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Deficits in Handwriting of Individuals with Autism: a Review on Identification and Intervention Approaches

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Abstract

The complex handwriting skill, necessary for effective expression that has spatial, temporal, and kinaesthetic aspects (three-aspects henceforth), needs planning alongwith fine motor skill. Unlike neurotypicals, individuals with Autism possess cognitive and motor deficits adversely affecting handwriting, addressable through intervention. This necessitates to have comprehensive review on the struggles these children face while (hand)writing alongwith appropriate intervention. None categorize studies identifying the three-aspects of handwriting alongwith cognitive and motor processes and the intervention techniques. Here, we present a holistic review (i) categorizing studies emphasizing the three aspects of handwriting alongwith the underlying processes and (ii) highlighting the conventional, computer-assisted, and robot-assisted intervention techniques. Our review indicates that individuals with Autism struggle with the three-aspects of handwriting which can be addressed through intervention.

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References

  • Alaniz, M. L., Galit, E., Necesito, C. I., & Rosario, E. R. (2015). Hand strength, handwriting, and functional skills in children with autism. American Journal of Occupational Therapy, 69(4), 6904220030p1-6904220030p9.

  • Amundson, S. J. (1995). Evaluation tool of children’s handwriting: ETCH examiner’s manual. OT KIDS.

    Google Scholar 

  • Annett, M., Anderson, F., Bischof, W. F., & Gupta, A. (2014, May). The pen is mightier: understanding stylus behaviour while inking on tablets. In Proceedings of Graphics Interface 2014 (pp. 193-200). Canadian Information Processing Society.

  • Asperger, H., & Frith, U. T. (1991). ‘Autistic psychopathy’ in childhood.

    Book  Google Scholar 

  • Asaro-Saddler, K. (2016). Writing instruction and self-regulation for students with autism spectrum disorders. Topics in Language Disorders, 36(3), 266–283.

    Article  Google Scholar 

  • Asselborn, T., Guneysu, A., Mrini, K., Yadollahi, E., Ozgur, A., Johal, W., & Dillenbourg, P. (2018, June). Bringing letters to life: handwriting with haptic-enabled tangible robots. In Proceedings of the 17th ACM Conference on Interaction Design and Children (pp. 219-230).

  • Azañón, E., Tamè, L., Maravita, A., Linkenauger, S. A., Ferrè, E. R., Tajadura-Jiménez, A., & Longo, M. R. (2016). Multimodal contributions to body representation. Multisensory Research, 29(6–7), 635–661.

    Article  Google Scholar 

  • Bailey, C. A. (1988). Handwriting: ergonomics, assessment and instruction. British Journal of Special Education, 15(2), 65–71.

    Article  Google Scholar 

  • Batchelder, A., McLaughlin, T. F., Weber, K. P., Derby, K. M., & Gow, T. (2009). The effects of hand-over-hand and a dot-to-dot tracing procedure on teaching an autistic student to write his name. Journal of Developmental and Physical Disabilities, 21(2), 131–138.

    Article  Google Scholar 

  • Berninger, V. W., Abbott, R. D., Abbott, S. P., Graham, S., & Richards, T. (2002). Writing and reading: connections between language by hand and language by eye. Journal of Learning Disabilities, 35(1), 39–56.

    Article  PubMed  Google Scholar 

  • Beversdorf, D. Q., Anderson, J. M., Manning, S. E., Anderson, S. L., Nordgren, R. E., Felopulos, G. J., & Bauman, M. L. (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 

  • Blijd-Hoogewys, E. M. A., Bezemer, M. L., & Van Geert, P. L. C. (2014). Executive functioning in children with ASD: an analysis of the BRIEF. Journal of Autism and Developmental Disorders, 44(12), 3089–3100.

    Article  PubMed  Google Scholar 

  • Briggs, D. (1980). A study of the influence of handwriting upon grades using examination scripts. Educational Review, 32(2), 186–193.

    Article  Google Scholar 

  • Carlson, B., Mclaughlin, T. F., & Blecher, J. (2009). Teaching preschool children with autism and developmental delays to write.

