NEUROLOGY 2009;73:1532-1537
© 2009 American Academy of Neurology
Children with autism show specific handwriting impairments
Christina T. Fuentes, BS,
Stewart H. Mostofsky, MD and
Amy J. Bastian, PhD
From the Departments of Neuroscience (C.T.F., A.J.B.) and Neurology (S.H.M., A.J.B.), Johns Hopkins School of Medicine, Baltimore; and Kennedy Krieger Institute (C.T.F., S.H.M., A.J.B.), Baltimore, MD.
Address correspondence and reprint requests to Dr. Amy Bastian, Kennedy Krieger Institute, 707 N Broadway–G05, Baltimore, MD 21205 bastian{at}kennedykrieger.org
Background: Handwriting skills, which are crucial for success in school, communication, and building children’s self-esteem, have been observed to be poor in individuals with autism. Little information exists on the handwriting of children with autism, without delineation of specific features that can contribute to impairments. As a result, the specific aspects of handwriting in which individuals with autism demonstrate difficulty remain unknown.
Methods: A case-control study of handwriting samples from children with and without autism spectrum disorders (ASD) was performed using the Minnesota Handwriting Assessment. Samples were scored on an individual letter basis in 5 categories: legibility, form, alignment, size, and spacing. Subjects were also tested on the Wechsler Intelligence Scale for Children–IV and the Physical and Neurological Examination for Subtle (Motor) Signs.
Results: We found that children with ASD do indeed show overall worse performance on a handwriting task than do age- and intelligence-matched controls. More specifically, children with ASD show worse quality of forming letters but do not show differences in their ability to correctly size, align, and space their letters. Within the ASD group, motor skills were significantly predictive of handwriting performance, whereas age, gender, IQ, and visuospatial abilities were not.
Conclusions: We addressed how different elements of handwriting contribute to impairments observed in children with autism. Our results suggest that training targeting letter formation, in combination with general training of fine motor control, may be the best direction for improving handwriting performance in children with autism.
Abbreviations: ADI-R = Autism Diagnostic Interview–Revised; ADOS-G = Autism Diagnostic Observation Schedule–Generic; ASD = autism spectrum disorders; DICA-IV = Diagnostic Interview for Children and Adolescents, 4th edition; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; FSIQ = full-scale IQ; PANESS = Physical and Neurological Examination for Subtle (Motor) Signs; PRI = Perceptual Reasoning Indices; WISC-IV = Wechsler Intelligence Scale for Children–IV.
Supported by an Autism Speaks Pre-Doctoral Fellowship (A.J.B. and C.T.F.) and NIH Grant R01 NS048527 (S.H.M.).
Disclosure: Author disclosures are provided at the end of the article.
Received April 24, 2009. Accepted in final form August 7, 2009.
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Handwriting Deficits in Children with Autism
Journal Watch Pediatrics and Adolescent Medicine,
November 18, 2009;
2009(1118):
5 - 5.
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