Visual perceptual and handwriting skills in children with Developmental Coordination Disorder

Which outcomes are key to the pre-intervention assessment profile of a child with developmental coordination disorder? A systematic review and meta-analysis

BACKGROUND

Purpose of this study was to determine what key aspects of function should be incorporated to make up a pre-intervention assessment profile of a child with Developmental Coordination Disorder (DCD); more specifically, what aspects of functioning are implicated in DCD and what is their relative impact?

METHODS

A systematic review and meta-analysis were conducted, for which Pubmed, Web of Science, Scopus and Proquest were searched (last update: April 2023, PROSPERO: CRD42023461619). Case-control studies were included to determine point estimates for performances on field-based tests in different domains of functioning. Risk of bias was assessed, and level of evidence estimated. Random-effect meta-analyses were performed to calculate the pooled standardized mean differences for domains of functioning and subgrouping was done for clinically relevant subdomains. Heterogeneity was determined with I2.

RESULTS

121 papers were included for analyses. Data of 5 923 children with DCD were included (59.8% boys) and 23 619 Typically Developing (TD) children (45.8% boys). The mean (SD) age of the DCD group was 10.3y (1.2) and 9.3y (1.3) for the TD children. Moderate evidence was found for motor performance, executive functions, sensory processing and perceptions, cognitive functions and sports and leisure activities to be affected in children with DCD.

CONCLUSION

Differences between the two groups varied per domain of functioning. This emphasizes the diversity present within children with DCD and provides a rationale for explaining the heterogeneity in this patient group. Yet, results highlight the potential involvement of all these domains and call for clinicians to be alert not only to examine motor skill difficulties but also other aspects of function. Results indicate the need to develop an individualized pre-intervention multi-dimensional assessment profile for each child with DCD. It also supports the important role that clinicians play in an interdisciplinary team to tackle the difficulties encountered by children with DCD.

"Picture this from there": spatial perspective-taking in developmental visuospatial disorder and developmental coordination disorder

Introduction

Either Developmental Visuospatial Disorder (DVSD) and Developmental Coordination Disorder (DCD) present with difficulties in visuospatial processing, even though entailing different degrees of impairment. Among the visuospatial domain, spatial perspective taking is essential to interact with the environment and is significantly involved in many daily activities (e.g., environment navigation and spatial orienting). Notwithstanding, no previous studies have investigated this spatial domain in children with DVSD and limited evidence is available regarding DCD. Consistent with a transdiagnostic approach, the first goal of the present study was to compare spatial perspective taking abilities of these groups, also including a control group of not diagnosed peers (ND). Secondly, the role of different fine-motor and visuo-spatial predictors on the spatial perspective taking performance was considered.

Method

A total of 85 participants (DVSD = 26; DCD = 26; ND = 33), aged between 8 and 16 years old, were included in the study. Tasks assessing spatial perspective taking, fine-motor, visual imagery, and mental rotation skills, as well as visuo-spatial working memory were administered.

Results and Discussion

Overall, our results confirmed weaknesses in spatial perspective taking in both clinical groups, with the DVSD obtaining the lowest scores. Similarities and differences in the predictors accounting for the performance in the spatial perspective taking task emerged, suggesting the possible employment of different fine-motor or visuospatial strategies by group. Findings are discussed considering the potential impact they may have both in research and clinical practice.

Impact of strabismus and binocular dysfunctions in the developmental eye movement test and test of visual perception skills: A multicentric and retrospective study

PURPOSE

To compare the performance in the Developmental Eye Movement test (DEM) and the Test of Visual Perceptual Skills (TVPS) between three groups: individuals with strabismus and amblyopia, patients with binocular and accommodative dysfunctions, and subjects with normal binocular and accommodative function.

METHODS

A multicentric, retrospective study including 110 children aged 6-14 years old was conducted to investigate the potential impact of strabismus, amblyopia, and different binocular conditions in DEM results (adjusted time in vertical and horizontal parts) and TVPS (percentiles in the seven sub-skills).