    Google Scholar 

  • Cartmill, L., Rodger, S., & Ziviani, J. (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 

  • Case-Smith, J., Holland, T., & Bishop, B. (2011). Effectiveness of an integrated handwriting program for first-grade students: a pilot study. American Journal of Occupational Therapy, 65(6), 670–678.

    Article  Google Scholar 

  • Chang, S. H., Chen, C. L., & Yu, N. Y. (2015). Biomechanical analyses of prolonged handwriting in subjects with and without perceived discomfort. Human Movement Science, 43, 1–8.

    Article  PubMed  Google Scholar 

  • Cho, Y., Bianchi, A., Marquardt, N., & Bianchi-Berthouze, N. (2016, October). RealPen: Providing realism in handwriting tasks on touch surfaces using auditory-tactile feedback. In Proceedings of the 29th Annual Symposium on User Interface Software and Technology (pp. 195-205).

  • Cosby, E., McLaughlin, T. F., & Derby, K. M. (2009). Using tracing and modeling with a handwriting without tears® worksheet to increase handwriting legibility for a preschool student with autism. The Open Social Science Journal, 2(1).

  • Dababnah, S., Ghosh, S., Campion, K., Hussein, D., & Downton, K. D. (2018). Autism interventions in India: a systematic review. Review Journal of Autism and Developmental Disorders, 5(3), 260–267.

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Denckla, M. B. (1985). Revised neurological examination and subtle signs. Psychopharmacology Bulletin, 21, 773–779.

    PubMed  Google Scholar 

  • Erez, N., & Parush, S. (1999). The Hebrew handwriting evaluation. School of Occupational Therapy. Faculty of Medicine: Hebrew University of Jerusalem, Israel.

    Google Scholar 

  • Eysenck, M. W., & Keane, M. T. (2015). Cognitive psychology: a student’s handbook. Psychology press.

  • Falk, T. H., Tam, C., Schellnus, H., & Chau, T. (2011). On the development of a computer-based handwriting assessment tool to objectively quantify handwriting proficiency in children. Computer Methods and Programs in Biomedicine, 104(3), e102–e111.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  • Finnegan, E., & Accardo, A. L. (2018). Written expression in individuals with autism spectrum disorder: a meta-analysis. Journal of Autism and Developmental Disorders, 48(3), 868–882.

    Article  PubMed  Google Scholar 

  • Forti, S., Valli, A., Perego, P., Nobile, M., Crippa, A., & Molteni, M. (2011). Motor planning and control in autism. A kinematic analysis of preschool children. Research in Autism Spectrum Disorders, 5(2), 834–842.

    Article  Google Scholar 

  • Fournier, K. A., Hass, C. J., Naik, S. K., Lodha, N., & Cauraugh, J. H. (2010). Motor coordination in autism spectrum disorders: a synthesis and meta-analysis. Journal of Autism and Developmental Disorders, 40(10), 1227–1240.

    Article  PubMed  Google Scholar 

  • Freeman, A. R., Mackinnon, J. R., & Miller, L. T. (2005). Keyboarding for students with handwriting problems: a literature review. Physical & Occupational Therapy in Pediatrics, 25(1–2), 119–147.

    Article  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  • Fuentes, C. T., Mostofsky, S. H., & Bastian, A. J. (2010). Perceptual reasoning predicts handwriting impairments in adolescents with autism. Neurology, 75(20), 1825–1829.

    Article  PubMed  PubMed Central  Google Scholar 

  • Godde, A., Tsao, R., Gepner, B., & Tardif, C. (2018). Characteristics of handwriting quality and speed in adults with autism spectrum disorders. Research in Autism Spectrum Disorders, 46, 19–28.

    Article  Google Scholar 

  • Goldstand, S., Gevir, D., Cermak, S., & Bissell, J. (2013). Here’s how I write: a child’s self-assessment of handwriting and goal setting tool. Franingham: Therapro.

    Google Scholar 

  • Grace, N., Enticott, P. G., Johnson, B. P., & Rinehart, N. J. (2017a). Do handwriting difficulties correlate with core symptomology, motor proficiency and attentional behaviours? Journal of Autism and Developmental Disorders, 47(4), 1006–1017.

    Article  PubMed  Google Scholar 

  • Grace, N., Rinehart, N. J., Enticott, P. G., & Johnson, B. P. (2017b). Do children with ASD have difficulty handwriting under time pressure? Research in Autism Spectrum Disorders, 37, 21–30.

