Developmental skills between kindergarten children with handwriting difficulties in Chinese and/or English

Cognitive strategies utilised by early learners when writing alphabet-letters from memory

INTRODUCTION

Occupational therapy handwriting studies have shown cognitive instructional techniques are effective methods to assist beginning or challenged handwriters. However, information about how children's cognitive (thinking) skills impact their handwriting development is scarce. This study examined the cognitive strategy efficiency of early learners while writing the alphabet-letters from memory.

METHODS

Participants included 408 mainstream children in their first two years of formal schooling (Year 1 and Year 2). Children were asked to write the 26-lowercase alphabet-letters from memory. Data were collected using alphabet-letters generated by the children and observation of their cognitive strategy use while writing. The measurement tool employed was the Perceive, Recall, Plan, and Perform (PRPP) System of Task Analysis (Stage Two).

RESULTS

The results found that Year 1 and Year 2 children had difficulties applying cognitive strategies across all four PRPP quadrants while writing the lowercase alphabet-letters from memory. Application of the cognitive strategies from the Plan and Recall quadrants showed the most inefficiencies. The lowest PRPP subquadrant scores were observed in Evaluating, Recall Facts, Sensing, and Programming. Except for the Attending subquadrant and the descriptor 'Regulates', Year 2 children were significantly better than Year 1 children at applying cognitive strategies from all other PRPP quadrants and subquadrants.

CONCLUSION

The findings provide beginning evidence that efficient use of cognitive strategies from all four PRPP quadrants is important for children achieving proficiency in accurate and automatic alphabet-letter-writing skills. Recommendations for occupational therapy handwriting assessment and intervention are provided.

PLAIN LANGUAGE SUMMARY

Research suggests that occupational therapists can best help children with handwriting difficulties by using a cognitive approach. This approach involves instructing children how to form letters correctly, encouraging self-evaluation, and providing opportunities to practice handwriting. However, the cognitive (thinking) skills required for children to write alphabet-letters accurately are not well understood. To investigate this, a study was conducted on 408 mainstream children in their first two years of formal schooling (Year 1 and Year 2). The study examined how accurately the children could write lowercase alphabet-letters from memory and which cognitive skills they used to do so. The cognitive skills investigated were related to attention, perception, recalling, planning, and performing. The assumption tested was that mistakes in correctly writing alphabet-letters could be attributed to difficulties in using these cognitive skills effectively. The study found that Year 1 and Year 2 children made errors in over half of the 26-lowercase alphabet-letters they wrote. The cognitive skills, which scored the lowest were children's ability to evaluate their writing, recall how and where to write letters, gather information from their vision, and think carefully to ensure accuracy while writing. This implied that these thinking skills had the most impact on the children's ability to write alphabet-letters correctly. More research is needed to confirm these findings and determine the reliability of the tool used in this study to measure the children's thinking skills.

The relevance of motor sequence and visual perception skills in learning Chinese handwriting

This study explored visual perception skills and the ability to write according to standard stroke order and their links to the learning of Chinese handwriting. Thirty-seven children (aged 6-8) (15 boys and 22 girls) participated in a handwriting test and visual perception evaluation (Test of Visual Perceptual Skills-3rd Edition, TVPS-3). A computerized system was used to evaluate the stroke order accuracy, legibility, and automation of stroke movements. The stroke order accuracy was found to positively correlate with the scores of TVPS-3 (r = .498, p < .05) and to significantly correlate with handwriting legibility (r = .435, p < .05) as well as the automation of stroke movements (r = .494, p < .01). This study revealed that visual perception skill is related to stroke order accuracy and provides directions to assist students who encounter difficulties in learning Chinese handwriting.

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.

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.