RESULTS

No significant differences were found in the different subtests of the vertical and horizontal DEM and all the sub-skills in the TVPS between the three groups of the study. We found high variability of performance in the DEM test between participants with strabismus and amblyopia compared with binocular and accommodative problems.

CONCLUSION

DEM and TVPS scores have not been found to be influenced by the presence of strabismus with or without amblyopia, nor by binocular and accommodative dysfunctions. A slightly correlation tendency with horizontal DEM and degree of exotropia deviation was observed.

Functional Assessment of Handwriting Among Children: A Systematic Review of the Psychometric Properties

IMPORTANCE

Handwriting legibility and speed assessments have a critical role in identifying and evaluating handwriting problems, which are common among children.

OBJECTIVE

The objective was to evaluate the psychometric properties and clinical utility of handwriting assessments for children ages 3 to 16 yr.

DATA SOURCES

A systematic review was conducted in CINAHL, PubMed (MEDLINE), Scopus, and education databases, with no time limits. The search strategy included a combination of the following keywords: handwriting, write, children, assessment, and validity. The exclusion criteria were assessment tools that were electronic, that focused on cognitive components of handwriting, or that only evaluated alphabets other than Latin.

STUDY SELECTION AND DATA COLLECTION

The systematic review was carried out on the basis of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The protocol was registered in the Prospective Register of Systematic Reviews (PROSPERO).

FINDINGS

The 14 included instruments had a total sample of 4,987 children. Internal consistency ranged from moderate (.73; Writing Readiness Inventory Tool in Context) to high (.98; Letter Writing). The interexaminer reliability values of the 11 direct assessment instruments ranged from .77 (Systematic Screening for Handwriting Difficulties) to 1.00 (Handwriting Speed Test).

CONCLUSIONS AND RELEVANCE

In this systematic review, existing tools were evaluated by clinical utility and the quality of psychometric properties. Direct assessments showed good psychometric properties. Indirect and self-assessment tools demonstrated poor psychometric properties. Further research on screening tools and tools in other languages is needed. What This Article Adds: Specific learning disorders (e.g., dysgraphia) negatively affect academic learning and, when prolonged in time, self-concept. However, handwriting legibility and speed assessments could be used to identify and evaluate these learning disorders if an early referral to occupational therapy is carried out.

Visual Perception and Attentional Skills in School-age Children: A Cross-Sectional Study of Reading Proficiency in the Hearing Impaired

Background

Auditory impairment is one of the common sensory deficits that occur in humans. Hearing loss affects students' ability to communicate and read, which eventually causes social and scholastic stigma. Reading relies heavily on phonics as well as visual attention. Students with normal hearing read by transforming phonic sounds into words. Hearing impaired has little to no phonic ability, making them visual readers who rely on visual cues while reading. Present study sought to investigate factors that affect reading skills in hearing-impaired children.

Material and Methods

A cross-sectional study was conducted in hearing- and hearing-impaired schools of Ludhiana, Punjab, India. After vision screening among all students, sixty students were enrolled via convenient sampling. Higher order of visual perception, attention, and reading ability was investigated.

Results

A total of 60 students were evaluated (30 hearing impaired and 30 age-matched hearing). The hearing group was statistically better than the hearing impaired (p = 0.001), Hearing impaired were better in visual attention (p = 0.001), whereas a correlation was found between reading ability and visual perception, attention skill of hearing- and hearing-impaired students (r = 0.80, P = 0.001).

Conclusion

Present study concludes that hearing-impaired students exhibit issues with visual-motor integration, visual-spatial relationships, and visual sequential memory. Higher visual attention was demonstrated by hearing-impaired students. The results of the current investigation revealed a correlation between visual perception and attention skills and reading competency. Thus, the present study demands that the newly enrolled hearing-impaired students must undergo a thorough ocular evaluation.