    Article  Google Scholar 

  • Grace, N., Johnson, B. P., Rinehart, N. J., & Enticott, P. G. (2018). Are motor control and regulation problems part of the ASD motor profile? A handwriting study. Developmental Neuropsychology, 43(7), 581–594.

    Article  PubMed  Google Scholar 

  • Graham, S., & Miller, L. (1980). Handwriting research and practice: a unified approach. Focus on Exceptional Children, 13(2).

  • Graham, S., Berninger, V., Weintraub, N., & Schafer, W. (1998). Development of handwriting speed and legibility in grades 1–9. The Journal of Educational Research, 92(1), 42–52.

    Article  Google Scholar 

  • Harris, T. L., & Rarick, G. L. (1957). The problem of pressure in handwriting. The Journal of Experimental Education, 26(2), 151–178.

    Article  Google Scholar 

  • Harris, T. L., & Rarick, G. L. (1959). The relationship between handwriting pressure and legibility of handwriting in children and adolescents. The Journal of Experimental Education, 28(1), 65–84.

    Article  Google Scholar 

  • Harris, S. J., & Livesey, D. J. (1992). Improving handwriting through kinaesthetic sensitivity practice. Australian Occupational Therapy Journal, 39(1), 23–27.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  • Hill, E. L. (2004). Evaluating the theory of executive dysfunction in autism. Developmental Review, 24(2), 189–233.

    Article  Google Scholar 

  • Hossain, M. D., Ahmed, H. U., Uddin, M. J., Chowdhury, W. A., Iqbal, M. S., Kabir, R. I., et al. (2017). Autism Spectrum disorders (ASD) in South Asia: a systematic review. BMC Psychiatry, 17(1), 1–7.

    Article  Google Scholar 

  • Jasmin, E., Couture, M., McKinley, P., Reid, G., Fombonne, E., & Gisel, E. (2009). Sensori-motor and daily living skills of preschool children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(2), 231–241.

    Article  PubMed  Google Scholar 

  • Johnson, B. P., Phillips, J. G., Papadopoulos, N., Fielding, J., Tonge, B., & Rinehart, N. J. (2013a). Understanding macrographia in children with autism spectrum disorders. Research in Developmental Disabilities, 34(9), 2917–2926.

    Article  PubMed  Google Scholar 

  • Johnson, B. P., Papadopoulos, N., Fielding, J., Tonge, B., Phillips, J. G., & Rinehart, N. J. (2013b). A quantitative comparison of handwriting in children with high-functioning autism and attention deficit hyperactivity disorder. Research in Autism Spectrum Disorders, 7(12), 1638–1646.

    Article  Google Scholar 

  • Kandalaft, M. R., Didehbani, N., Krawczyk, D. C., Allen, T. T., & Chapman, S. B. (2013). Virtual reality social cognition training for young adults with high-functioning autism. Journal of Autism and Developmental Disorders, 43(1), 34–44.

    Article  PubMed  Google Scholar 

  • Karavanidou, E. (2017). Is handwriting relevant in the digital era? Antistasis, 7(1).

  • Kenworthy, L. E., Black, D. O., Wallace, G. L., Ahluvalia, T., Wagner, A. E., & Sirian, L. M. (2005). Disorganization: the forgotten executive dysfunction in high-functioning autism (HFA) spectrum disorders. Developmental Neuropsychology, 28(3), 809–827.

    Article  PubMed  Google Scholar 

  • Kiefer, M., & Trumpp, N. M. (2012). Embodiment theory and education: the foundations of cognition in perception and action. Trends in Neuroscience and Education, 1(1), 15–20.

    Article  Google Scholar 

  • Kim, Y. S., Collins, M., Bulmer, W., Sharma, S., & Mayrose, J. (2013, April). Haptics Assisted Training (HAT) system for children’s handwriting. In 2013 World Haptics Conference (WHC) (pp. 559-564). IEEE.

  • Kushki, A., Chau, T., & Anagnostou, E. (2011). Handwriting difficulties in children with autism spectrum disorders: a scoping review. Journal of Autism and Developmental Disorders, 41(12), 1706–1716.