Validation of the Concise Assessment Scale for Children's Handwriting (BHK) in an Italian Population

Handwriting difficulties represent a common complaint among children and may cause a significant delay in motor skills achievement. The Concise Assessment Scale for Children's Handwriting (BHK) assesses handwriting skill in clinical and experimental settings, providing a quick evaluation of handwriting quality and speed through a copying text. The aim of the present study was to validate the Italian adaptation of the BHK in a representative primary school population. Overall, 562 children aged 7-11 from 16 public primary schools of Rome were included and asked to copy a text in 5 min using cursive handwriting. Handwriting quality and copying speed were measured. The included population followed a normal distribution for the BHK quality scores. Sex influenced the total quality scores, whereas school level influenced the copying speed. The BHK quality score was higher in girls (p < 0.05) and resulted as a stable parameter along the school years, without significant variations with regard to the years spent in handwriting exercise (p = 0.76). The handwriting speed was influenced by school level, and significant differences were found for each of the grades from the second to the fifth (p < 0.05), but not for gender (p = 0.47). Both BHK measures represent a helpful tool for the characterization and assessment of children with handwriting difficulties. The present study confirms that sex influences total BHK quality score, while school level influences handwriting speed.

Children with handwriting difficulties: Impact of cognitive strategy training for acquisition of accurate alphabet-letter-writing

Introduction:

An occupational therapy handwriting programme integrating cognitive strategy training with alphabet-letter-writing instruction was found more effective than in-class instruction alone for early writers. This study investigated the impact of cognitive strategy training for children struggling to correctly write alphabet-letters.

Method:

Participants were ten children in the first 2 years of formal schooling identified with challenges in alphabet-letter-writing. A nonconcurrent A1BA2 single system research design was used. The A Phases represented within-class handwriting instruction only and B Phase represented additional handwriting intervention which included cognitive strategy training. The Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis (Stage 2) was the repeated outcome measure.

Results:

Results revealed all ten children demonstrated a similar pattern of change in cognitive strategy application which was concomitant with improvement and mastery in writing all 26-lowercase alphabet-letters from memory. Cognitive strategies which exhibited the greatest impact on acquiring and executing accurate alphabet-letter-writing skills were those related to planning, memory, attention and sensory perception. The least influential were those associated with generating and controlling motor actions.

Conclusion:

This study provides beginning support for including cognitive strategies training concurrently with alphabet-letter-writing instruction to assist children struggling to write alphabet-letters.

Development and Psychometric Evaluation of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) for School-Age Children

IMPORTANCE

Handwriting legibility is the main criterion for determining whether a child has handwriting difficulties. A comprehensive assessment of handwriting legibility with sound psychometrics is essential to timely identification of handwriting difficulties and outcome measurement after handwriting interventions.

OBJECTIVE

To evaluate the psychometrics of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) and to investigate Chinese handwriting legibility in school-age children using the CAM-CHL.

DESIGN

Cross-sectional, repeated observation, test-retest.

SETTING

Elementary schools in Taiwan.

PARTICIPANTS

We recruited 25 lower-grade children for the examination of test-retest reliability, 75 children from all grade levels, and 10 senior schoolteachers for the examination of the CAM-CHL's convergent validity and the investigation of handwriting legibility.

OUTCOMES AND MEASURES

Children were asked to copy a set of Chinese characters as legibly as possible. We used the CAM-CHL to assess handwriting legibility in four domains: Size, Orientation, Position, and Deformation. The schoolteachers were asked to subjectively assess the handwriting legibility using a 3-point Likert-type scale.

RESULTS

The CAM-CHL demonstrated good to excellent test-retest reliability and acceptable random measurement error in all legibility domains. The CAM-CHL had fair to moderate convergent validity with schoolteachers' perceptions. Additionally, upper-grade children had better handwriting legibility in the Size and Position domains than lower-grade children.

CONCLUSIONS AND RELEVANCE

The CAM-CHL, a comprehensive and objective method of assessing Chinese handwriting legibility, has sound reliability and acceptable validity, suggesting its potential as an outcome measure for school-age children. What This Article Adds: The CAM-CHL can be used in comprehensive evaluations of Chinese handwriting legibility in school-age children. The CAM-CHL has acceptable psychometrics for use as an outcome measure.

Evaluation of a group-based sensorimotor intervention programme to improve Chinese handwriting of primary school students

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.

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

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.