In a split second: Handwriting pauses in typical and struggling writers

Introduction

A two-second threshold has been typically used when analyzing the writing processes. However, there is only a weak empirical basis to claim that specific average numbers and durations of pauses may be associated with specific writing processes. We focused on handwriting execution pauses, because immature writers are known to struggle with transcription skills. We aimed to provide an evidence-based account of the average number and duration of handwriting pauses in the mid-Primary grades and to identify process-level markers of writing difficulties.

Methods

Eighty 3rd and 5th graders, with and without writing difficulties, participated in the study. We examined pauses in a handwriting-only task, to be able to isolate those which could only be attributed to handwriting processes. Letter features were considered, as well as children's handwriting fluency level.

Results

The average duration of handwriting pauses was around 400ms, in line with assumptions that transcription pauses would fall under the 2,000ms threshold. We found that 3rd graders made more and longer pauses than 5th graders. Struggling writers made a similar number of pauses across grades than typically-developing children, although they were significantly longer, even after controlling for the effect of handwriting fluency.

Discussion

Our findings provide an evidence-based account of the duration of handwriting pauses. They also suggest that children need fewer and shorter handwriting pauses as they progress in automatizing transcription. However, some young writers struggle with letter formation even after 3 to 5 years of instruction.

Academic Challenges in Developmental Coordination Disorder: A Systematic Review and Meta-Analysis

AIMS

Developmental Coordination Disorder (DCD) is a chronic condition affecting motor coordination in daily activities. While motor difficulties are well documented in this population, it is unclear how frequent and to what extent academic activities are affected. This systematic review aims to comprehensively summarize the knowledge regarding the prevalence and extent of academic difficulties in reading, writing and mathematics in school-aged children with DCD.

METHODS

Two independent reviewers analyzed original studies on academic difficulties in school-aged children with DCD. A binary random-effects model was used to calculate the pooled prevalence by academic difficulty. A random-effects model using standardized mean differences (g statistic) was calculated to estimate the extent of the academic difficulties.

RESULTS

Twenty-four studies were included. A pooled prevalence of 84% of handwriting difficulties and 89.5% of mathematical difficulties was reported. No pooled prevalence of difficulties could be calculated for the other academic outcomes. Children with DCD present with poorer performance in handwriting legibility (g = -1.312) and speed (g = -0.931), writing (g = -0.859), mathematics (g = -1.199) and reading (g = -1.193).

CONCLUSIONS

This review highlights the high frequency and severity of academic difficulties in children with DCD, specifically in mathematics, which stresses the importance of evaluating academic performance to target interventions to support optimal functioning in daily life.

Motor Skills and Visual Deficits in Developmental Coordination Disorder: A Narrative Review

BACKGROUND

Developmental coordination disorder (DCD) is a developmental disorder in which numerous comorbidities seem to coexist, such as motor and visual impairment and some executive functions; Methods: A narrative review on motor and visual deficits in children with DCD was carried out; Results and Discussion: Fine and gross motor skills are affected in children with DCD. In addition, they seem to be related to visual deficits, such as difficulty in visual perception, sensory processing and visual memory. Limitations have also been found in accommodation. Interventions in children with DCD should be aimed at improving both aspects, since vision affects motor skills and vice versa; Conclusions: In children with DCD, who present a marked deficit in global shape processing, it causes an association between deficiencies in visual perception and motor skills.

