report (Guy et al., 2004) and copied a paragraph on a digitizing tablet. ComPET software (Rosenblum et al., 2003) was used to analyze aspects of the handwriting process. The copied script was also scored with the Handwriting Legibility Scale (Barnett et al., 2018). We used MANOVA to measure between-group differences in all measures, and Pearson correlations to measure associations between EFs and handwriting legibility in each group separately.
RESULTS: As expected, the results showed no significant between-group differences in EF measures. Adolescents with handwriting difficulties wrote significantly faster, but their legibility was significantly poorer. Significant correlations were found between EFs and handwriting process but not legibility.
CONCLUSION: Results indicate that adolescents with self-reported handwriting difficulties may have significantly less legible handwriting than do adolescents with self-reported difficulties in daily activities. Further, EF deficits may be related to process measures and might be considered as an underlying mechanism for difficulties in daily activities, as for handwriting production. However, the finding that legibility had no relationship with EFs suggests other explanatory factors account for illegible handwriting and reflect the nature of the legibility measure. Further research is needed. The practical contribution of this study is its proposal of legibility as a sensitive handwriting measure to evaluate adolescents with specific handwriting difficulties and the Handwriting Legibility Scale as an effective tool for that purpose.
References
Barnett, A. L., Prunty, M., & Rosenblum, S. (2018). Development of the Handwriting Legibility Scale (HLS): A preliminary examination of reliability and validity. Research in Developmental Disabilities, 72, 240–247. https://doi.org/10.1016/j.ridd.2017.11.013
Guy, S.C., Isquith, P.K., & Gioia, G.A. (2004). Behavior Rating Inventory of Executive Function- Self-Report version professional manual. Lutz, FL: Psychological Assessment Resources.
Rosenblum, S., Parush, S., & Weiss, P. L. (2003). Computerized temporal handwriting characteristics of proficient and non-proficient hand writers. The American Journal of Occupational Therapy, 57(2), 129-138.
