Dysgraphia Among Adolescents: What Do We Know About Their Body Function,Activity,and Participation Characteristics?

RATIONALE AND BACKGROUND: The aim of this study was to compare body function, activity (handwriting), and leisure participation characteristics of adolescents with dysgraphia to those of a control group. Writing is a complex human skill constituting a central occupation for school-age children and adolescents. Dysgraphia is a developmental deficit expressed in deficits in handwriting. Difficulties in writing have long-term implications and may negatively affect an adolescent’s participation, involvement, choice of leisure activities, and quality of life.

Knowledge about body functions, the activity of handwriting (process, product, and content), and the participation of these adolescents is scarce. Furthermore, although a high percentage of comorbidity (50%) has been found between deficient handwriting and attention and coordination deficits, literature about these deficits among adolescents is lacking. Identifying the characteristics of deficient handwriting in adolescents may lead to improved evaluation and more focused intervention for this population.

METHOD: The study was designed as a comparative study and examined developmental and functional background variables and three levels of functioning according to the International Classification of Functioning, Disability and Health for Children and Youth (World Health Organization, 2007) model—body functions (pinch strength, in-hand manipulations, sensory reaction, sensorimotor functions, memory, attention, and executive functions), activity (handwriting), and leisure participation—in a group of adolescents with dysgraphia and a group without handwriting difficulties. Participants were 80 adolescents aged 13–18 who were Hebrew speakers and physically and mentally healthy. Forty adolescents were diagnosed with dysgraphia according to Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) criteria. The control group comprised 40 adolescents with proficient handwriting matched for age, gender, and maternal education level.

An evaluation process examined the differences between adolescents with dysgraphia and the control group. Background and developmental data were gathered using parent reports and the Child Evaluation Checklist. Standardized questionnaires were administered to find markers of attention and coordination deficits. Body functions were assessed using a pinch gauge, the Purdue Pegboard Test (Tiffin & Asher, 1948), the Sensory Responsiveness Questionnaire (Bar-Shalita et al., 2009), and WebNeuro (Silverstein et al., 2007). The Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000) for parents and BRIEF–Self-Report version (BRIEF–SR; Guy et al., 2004) for adolescents examined the manifestation of executive functions in daily life. Handwriting performance (activity) was measured with the Computerized Penmanship Evaluation Tool (Rosenblum et al., 2003) and the Six-Trait Writing method (Spandel & Stiggins, 1997). Leisure participation was measured using the Children’s Leisure Assessment Scales completed by parents and adolescents (Rosenblum et al., 2010). Multivariate analysis of variance was performed with IBM SPSS Statistics Version 23 (IBM Corp., Armonk, NY) to examine group differences on the measures.

RESULTS: Markers of coordination and attention deficits were found in a large percentage of the adolescents with dysgraphia. Significant group differences were found in in-hand manipulation skills, t(68) = –3.12, p < .01; attentional functions, t(78) = –2.93, p < .01; memory functions, t(78) = –3.06, p < .01; and executive functions as reflected in scores on the BRIEF, F(8, 69) = 4.109, p < .001, η² = .323, and BRIEF–SR, F(8, 71) = 4.44, p < .001, η² = .334. Significant differences were also found between the capabilities of the two groups in handwriting: execution, F(9, 66) = 4.073, p < .001, η² = .357; product legibility, t(78) = 6.99, p < .001; and content, F(6, 72) = 14.58, p < .001, η² = .549. No differences were found for participation in leisure activities.

CONCLUSION: The results help define the basic body function, activity, and participation characteristics of adolescents with dysgraphia and reinforce the assumption of a basic neurological mechanism causing developmental disorders.

IMPACT STATEMENT: This research identified the main characteristics of adolescents with dysgraphia for the first time using a valid evaluation process.

References

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