Legibility as a Significant Measure for Evaluation of Handwriting Performance Among Adolescents in OT

Abstract

Date Presented 03/27/20

Adolescents with handwriting difficulties are referred to OT services due to inadequate writing process (speed and space) or product (illegibility). Executive function (EF) components are one of the underlying mechanisms of handwriting. The results indicate that EF levels of adolescents with handwriting difficulties were correlated only with product legibility. The results emphasize the importance of using a standardized tool to evaluate legibility in this population.

Primary Author and Speaker: Liat Hen-Herbst

Additional Authors and Speakers: Yael Fogel

Contributing Authors: Sara Rosenblum, Anna Barnett

PURPOSE: The purpose of the current study was to offer insights into the evaluation of handwriting process and product and executive functions (Efs), to assist practitioners’ theoretical and clinical thinking about handwriting. Little is known about the characteristics of adolescents with handwriting difficulties and accordingly, there is lack of evidence that might help occupational therapists (OTs) evaluate and choose an effective intervention for them.

Previous research demonstrated the association between writing and daily functioning task, with EF components as an underlying mechanism.

Written assignments for school, require adolescents to maintain sufficient speed and a certain level of legibility. Adolescents who are unsuccessful in developing proficient handwriting are at risk of low grades and severe academic difficulties. Since little is known about the characteristics of handwriting difficulties in adolescents, OTs often find it difficult to find appropriate and simple to use tools to identify the specific challenges that distinguish between the referred adolescents with handwriting difficulties and those who present general daily functional difficulties.

Thus, adolescents who were referred to OTs with general difficulties in daily activities were found as the best group for comparison, because they expected to present similar EF levels as adolescents with handwriting difficulties.

An understanding of how EF levels are associated with the handwriting components of adolescents with handwriting difficulties and of adolescents with EF deficiencies might be as important key in developing effective handwriting interventions.

DESIGN: This cross-sectional study was based on a sample of 81 adolescents aged 10 to 18 years, divided into two groups: Group 1, adolescents aged 13–18 years with self-reported handwriting difficulties (n = 40; M = 15.60, SD = 1.34); Group 2, adolescents aged 10–15 years, with self-reported difficulties with daily functions (n = 41; M = 13.83, SD = 2.19).

METHOD: Adolescents completed the Behavior Rating Inventory of Executive Function-Self Report questionnaire (Guy, Isquith, & Gioia, 2004) and copied a given paragraph on a digitizing tablet which analyzed with the ComPET (Rosenblum, Parush & Weiss, 2003), a standardized, computerized, validated assessment for handwriting process. The Handwriting Legibility Scale (HLS; Barnett et al., 2018), was then applied to the copied script.

Multivariate analysis of variance was used to measure differences in Efs and legibility, comparing the two group. Pearson correlations were used to measure associations between EFs and writing legibility in each group separately.

RESULTS: As was expected, the results showed that there were no significant differences between the groups in the EF measures. Adolescents with handwriting difficulties wrote significantly faster, but their product legibility was significantly poorer and less legible. Significant correlations were found between handwriting process and EFs, whereas no relationships were found with legibility.

CONCLUSION: Theoretically, the results define illegibility as an important characteristic of adolescents with handwriting difficulties. The results indicated that deficits in EFs may be related to process measures and can be considered as the underlying-mechanism for difficulties in daily activities including handwriting production. However, since legibility had no relationships with EFs, the results might suggest that other explanatory factors account for illegible handwriting. This study’s practical contribution is its proposal of legibility as a sensitive handwriting measure that can be used to evaluate adolescents’ handwriting difficulties and that HLS is an effective tool for that purpose.

References

Barnett, A. L., Prunty, M., & Rosenblum, S. (2018). Development of the Handwriting Legibility Scale (HLS): A preliminary examination of reliability and validity. Research in Developmental Disabilities, 72, 240–247. doi:10.1016/j.ridd.2017.11.013

Guy, S.C., Isquith, P.K., & Gioia, G.A. (2004). Behavior Rating Inventory of Executive Function- Self-Report version professional manual. Lutz, FL: Psychological Assessment Resources.

Rosenblum, S., Parush, S., & Weiss, P. L. (2003). Computerized temporal handwriting characteristics of proficient and non-proficient hand writers. The American Journal of Occupational Therapy, 57(2), 129-138.