The importance of diagnostic, demographic, and neurocognitive correlates of dysgraphia in 1006 students 6–16 years was determined. Children with ADHD or autism (n = 831) and neurotypical children (n = 175) were administered the Developmental Test of Visual-Motor Integration (VMI), Wechsler subscales, and reading and math tests. IQ was the strongest correlate of dysgraphia (VMI scores), followed by diagnosis (ADHD/autism vs. neurotypical). Visual-fine motor ability was the only other significant correlate. Verbal and visual reasoning ability, processing speed, working memory, attention, reading, and math did not contribute significantly more to concurrently predicting dysgraphia, nor did age, sex, race, and parent occupation. Dysgraphia was common in children with ADHD (56%) and autism (56%), especially those with a learning disability in reading (71%) or math (72%). The study demonstrates the importance of controlling for both IQ and diagnosis when examining factors related to dysgraphia, which previous studies have not done. Students with ADHD, autism, learning disability, or fine motor problems should be evaluated for dysgraphia because the majority of students with any one of these problems will have impaired handwriting, which needs to be identified and addressed in school. Effective accommodations to compensate for dysgraphia are available to help avoid its negative repercussions.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Adi-Japha, E., Landau, Y. E., Frenkel, L., Teicher, M., Gross-Tsur, V., & Shalev, R. S. (2007). ADHD and dysgraphia: Underlying mechanisms. Cortex, 43, 700–709.
Aylward, E. H., & Schmidt, S. (1986). An examination of three tests of visual-motor integration. Journal of Learning Disabilities, 19, 328–330.
Aylward, G. P., Verhulst, S. J., & Bell, S. (1990). Individual and combined effects of attention deficits and learning disabilities on computerized ADHD assessment. Journal of Psychoeducational Assessment, 8, 497–508.
Beery, K. E. (1997). The Beery-BuktenicaDevelopmental Test of Visual-Motor Integration (VMI): Administration, scoring, and teaching manual. (4th ed., rev.). Parsippany, NJ: Modern Curriculum Press.
Beery, K. E., & Beery, N. A. (2006). The Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI): Administration, scoring, and teaching manual. (5th ed., rev.). Minneapolis, MN: Pearson.
Berninger, V., Nielsen, K. H., Abbott, R. D., Wijsman, E., & Raskind, W. (2008). Gender differences in severity of writing and reading disabilities. Journal of School Psychology, 46, 151–172.
Berninger, V., & Richards, T. (2010). Inter-relationships among behavioral markers, genes, brain and treatment in dyslexia and dysgraphia. Future Neurology, 5, 597–617.
Bixler, E. O., Vgontzas, A. N., Lin, H-M., Calhoun, S., Vela-Bueno, A., Fedok. F., Vlasic, V., & Graff, G. (2009). Sleep disordered breathing in children in a general population sample: Prevalence and risk factors. Sleep, 32, 731–736.
Brossard-Racine, M., Majnemer, A., Shevell, M., Snider, L., & Bélanger, S. A. (2011). Handwriting capacity in children newly diagnosed with attention deficit hyperactivity disorder. Research in Developmental Disabilities, 32, 2927–2934.
Case-Smith, J. (2002). Effectiveness of school-based occupational therapy intervention on handwriting. American Journal of Occupational Therapy, 56, 17–25.
Conrad, A. L., Richman, L., Lindgren, S., & Nopoulos, P. (2010). Biological and environmental predictors of behavioral sequelae in children born preterm. Pediatrics, 125, e83–e89.
Cornhill, H., & Case-Smith, J. (1996). Factors that relate to good and poor handwriting. American Journal of Occupational Therapy, 50, 732–739.
Dakin, S., & Frith, U. (2005). Vagaries of visual perception in autism. Neuron, 48, 497–507.
Faraone, S., Biederman, J., Weber, W., & Russell, R. L. (1998). Psychiatric, neuropsychological, and psychosocial features of DSM-IV subtypes of attention-deficit/hyperactivity disorder: Results from a clinically-referred sample. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 185–193.
Forgrave, K. E. (2002). Assistive technology: Empowering students with learning disabilities. The Clearing House: A journal of Educational Strategies, Issues and Ideas, 75, 122–126.
Frank, Y., & Pavlakis, S. G. (2001). Brain imaging in neurobehavioral disorders. Pediatric Neurology, 25, 278–287.
