Handwriting Performance of Children with Attention Deficit Hyperactivity Disorder: The Role of Visual-Motor Integration

Background:

 Poor performance in motor skills is common among children with Attention Deficit Hyperactivity Disorder (ADHD). However, difficulties of children with ADHD in handwriting and its underlying mechanism have rarely been studied. We aimed to investigate the handwriting performance of children with ADHD by considering the role of Visual-Motor Integration (VMI) as a possible underlying mechanism.

The present study used a comparative-correlational method, which was carried out in 2019 in Gorgan, Iran. Twenty-four children with ADHD and 24 healthy children of primary-school-age performed the Persian Handwriting Assessment Tool (PHAT). Children copied words on a paper sheet in which words were printed on top of the paper, and they had to copy words as accurately as possible. In the dictation part, the experimenter read a text aloud, and children had to write words on a paper sheet as accurately as possible. Legibility (including word formation, size, space, alignment, and text slant), as well as the speed of handwriting, were evaluated in both copying and dictation parts. The Beery test was used to measure VMI. 

Results showed that children with ADHD were weaker in word-formation compared to healthy children. However, they had the same performances as healthy children in terms of word size, space, alignment, and text slant. The speed of handwriting was not significantly different between healthy and ADHD groups. ADHD children showed significantly lower scores in VMI compared to healthy children (p = 0.004). 

Conclusion: 

Children with ADHD had weaker handwriting legibility compared to healthy children, which is mainly due to word-formation. Moreover, VMI might act as a possible underlying mechanism affecting poor handwriting in ADHD children.