Skip to main content
Log in

Handwriting Difficulties in Children with Autism Spectrum Disorders: A Scoping Review

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

An Erratum to this article was published on 24 July 2011

Abstract

Functional handwriting involves complex interactions among physical, cognitive and sensory systems. Impairments in many aspects of these systems are associated with Autism spectrum disorders (ASD), suggesting a heightened risk of handwriting difficulties in children with ASD. This scoping review aimed to: (1) survey the existing evidence about potential contributions to compromised handwriting function in children with ASD, and (2) map out the existing studies documenting handwriting difficulties in children with ASD. The current evidence implicates impairments in fine motor control and visual-motor integration as likely contributors to handwriting difficulties in children with ASD, though the role of the latter is not well-understood. Moreover, diminished overall legibility and compromised letter formation are emerging points of convergence among existing studies of handwriting quality in children with ASD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Amundson, S. (1995). Evaluation tool of children’s handwriting. Homer, AK: OT Kids.

    Google Scholar 

  • Amundson, S., & Weil, M. (1996). Prewriting and handwriting skills. In J. Case-Smith, A. Allen, & P. Pratt (Eds.), Occupational therapy for children (pp. 524–541). St Louis, MO: Mosby.

    Google Scholar 

  • Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32.

    Article  Google Scholar 

  • Ayres, A. (1989). Sensory integration and praxis tests (SIPT). Los Angeles: Western Psychological Services.

    Google Scholar 

  • Beery, K., & Buktenica, N. (1989). Developmental test of visual motor integration. Cleveland: Modern Curriculum Press.

    Google Scholar 

  • Beversdorf, D., Anderson, J., Manning, S., Anderson, S., Nordgren, R., Felopulos, G., et al. (2001). Brief report: Macrographia in high-functioning adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 31(1), 97–101.

    Article  PubMed  Google Scholar 

  • Bishop, D. (1994). Annotation: Autism, executive functions, and theory of mind: A neuropsychological perspective. Annual Progress in Child Psychiatry and Child Development (pp. 359–376).

  • Cahill, S. (2009). Where Does Handwriting Fit in? Strategies to Support Academic Achievement. Intervention in School and Clinic, 44(4), 223–229.

    Article  Google Scholar 

  • Cartmill, L., Boccthy, M., Rodger, S., & Medst, B. (2009). Handwriting of eight-year-old children with autistic spectrum disorder: An exploration. Journal of Occupational Therapy, Schools & Early Intervention, 2(2), 103–118.

    Article  Google Scholar 

  • Chang, S., & Yu, N. (2009). Characterization of motor control in handwriting difficulties in children with or without developmental coordination disorder. Developmental Medicine and Child Neurology, 52(3), 244–250.

    Article  Google Scholar 

  • Chau, T., Ji, J., Tam, C., & Schwellnus, H. (2006). A novel instrument for quantifying grip activity during handwriting. Archives of Physical Medicine and Rehabilitation, 87(11), 1542–1547.

    Article  PubMed  Google Scholar 

  • Cornhill, H., & Case-Smith, J. (1996). Factors that relate to good and poor Handwriting. American Journal of Occupational Therapy, 50, 732–739.

    PubMed  Google Scholar 

  • Dakin, S., & Frith, U. (2005). Vagaries of visual perception in autism. Neuron, 48(3), 497–507.

    Article  PubMed  Google Scholar 

  • Daly, C., Kelley, G., & Krauss, A. (2003). Relationship between visual-motor integration and handwriting skills of children in kindergarten: A modified replication study. American Journal of Occupational Therapy, 57(4), 459–462.

    Article  PubMed  Google Scholar 

  • David, F., Baranek, G., Giuliani, C., Mercer, V., Poe, M., & Thorpe, D. (2009). A pilot study: Coordination of precision grip in children and adolescents with high functioning Autism. Pediatric Physical Therapy, 21(2), 205–211.

    Article  PubMed  Google Scholar 

  • Denckla, M. (1974). Development of motor co-ordination in normal children. Developmental Medicine and Child Neurology, 16(6), 729–741.

    Article  PubMed  Google Scholar 

  • Dowell, L., Mahone, E., & Mostofsky, S. (2009). Associations of postural knowledge and basic motor skill with dyspraxia in autism: Implication for abnormalities in distributed connectivity and motor learning. Neuropsychology, 23(5), 563–570.

    Article  PubMed  Google Scholar 

  • Dziuk, M., Larson, J., Apostu, A., Mahone, E., Denckla, M., & Mostofsky, S. (2007). Dyspraxia in autism: Association with motor, social, and communicative deficits. Developmental Medicine and Child Neurology, 49(10), 734–739.

