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Li-Tsang CW, Li TM, Yang C, Cheung PP, Au K, Chan Y, Cheung K, Ho K, Kwok K, Leung HW. Evaluation of a group-based sensorimotor intervention programme to improve Chinese handwriting of primary school students. Heliyon 2022; 9:e12554. [PMID: 36816238 PMCID: PMC9932709 DOI: 10.1016/j.heliyon.2022.e12554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/18/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Sensorimotor performance is influential in Chinese handwriting, but few studies have examined the efficacy of sensorimotor-based interventions on Chinese handwriting among primary school students with poor handwriting performance. The study aims to evaluate a sensorimotor-based intervention to improve handwriting in the mainstream primary schools. Methods This study adopted a two-group pretest-posttest design. An 8-session group-based sensorimotor intervention was delivered to school-aged children (mean age = 8.1, 68% male). Group A had 2 sessions every week, while Group B had 4 sessions every week. Analysis of variance with repeated measures was used to test the effects. Results The intervention had a significant time effect (p < .05) in terms of improving handwriting process (d = 0.33-1.10), manual dexterity (d = 0.57), visual memory (d = 0.70), visual-spatial perception (d = 0.37), and motor and postural skills (d = 0.73). The effect sizes ranged from medium to large. For the handwriting process, time per character had a significant group × time interaction, with post hoc analysis showing that Group A had a significantly large effect (d = 1.89, p < .001) while Group B did not. Conclusions The group-based sensorimotor intervention programme appeared to show improvements in students with fair skills in writing Chinese characters. It appears that the effect is better if the training sessions are spaced out in one month rather than intensively conducted within two weeks. It might be related to more involvement from parents, and students need more time for practice after the training sessions.
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Affiliation(s)
- Cecilia W.P. Li-Tsang
- Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong,Corresponding author.
| | - Tim M.H. Li
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - C.N. Yang
- Department of Computer Science, City University of Hong Kong, Hong Kong
| | | | - K.Y. Au
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Y.P. Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - K.Y. Cheung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - K.H. Ho
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - K.W. Kwok
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Howard W.H. Leung
- Department of Computer Science, City University of Hong Kong, Hong Kong
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Computerized handwriting evaluation and statistical reports for children in the age of primary school. Sci Rep 2022; 12:15675. [PMID: 36123417 PMCID: PMC9485126 DOI: 10.1038/s41598-022-19913-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 09/06/2022] [Indexed: 11/09/2022] Open
Abstract
This study proposed a novel computational method for evaluating logographic handwriting. It can precisely evaluate both the handwriting product and the process. The measures included handwriting performance as well as the temporospatial, kinematics, and kinetics features. For examining the psychometrics of this comprehensive evaluation system, typical development children aged 6 to 9 years old (grade 1 to grade 3) (n = 641) were involved in the study of factor analysis. From twelve measuring variables, the exploratory factor analysis extracted five factors (handwriting performance, motor control, speed and automation, halt and exertion, and “in air” events). The test reliability was confirmed by further recruitment of typically developing children (n = 242). The internal consistency mostly demonstrated good to excellent results for every measure. This study further recruited children with handwriting difficulties (n = 33) for testing the discriminative validity of the evaluation system. A series of two-way ANOVA tests was conducted to test the significance of the main effects of the groups (typical development and handwriting deficit) and grades (1, 2, and 3) and their interaction effects on the handwriting measures. All the measures showed significant differences between the two groups, indicating the discriminative validity for identifying handwriting deficits. Seven of twelve measures showed significant interaction effects, indicating the different trends across the grades between the two groups. Typically-developing children demonstrated ongoing progress from grade 1 to grade 3, suggesting a developmental trend during their early school age. Implications for motor development and clinical evaluation are discussed herein in relation to the five dimensions.
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Takagi S, Hori H, Yamaguchi T, Ochi S, Nishida M, Maruo T, Takahashi H. Motor Functional Characteristics in Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorders: A Systematic Review. Neuropsychiatr Dis Treat 2022; 18:1679-1695. [PMID: 35971415 PMCID: PMC9375548 DOI: 10.2147/ndt.s369845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The development of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs) has various influences on physical abilities. Identification of specific physical abilities of people with ADHD/ASDs as biomarkers for diagnosing these conditions is necessary. Therefore, in the present review, we aimed firstly to extract the difference in physical abilities of people with ADHD or ASDs compared to those of normal individuals. Secondly, we aimed to extract the specific physical ability characteristics for identifying potential diagnostic biomarkers in people with ADHD/ASDs. METHODS A systematic literature review was performed. The databases were searched for relevant articles on motor function deficits and characteristics of ADHD or ASD. RESULTS Forty-one cross-sectional studies and three randomized controlled trials were identified, comprising 33 studies of ADHD, 10 studies of ASDs, and 1 study of both ADHD and ASDs. The quality of studies varied. Three types of physical activities/exercises were identified, including coordinated movement, resistance-type sports, and aerobic-type sports. People with ADHD/ASDs generally exhibited poorer physical abilities for all types of activities, possibly because of low levels of physical activity. Specifically, we found temporal discoordination of movement in ADHD and integration or synchronization of separate movements in ASDs. CONCLUSION Specific deficits in physical ability may be attributed to ADHD/ASDs. However, there is not enough research on the physical abilities of people with ADHD and ASDs to clarify the specific deficits. Investigation of specific motor functions that characterize ADHD/ASDs should be facilitated.
