A systematic review of occupational therapy intervention for handwriting skills in 4-6 year old children

Preliminary Psychometric Properties of the Letter Form Assessment Version 2 (LFA-2) Scale

IMPORTANCE

Because handwriting is fundamental to academic success and early literacy development, it is crucial to identify letter formation difficulties. The Letter Form Assessment Version 2 (LFA-2) was developed to measure letter formation fluency but requires validation.

OBJECTIVE

To examine the LFA-2's interrater reliability, construct validity (factor structure), and concurrent validity.

DESIGN

Observational cross-sectional analysis of data from a longitudinal study.

SETTING

School.

PARTICIPANTS

Seventy-eight kindergarten students in Australia (41 boys, 37 girls; M age = 68.5 mo, SD = 4.2) were recruited for construct and concurrent validity studies. A subgroup (n = 16) was used for interrater reliability testing.

RESULTS

Interrater reliability for LFA-2 total was excellent (interclass correlation coefficient = .96, 95% confidence interval [.90, .98]). Interrater agreement coefficients for individual letters scores were good to excellent (Cohen's κ = .71 to 1.00; Gwet's AC1 = .79 to 1.00). Factor analysis established unidimensionality with good total score reliability (ω = .92). Correlations of the LFA-2 total score were moderate to strong with timed and untimed alphabet writing (rs = .32 and rs = .36, respectively), visual-motor integration (rs = .55), fine motor precision (rs = .35), and manual dexterity (rs = .34; all ps < .01).

CONCLUSIONS AND RELEVANCE

Preliminary findings support the LFA-2's reliability and validity for assessing letter formation fluency among beginning writers. Multiple raters using the LFA-2 were reliable in their use of the tool (interrater reliability), and item structure was confirmed to be unidimensional (construct validity). The LFA-2 performed as expected compared with other measures (concurrent validity). Research on larger samples is required to verify these results. Plain-Language Summary: Handwriting is an important skill in early education and supports the development of reading and writing skills. To write by hand efficiently, children need to develop movement patterns that allow them to form letters correctly and from memory. Children can advance their literacy skills once they can perform these letter formation patterns automatically. There are limited assessments of beginning writers' letter formation patterns, making it difficult for occupational therapists and teachers to identify children who need more help with their early handwriting. A new tool, the Letter Form Assessment Version 2 (LFA-2), has been developed to address this need. This study presents the first results of the development and validation of the LFA-2.

Kindergarten Visual-Perceptual and Motor Skills and Behavioral Traits Predict First-Grade Chinese Handwriting Legibility and Speed

IMPORTANCE

Clarifying the relationship between kindergarteners' characteristics and their future handwriting performance is beneficial for the early detection of children at risk of handwriting difficulties.

OBJECTIVE

To determine which visual-perceptual and motor skills and behavioral traits significantly predict kindergartners' Chinese handwriting legibility and speed in the first grade.

DESIGN

One-year longitudinal, observational design.

SETTING

Kindergarten and elementary schools.

PARTICIPANTS

One hundred six kindergarten children (53 boys and 53 girls; ages 5 or 6 yr) were recruited.

OUTCOMES AND MEASURES

The participants completed two subtests of the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition, Test of Visual Perceptual Skills-Third Edition, Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery™ VMI), and the Attention-Deficit/Hyperactivity Disorder Test-Chinese Version in kindergarten. Their handwriting legibility (character accuracy and construction) and speed were assessed by investigator-developed Chinese handwriting tests in the first grade.

RESULTS

Multivariate regression analyses indicated the independent predictive power of spatial relationships (p = .042) and inattention (p = .004) for character accuracy. Visual-motor integration (VMI; p = .008) and inattention (p = .002) were the key predictors of character construction. Manual dexterity (p = .001) was the only significant predictor of writing speed.

CONCLUSIONS AND RELEVANCE

Kindergarteners who perform poorly in spatial relationships, VMI, manual dexterity, and attention are likely to have less legible Chinese handwriting and slow writing speed in first grade. Plain-Language Summary: Children's visual-perceptual and motor skills and behavioral traits in kindergarten can predict their Chinese handwriting legibility and speed in first grade. This study found that kindergarteners who performed poorly in spatial relationships, VMI, manual dexterity, and attention were likely to have less legible Chinese handwriting and slow writing speed in the first grade.