    Article  PubMed  Google Scholar 

  • LeBrun, M., McLaughlin, T. F., Derby, K. M., & McKenzie, M. (2012). The effects of using Handwriting without Tears® to teach thirty-one integrated preschoolers of varying academic ability to write their names. Academic Research International, 2(2), 373.

    Google Scholar 

  • Lee, O. (2015). The effects of HHIW intervention on handwriting for children with autism. Science and Engineering Research Support Society.

    Book  Google Scholar 

  • Li-Tsang, C. W., Li, T. M., Ho, C. H., Lau, M. S., & Leung, H. W. (2018). The relationship between sensorimotor and handwriting performance in Chinese adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(9), 3093–3100.

    Article  PubMed  Google Scholar 

  • Löfgren, F., Thunberg, S., & Thellman, S. (2018, March). LetterMoose: a handwriting tutor robot. In Companion of the 2018 ACM/IEEE International Conference on Human-Robot Interaction (pp. 355-356).

  • MacDonald, M., Lord, C., & Ulrich, D. A. (2013). The relationship of motor skills and social communicative skills in school-aged children with autism spectrum disorder. Adapted Physical Activity Quarterly, 30(3), 271–282.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Mayes, S. D., & Calhoun, S. L. (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 

  • Myles, B. S., Huggins, A., Rome-Lake, M., Hagiwara, T., Barnhill, G. P., & Griswold, D. E. (2003). Written language profile of children and youth with Asperger syndrome: from research to practice. Education and Training in Developmental Disabilities, 362–369.

  • Moore, D. W., Anderson, A., Treccase, F., Deppeler, J., Furlonger, B., & Didden, R. (2013). A video-based package to teach a child with autism spectrum disorder to write her name. Journal of Developmental and Physical Disabilities, 25(5), 493–503.

    Article  Google Scholar 

  • Palluel-Germain, R., Bara, F., De Boisferon, A. H., Hennion, B., Gouagout, P., & Gentaz, E. (2007, March). A visuo-haptic device-telemaque-increases kindergarten children’s handwriting acquisition. In Second Joint EuroHaptics Conference and Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems (WHC'07) (pp. 72-77). IEEE.

  • Palsbo, S. E., & Hood-Szivek, P. (2012). Effect of robotic-assisted three-dimensional repetitive motion to improve hand motor function and control in children with handwriting deficits: a nonrandomized phase 2 device trial. American Journal of Occupational Therapy, 66(6), 682–690.

    Article  Google Scholar 

  • Pennington, R. C. (2010). Computer-assisted instruction for teaching academic skills to students with autism spectrum disorders: a review of literature. Focus on Autism and Other Developmental Disabilities, 25(4), 239–248.

    Article  Google Scholar 

  • Peverly, S. T. (2006). The importance of handwriting speed in adult writing. Developmental Neuropsychology, 29(1), 197–216.

    Article  PubMed  Google Scholar 

  • Plamondon, R., Yu, L. D., Stelmach, G. E., & Clément, B. (1991). On the automatic extraction of biomechanical information from handwriting signals. IEEE Transactions on Systems, Man, and Cybernetics, 21(1), 90–101.

    Article  Google Scholar 

  • Quant, L. (1946). Factors affecting the legibility of handwriting. The Journal of Experimental Education, 14(4), 297–316.

    Article  Google Scholar 

  • Reisman, J. (1999). Minnesota handwriting assessment. Psychological Corporation.

  • Robins, B., Dautenhahn, K., Te Boekhorst, R., & Billard, A. (2005). Robotic assistants in therapy and education of children with autism: can a small humanoid robot help encourage social interaction skills? Universal Access in the Information Society, 4(2), 105–120.

    Article  Google Scholar 

  • Roland, J. (2006). Measuring up: online technology assessment tools ease the teacher’s burden and help students learn. Learning & Leading with Technology, 34(2), 12–17.

    Google Scholar 

  • Rosenblum, S., Parush, S., & Weiss, P. L. (2003). The in air phenomenon: temporal and spatial correlates of the handwriting process. Perceptual and Motor Skills, 96(3), 933–954.