Frazier, J. A., Biederman, J., Bellordre, C. A., Garfield, S. B., Geller, D. A., Coffey, B. J., & Faraone, S. V. (2001). Should the diagnosis of attention-deficit/hyperactivity disorder be considered in children with pervasive developmental disorder? Journal of Attention Disorders, 4, 203–211.
Fuentes, C. T., Mostofsky, S. H., & Bastian, A. J. (2009). Children with autism show specific handwriting impairments. Neurology, 73, 1532–1537.
Fuentes, C. T., Mostofsky, S. H., & Bastian, A. J. (2010). Perceptual reasoning predicts handwriting impairments in adolescents with autism. Neurology, 75, 1825–1829.
Gadow, K. D., DeVincent, C. J., Pomeroy, J., & Azizian, A. (2005). Comparison of DSM-IV symptoms in elementary school-aged children with PDD versus clinic and community samples. Autism, 9, 392–415.
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, 279–284.
Gordon, M. (1983). Gordon Diagnostic System. DeWitt, NY: Gordon Systems.
Gordon, M., Thomasson, D., & Cooper, S. (1990). To what extent does attention affect K-ABC scores? Psychology in the Schools, 27, 144–147.
Graf, M., & Hinton, R. N. (1997). Correlations for the developmental visual-motor integration test and the Wechsler intelligence for children-III. Perceptual and Motor Skills, 84, 699–702.
Graham, S. (1999). The role of text production skills in writing development: A special issue-I. Learning Disability Quarterly, 22, 75–77.
Graham, S., Collins, A. A., & Rigby-Wills, H. (2016a). Writing characteristics of students with learning disabilities and typically achieving peers: A meta-analysis. Exceptional Children, 83, 199–218.
Graham, S., Fishman, E. J., Reid, R., & Hebert, M. (2016b). Writing characteristics of students with attention deficit hyperactive disorder: A meta-analysis. Learning Disabilities Research and Practice, 31, 75–89.
Graham, S., Harris, K. R., & Fink, B. (2000). Is handwriting causally related to learning to write? Treatment of handwriting problems in beginning writers. Journal of Educational Psychology, 92, 620–633.
Hamstra-Bletz, L., & Blote, A. W. (1993). A longitudinal study on dysgraphic handwriting in primary school. Journal of Learning Disabilities, 26, 689–699.
Hattori, J., Ogino, T., Abiru, K., Nakano, K., Oka, M., & Ohtsuka, Y. (2006). Are pervasive developmental disorders and attention-deficit/hyperactivity disorder distinct disorders? Brain and Development, 28, 371–374.
Hellinckx, T., Roeyers, H., & Van Waelvelde, H. (2013). Predictors of handwriting in children with autism spectrum disorder. Research in Autism Spectrum Disorders, 7, 176–186.
Hetzroni, O. E., & Shrieber, B. (2004). Word processing as an assistive technology tool for enhancing academic outcomes of students with writing disabilities in the general classroom. Journal of Learning Disabilities, 37, 143–154.
Hooper, S. R., Swartz, C. W., Montgomery, J. W., Reed, M. S., Brown, T., Wasileski, T., et al. (1993). Prevalence of writing problems across three middle school samples. School Psychology Review, 22, 608–620.
Hooper, S. R., Swartz, C. W., Wakely, M. B., de Kruif, E. E. L., & Montgomery, J. W. (2002). Executive functions in elementary school children with and without problems in written expression. Journal of Learning Disabilities, 35, 57–68.
Karlsdottir, R., & Stefansson, T. (2002). Problems in developing functional handwriting. Perceptual and Motor Skills, 94, 623–662.
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, 1706–1716.
Lalonde, J., Turgay, A., & Hudson, J. I. (1998). Attention-deficit hyperactivity disorder subtypes and comorbid disruptive behavior disorders in a child and adolescent mental health clinic. Canadian Journal of Psychiatry, 43, 623–628.
Lane, S. E., & Lewandoski, L. (1994). Oral and written compositions of students with and without learning disabilities. Journal of Psychoeducational Assessment, 12, 142–153.
Langmaid, R. A., Papadopoulos, N., Johnson, B. P., Phillips, J. G., & Rinehart, N. J. (2014). Handwriting in children with ADHD. Journal of Attention Disorders, 18, 504–510.
