Abstract
This study tests a handwriting model for children and youth with Autism Spectrum Disorder (ASD) that displays the relationships between handwriting process and product characteristics, and the predictors of these characteristics. Structural Equation Modelling was used to test the model for children and youth with ASD (n = 50) and typically developing peers (n = 50), ages 10 to 15, for a copying and freestyle handwriting task. Findings suggest a generic handwriting model applying to both groups and both handwriting tasks. Unique effects for children and youth with ASD were identified for: (1) high interdependence of handwriting process characteristics, (2) longer pen stroke in air leading to better legibility, and (3) lower scores for executive functions leading to lower scores for legibility.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Change history
13 January 2023
A Correction to this paper has been published: https://doi.org/10.1007/s10803-022-05836-0
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:Author
Arbuckle, J. L. (2012). IBM SPSS Amos 21 Users Guide. Chicago, IL: IBM Software Group
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(1), 240–247. https://doi.org/10.1016/j.ridd.2017.11.013
Beery, K. E., Buktenica, N. A., & Beery, N. A. (2010). The Beery–Buktenica Developmental Test of Visual–Motor Integration: Administration, scoring, and teaching manual (6th ed.). Minneapolis, MN: Pearson
Bentler, P. M., & Dudgeon, P. (1996). Covariance structure analysis: Statistical practice, theory, and directions. Annual Review of Psychology, 47(1), 563–592
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. https://doi.org/10.1007/s10803-014-2176-9
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(1), 103–118. https://doi.org/10.1080/19411240903146426
Civetta, L. R., & Hillier, S. L. (2008). The Developmental Coordination Disorder Questionnaire and Movement Assessment Battery for Children as a diagnostic method in Australian children. Pediatric Physical Therapy, 20(1), 39–46. https://doi.org/10.1097/PEP.0b013e31815ccaeb
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers
Dockrell, J. E., Charman, R. J., G., & Lindsay, G. (2014). Exploring writing products in students with language impairments and autism spectrum disorders. Learning and Instruction, 32(1), 81–90. https://doi.org/10.1016/j.learninstruc.2014.01.008
Eigisti, I., de Marchena, A. B., Schuh, J. M., & Kelley, E. (2011). Language acquisition in autism spectrum disorders: A developmental review. Research in Autism Spectrum Disorders, 5(1), 681–692. https://doi.org/10.1016/j.rasd.2010.09.001
Ellinoudis, T., Evaggelinou, C., Kourtessis, T., Konstantinidou, Z., Venetsanou, F., & Kambas, A. (2011). Reliability and validity of age band 1 of the Movement Assessment Battery for Children – Second Edition. Research in Developmental Disabilities, 32(1), 1046–1051. https://doi.org/10.1016/j.ridd.2011.01.035
Feder, K. P., & Majnemer, A. (2007). Handwriting development, competency, and intervention
DevelopmentalMedicine and Child Neurology, 49(4),312–317. https://doi.org/10.1111/j.1469-8749.2007.00312.x
Finnegan, E., & Accardo, A. L. (2018). Written expression in individuals with autism spectrum disorder: A meta-analysis.Journal of Autism and Developmental Disorders, 48(4),868–882. https://doi.org/10.1007/s10803-017-3385-9
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(1), 1227–1240. https://doi.org/10.1007/s10803-010-0981-3
Fuentes, C. T., Mostofsky, S. H., & Bastian, A. J. (2009). Children with autism show specific handwriting impairments. Neurology, 73(19), 1532–1537. https://doi.org/10.1212/WNL.0b013e3181c0d48c
Fuentes, C. T., Mostofsky, S. H., & Bastian, A. J. (2010). Perceptual reasoning predicts handwriting impairment in adolescents with autism. Neurology, 75(1), 1825–1829. https://doi.org/10.1212/WNL.0b013e3181fd633d
George, D., & Mallery, M. (2010). SPSS for Windows Step by Step: A Simple Guide and Reference. Boston: Pearson
Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). Behavior Rating Inventory of
Executive Function Professional Manual. Florida:Psychological Assessment Resources
Gowen, E., & Hamilton, A. (2013). Motor abilities in autism: A review using a computation context. Journal of Autism Development Disorder, 43(1), 323–344. https://doi.org/10.1007/s10803-012-1574-0
Grace, N., Enticott, P. G., Johnson, B. P., & Rinehart, N. J. (2017). Do handwriting difficulties correlate with core symptomology, motor proficiency and attentional behaviours? Journal of Autism and Developmental Disorders, 47(1), 1006–1017. https://doi.org/10.1007/s10803-016-3019-7