    Article  PubMed  Google Scholar 

  • Exner, C. (2001). Development of hand skills. In J. Case-Smith, A. Allen, & P. Pratt (Eds.), Occupational therapy for children (pp. 289–328).

  • Feder, K., & Majnemer, A. (2003). Children’s handwriting evaluation tools and their psychometric properties. Physical & Occupational Therapy in Pediatrics, 23(3), 65–84.

    Article  Google Scholar 

  • Feder, K., & Majnemer, A. (2007). Handwriting development, competency, and intervention. Developmental Medicine and Child Neurology, 49(4), 312–317.

    Article  PubMed  Google Scholar 

  • Feder, K., Majnemer, A., & Synnes, A. (2000). Handwriting: Current trends in occupational therapy practice. Canadian journal of occupational therapy. Revue canadienne d’ergothérapie, 67(3), 197–204.

    PubMed  Google Scholar 

  • Frith, U. (1991). Autistic psychopathy. In U. Frith (Ed.), Autism and Asperger syndrome (U. Frith, Trans. and Annotated) (pp. 37–92).

  • Fuentes, C., Mostofsky, S., & Bastian, A. (2009). Children with autism show specific handwriting impairments. Neurology, 73(19), 1532–1537.

    Article  PubMed  Google Scholar 

  • Fuentes, C., Mostofsky, S., & Bastian, A. (2010). Perceptual reasoning predicts handwriting impairments in adolescents with autism. Neurology, 75(20), 1825.

    Article  PubMed  Google Scholar 

  • Gardner, M. F. (1996). Test of visual perceptual skills (non-motor)Revised (TVPS-R): Manual. Novato, CA: Academic Therapy Publications.

    Google Scholar 

  • Ghaziuddin, M., & Butler, E. (1998). Clumsiness in autism and Asperger syndrome: A further report. Journal of Intellectual Disability Research, 42(1), 43–48.

    Article  PubMed  Google Scholar 

  • Ghaziuddin, M., & Mountain-Kimchi, K. (2004). Defining the intellectual profile of Asperger Syndrome: Comparison with high-functioning autism. Journal of Autism and Developmental Disorders, 34(3), 279–284.

    Article  PubMed  Google Scholar 

  • Gibbs, J., Appleton, J., & Appleton, R. (2007). Dyspraxia or developmental coordination disorder? Unravelling the enigma. Archives of Disease in Childhood, 92(6), 534–539.

    Article  PubMed  Google Scholar 

  • Gilliam, J. (1995). Gilliam autism rating scale. Taskmaster Ltd.

  • Glazebrook, C., Elliott, D., & Szatmari, P. (2008). How do individuals with autism plan their movements? Journal of Autism and Developmental Disorders, 38(1), 114–126.

    Article  PubMed  Google Scholar 

  • Glazebrook, C., Gonzalez, D., Hansen, S., & Elliott, D. (2009). The role of vision for online control of manual aiming movements in persons with autism spectrum disorders. Autism, 13(4), 411–433.

    Article  PubMed  Google Scholar 

  • Graham, S. (1999). The role of text production skills in writing development: A special issue: I. Learning Disability Quarterly, 22(2), 75–77.

    Article  Google Scholar 

  • Graham, S., Berninger, V., Abbott, R., Abbott, S., & Whitaker, D. (1997). Role of mechanics in composing of elementary school students: A new methodological approach. Journal of Educational Psychology, 89(1), 170–182.

    Article  Google Scholar 

  • Graham, S., Harris, K., & Fink, B. (2000). Is handwriting causally related to learning to write? Treatment of handwriting problems in beginning writers. Journal of Educational Psychology, 92(4), 620–633.

    Article  Google Scholar 

  • Graham, S., & Weintraub, N. (1996). A review of handwriting research: Progress and prospects from 1980 to 1994. Educational Psychology Review, 8(1), 7–87.

    Article  Google Scholar 

  • Green, D., Baird, G., Barnett, A., Henderson, L., Huber, J., & Henderson, S. (2002). The severity and nature of motor impairment in Asperger’s syndrome: A comparison with specific developmental disorder of motor function. Journal of Child Psychology and Psychiatry, 43(5), 655–668.

    Article  PubMed  Google Scholar 

  • Green, D., Charman, T., Pickles, A., Chandler, S., Loucas, T., Simonoff, E., et al. (2009). Impairment in movement skills of children with autistic spectrum disorders. Developmental Medicine and Child Neurology, 51, 311–316.