Underlying functions associated with keyboarding performance of elementary-school students

BACKGROUND

Keyboarding (Typing) is a major writing mode in educational settings in addition to, or as an alternative to, handwriting. Therefore, it is important that occupational therapists become experts on this activity, to support students' performance. Yet, the knowledge of keyboarding performance of elementary-school students, and the underlying functions it entails, is limited.

AIM

To compare keyboarding performance (speed and accuracy) of 4th-grade students in copying and dictation keyboarding tasks, and to examine the role of underlying functions in predicting keyboarding performance.

MATERIAL AND METHODS

The sample consisted of 57 4th-grade students, recruited from 2 elementary schools. Students were tested for reading speed, attention shifting, fine-motor skills, kinaesthetic awareness, and keyboarding performance.

RESULTS

Keyboarding performance differed in the copying and dictation tasks. Reading speed was the major underlying function predicting keyboarding performance in both tasks. Additionally, kinaesthetic awareness had a low, negative correlation with dictation accuracy.

CONCLUSIONS

When occupational therapists assess students' keyboarding performance, they should use various tasks. Additionally, therapists should consider students' reading speed and kinaesthetic awareness, as they may explain keyboarding performance. This knowledge may also support decision-making when considering keyboarding as an alternative writing mode for students with handwriting difficulties.

Teaching and Rehabilitation of Handwriting for Children in the Digital Age: Issues and Challenges

Handwriting is a determining factor for academic success and autonomy for all children. Making knowledge accessible to all is a challenge in the context of inclusive education. Given the neurodevelopmental diversity within a classroom of children, ensuring that the handwriting of all pupils progresses is very demanding for education professionals. The development of tools that can take into account the variability of the profiles and learning abilities of children with handwriting difficulties offers a new potential for the development of specific and adapted remediation strategies. This narrative review aims to present and discuss the challenges of handwriting learning and the opportunities offered by new technologies involving AI for school and health professionals to successfully improve the handwriting skills of all children.

Identification and characterization of learning weakness from drawing analysis at the pre-literacy stage

Handwriting learning delays should be addressed early to prevent their exacerbation and long-lasting consequences on whole children's lives. Ideally, proper training should start even before learning how to write. This work presents a novel method to disclose potential handwriting problems, from a pre-literacy stage, based on drawings instead of words production analysis. Two hundred forty-one kindergartners drew on a tablet, and we computed features known to be distinctive of poor handwriting from symbols drawings. We verified that abnormal features patterns reflected abnormal drawings, and found correspondence in experts' evaluation of the potential risk of developing a learning delay in the graphical sphere. A machine learning model was able to discriminate with 0.75 sensitivity and 0.76 specificity children at risk. Finally, we explained why children were considered at risk by the algorithms to inform teachers on the specific weaknesses that need training. Thanks to this system, early intervention to train specific learning delays will be finally possible.

Making all the right moves: Clinician-led development and pilot of an evaluative toolkit for a community-based school readiness group program

Introduction

Children often present to occupational therapy with delays in pre-school occupations, with underlying skill deficits. If unaddressed, deficits may affect adjustment to school, jeopardising educational progress. Although evidence supports group-based interventions, evaluation can be time-intensive and expensive. We developed and piloted an evaluative toolkit to measure and report outcomes for short school readiness groups.

Method

We sought measures that were inexpensive, reliable and responsive to change in key domains. Skills and pre-school occupations were measured in children [n = 58; mean = 5 years] before and after our school starters group program. Parents rated their children's skills, school readiness and level of school-related anxiety.

Results

Our resource-efficient, multi-measure, skills-based evaluative toolkit reliably recorded changes in children's performance in our school readiness program. Measures were adapted for groups. Children demonstrated improvements in skills important for successful school transition pre-post program; including static and dynamic balance, pencil grasp/control, pre-writing/drawing skills and name writing. Parents' confidence in their child's readiness for school increased, while school-related-anxiety decreased.

Conclusion

The evaluative toolkit proved responsive to change and showed excellent inter-rater reliability. Measures were practicable for groups, easy to administer and score, and engaged parents in their child's progress. In our six-session School Starters group, important pre-school skills were improved in participating children.