Anticipatory Awareness and Actual Handwriting Performance Measures among Adolescents with Deficient Executive Functions

This secondary analysis explores differences and correlations between handwriting anticipatory awareness (time estimation, expected performance, and expected difficulty) before a paragraph copying task and actual performance time and legibility among adolescents with executive function deficits (EFD) versus neurotypical adolescents. Eighty-one adolescents (10–18 years old; 41 with EFD and daily functioning difficulties as per parent reports) estimated their time, expected performance, and expected difficulty before the paragraph copying task using the Self-Awareness of Performance Questionnaire (SAP-Q). Time duration was assessed using the Computerized Penmanship Evaluation Tool (ComPET) software, and legibility was scored using the Handwriting Legibility Scale (HLS). Significant between-group differences were found in actual time duration (ComPET), HLS total score and legibility components, and three SAP-Q questions. Both groups estimated significantly more performance time than their actual performance duration. The adolescents with EFD underestimated their performance before the handwriting task. Significant correlations were found between actual performance, anticipatory awareness, and Executive Function (EF) in both groups. Their performance predictions were significantly correlated with their EF and product’s legibility. The results highlight the potential relationships between anticipatory awareness and actual handwriting performance (time duration and legibility) of adolescents with and without EFD. Further studies may analyze the benefits of focusing on both EF and anticipatory awareness for handwriting improvement among populations with EF deficits.

Handwriting and Motor-Related Daily Performance among Adolescents with Dysgraphia and Their Impact on Physical Health-Related Quality of Life

Knowledge is limited about dysgraphia in adolescence and its association with daily motor-related daily performance and health-related quality of life (HRQOL). This study aimed to (1) compare and (2) examine correlations between handwriting measures, motor-related daily performance, and HRQOL of adolescents with and without dysgraphia and (3) examine the contribution of motor-related daily performance and handwriting measures to predict their physical HRQOL. There were eighty adolescents (13-18 yr): half with dysgraphia and half matched controls without dysgraphia per the Handwriting Proficiency Screening Questionnaire and Handwriting Legibility Scale participated. They copied a paragraph script onto a paper attached to the Computerized Penmanship Evaluation Tool digitizer and completed the World Health Organization Quality of Life Questionnaire-brief version and the Adult Developmental Coordination Disorder Checklist (ADC). We found significant between-group differences in motor-related daily performance, handwriting measures, and HRQOL and significant correlations between HRQOL and handwriting process measures and motor-coordination ability. Handwriting measures predicted 25%, and the ADC A and C subscales 45.6%, of the research group's physical QOL domain score variability. Notably, the control group's current perceptions of their motor-coordination performance (ADC-C) predicted 36.5% of the variance in physical QOL. Dysgraphia's negative effects during childhood and adolescence may reduce adolescents' HRQOL now and into adulthood.

Cognitive, perceptual, and motor profiles of school-aged children with developmental coordination disorder

Developmental coordination disorder (DCD) is a heterogeneous condition. Besides motor impairments, children with DCD often exhibit poor visual perceptual skills and executive functions. This study aimed to characterize the motor, perceptual, and cognitive profiles of children with DCD at the group level and in terms of subtypes. A total of 50 children with DCD and 31 typically developing (TD) peers (7–11 years old) underwent a comprehensive neuropsychological (15 tests) and motor (three subscales of the Movement Assessment Battery for Children-2) assessment. The percentage of children with DCD showing impairments in each measurement was first described. Hierarchical agglomerative and K-means iterative partitioning clustering analyses were then performed to distinguish the subtypes present among the complete sample of children (DCD and TD) in a data-driven way. Moderate to large percentages of children with DCD showed impaired executive functions (92%) and praxis (meaningless gestures and postures, 68%), as well as attentional (52%), visual perceptual (46%), and visuomotor (36%) skills. Clustering analyses identified five subtypes, four of them mainly consisting of children with DCD and one of TD children. These subtypes were characterized by: (i) generalized impairments (8 children with DCD), (ii) impaired manual dexterity, poor balance (static/dynamic), planning, and alertness (15 DCD and 1 TD child), (iii) impaired manual dexterity, cognitive inhibition, and poor visual perception (11 children with DCD), (iv) impaired manual dexterity and cognitive inhibition (15 DCD and 5 TD children), and (v) no impairment (25 TD and 1 child with DCD). Besides subtle differences, the motor and praxis measures did not enable to discriminate between the four subtypes of children with DCD. The subtypes were, however, characterized by distinct perceptual or cognitive impairments. These results highlight the importance of assessing exhaustively the perceptual and cognitive skills of children with DCD.