    Article  PubMed  Google Scholar 

  • Hamstra-Bletz, L., & Blote, A. (1993). A longitudinal study on dysgraphic handwriting in primary school. Journal of Learning Disabilities, 26(10), 689–699.

    Article  PubMed  Google Scholar 

  • Happé, F., & Frith, U. (2006). The weak coherence account: Detail-focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders, 36(1), 5–25.

    Article  PubMed  Google Scholar 

  • Hardan, A., Kilpatrick, M., Keshavan, M., & Minshew, N. (2003). Motor performance and anatomic magnetic resonance imaging (MRI) of the basal ganglia in autism. Journal of Child Neurology, 18(5), 317–324.

    Article  PubMed  Google Scholar 

  • Harvey, C., & Henderson, S. (1997). Childrens handwriting in the first three years of school: Consistency over time and its relationship to academic achievement. Handwriting Review, 11, 8–25.

    Google Scholar 

  • Haswell, C., Izawa, J., Dowell, L., Mostofsky, S., & Shadmehr, R. (2009). Representation of internal models of action in the autistic brain. Nature Neuroscience, 12(8), 970–972.

    Article  PubMed  Google Scholar 

  • Henderson, S., & Green, D. (2001). Handwriting problems in children with asperger syndrome. Handwriting Today, 2, 65–79.

    Google Scholar 

  • Hughes, C. (1996). Brief report: Planning problems in autism at the level of motor control. Journal of Autism and Developmental Disorders, 26(1), 99–107.

    Article  PubMed  Google Scholar 

  • Jansiewicz, E., Goldberg, M., Newschaffer, C., Denckla, M., Landa, R., & Mostofsky, S. (2006). Motor signs distinguish children with high functioning autism and Aspergers syndrome from controls. Journal of Autism and Developmental Disorders, 36(5), 613–621.

    Article  PubMed  Google Scholar 

  • Jones, D., & Christensen, C. (1999). Relationship between automaticity in handwriting and students’ ability to generate written text. Journal of Educational Psychology, 91(1), 44–49.

    Article  Google Scholar 

  • Jongmans, M., Linthorst-Bakker, E., Westenberg, Y., & Smits-Engelsman, B. (2003). Use of a task-oriented self-instruction method to support children in primary school with poor handwriting quality and speed. Human Movement Science, 22(4–5), 549–566.

    Article  PubMed  Google Scholar 

  • Larsen, S., & Hammill, D. (1989). Test of legible handwriting.

  • Laszlo, J., & Bairstow, P. (1984). Handwriting: Difficulties and possible solutions. School Psychology International, 5(4), 207–213.

    Article  Google Scholar 

  • Levine, M. (1987). Developmental variation and learning disorders. Cambridge, MA: Educators Pub Service.

    Google Scholar 

  • Lord, C., Cook, E., Leventhal, B., & Amaral, D. (2000). Autism spectrum disorders. Neuron, 28(2), 355–363.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., & Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.

    Article  PubMed  Google Scholar 

  • Malloy-Miller, T. (1995). Handwriting error patterns of children with mild motor difficulties. Canadian Journal of Occupational Therapy, 62(5), 258–267.

    Google Scholar 

  • Masterton, B., & Biederman, G. (1983). Proprioceptive versus visual control in autistic children. Journal of Autism and Developmental Disorders, 13(2), 141–152.

    Article  PubMed  Google Scholar 

  • Maurer, R., & Damasio, A. (1982). Childhood autism from the point of view of behavioral neurology. Journal of Autism and Developmental Disorders, 12(2), 195–205.

    Article  PubMed  Google Scholar 

  • Mayes, S., & Calhoun, S. (2003a). Ability profiles in children with autism: Influence of age and IQ. Autism, 7(1), 65–80.

    Article  PubMed  Google Scholar 

  • Mayes, S., & Calhoun, S. (2003b). Analysis of WISC-III, Stanford-Binet: IV, and academic achievement test scores in children with autism. Journal of Autism and Developmental Disorders, 33(3), 329–341.

    Article  PubMed  Google Scholar 

  • Mayes, S., & Calhoun, S. (2006). Frequency of reading, math, and writing disabilities in children with clinical disorders. Learning and Individual Differences, 16(2), 145–157.

    Article  Google Scholar 

  • Mayes, S., & Calhoun, S. (2007). Learning, attention, writing, and processing speed in typical children and children with ADHD, autism, anxiety, depression, and oppositional-defiant disorder. Child Neuropsychology (Neuropsychology, Development and Cognition: Section C), 13(6), 469–493.