Graham, S., Weintraub, N., Berninger, V., & Schafer, W. (1988). Development of handwriting speed and legibility in grades 1–9. The Journal of Educational Research, 92(1), 42–52
Granader, Y., Wallace, G. L., Hardy, K. K., Yerys, B. E., Lawson, R. A., Rosenthal, M., & Kenworthy, L. (2014). Characterizing the factor structure of parent reported executive functioning in autism spectrum disorders: The impact of cognitive inflexibility. Journal of Autism and Developmental Disorders, 44(12), 3056–3062. https://doi.org/10.1007/s10803-014-2169-8
Green, R. R., Bigler, E. D., Froehlich, A., Prigge, M. B. D., Travers, B. G., Cariello, A. N., Anderson, J. S., Zielinski, B. A., Alexander, A., Lange, N., & Lainhart, J. E. (2016). Beery VMI Performance in Autism Spectrum Disorder. Child Neuropsychology, 22(7), 795–817. https://doi.org/10.1080/09297049.2015.1056131
Gregg, N., Coleman, C., Davis, M., & Chalk, J. C. (2007). Timed essay writing: Implications for high-stakes tests. Journal of Learning Disabilities, 40(4), 306–318. https://doi.org/10.1177/00222194070400040201
Hellinckx, T., Roeyers, H., & Van Waelvelde, H. (2013). Predictors of handwriting in children with autism spectrum disorder. Research in Autism Spectrum Disorders, 7(1), 176–186. https://doi.org/10.1016/j.rasd.2012.08.009
Henderson, S. E., Sugden, D. A., & Barnett, A. L. (2007). Movement Assessment Battery for Children-2 second edition (Movement ABC-2). London, UK: The Psychological Corporation
Hox, J., & Bechger, T. (1999). An introduction to Structural Equation Modelling. Family Science Review, 11(1), 354–373
Hua, J., Gu, G., Meng, W., & Wu, A. (2013). Age band 1 of the Movement Assessment Battery for Children – Second Edition: Exploring its usefulness in mainland China. Research in Developmental Disabilities, 34(2), 801–808. https://doi.org/10.1016/j.ridd.2012.10.012
Huizinga, M., & Smidts, D. P. (2011). Age-related changes in executive function: A normative study with the Dutch version of the Behavior Rating Inventory of Executive Function (BRIEF). Child Neuropsychology, 17(1), 51–66. https://doi.org/10.1080/09297049.2010.509715
Iarocci, G., & McDonald, J. (2006). Sensory integration and the perceptual experience of persons with autism. Journal of Autism and Developmental Disorders, 36(1), 77–90. https://doi.org/10.1016/j.dcn.2017.04.010
James, K. H. (2017). The importance of handwriting experience on the development of the literate brain. Current Directions in Psychological Science, 26(1), 502–508. https://doi.org/10.1177/0963721417709821
James, K. H., & Engelhardt, L. (2012). The effects of handwriting experience on functional brain development in pre-literate children. Trends in Neuroscience and Education, 1(1), 32–42. https://doi.org/10.1016/j.tine.2012.08.001
Johnson, B. P., Papadopoulos, N., Fielding, J., Tonge, B., Phillips, J. G., & Rinehart, N. J. (2013). A quantitative comparison of handwriting in children with high-functioning autism and attention deficit hyperactivity disorder. Research in Autism Spectrum Disorders, 7(1), 1638–1646. https://doi.org/10.1016/j.rasd.2013.09.008
Johnson, B. P., Phillips, J. G., Papadopoulos, N., Fielding, J., Tonge, B., & Rinehart, N. J. (2013). Understanding macrographia in children with autism spectrum disorders. Research in Developmental Disabilities, 34(1), 2917–2926. https://doi.org/10.1016/j.ridd,2013.06.003
Johnson, B. P., Phillips, J. G., Papadopoulos, N., Fielding, J., Tonge, B., & Rinehart, N. J. (2015). Do children with autism and Asperger’s disorder have difficulty controlling handwriting size? A kinematic evaluation. Research in Autism Spectrum Disorder, 11(1), 20–26. https://doi.org/10.1016/j.rasd.2014.11.001
Kita, Y., Suzuki, K., Hirata, S., Sakihara, K., Inagaki, M., & Nakai, A. (2016). Applicability of the Movement Assessment Battery for Children – Second Edition to Japanese children: A study of the age band 2. Brain and Development, 38(8), 706–713. https://doi.org/10.1016/j.braindev.2016.02.012
Kline, R. B. (2005). Principles and practice of structural equation modeling (2nd ed.). Guilford Press
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. https://doi.org/10.1007/s10803-011-1206-0
Langendorfer, S. J., Roberton, M. A., & Stodden, D. F. (2011). Biomechanical aspects of the development of object projection skills. In M. Dd, S. Croix, & T. Koriff (Eds.), Paediatric biomechanics and motor control. New York, NY: Routledge