Visual Processing Impairment in Children With Suspected Auditory Processing Disorder: A Transdisciplinary Dimensional Approach to Diagnosis

PURPOSE

The purpose of this study is to explore the utility of impairment(s) in language (LI), manual dexterity (IMD), and visual perceptual skills (IVPS) as a reference standard for diagnosing auditory processing disorder (APD).

METHOD

Data from 104 participants with suspected APD (males = 57, females = 47; 6-16 years) were retrospectively analyzed. Index auditory processing (AP) tests included Auditory Figure Ground 0 dB, Competing Words-Directed Ear (CW-DE), and Time-Compressed Sentences (TCS). General Communication Composite (GCC) of the Children's Communication Checklist-2, manual dexterity (MD) component of the Movement Assessment Battery for Children-Second Edition, and Test for Visual Perceptual Skills-Third Edition (TVPS-3) were used to identify LI, IMD, and IVPS, respectively.

RESULTS

Eighty-one (77.8%), 58 (55.8%), and 37 (35.6%) participants had LI, IVPS, and IMD, respectively. Four factors explaining 67.69% of the variance were extracted. TVPS-3 (except visual closure [VClo]) represented the first; AFG 0, VClo, and MD the second; CW-DE and GCC the third; and TCS the fourth. APD diagnosed by combining AP tests and comorbidities had better accuracy compared to AP tests alone. The combined approach had overall diagnostic accuracy of 92.2%, 88.4%, and 81.7% for the 9th, 5th, and 2nd percentile AP test cutoffs, respectively.

CONCLUSIONS

First-order AP tests in this study were related to language, MD, and visual perceptual skills. Given the overlap of LI, IMD, and IVPS with impaired AP, these comorbidities are an effective reference standard for APD. APD can be diagnosed following failing one AP test if one or more comorbidities exist. Ninth percentile AP test cutoff had better diagnostic accuracy compared to the currently used 2nd percentile cutoff.

Effect of Wii Fit training on visual perception and executive function in boys with developmental coordination disorders: A randomized controlled trial

BACKGROUND

This paper elucidated the influence of Wii Fit training on visual perception and executive function in boys with developmental coordination disorders (DCD).

METHODS

50 school boy with DCD (Mean Age = 9.55 ± 2.24) were randomly assigned to one of two groups, Wii Fit training (intervention; n = 25) or usual school program (control; n = 25). Visual perception and executive function were measured pre-, post- (8 weeks, 3 sessions per week, 30 minute per session), using Cognitive Assessment System (CAS) and Test of Visual-Perceptual Skills-Revised (TVPS-R), respectively. Pre- and post-test changes in executive function and visual perception were calculated using one-way ANCOVA, with pre-test values as covariate and post-test values as dependent variables.

RESULTS

The findings show that the rates of change in total score of visual perception from pre to post were significantly different between groups (F(1, 47) = 660.76, P = 0.024). Similarly, intervention group showed significantly different rates of change in total score of executive function from pre to post (F (1, 47) = 26.15, P = 0.013).

CONCLUSION

Findings support that when developing interventions for the improvement or management of visual perception and executive function in children with DCD, key stakeholders should include the Wii Fit training programs.

Cognitive Profiles of Children with Low Motor Performance: A Contribution to the Validation of the WPPSI-IV

(1) Background: Developmental Coordination Disorder (DCD) is a common developmental disorder of preschool age. Children often show cognitive deficits in addition to motor problems. Various studies point in particular to problems in visual perception, working memory and processing speed. In this context, it is investigated whether the Wechsler Preschool and Primary Scale-IV (WPPSI-IV) is a suitable instrument for mapping these deficits in a valid and economical way. (2) Methods: The WPPSI-IV profiles of children with DCD (n = 12), below-average motor performance (n = 22) and a control group (n = 32) were compared. (3) Results: Children with DCD achieved significantly poorer test performance in the primary indices Verbal Comprehension, Visual Spatial, Processing Speed and Full Scale compared to a control group. Children with below-average motor skills, on the other hand, do not differ from the children in the control group. (4) Conclusions: The WPPSI-IV is a suitable instrument for diagnosing cognitive deficits in the context of DCD. The Fluid Reasoning and Verbal Comprehension indices should be used as a supplement to assess cognitive performance levels.