Lindgren, S. D., & Koeppl, G. K. (1987). Assessing child behavior problems in a medical setting: Development of the Pediatric Behavior Scale. In R. J. Prinz (Ed.), Advances in behavioral assessment of children and families (pp. 57–90). Greenwich, CT: JAI.
Luteijn, E. F., Serra, M., Jackson, S., Steenhuis, M. P., Althaus, M., Volkmar, F., & Minderaa, R. (2000). How unspecified are disorders of children with pervasive developmental disorder not otherwise specified? A study of social problems in children with PDD-NOS and ADHD. European Child and Adolescent Psychiatry, 9, 168–179.
MacArthur, C. A. (1996). Using technology to enhance the writing processes of students with learning disabilities. Journal of Learning Disabilities, 29, 344–354.
MacArthur, C. A. (2000). New tools for writing: Assistive technology for students for writing difficulties. Topics in Language Disorders, 20, 85–100.
Maeland, A. E. (1992). Handwriting and perceptual motor skills in clumsy, dysgraphic, and normal children. Perceptual and Motor Skills, 75, 1207–1217.
Mattison, R. E., & Mayes, S. D. (2012). Relationship between learning disability, executive function, and psychopathology in children with ADHD. Journal of Attention Disorders, 16, 138–146.
Mayes, S. D. (2012). Checklist for Autism Spectrum Disorder. Wood Dale, IL: Stoelting.
Mayes, S. D., Breaux, R. P., Calhoun, S. L., & Frye, S. S. (2017). High prevalence of dysgraphia in elementary through high school students with ADHD and autism. Journal of Attention Disorders. https://doi.org/10.1177/1087054717720721.
Mayes, S. D., & Calhoun, S. L. (1998). Comparison of scores on two recent editions of the Developmental Test of Visual-Motor Integration. Perceptual and Motor Skills, 87, 1324–1354.
Mayes, S. D., & Calhoun, S. L. (1999). Symptoms of autism in young children and correspondence with the DSM. Infants and Young Children, 12, 90–97.
Mayes, S. D., & Calhoun, S. L. (2002). Comparative and incremental validity of the Gordon Diagnostic System and WISC-III Freedom from Distractibility Index in identifying referred children with and without ADHD. Psychological Reports, 91, 575–587.
Mayes, S. D., & Calhoun, S. L. (2003a). Ability profiles in children with autism: Influence of age and IQ. Autism, 7, 65–80.
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, 329–341.
Mayes, S. D., & Calhoun, S. L. (2004a). Influence of IQ and age in childhood autism: Lack of support for DSM-IV Asperger’s disorder. Journal of Developmental and Physical Disabilities, 16, 257–272.
Mayes, S. D., & Calhoun, S. L. (2004b). Similarities and differences in Wechsler intelligence. Scale for Children-Third Edition (WISC-III) profiles: Support for subtest analysis in clinical referrals. The Clinical Neuropsychologist, 18, 559–572.
Mayes, S. D., & Calhoun, S. L. (2006a). Frequency of reading, math, and writing disabilities in children with clinical disorders. Learning and Individual Differences, 16, 145–157.
Mayes, S. D., & Calhoun, S. L. (2006b). WISC-IV and WISC-III profiles in children with ADHD. Journal of Attention Disorders, 9, 486–493.
Mayes, S. D., & Calhoun, S. L. (2007a). Learning, attention, writing, and processing speed in typical children and children with ADHD, autism, anxiety, depression, and oppositional-defiant disorder. Child Neuropsychology, 13, 469–493.
Mayes, S. D., & Calhoun, S. L. (2007b). Challenging the assumptions about the frequency and coexistence of learning disability types. School Psychology International, 28, 437–448.
Mayes, S. D., & Calhoun, S. L. (2007c). Wechsler Intelligence Scale for Children-third and -fourth edition predictors of academic achievement in children with ADHD. School Psychology Quarterly, 22, 234–249.
Mayes, S. D., & Calhoun, S. L. (2008). WISC-IV and WIAT-II profiles in children with high-functioning autism. Journal of Autism and Developmental Disorders, 38, 428–439.
Mayes, S. D., Calhoun, S. L., Bixler, E. O., & Zimmerman, D. N. (2009a). IQ and neuropsychological predictors of academic achievement. Learning and Individual Differences, 19, 238–241.