Effects of occupational therapy on improvements in the handwriting ability of the adult non-dominant hand: An exploratory randomised controlled trial

INTRODUCTION

Occupational therapy often involves handwriting acquisition practices that include the non-dominant hand when improvements in the dominant hand function are not possible because of trauma or stroke. This study explored whether character tracing and using a pegboard can effectively improve the handwriting of the non-dominant hand.

METHODS

A randomised controlled trial involving 60 healthy university students aged ≥18 years was conducted. Participants were randomly assigned to the writing group, peg group or control group. The character recognition rate was evaluated by computer software. Furthermore, character quality and writing speed were evaluated by humans using global legibility scales. Evaluations were performed before the intervention (baseline) and on days 5 and 10 of the intervention. Using the non-dominant hand, the writing group traced characters on paper with a ballpoint pen, and the peg group used a pegboard for 15 min/day for 10 days.

RESULTS

Compared with the peg and control groups, the writing group showed significant improvements in the character recognition rate and global legibility scale score. However, the global legibility scale score did not improve to the same level as that achieved with the dominant hand. None of the evaluation scores of the peg group showed significant improvements compared with those of the control group. There were no significant differences in improvements in the writing speed of the writing and peg groups compared with the control group.

CONCLUSION

Tracing characters can improve the handwriting ability of the non-dominant hand, but using a pegboard may be less effective. Future research is needed to examine how much practice is necessary to improve the handwriting ability of the non-dominant hand sufficiently.

Association between reduced visual-motor integration performance and socioeconomic factors among preschool children in Malaysia: A cross-sectional study

Visual-motor integration (VMI) is related to children’s academic performance and school readiness. VMI scores measured using the Beery-Bucktenicka Developmental Test of Visual-Motor Integration (Beery-VMI) can differ due to differences in cultural and socioeconomic backgrounds. This study compared the VMI scores of Malaysian preschoolers with the corresponding US norms and determined the association between their VMI scores and socioeconomic factors. A cross-sectional study was conducted among 435 preschoolers (mean age: 5.95±0.47 years; age range: 5.08–6.83 years) from randomly selected public and private preschools. VMI scores were measured using Beery-VMI in the preschools’ classrooms. Information on the socioeconomic characteristics of the preschoolers was obtained using a parent-report questionnaire. One sample t-test was used to compare their VMI scores with the corresponding US norms. Multivariate logistic regression models were used to explore the influence of socioeconomic factors on the preschoolers’ VMI scores. Overall, Malaysian preschoolers’ VMI performance was similar to the US standardized norms (p>0.05). Children from low-income families were twice likely to obtain lower than average VMI scores than those from higher-income families (OR = 2.47, 95%CI 1.05, 5.86). Children enrolled at public preschools were more likely to obtain a lower than average VMI score than those who enrolled at private preschools (OR = 2.60, 95%CI 1.12, 6.06). Children who started preschool at the age of six were more likely to obtain lower than average VMI scores than those who started at an earlier age (OR = 4.66, 95%CI 1.97, 11.04). Low maternal education level was also associated with lower than average VMI score (OR = 2.60, 95%CI 1.12, 6.06). Malaysian preschoolers’ Beery-VMI performance compared well to their US counterparts. Some socioeconomic factors were associated with reduced VMI scores. Those from disadvantaged socioeconomic backgrounds are more likely to have reduced VMI performance, potentially adversely affecting their school readiness, cognitive performance, and future academic achievements.

Handwriting Readiness among Digital Native Kindergarten Students

Aims: Handwriting is an essential life skill, impacted by proficiency in visual-motor integration and fine motor control. The increase in the use of digital technology has changed the way children interact with their environments, and potentially, the development of the important requisite skills for handwriting. This study examined the "handwriting readiness" skills of children born in the digital age.Methods: 219 children in their first year of formal schooling (mean age = 5 years, 10 months), completed the Beery Buktenica Developmental Test of Visual Motor Integration (Beery-VMI) and the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) Short Form to assess visual motor integration, overall motor proficiency, and fine motor proficiency. Pencil grasp was also observed. Data analysis consisted of descriptive statistics and comparison to established normative data using summary t-tests.Results: Participants met the expected performance level on the Beery-VMI and the manual dexterity subtest of the BOT-2. However, overall motor proficiency on the BOT-2 for our sample was lower than published normative data. Further, 60.3% of participants used static pencil grasps.Conclusions: The findings prompt us to question the potential contribution of digital technology to changes in motor performance among children in the digital age.