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Affiliation(s)
- Shunsuke Takagi
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Hikaru Hori
- Department of Psychiatry, School of Medicine, Fukuoka University, Fukuoka, 814-0180, Japan
| | - Tatsuya Yamaguchi
- Institute for Integrated Sports Medicine, School of Medicine, Keio University, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shinichiro Ochi
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Ehime, 791-0295, Japan
| | - Masaki Nishida
- Faculty of Sport Science, Waseda University Tokorozawa, Saitama, 359-1192, Japan
| | - Takashi Maruo
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Hidehiko Takahashi
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
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Lelong M, Zysset A, Nievergelt M, Luder R, Götz U, Schulze C, Wieber F. How effective is fine motor training in children with ADHD? A scoping review. BMC Pediatr 2021; 21:490. [PMID: 34736439 PMCID: PMC8567617 DOI: 10.1186/s12887-021-02916-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background Motor deficiencies are observed in a large number of children with ADHD. Especially fine motor impairments can lead to academic underachievement, low self-esteem and frustration in affected children. Despite these far-reaching consequences, fine motor deficiencies have remained widely undertreated in the ADHD population. The aim of this review was to systematically map the evidence on existing training programs for remediating fine motor impairments in children with ADHD and to assess their effectiveness. Methods The scoping review followed the PRISMA-ScR guidelines. In March 2020, PsycINFO, MEDLINE (PubMed), Web of Science, Google Scholar and The Cochrane Database of Systematic Reviews were searched for evidence. The eligibility criteria and the data charting process followed the PICO framework, complemented by study design. The investigated population included children with a formal ADHD diagnosis (either subtype) or elevated ADHD symptoms aged between 4 and 12 years, both on and off medication. All training interventions aiming at improving fine motor skills, having a fine motor component or fine motor improvements as a secondary outcome were assessed for eligibility; no comparators were specified. Results Twelve articles were included in the final report, comprising observational and experimental studies as well as a review. Both offline and online or virtual training interventions were reported, often accompanied by physical activity and supplemented by training sessions at home. The training programs varied in length and intensity, but generally comprised several weeks and single or multiple training sessions per week. All interventions including more than one session were effective in the treatment of fine motor deficiencies in children with ADHD and had a wide range of additional positive outcomes. The effects could be maintained at follow-up. Conclusions Fine motor training in children with ADHD can be very effective and multiple approaches including specific fine motor and cognitive training components, some kind of physical activity, feedback mechanisms, or multimodal treatments can be successful. Training programs need to be tailored to the specific characteristics of the ADHD population. A mHealth approach using serious games could be promising in this context due to its strong motivational components. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02916-5.
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Affiliation(s)
| | - Annina Zysset
- School of Health Professions, Institute of Health Science, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
| | - Mirjam Nievergelt
- Zurich University of Teacher Education, Centre for Inclusion and Health in Schools, Zuerich, Switzerland
| | - Reto Luder
- Zurich University of Teacher Education, Centre for Inclusion and Health in Schools, Zuerich, Switzerland
| | - Ulrich Götz
- Zurich University of the Arts, Institute for Design Research, Zuerich, Switzerland
| | - Christina Schulze
- School of Health Professions, Institute of Occupational Therapy, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
| | - Frank Wieber
- School of Health Professions, Institute of Health Science, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland. .,Department of Psychology, University of Konstanz, Konstanz, Germany.
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Reliability and validity of Handwriting Test for Preschool Children (HT-PRE): A new tool to assess the handwriting ability of preschool children aged 5-6 years old in Mainland China. PLoS One 2020; 15:e0229786. [PMID: 32119715 PMCID: PMC7051084 DOI: 10.1371/journal.pone.0229786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 02/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Handwriting ability is related to many neuronal functions, such as visual-perceptual skills, orthographic coding, motor planning and execution, kinesthetic feedback and visual-motor coordination. To date, there is no specific assessment tool for to assess preschool children's handwriting ability in Mainland China. Our study aimed to develop a tool to assess the handwriting ability of children aged 5-6 years old in Mainland China and to analyze its reliability and validity. METHODS The investigation comprised three phases: 1) original tool generation, 2) tool revision, 3) reliability analysis (i.e., interrater, test-retest) and validity analysis (i.e., content, criterion). RESULTS The sample included a total of 482 children. The internal consistency (Cronbach alpha) was 0.74. The test-retest correlation coefficients ranged from 0.38 to 0.80. As expected, our data showed an improving trend in handwriting, and differences in respect to age and gender. When compared with the 'handwriting difficulty' group, each subtest score of children in the 'normal' group showed significant differences (p < 0.05). The correlation validity, compared with the visual-motor integration development test (VMI), was 0.17-0.52. CONCLUSION The Handwriting Test for Preschool Children (HT-PRE), which is a newly developed handwriting screening tool for preschool children aged 5-6 years old in Mainland China, has displayed a very good internal consistency, acceptable test-retest reproducibility, and good criterion-based validity, and has also shown good application prospects for handwriting difficulty screening in a clinical setting.