Mayes, S. D., Calhoun, S. L., Murray, M. J., Morrow, J. D., Yurich, K. K. L., Mahr, F., et al. (2009b). Comparison of scores on the Checklist for Autism Spectrum Disorder, Childhood Autism Rating Scale (CARS), and Gilliam Asperger’s Disorder Scale (GADS) for children with low functioning autism, high functioning autism or Asperger’s disorder, ADHD, and typical development. Journal of Autism and Developmental Disorders, 39, 99–1693.
Mayes, S. D., Calhoun, S. L., Chase, G. A., Mink, D. M., & Stagg, R. E. (2009c). ADHD. subtypes and co-occurring anxiety, depression, and oppositional-defiant disorder: Differences in Gordon Diagnostic System and Wechsler Working Memory and Processing Speed Index scores. Journal of Attention Disorders, 12, 540–550.
Mayes, S. D., Calhoun, S. L., & Crowell, E. (1998). WISC-III freedom from distractibility as a measure of attention in children with and without attention deficit hyperactivity disorder. Journal of Attention Disorders, 2, 217–227.
Mayes, S. D., Calhoun, S. L., & Crowell, E. W. (2001). Clinical validity and interpretation of. the Gordon Diagnostic System in ADHD assessments. Child Neuropsychology, 7, 32–41.
Mayes, S. D., Calhoun, S. L., Mayes, R. D., & Molitoris, S. (2012). Autism and ADHD: Overlapping and discriminating symptoms. Research in Autism Spectrum Disorders, 6, 93–285.
Mayes, S. D., Calhoun, S. L., Waxmonsky, J., Kokotovich, C., Baweja, R., Lockridge, R., et al. (2016). Demographic differences in disruptive mood dysregulation disorder (DMDD) symptoms in ADHD, autism, and general population samples. Journal of Attention Disorders. https://doi.org/10.1177/1087054716664409.
Mayes, S. D., Gordon, M., Calhoun, S. L., & Bixler, E. O. (2014). Long-term temporal stability of measured inattention and impulsivity in typical and referred children. Journal of Attention Disorder, 18, 23–30.
Mayes, S. D., Waxmonsky, J., Calhoun, S. L., Kokotovich, C., Mathiowetz, C., & Baweja, R. (2015). Disruptive mood dysregulation disorder (DMDD) symptoms in children with autism, ADHD, and neurotypical development and impact of co-occurring ODD, depression, and anxiety. Research in Autism Spectrum Disorders, 18, 64–72.
McDermott, P. A., Fantuzzo, J. W., & Glutting, J. J. (1990). Just say no to subtest analysis: A critique on Wechsler theory and practice. Journal of Psychoeducational Assessment, 8, 290–302.
Molitor, S. J., Langberg, J. M., Bourchtein, E., Eddy, L. D., Dvorsky, M. R., & Evans, S. W. (2016). Writing abilities longitudinally predict academic outcomes of adolescents with ADHD. School Psychology Quarterly, 31, 393–404.
Murray, M. J., Mayes, S. D., & Smith, L. A. (2011). Brief report: Excellent agreement between two brief autism scales (Checklist for Autism Spectrum Disorder and Social Responsiveness Scale) completed independently by parents and the Autism Diagnostic Interview-Revised. Journal of Autism and Developmental Disorders, 41, 1586–1590.
Nichols, S., Mahoney, E. M., Sirois, P. A., Bordeaux, J. D., Stehbens, J. A., Loveland, K. A., & Amodei, N. (2000). HIV-associated changes in adaptive, emotional, and behavioral functioning in children and adolescents with hemophilia: Results from the hemophilia growth and development study. Journal of Pediatric Psychology, 25, 545–556.
Overvelde, A., & Hulstijn, W. (2011). Handwriting development in grade 2 and 3 primary school children with normal, at risk, or dysgraphic characteristics. Research in Developmental Disabilities, 32, 540–548.
Psychological Corporation. (1999). Wechsler Abbreviated Scale of Intelligence manual. San Antonio: Psychological Corporation.
Rapcsak, S. Z., Beeson, P. M., Henry, M. L., Leyden, A., Kim, E., Rising, K., Andersen, S., & Cho, H. S. (2009). Phonological dyslexia and dysgraphia: Cognitive mechanisms and neural substrates. Cortex, 45, 575–591.
Rapp, B., Purcell, J., Hillis, A. E., Capasso, R., & Miceli, G. (2016). Neural bases of orthographic long-term memory and working memory in dysgraphia. Brain, 139, 588–604.
