Predictors of handwriting performance among children with autism spectrum disorder

Background: Literature indicates that deficient handwriting abilities among children with autism spectrum disorder (ASD) relate especially to their overall legibility and speed. The aim of this study was to investigate further whether the handwriting production process in children with ASD relates to lower-level processes, such as visual perception, motor coordination, and visual-motor integration, and to higher-level processes, such as executive functions. Method: Sixty children aged 9-12 years, including 30 children with ASD and 30 controls with typical development participated in the study. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire. The children were tested using the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI-V) and performed a story-writing task on a sheet of paper affixed to an electroic tablet of ComPET, a computerized penmanship evaluation tool. Results: Significant differences were found between children with ASD and children with typical development in executive function, in all BRIEF scales, and in the visual-motor integration and motor coordination sections of the VMI-V, but not in the VMI-V visual-perception subtest. Visual-motor integration did not predict handwriting process measures. However, executive functions-specifically working memory and shifting-correlated with the handwriting process measures of children with ASD and were found to predict the handwriting. Conclusion: The results of this study provide further insight into the handwriting difficulties of children with ASD by highlighting the role of executive functions, specifically working memory and shifting, in the story-writing process of children with ASD.