Abstract
Date Presented 4/8/2016
Executive control and especially working memory, material organization, and emotional control predict handwriting performance features of children with dysgraphia. Occupational therapists should refer to this in research and practice to improve children’s handwriting as their main school occupation.
Primary Author and Speaker: Sara Rosenblum
PURPOSE: This study aimed to describe handwriting and executive control features and their interrelationships among children with developmental dysgraphia, in comparison to controls.
RATIONALE: Skilled handwriting is essential for school-age children. Children unsuccessful in developing proficient handwriting are defined with dysgraphia as a specific learning disability. In recent years, extensive research has explored the relationship between executive function (EF) and learning and behavior. However, literature focusing on the relationships between handwriting performance and EF is scarce.
DESIGN: This was a comparative and correlative study, based on a convenience sample.
PARTICIPANTS: The study included 64 children ages 10–12 yr from regular schools. Thirty-two children were defined by their teacher as having dysgraphia based on the Handwriting Proficiency Screening Questionnaire (HPSQ), and 32 were age- and gender-matched controls with typical development (TD).
METHOD: Children copied a paragraph on an electronic tablet that is part of a computerized system supplying temporal, spatial, and pressure measures of the handwriting process. Their writing fluency and their written product was evaluated by the Hebrew Handwriting Evaluation (HHE). Furthermore, their parents competed the Behavioral Rating Inventory of Executive Function (BRIEF)supplying both final scores and scores for each of eight EF domains.
ANALYSIS: Mann–Whitney U test was applied to find group differences in the HHE measures and multivariate analysis of variance analysis in the BRIEF subscales. Three stepwise regression analyses were performed in the group with dysgraphia for prediction of handwriting performance by the BRIEF eight subdomains.
RESULTS: Significant group differences were found for handwriting fluency, for all written product outcome measures (HHE), and across the eight BRIEF subdomains. Regression analysis indicated that the BRIEF working memory subdomain accounted for 33% and organization of materials added 10% of the variance to prediction of number of letters erased or written over. Interestingly, emotional control accounted for 20% of the variance of the mean writing pressure, and 30% of the variance of strokes’ mean height was predicted by monitoring, initiation, and organization of materials.
DISCUSSION: The current results of exhibiting inferior handwriting fluency and legibility among children with dysgraphia is in line with previous findings. Due to these children’s energy investment in orthographic motor processing, they are unavailable to think about the writing content, and it may cause increased fatigue and frustration.
Previous studies stressed the importance of working memory and other executive control domains related to the written content. However, the relations between executive control domains and writing production have not yet been studied. Results of the regression analysis highlight the importance of EF domains to handwriting performance abilities. Several theoretical and practical implications for improving handwriting performance and consequently academic success and self-efficacy will be discussed.
IMPACT STATEMENT: This is one of the first studies to highlight the important contribution of EF domains to actual activity performance, that is, handwriting proficiency. The study emphasizes the need to consider EF deficits as related to deficient performance and to evaluate it in a case of handwriting difficulties.