Richards, T. I., Grabowski, T. J., Boord, P., Yagle, K., Askren, M., Mestre, Z., et al. (2015). Contrasting brain patterns of writing-related DTI parameters, fMRI connectivity, and DTI-fMRI connectivity correlations in children with and without dysgraphia or dyslexia. Neuro Image: Clinical, 8, 408–421.
Siegel, D. J., Minshew, N. J., & Goldstein, G. (1996). Wechsler IQ profiles in diagnosing high-functioning autism. Journal of Autism and Developmental Disorders, 26, 389–406.
Smits-Engelsman, B. C., & Van Galen, G. P. (1997). Dysgraphia in children: Lasting psychomotor deficiency or transient developmental delay? Journal of Experimental Child Psychology, 67, 164–184.
Tierney, C., Mayes, S. D., Lohs, S. R., Black, A., Gisin, E., & Veglia, M. (2015). How valid is the Checklist for Autism Spectrum Disorder when a child has apraxia of speech? Journal of Developmental and Behavioral Pediatrics, 36, 569–574.
Tryon, P. A., Mayes, S. D., Rhodes, R., & Waldo, M. (2006). Can Asperger’s disorder be differentiated from autism using DSM-IV criteria? Focus on Autism and Other Developmental Disabilities, 21, 2–6.
Tseng, M. H., & Cermak, S. A. (1993). The influence of ergonomic factors and perceptual-motor abilities on handwriting performance. American Journal of Occupational Therapy, 47, 919–926.
Tseng, M. H., & Murray, E. A. (1994). Differences in perceptual-motor measures in children with good and poor handwriting. Occupational Therapy Journal of Research, 14, 19–36.
Volman, M. J. M., van Schendel, B. M., & Jongmans, M. J. (2006). Handwriting difficulties in primary school children: A search for underlying mechanisms. American Journal of Occupational Therapy, 60, 451–460.
Waxmonsky, J., Mayes, S. D., Calhoun, S. L., Fernandez-Mendoza, J., Waschbusch, D., & Bixler, E. O. (2017). Disruptive mood dysregulation disorder symptoms and sleep problems in child ADHD and general population samples. Sleep. https://doi.org/10.1016/j.sleep.2017.02.006.
Wechsler, D. (1991). Wechsler Intelligence Scale for Children (3rd ed.). San Antonio, TX: Psychological Corporation.
Wechsler, D. (1992). Wechsler Individual Achievement Test. San Antonio, TX: Psychological Corporation.
Wechsler, D. (2001). Wechsler Individual Achievement Test (2nd ed.). San Antonio, TX: Psychological Corporation.
Wechsler, D. (2003). Wechsler Intelligence Scale for Children (4th ed.). San Antonio, TX: Psychological Corporation.
Wechsler, D. (2014). Wechsler Intelligence Scale for Children (5th ed.). Bloomington, MN: Psychological Corporation.
Weil, M. J., & Amundson, S. J. (1994). Relationship between visuomotor and handwriting skills of children in kindergarten. American Journal of Occupational Therapy, 48, 982–988.
Weintraub, N., & Graham, S. (2000). The contribution of gender, orthographic, finger function, and visual-motor processes to the prediction of handwriting status. The Occupational Therapy Journal of Research, 20, 121–140.
Wilkinson, G. S. (1993). Wide Range Achievement Test 1993 edition manual. Wilmington, DE: Jastak Associates.
Wolraich, M. L., Lindgren, S. D., Stumbo, P. J., Stegink, L. D., Appelbaum, M. I., & Kiritsy, M. C. (1994). Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. New England Journal of Medicine, 330, 301–307.
All procedures performed in this study were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
The study was approved by our Institutional Review Board. Informed consent was waived by the Institutional Review Board because analyses were conducted retrospectively on existing clinical data.
Conflict of Interest
The authors have no conflicts of interest to declare.
Rights and permissions
About this article
Cite this article
Mayes, S.D., Frye, S.S., Breaux, R.P. et al. Diagnostic, Demographic, and Neurocognitive Correlates of Dysgraphia in Students with ADHD, Autism, Learning Disabilities, and Neurotypical Development. J Dev Phys Disabil 30, 489–507 (2018). https://doi.org/10.1007/s10882-018-9598-9
- Neurotypical students
- Developmental test of visual-motor integration