Behavioral and Neuroimaging Research on Developmental Coordination Disorder (DCD): A Combined Systematic Review and Meta-Analysis of Recent Findings

AIM

The neurocognitive basis of Developmental Coordination Disorder (DCD; or motor clumsiness) remains an issue of continued debate. This combined systematic review and meta-analysis provides a synthesis of recent experimental studies on the motor control, cognitive, and neural underpinnings of DCD.

METHODS

The review included all published work conducted since September 2016 and up to April 2021. One-hundred papers with a DCD-Control comparison were included, with 1,374 effect sizes entered into a multi-level meta-analysis.

RESULTS

The most profound deficits were shown in: voluntary gaze control during movement; cognitive-motor integration; practice-/context-dependent motor learning; internal modeling; more variable movement kinematics/kinetics; larger safety margins when locomoting, and atypical neural structure and function across sensori-motor and prefrontal regions.

INTERPRETATION

Taken together, these results on DCD suggest fundamental deficits in visual-motor mapping and cognitive-motor integration, and abnormal maturation of motor networks, but also areas of pragmatic compensation for motor control deficits. Implications for current theory, future research, and evidence-based practice are discussed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, identifier: CRD42020185444.

Effect of comorbid developmental dyslexia on oculomotor behavior in children with developmental coordination disorder: A study with the Developmental Eye Movement test

Studies have suggested a dysfunction in oculomotor skills in children with developmental coordination disorder (DCD). It has been proposed that the Developmental Eye Movement (DEM) test is useful in testing the dyslexics' (DD) oculomotor behavior during reading, in a simple and indirect manner. The present study aimed at exploring the oculomotor behavior in children with DCD as assessed with the DEM test. We thus compared children with DCD to children with DD and to children with both DCD and DD in order to investigate the specificity of the oculomotor difficulties, as measured by the DEM test. Results showed that 1) children with DCD presented mild atypical performance at the DEM test (error z-score only), 2) children with DD presented particularly poor performance at the DEM test, and 3) the co-morbid condition (DCD + DD) did not add to the severity of atypical performance at the DEM test. In sum, children with DCD were the less affected according to the DEM test, and children with DD (isolated or comorbid) presented the most atypical performance. Results at the DEM test did not allow to highlight clear oculomotor atypicalities in DCD. We thus concluded that more research using eye-tracking techniques is needed to explore the nature of oculomotor atypicalities in DCD children, to distinguish DD and DCD oculomotor behavior, and to understand the profile of children with dual diagnosis.

Prevalence and Cognitive Profiles of Children With Comorbid Literacy and Motor Disorders

There is a high prevalence of comorbidity between neurodevelopmental disorders. Contemporary research of these comorbidities has led to the development of multifactorial theories of causation, including the multiple deficit model (MDM). While several combinations of disorders have been investigated, the nature of association between literacy and motor disorders remains poorly understood. Comorbid literacy and motor disorders were the focus of the two present studies. In Study 1, we examined the prevalence of comorbid literacy and motor difficulties relative to isolated literacy and motor difficulties in a community sample (N = 605). The prevalence of comorbidity was five times greater than expected by chance alone, implying some relationship between difficulties. In Study 2, we examined the cognitive profiles of children with literacy and motor disorders amongst a subsample of children from Study 1 (N = 153). Children with literacy disorder had deficits in phonological processing, selective attention, and memory whilst children with motor disorder had deficits in visuospatial processing and memory, suggesting the disorders should be considered to have both independent and shared (memory) cognitive risk factors. Children with comorbid literacy and motor disorder demonstrated an additive combination of these deficits. Together, these findings are consistent with predictions from the MDM.

