Cherie J. Duval-White, Tracy Jirikowic, Dianne Rios, Jean Deitz, Heather Carmichael Olson; Functional Handwriting Performance in School-Age Children With Fetal Alcohol Spectrum Disorders. Am J Occup Ther 2013;67(5):534-542. doi: 10.5014/ajot.2013.008243.
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Handwriting is a critical skill for school success. Children with fetal alcohol spectrum disorders (FASD) often present with fine motor and visual–motor impairments that can affect handwriting performance, yet handwriting skills have not been systematically investigated in this clinical group. This study aimed to comprehensively describe handwriting skills in 20 school-age children with FASD. Children were tested with the Process Assessment of the Learner, 2nd Edition (PAL–II), and the Visuomotor Precision subtest of NEPSY, a developmental neuropsychological assessment. Participants performed below average on PAL–II measures of handwriting legibility and speed and on NEPSY visual–motor precision tasks. In contrast, PAL–II measures of sensorimotor skills were broadly within the average range. Results provide evidence of functional handwriting challenges for children with FASD and suggest diminished visual–motor skills and increased difficulty as task complexity increases. Future research is needed to further describe the prevalence and nature of handwriting challenges in this population.
How do school-age children with FASD score on measures of handwriting legibility, specifically the Handwriting Total Automatic Letter Legibility Composite and the Handwriting Total Legibility Composite of the Process Assessment of the Learner, 2nd Edition (PAL–II; Berninger, 2007)?
How do school-age children with FASD score on a measure of speed of handwriting production, specifically the Handwriting Total Time Composite of the PAL–II (Berninger, 2007)?
How do school-age children with FASD score on measures of sensorimotor performance and motor control, specifically the Finger Sense subtests of the PAL–II (Berninger, 2007) and the NEPSY Visuomotor Precision subtest (Korkman, Kirk, & Kemp, 1998)?
FAS/alcohol exposure unknown
Occupational therapists should consider evaluating the handwriting performance of children with FASD both when they start school and later during key academic transitions as grade-level expectations and writing demands change and increase.
Even for children who do not show early handwriting or sensorimotor problems, the pattern of difficulties noted in this study suggests that periodic monitoring and screening of children with FASD across the elementary grades could help identify emerging problems and ensure timely evaluation and intervention.
Timely evaluation and intervention, in turn, could better support these children’s ability to successfully participate in the many important school-based activities that require written communication.
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