    Article  PubMed  Google Scholar 

  • Rosenblum, S., Simhon, H. A. B., & Gal, E. (2016). Unique handwriting performance characteristics of children with high-functioning autism spectrum disorder. Research in Autism Spectrum Disorders, 23, 235–244.

    Article  Google Scholar 

  • Sacrey, L. A. R., Germani, T., Bryson, S. E., & Zwaigenbaum, L. (2014). Reaching and grasping in autism spectrum disorder: a review of recent literature. Frontiers in Neurology, 5, 6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shire, K. A., Hill, L. J., Snapp-Childs, W., Bingham, G. P., Kountouriotis, G. K., Barber, S., & Mon-Williams, M. (2016). Robot guided ‘pen skill’ training in children with motor difficulties. PLoS One, 11(3), e0151354.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sitdhisanguan, K., Chotikakamthorn, N., Dechaboon, A., & Out, P. (2012). Using tangible user interfaces in computer-based training systems for low-functioning autistic children. Personal and Ubiquitous Computing, 16(2), 143–155.

    Article  Google Scholar 

  • Smith, E., McLaughlin, T. F., Neyman, J., & Rinaldi, L. (2013). The effects of, lined paper, prompting, tracing, rewards, and fading to increase handwriting performance and legibility with two preschool special education students diagnosed with developmental delays, and fine motor deficits. Journal on Educational Psychology, 6(4), 23–29.

    Google Scholar 

  • Srinivasan, S. M., Kaur, M., Park, I. K., Gifford, T. D., Marsh, K. L., & Bhat, A. N. (2015). The effects of rhythm and robotic interventions on the imitation/praxis, interpersonal synchrony, and motor performance of children with autism spectrum disorder (ASD): a pilot randomized controlled trial. Autism research and treatment, 2015.

  • Sudsawad, P., Trombly, C. A., Henderson, A., & Tickle-Degnen, L. (2002). Testing the effect of kinesthetic training on handwriting performance in first-grade students. American Journal of Occupational Therapy, 56(1), 26–33.

    Article  Google Scholar 

  • Sugasawara, H., & Yamamoto, J. I. (2007). Computer-based teaching of word construction and reading in two students with developmental disabilities. Behavioral Interventions: Theory & Practice in Residential & Community-Based Clinical Programs, 22(4), 263–277.

    Article  Google Scholar 

  • Suppes, P. (1966). The uses of computers in education. Scientific American, 215(3), 206–223.

    Article  Google Scholar 

  • Thompson, J., McLaughlin, T. F., Derby, K. M., & Conley, D. (2012). Using tracing and modeling with a handwriting without tears® worksheet to increase handwriting legibility for two preschool students with developmental delays: a brief report. Academic Research International, 2(2), 309.

    Google Scholar 

  • Van Galen, G. P. (1991). Handwriting: Issues for a psychomotor theory. Human Movement Science, 10(2–3), 165–191.

    Article  Google Scholar 

  • Yamaguchi, K., Sano, M., & Fukatsu, R. (2019). Hand and finger functions and characteristics of line drawing movement in preschool children with autism spectrum disorder: preliminary study. Asian Journal of Occupational Therapy, 15(1), 77–83.

    Article  Google Scholar 

  • Zajic, M. C., & Wilson, S. E. (2020). Writing research involving children with autism spectrum disorder without a co-occurring intellectual disability: a systematic review using a language domains and mediational systems framework. Research in Autism Spectrum Disorders, 70, 101471.

    Article  Google Scholar 

  • Zhao, H., Zheng, Z., Swanson, A., Weitlauf, A., Warren, Z., & Sarkar, N. (2018). Design of a Haptic-Gripper Virtual reality system (Hg) for analyzing fine motor behaviors in children with autism. ACM Transactions on Accessible Computing (TACCESS), 11(4), 1–21.

    Article  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 

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Acknowledgements

The authors would like to thank the anonymous reviewers for their insightful and valuable comments which helped improve the quality of this review article. The authors would also like to thank IIT Gandhinagar and TCS Research Scholar Program for providing resources for carrying out this survey.

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Verma, P., Lahiri, U. Deficits in Handwriting of Individuals with Autism: a Review on Identification and Intervention Approaches. Rev J Autism Dev Disord 9, 70–90 (2022). https://doi.org/10.1007/s40489-020-00234-7

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