Visual Perception, Fine Motor, and Visual-Motor Skills in Very Preterm and Term-Born Children before School Entry-Observational Cohort Study

Very preterm children (<32 weeks gestation at birth; VP) are at risk of developmental difficulties. Specific functional difficulties and delays in visual perception, fine motor, and visual-motor skills have received little research attention, although they are critical for daily life and school readiness. Our aim was to assess these skills in a contemporary cohort of 60 VP and 60 matched term-born children before school entry. We administered the Movement Assessment Battery for Children (M-ABC-2) and the Developmental Test of Visual Perception (DTVP-2). Linear and logistic regressions were run to test group differences in performance and rates of developmental delay in visual perception, fine motor, and visual-motor skills. Very preterm children had lower scores than term-born children in visual perception (β = -0.25; p = 0.006), fine motor (β = -0.44; p < 0.001), and visual-motor tasks (β = -0.46; p < 0.001). The rate of developmental delay (<-1 SD) was higher among VP in visual perception (odds ratio (OR) = 3.4; 95% confidence interval (CI 1.1-10.6)), fine motor (OR = 6.2 (2.4-16.0)), and visual-motor skills (OR = 13.4 (4.1-43.9)) than in term-born controls. VP children are at increased risk for clinically relevant developmental delays in visual perception, fine motor, and visual-motor skills. Following up VP children until preschool age may facilitate early identification and timely intervention.

Handwriting skills of children with tic disorders

INTRODUCTION

Although circumstantial evidence suggests children with tic disorders (TD) experience challenges in handwriting which may be attributed to their tics, few studies have systematically investigated handwriting performance among children with TD. This study examined the relationship between handwriting deficits and TD using a causal comparative research design.

METHODS

Thirty-four children with TD completed the Test of Handwriting Skills-Revised (THS-R). The overall percentile ranks of the THS-R were analysed to determine if children with TD have lower scores compared to the test's normative values. Writing speed, letter reversals, touching letters and case errors were also evaluated.

RESULTS

Data revealed the median percentile rank of the THS-R for the participants was significantly lower than the median percentile score of the THS-R for the normative sample. Close to 80% (n = 27) of writing samples were scored below 50th percentile. More than one-third (35.3%, n = 12) of the writing samples were scored greater than one standard deviation below the normative mean on the THS-R. Of the four ancillary scores, 82.4% (n = 28) of the participants' writing samples scored below 50th percentile (in the categories of watch or test further) on case errors and 67.6% (n = 23) scored below 50th percentile on writing speed.

CONCLUSION

Findings suggested that children with TD took longer to complete the writing task, and committed more case substitution errors than the normative sample of the THS-R and were likely to exhibit handwriting deficits.

Impact of Psycho-Educational Activities on Visual-Motor Integration, Fine Motor Skills and Name Writing among First Graders: A Kinematic Pilot Study

This pilot study presents the effects on acquisition of pre-writing skills of educational activities targeting visual-motor integration and fine motor skills on a convenient sample of first graders. After a 10-week intervention program, visual perceptual skills and fine motor control were tested on 13 six-year-old aged children. Participants completed the Beery-Buktenica VMI and the manual dexterity scale of the Movement ABC-2 at baseline (T1), after the intervention program (T2), and one month after the end of the educational activities (T3). Children's writing pressure, frequency, and automaticity were measured using a digitizer during the administration of name writing test at T1, T2, and T3. The purpose of the study was to investigate changes in visual-perceptual abilities and fine motor skills after the intervention program and examine correlational effects on children's kinematic writing performances. Findings reveal that educational activities impacted positively on children's visual motor coordination component of writing improving VMI scores. No statistically significant difference was detected across the three time points on students' manual dexterity skills. Measurement of writing kinematics allows to report and document variations in children's writing during intervention. This pilot study discusses these findings and their implications for the field on early childhood acquisition of foundational skills for handwriting. It also proposes potential topics for future research on this field.