Using Head-Mounted Eye-Tracking to Study Handwriting Development

Even with the increasing use of technology in the classroom, handwriting remains a developmental foundation of education. When children fail to learn to write efficiently, they encounter cascading difficulties in using writing to communicate and learn content. Traditionally, the development of handwriting has been studied via neuropsychological testing or the moment-to-moment kinematics of pen movements. By measuring children’s handwriting with neuropsychological testing, investigators have determined that children’s visual-motor integration abilities predict children’s handwriting. Further, by measuring children’s pen movements while writing, investigators have determined that children’s handwriting becomes more fluent as they become skilled writers. Both of these literatures have advanced our understanding of handwriting substantially, but fall short of providing a full account of handwriting development. Here, we offer a perception–action account of handwriting development by describing how eye and hand movements become integrated during early writing. We describe how head-mounted eye-tracking technology can be used to measure children’s eye movements as they write in real-time. We illustrate this approach with findings from research on letter, form, and word copying in school-entry age children. We conclude by discussing how a perception–action approach can be extended for use with atypical populations.

Motor functions of higher education students with dysgraphia

This study examines the motor skills and motor-related daily functions of higher education students with and without dysgraphia, and their contribution in predicting handwriting performance. The sample included 82 higher education students aged 20-35 years old. Thirty-four were students without any known developmental disorder (NDD) and 48 students had dysgraphia. We individually administered a test battery evaluating handwriting performance, fine-motor skills, and visual-motor spatial-organization skills. Students also filled out a questionnaire relating to their fine- and gross-motor-related daily functions. Overall, the NDD students had significantly better motor skills and motor-related daily functions. Additionally, the motor skills and daily functions explained 62.9% of the variance in handwriting performance, and they correctly classified 90% of the students into the handwriting performance groups. Yet only visual-motor spatial organization and fine-motor-related daily functions significantly contributed to the fit of the model. These findings suggest that students with dysgraphia continue to encounter handwriting difficulties in higher education. These difficulties are linked to poor motor skills and motor-related daily functions. Therefore, higher education students with dysgraphia may require assistance and accommodations throughout their studies, not only with regard to their academic performance, but also in their motor-related daily functions.

Prevalence of suspected developmental coordination disorder and associated factors in Spanish classrooms

BACKGROUND

Developmental Coordination Disorder (DCD) is a multifactorial, neurodevelopmental motor disorder that severely affects the activities of a child's daily life and classroom performance. The aim of this study was to determine the prevalence of suspected DCD in a sample of Spanish schoolchildren and its association with socio-demographic factors.

METHODS

We conducted a cross-sectional study including a random sample of 460 children attending mainstream schools in northwest Spain in 2017. A Developmental Coordination Disorder Questionnaire-European Spanish was used to evaluate suspected DCD prevalence. We performed multivariate logistic and linear regression analysis to determine the socio-demographic variables associated with suspected DCD and problematic motor coordination performance.

RESULTS

The prevalence of suspected DCD was 12.2%. According to the multivariate analysis, DCD symptoms were significantly associated with males (OR = 3.0), ages above 10 years old (OR = 5.0) and low participation in out-of-school physical activities (OR = 2.3). Preterm birth children were twice as likely to show suspected DCD, although this association was not statistically significant (OR = 2.1).

CONCLUSIONS

A high percentage of Spanish schoolchildren are at risk for developing DCD. There is a strong connection between suspected DCD and socio-demographic factors. Protocols aimed to detect DCD and intervention programmes in classrooms designed to promote motor coordination skills need to take these factors into consideration.