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Cohen R, Cohen-Kroitoru B, Halevy A, Aharoni S, Aizenberg I, Shuper A. Handwriting in children with Attention Deficient Hyperactive Disorder: role of graphology. BMC Pediatr 2019; 19:484. [PMID: 31823772 PMCID: PMC6902409 DOI: 10.1186/s12887-019-1854-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/22/2019] [Indexed: 11/18/2022] Open
Abstract
Background Handwriting difficulties are common in children with attention deficient hyperactive disorder (ADHD). The aim of our study was to find distinctive characteristics of handwriting in children with ADHD by using graphology to analyze physical characteristics and patterns, and to evaluate whether graphological analysis is an effective ADHD diagnostic tool for clinicians. Method The cohort included 49 children aged 13–18 years attending a tertiary neurology and epilepsy center in 2016–2017; 22 had a previous DSM-IV/V diagnosis of ADHD. The children were asked to write a 10–12-line story in Hebrew on a blank sheet of paper with a blue pen over a 20-min period. The samples were analyzed by a licensed graphologist blinded to the clinical details of the children against a predetermined handwriting profile of individuals with ADHD. Each ADHD characteristic identified in each sample was accorded 1 point, up to a total of 15 points. Patients with a graphology score of 9–15 were considered to have ADHD. Results There were 21 boys (43%) and 28 girls (57%) in the cohort; 15 boys (71.4%) and 7 girls (25%) had a DSM-IV/V diagnosis of ADHD. The mean graphology score was significantly higher in the children who had a DSM-IV/V diagnosis of ADHD than in the children who did not (9.61 + 3.49 vs. 5.79 + 4.01, p = 0.002, respectfully). Using a score of 9 as the cutoff, in the girls, graphology had a specificity of 80% (95% CI 59.2–92.8) and a of sensitivity 71.4% for predicting ADHD. Corresponding values in the boys were 75.0 and 76.2%. Conclusion The handwriting of children with ADHD has specific characteristics. Graphology may serve as a clinically useful tool in the diagnosis of ADHD.
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Affiliation(s)
- Rony Cohen
- Department of Pediatric Neurology and Epilepsy Center, Schneider Children's Medical Center of Israel, Petach Tikva, Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Meuhedet Health Services, North District, Jerusalem, Israel.
| | - Batia Cohen-Kroitoru
- Department of Pediatric Neurology and Epilepsy Center, Schneider Children's Medical Center of Israel, Petach Tikva, Tikva, Israel.,Institute of Applied Graphology, Meitar, Jerusalem, Israel
| | - Ayelet Halevy
- Department of Pediatric Neurology and Epilepsy Center, Schneider Children's Medical Center of Israel, Petach Tikva, Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Aharoni
- Department of Pediatric Neurology and Epilepsy Center, Schneider Children's Medical Center of Israel, Petach Tikva, Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Avinoam Shuper
- Department of Pediatric Neurology and Epilepsy Center, Schneider Children's Medical Center of Israel, Petach Tikva, Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Li-Tsang CWP, Li TMH, Lau MSW, Ho CHY, Leung HWH. Handwriting assessment to distinguish comorbid learning difficulties from attention deficit hyperactivity disorder in Chinese adolescents: A case-control study. Int J Methods Psychiatr Res 2018; 27:e1718. [PMID: 29761583 PMCID: PMC6877185 DOI: 10.1002/mpr.1718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/15/2018] [Accepted: 04/09/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Attention deficit hyperactivity disorder (ADHD) and learning difficulties (LDs) are proposed as 2 overlapping disorders. The objective of this study was to investigate the handwriting performance in ADHD and comorbid ADHD-LD adolescents. METHODS The study examined the Chinese and English handwriting performance and sensorimotor skills of 32 ADHD, 12 ADHD-LD, and their matched controls. RESULTS Participants with ADHD had comparable writing time and speed, but the readability was lower than their controls. Participants with ADHD-LD had lower writing speeds in both Chinese and English handwriting than their controls. The ADHD and ADHD-LD groups also showed larger variations in either speed or pen pressure than their controls. Chinese handwriting assessment effectively classified ADHD and ADHD-LD with good sensitivity and positive predictive value. CONCLUSIONS Clinicians should be aware of the fundamental difference between the 2 disorders and make good use of handwriting assessment as a reference to deliver effective therapies and trainings.
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Affiliation(s)
- Cecilia W P Li-Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Tim M H Li
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Mandy S W Lau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Choco H Y Ho
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.,Department of Computer Science, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Howard W H Leung
- Department of Computer Science, City University of Hong Kong, Kowloon Tong, Hong Kong
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