    Google Scholar 

  • Mayes, S., & Calhoun, S. (2008). WISC-IV and WIAT-II profiles in children with high-functioning autism. Journal of Autism and Developmental Disorders, 38(3), 428–439.

    Article  PubMed  Google Scholar 

  • Miller, L., Missiuna, C., Macnab, J., Malloy-Miller, T., & Polatajko, H. (2001). Clinical description of children with developmental coordination disorder. Canadian Journal of Occupational Therapy. Revue canadienne d’ergothérapie, 68(1), 5–15.

    PubMed  Google Scholar 

  • Ming, X., Brimacombe, M., & Wagner, G. (2007). Prevalence of motor impairment in autism spectrum disorders. Brain and Development, 29(9), 565–570.

    Article  PubMed  Google Scholar 

  • Minshew, N., Goldstein, G., & Siegel, D. (1997). Neuropsychologic functioning in autism: Profile of a complex information processing disorder. Journal of the International Neuropsychological Society, 3(04), 303–316.

    PubMed  Google Scholar 

  • Mostofsky, S., Dubey, P., Jerath, V., Jansiewicz, E., Goldberg, M., & Denckla, M. (2006). Developmental dyspraxia is not limited to imitation in children with autism spectrum disorders. Journal of the International Neuropsychological Society, 12(03), 314–326.

    Article  PubMed  Google Scholar 

  • Mottron, L., Dawson, M., Soulieres, I., Hubert, B., & Burack, J. (2006). Enhanced perceptual functioning in autism: An update, and eight principles of autistic perception. Journal of Autism and Developmental Disorders, 36(1), 27–43.

    Article  PubMed  Google Scholar 

  • Myles, B., Huggins, A., Rome-Lake, M., Hagiwara, T., Barnhill, G., & Griswold, D. (2003). Written Language Profile of Children and Youth with Asperger Syndrome: From Research to Practice. Education and Training in Developmental Disabilities, 38(4), 362–369.

    Google Scholar 

  • Noterdaeme, M., Mildenberger, K., Minow, F., & Amorosa, H. (2002). Evaluation of neuromotor deficits in children with autism and children with a specific speech and language disorder. European Child and Adolescent Psychiatry, 11(5), 219–225.

    Article  PubMed  Google Scholar 

  • Ozonoff, S., Pennington, B., & Rogers, S. (1991). Executive function deficits in high-functioning autistic individuals: Relationship to theory of mind. Journal of Child Psychology and Psychiatry, 32(7), 1081–1105.

    Article  PubMed  Google Scholar 

  • Racine, M., Majnemer, A., Shevell, M., & Snider, L. (2008). Handwriting performance in children with attention deficit hyperactivity disorder (ADHD). Journal of Child Neurology, 23(4), 399–406.

    Article  PubMed  Google Scholar 

  • Reisman, J. (1993). Development and reliability of the research version of the Minnesota Handwriting Test. Physical & Occupational Therapy in Pediatrics, 13(2), 41–55.

    Article  Google Scholar 

  • Rinehart, N., Bellgrove, M., Tonge, B., Brereton, A., Howells-Rankin, D., & Bradshaw, J. (2006). An examination of movement kinematics in young people with high-functioning autism and Aspergers disorder: Further evidence for a motor planning deficit. Journal of Autism and Developmental Disorders, 36(6), 757–767.

    Article  PubMed  Google Scholar 

  • Rinehart, N., Bradshaw, J., Brereton, A., & Tonge, B. (2001). Movement preparation in high-functioning autism and Asperger disorder: A serial choice reaction time task involving motor reprogramming. Journal of Autism and Developmental Disorders, 31(1), 79–88.

    Article  PubMed  Google Scholar 

  • Rosenblum, S., Epsztein, L., & Josman, N. (2008). Handwriting performance of children with attention deficit hyperactive disorders: A pilot study. Physical & Occupational Therapy in Pediatrics, 28(3), 219–234.

    Article  Google Scholar 

  • Rosenblum, S., & Livneh-Zirinski, M. (2008). Handwriting process and product characteristics of children diagnosed with developmental coordination disorder. Human Movement Science, 27(2), 200–214.

    Article  PubMed  Google Scholar 

  • Rosenblum, S., Weiss, P., & Parush, S. (2003). Product and process evaluation of handwriting difficulties. Educational Psychology Review, 15(1), 41–81.

    Article  Google Scholar 

  • Rumsey, J., & Hamburger, S. (1990). Neuropsychological divergence of high-level autism and severe dyslexia. Journal of Autism and Developmental Disorders, 20(2), 155–168.