Occlusal force predicts global motion coherence threshold in adolescent boys

Background

Beneficial effects of mastication on cognitive abilities in the elderly have been shown in human studies. However, little is currently known about the effect of masticatory stimulation on cognitive and perceptual ability in younger populations. The purpose of the present study is to investigate the influences of masticatory stimulation on perceptual ability in adolescent boys.

Methods

The present study examined the relationship between occlusal force (i.e., masticatory stimulation) and visual perception ability in adolescent boys. Visual perception ability was quantified by measuring global motion coherence threshold using psychophysical method. As an index of masticatory stimulation, occlusal force was measured by pressure sensitive film. We also measured participants’ athletic ability, e.g. aerobic capacity and grip strength, as potential confounding factor.

Results

The multiple regression analysis revealed a significant negative correlation between global motion coherence threshold and occlusal force, which persisted after controlling for confounding factors such as age and aerobic capacity.

Conclusions

This finding indicates that masticatory stimulation enhances visual perception in adolescent boys, indicating the possibility that beneficial effects of masticatory stimulation are observed not only in the elderly but in developing population consistently with the findings of the previous animal studies.

Chinese handwriting performance in preterm children in grade 2

Background

First graders born prematurely perform poorly on handwriting speed and legibility. However, whether there are specific legibility factors in which preterm children demonstrate difficulty remains unknown. In addition, handwriting performance beyond the first grade and the influence of sex on handwriting performance in preterm children are still unclear. We aimed to investigate the influence of prematurity and sex on multiple dimensions of handwriting in grade two and to identify the contributors to performance.

Methods

Sixty-three preterm (34 boys and 29 girls) and 67 full-term (27 boys and 40 girls) peers in grade two were included. Class teachers were asked to complete the Chinese Handwriting Evaluation Form. A subgroup of 39 preterm children received assessments on intelligence, visual perception, tactile and kinesthetic sensation, and fine motor skills. Their inattention behavior was rated using a maternal self-report with a behavioral scale.

Results

Boys born prematurely exhibited poorer performance in the speed dimension than full-term boys (p = 0.008), whereas there was comparable performance in the two groups of girls (p = 0.221). In the dimensions related to legibility, preterm boys (32.4%) had a higher percentage of children with difficulty in the construction dimension than the other groups (preterm girls: 6.9%, full-term boys: 7.4%, full-term girls: 5.0%). However, no group difference was found in the dimensions of accuracy and directionality. Of the sensory-perceptual-motor factors, attention was the most significant predictor of accuracy in performance (p = 0.046) and speed dimensions (p = 0.001) in preterm children.

Conclusions

Boys appear to be vulnerable to the adverse impacts of preterm birth in terms of performance in the dimensions of speed and construction in grade two. Based on the significant contribution of attention to handwriting performance in preterm children, assessment and intervention in the area of attention is strongly suggested for preterm children with handwriting problems.

The Computerized Perceptual Motor Skills Assessment: A new visual perceptual motor skills evaluation tool for children in early elementary grades

Visual perceptual motor skills have been proposed as underlying courses of handwriting difficulties. However, there is no evaluation tool currently available to assess these skills comprehensively and to serve as a sensitive measure. The purpose of this study was to validate the Computerized Perceptual Motor Skills Assessment (CPMSA), a newly developed evaluation tool for children in early elementary grades. Its test-retest reliability, concurrent validity, discriminant validity, and responsiveness were examined in 43 typically developing children and 26 children with handwriting difficulty. The CPMSA demonstrated excellent reliability across all subtests with intra-class correlation coefficients (ICCs)≥0.80. Significant moderate correlations between the domains of the CPMSA and corresponding gold standards including Beery VMI, the TVPS-3, and the eye-hand coordination subtest of the DTVP-2 demonstrated good concurrent validity. In addition, the CPMSA showed evidence of discriminant validity in samples of children with and without handwriting difficulty. This article provides evidence in support of the CPMSA. The CPMSA is a reliable, valid, and promising measure of visual perceptual motor skills for children in early elementary grades. Directions for future study and improvements to the assessment are discussed.