Use of nonverbal tests to screen for writing dysfluency in school-age children

Exploratory Investigation of Handwriting Disorders in School-Aged Children from First to Fifth Grade

Handwriting disorders (HDs) are prevalent in school-aged children, with significant interference with academic performances. The current study offers a transdisciplinary approach with the use of normed and standardized clinical assessments of neuropsychomotor, neuropsychological and oculomotor functions. The aim is to provide objective data for a better understanding of the nature and the etiology of HDs. Data from these clinical assessments were analyzed for 27 school-aged children with HD (first to fifth grade). The results underline a high heterogeneity of the children presenting HDs, with many co-occurrences often unknown. However, it was possible to highlight three levels of HDs based on BHK scores: mild HD not detected by the BHK test (26% of children), moderate HD (33%) and dysgraphia (41% of children). The mild nature of the HDs not detected by the BHK test appears to occur at a relatively low frequency of the associated disorders identified during clinical evaluations. On the contrary, dysgraphia appears to be associated with a high frequency of co-occurring disorders identified in the clinical assessment, with a predominance of oculomotor disorders (55% of children), leading to visual-perceptual difficulties and a high level of handwriting deterioration. Finally, children with moderate HD have fewer co-occurrences than children with dysgraphia, but have more difficulties than children with mild HD. This highlights the importance of differentiating between different degrees of HDs that do not respond to the same semiologies. Our findings support the interest in performing a transdisciplinary and standardized clinical examination with developmental standards (neuropsychomotor, neuropsychological and oculomotor) in children with HD. Indeed, HDs can therefore be associated with a multitude of disorders of different natures ranging from poor coordination of the graphomotor gesture to a more general and more complex impairment affecting perceptual-motor, cognitive and/or psycho-affective functions.

An Eye-Tracking Method for Directly Assessing Children's Visual-Motor Integration

BACKGROUND

Visual-motor integration is an integral component of many adaptive behaviors and has been linked to school readiness. In young school-age children, visual-motor integration is typically assessed with the Beery-Buktenica Developmental Test of Visual Motor Integration (Beery VMI), a standardized instrument that measures children's ability to copy 2-dimensional forms. The Beery VMI is scored according to children's final written product, but does not directly measure the process of visual-motor integration that underlies children's form copying.

OBJECTIVE

We describe a new way of directly assessing visual-motor integration in real time. We demonstrate how head-mounted eye-tracking technology for young children can be used to describe the dynamics of visual-motor integration when children copy forms.

DESIGN

This study used a cross-sectional design.

METHODS

Typically developing kindergarten children (N = 20) were tested as they wore an eye-tracker while performing the Beery VMI.

RESULTS

Participants' success (b = -0.66; SE = 0.08; Cohen f2 = 1.11) and their efficiency in visual (b = 0.29; SE = 0.02; Cohen f2 = 0.55) and motor (b = 0.12; SE = 0.01; Cohen f2 = 0.90) processes during form copying decreased as the stimulus complexity increased.

LIMITATIONS

A small convenience sample was used to determine proof of concept. A larger, more representative sample is necessary to provide generalizable results.

CONCLUSIONS

The new methods used here offer the possibility of more fine-grained assessments of eye-hand coordination in typically developing children and children with such clinical conditions as dysgraphia and developmental coordination disorder.

The Contribution of Gender, Orthographic, Finger Function, and Visual-Motor Processes to the Prediction of Handwriting Status

The present study examined if orthographic, finger function, and visual-motor processes as well as gender made a unique and significant contribution to the prediction of the handwriting status of fifth grade students classified as good or poor handwriters. Visual-motor integration and finger functioning made a unique and significant contribution to the prediction of handwriting status, whereas gender and orthographic processes did not. Furthermore, knowledge of children's gender, finger functioning, and visual-motor status resulted in the correct classification of 77% of the participating students as good or poor handwriters.

Discriminant Validity of the Visual Motor Integration Test in Screening Children with Handwriting Dysfunction

To examine the discriminant validity of the Visual Motor Integration test in screening children with handwriting dysfunction, 599 children in Grade 2, including 41 children with handwriting dysfunction identified by their teachers and 558 typically developing children, were assessed. The Visual Motor Integration test, with an area under the receiver operating characteristic curve (0.894), showed high accuracy regarding screening purposes. Judging from the values for sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, hit rate, Youden's index, and odds ratio, a standard score of 85 was the best cutoff point for screening children for handwriting dysfunction.

Factors associated with inadequate fine motor skills in Brazilian students of different socioeconomic status

The objective of this study was to evaluate and compare the motor coordination of Brazilian schoolchildren of different socioeconomic status in their first year of primary education. Factors associated with inadequate fine motor skills were identified. A total of 238 schoolchildren, 118 from a public school and 120 from a private school, were evaluated on fine motor skills using the Evolutional Neurological Examination. Statistical analysis was performed using univariate logistic regression followed by multivariate analysis. Children attending public school had a 5.5-fold greater risk of having inadequate fine motor skills for their age compared to children attending private school, while children who started school after four years of age had a 2.8-fold greater risk of having inadequate motor coordination compared to children who began school earlier. Data for this sample suggest socioeconomic factors and later entry of children to school may be associated with their fine motor skills.

Learning, attention, writing, and processing speed in typical children and children with ADHD, autism, anxiety, depression, and oppositional-defiant disorder

Learning, attention, graphomotor, and processing speed scores were analyzed in 149 typical control children and 886 clinical children with normal intelligence. Nonsignificant differences were found between control children and children with anxiety, depression, and oppositional-defiant disorder. Control children performed better than children with ADHD and autism in all areas. Children with ADHD and autism did not differ, except that children with ADHD had greater learning problems. Attention, graphomotor, and speed weaknesses were likely to coexist, the majority of children with autism and ADHD had weaknesses in all three areas, and these scores contributed significantly to the prediction of academic achievement.