    Article  PubMed  Google Scholar 

  • Sassoon, R. (1997). Dealing with adult handwriting problems. Handwriting Review, 11, 69–74.

    Google Scholar 

  • Schmitz, C., Martineau, J., Barthélémy, C., & Assaiante, C. (2003). Motor control and children with autism: Deficit of anticipatory function? Neuroscience Letters, 348(1), 17–20.

    Article  PubMed  Google Scholar 

  • Siegel, D., Minshew, N., & Goldstein, G. (1996). Wechsler IQ profiles in diagnosis of high-functioning autism. Journal of Autism and Developmental Disorders, 26(4), 389–406.

    Article  PubMed  Google Scholar 

  • Smits-Engelsman, B., & Van Galen, G. (1997). Dysgraphia in children: Lasting psychomotor deficiency or transient developmental delay? Journal of Experimental Child Psychology, 67(2), 164–184.

    Article  PubMed  Google Scholar 

  • Smyth, M. (1989). Visual control of movement patterns and the grammar of action. Acta Psychologica, 70(3), 253–265.

    Article  PubMed  Google Scholar 

  • Smyth, M., & Silvers, G. (1987). Functions of vision in the control of handwriting. Acta Psychologica, 65(1), 47–64.

    Article  Google Scholar 

  • Szatmari, P., Tuff, L., et al. (1990). Asperger’s syndrome and autism: Neurocognitive aspects. Journal of American Academy of Child & Adolescent Psychiatry, 29(1), 709–720.

    Article  Google Scholar 

  • Tseng, M., & Cermak, S. (1993). The influence of ergonomic factors and perceptual-motor abilities on handwriting performance. American Journal of Occupational Therapy, 47(10), 919–926.

    PubMed  Google Scholar 

  • Tseng, M., & Chow, S. (2000). Perceptual-motor function of school-age children with slow handwriting speed. American Journal of Occupational Therapy, 54(1), 83–88.

    Article  PubMed  Google Scholar 

  • Tseng, M., & Murray, E. (1994). Differences in perceptual-motor measures in children with good and poor handwriting. Occupational Therapy Journal of Research, 14(1), 19–36.

    Google Scholar 

  • van Doorn, R., & Keuss, P. (1992). The role of vision in the temporal and spatial control of handwriting. Acta Psychologica, 81(3), 269–286.

    Article  PubMed  Google Scholar 

  • Van Galen, G., Portier, S., Smits-Engelsman, B., & Schomaker, L. (1993). Neuromotor noise and poor handwriting in children. Acta Psychologica, 82(1–3), 161–178.

    Article  PubMed  Google Scholar 

  • Volman, M., Van Schendel, B., & Jongmans, M. (2006). Handwriting difficulties in primary school children: A search for underlying mechanisms. The American Journal of Occupational Therapy, 60(4), 451–460.

    Article  PubMed  Google Scholar 

  • Wann, J., & Jones, J. (1986). Space-time invariance in handwriting: Contrasts between primary school children displaying advanced or retarded handwriting acquisition. Human Movement Science, 5(3), 275–296.

    Article  Google Scholar 

  • Wechsler, D. (1974). Manual for the Wechsler intelligence scale for children. New York: The Psychological Corporation.

    Google Scholar 

  • Wechsler, D. (1999). Wechsler abbreviated scale of intelligence. Psychological Corp.

  • Weintraub, N., & Graham, S. (2000). The contribution of gender, orthographic, finger function, and visual-motor processes to the prediction of handwriting status. Occupational Therapy Journal of Research, 20(2), 121–140.

    Google Scholar 

  • Ziviani, J., & Elkins, J. (1986). Effect of pencil grip on handwriting speed and legibility. Educational Review, 38(3), 247–257.

    Article  Google Scholar 

  • Ziviani, J., & Wallen, M. (2006). The development of graphomotor skills. In A. Henderson & C. Pehoski (Eds.), Hand function in the child: Foundations for remediation (pp. 217–236). St. Louis: Mosby.

    Chapter  Google Scholar 

Download references

Acknowledgment

This work is support by the Ontario Ministry of Research and Innovation, Canada Research Chairs Program, and the Holland Bloorview Kids Rehabilitation Hospital Foundation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Evdokia Anagnostou.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s10803-011-1335-5

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kushki, A., Chau, T. & Anagnostou, E. Handwriting Difficulties in Children with Autism Spectrum Disorders: A Scoping Review. J Autism Dev Disord 41, 1706–1716 (2011). https://doi.org/10.1007/s10803-011-1206-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-011-1206-0

Keywords

Navigation