Relationship between visual-motor integration and spatial organization of written language and math

PURPOSE

The relationship between visual-motor integration and academic achievement is not clearly understood. The purpose of this study was to assess the type and frequency of errors made by children with poor visual-motor integration during a written language and math task.

METHODS

Eighteen children with normal visual-motor integration (> or =36%) and 19 children with low visual-motor integration (< or =16%) participated in the study. The two groups had similar ages, gender profiles, and cognitive and reading levels. Each group copied and solved math problems and copied a written passage. The errors for the math and writing task were combined into a total error score, and the time taken to complete each task was combined into a total time score.

RESULTS

The low visual-motor integration group made more errors than the normal visual-motor integration group. However, the time taken to copy both tasks was not different between the two groups. A secondary analysis of the errors revealed that alignment of numbers (p = 0.02), organization of math problems (p = 0.05), and spacing errors of letters and words (p = 0.01) were more common in the low visual-motor integration group.

CONCLUSIONS

The results suggest that reduced visual-motor integration may contribute to poor spatial organization of written work.

Clinical value of the Beery visual-motor integration supplemental tests of visual perception and motor coordination

PURPOSE

Children may perform poorly on a test of visual-motor integration due to deficits in one or more of the following: visual analysis/visual spatial ability, motor coordination, visual conceptualization, or visual-motor integration. The VMI Supplemental Developmental Test of Visual Perception (VP) and VMI Supplemental Developmental Test of Motor Coordination (MC) were developed to help differentiate between such difficulties after administration of the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI). However, the clinical value of the VMI supplemental tests has not been reported.

METHOD

The VMI, VP, and MC were administered to 193 children (mean age = 8.77 years).

RESULTS

Multiple linear regression revealed that the supplemental tests were significantly related to the VMI (VP: beta = 0.212 +/- 0.044, p < 0.001; MC: beta = 0.422 +/- 0.299, p < 0.001) but explained only 36.2% of the variance in the VMI. Poor performance was defined as a score >1 SD below the mean for study population norms and below the 16th percentile for published norms. Using study population norms, 35 children did poorly on the VMI, 20% of whom scored poorly on VP, 14.3% of whom scored poorly on MC, 17.1% of whom scored poorly on both supplemental tests, and 48.6% of whom scored within normal on both supplemental tests. Using the published norms, 40 children scored poorly on the VMI. Twenty-eight children scored poorly on VP, 39% of whom scored within normal on the VMI. Fifty-six children scored poorly on MC, 54% of whom scored within normal on the VMI.

CONCLUSION

There was a significant amount of variance in performance on the VMI that was not explained by performance on the tests of VP or MC alone. Each area should be individually assessed during the visual perceptual examination of children, regardless of performance on the VMI. Even children who perform within normal limits on the VMI may show a deficit in VP or MC.

Predicting handwriting performance of early elementary students with the developmental test of visual-motor integration

The purpose of this study was to examine use of the Developmental Test of Visual-Motor Integration in predicting handwriting performance of early elementary students and the contribution of sex. An additional purpose was to examine whether successful completion of the first nine figures or the oblique cross from the test predicted handwriting. 101 children were tested at the beginning of their kindergarten year and again in the middle of the first-grade year on the Scale of Children's Readiness In PrinTing (SCRIPT). The VMI kindergarten scores did not significantly predict first-grade SCRIPT scores for the sample as a whole. When boys and girls were considered separately. VMI scores predicted handwriting SCRIPT scores for girls, but accounted for only 10% of the variance. Successful performance on the first nine VMI figures was significantly associated with handwriting for girls but not boys, while the oblique cross did not significantly predict handwriting performance. These results do not provide clear support for administration of the Developmental Test of Visual-Motor Integration during kindergarten as a tool to identify children at risk for handwriting difficulties.

Double-coding test: a new paper-and-pencil measure of eye-hand coordination

The present research presents the development of a new paper-and-pencil coding task that may find a variety of uses in the psychological assessment of cognitive processes. The aim of the new test, named the Double-coding Test, was to create a more complex task than the previous coding tests. This new task requires two different coding processes before marking the correct sign in the appropriate space. To validate this new double-coding task it was administered along with the Coding B subtest of the Wechsler Intelligence Scale for Children-Revised and the d2 Test. Also for validation the new test was administered to a clinical group of children having Attention Deficit/Hyperactivity Disorder. A sample of normal children is presented for five different ages from 8 and 13 years. Analysis showed that the Double-coding Test differentiates between clinical group and normal children more effectively than does the WISC-R Coding B subtest or the d2 Test. Suggestions are offered for use of the Double-coding Test.

Comparison of error rates and performance on Wechsler's Coding and Digit Symbol subtests and the Symbol-Symbol test for children and adults

Performance on Digit Symbol, Coding, and similar symbol-substitution tests are known to be influenced by a wide variety of reversible and nonreversible organic syndromes and learning disabilities. Recently, questions regarding the interchangeability of different symbol-substitution tests have been raised. The present study compared the performance, i.e., number of substitutions completed accurately and number of errors, of 37 adults, 32 adolescents, and 45 children on the Wechsler symbol-substitution tests of Digit Symbol and Coding with their performance on the recently designed Symbol-Symbol test. Analysis indicated that, while Symbol-Symbol performance is highly correlated with Wechsler scores on symbol-substitution tests, significant differences in error rates and speed of performance suggest that the Symbol-Symbol test cannot be considered an equivalent symbol-substitution test. Further investigation of the properties and the potential uses of the Symbol-Symbol test with clinical populations must be undertaken.