Li-Tsang, C. W. P., Li, T. M. H., Choco, H. Y. H., Lau, M. S. W., & Leung, H. (2018).W. H. The relationship between sensorimotor and handwriting performance in Chinese adolescents with autism spectrum disorder. Journal of Autism and Developmental >Disorders, 48(1),3093–3100. https://doi.org/10.1007/s10803-018-3580-3
Luria, G., & Rosenblum, S. (2012). A Computerised Multidimensional Measurement of Mental Workload via Handwriting. Behavioural Research Methods, 44(1), 575–586. https://doi.org/10.3758/s13428-011-0159-8
Manfra, L., Squires, C., Dinehart, L. H. B., Bleiker, C., Hartman, S. C., & Winsler, A. (2016). Preschool writing and premathematics predict Grade 3 achievement for low-income ethnically diverse children.Journal of Educational Research, 110(5),1–10. https://doi.org/10.1080/00220671.2016.1145095
Mayes, S. D., Breaux, R. P., Calhoun, S. L., & Frye, S. S. (2019). High prevalence of dysgraphia in elementary through high school student with ADHD and Autism. Journal of Attention Disorders, 23(8), 787–796. https://doi.org/10.1177/1087054717720721
Mayes, S. D., & Calhoun, S. L. (2006). Frequency of reading, math, and writing disabilities in children with clinical disorders. Learning and Individual Differences, 16(1), 145–157. https://doi.org/10.1016/j.lindif.2005.07.004
McCormick, C., Hepburn, S., Young, G. S., & Rogers, S. J. (2016). Sensory symptoms in children with autism spectrum disorder, other developmental disorders and typical development: A longitudinal study. Autism, 20(5), 572–579. https://doi.org/10.1177/1362361315599755
Miller, M., Chukoskie, L., Zinni, M., Townsend, J., & Trauner, D. (2014). Dyspraxia, motor function and visual-motor integration in autism. Behavioural Brain Research, 269(1), 95–102. https://doi.org/10.1016/j.bbr.2014.04.011 Qualtrics, Provo, U. T., USA. https://www.qualtrics.com
Rosenblum, S., Simhon, B., H. A., & Gal, E. (2016). Unique handwriting performance characteristics of children with high-functioning autism spectrum disorders. Research in Autism Spectrum Disorders, 23(1), 235–244. https://doi.org/10.1016/j.rasd.2015.11.004
Rosenblum, S., Ben-Shimon, H. A., Meyers, S., & Gal, E. (2019). Predictors of handwriting performance among children with autism spectrum disorder. Research in Autism Spectrum Disorders, 60(1), 16–24. https://doi.org/10.1016/j.rasd.2019.01.00
Rosenblum, S., Goldstand, S., & Parush, S. (2006). Relationships among biomechanical ergonomic factors, handwriting product quality, handwriting efficiency, and computerized handwriting process measures in children with and without handwriting difficulties. American Journal of Occupational Therapy, 60(1), 28–39. https://doi.org/10.5014/ajot.60.1.28
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(1), 933–954. https://doi.org/10.2466/PMS.96.3.933-954
Rosenblum, S., Weiss, P. L., & Parush, S. (2003). Product and process evaluation of handwriting difficulties. Educational Psychology Review, 15(1), 41–81. https://doi.org/10.1023/A:1021371425220
Rosenblum, S., Weiss, P. L., & Parush, S. (2004). Handwriting evaluation for developmental dysgraphia: Process versus product. Reading and Writing, 17(5), 433–458. https://doi.org/10.1023/B:READ.0000044596.91833.55
Sigmundsson, H., Newell, K. M., Polman, R., & Haga, M. (2021). Exploration of the specificity of motor skills hypothesis in 7–8 years old primary school children: Exploring the relationship between 12 different motor skills from two different motor competence test batteries. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2021.631175
Smits-Engelsman. (2010). Movement Assessment Battery for Children-2. Dutch Standardization. Amsterdam: Pearson Education
Tarka, P. (2018). An overview of structural equation modelling: Its beginnings, historical development, usefulness and controversies in the social sciences. Quality & Quantity, 52(1), 313–354. https://doi.org/10.1007/s11135-017-0469-8
Van den Bos, N., Houwen, S., Schoemaker, M., & Rosenblum, S. (2021). Balancing text generative and text transcriptive demands: Written content and handwriting legibility and speed of children and youth with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-021-05325-w
Van den Bos, N., & Rosenblum, S. (2022). The Underlying Mechanisms of Handwriting of Individuals with Autism Spectrum Disorder: A Scoping Review [Manuscript submitted for publication]. Department of Occupational Therapy, University of Haifa
Van Dijk, H., & Tellegen, P. J. (2004). Nederlandse Intelligentietest voor Onderwijsniveau: Instructie. Amsterdam: Boom Test Uitgevers
Werner, P., Rosenblum, S., Bar-On, G., Heinik, J., & Korczyn, A. (2006). Handwriting process variables discriminating mild Alzheimer’s disease and mild cognitive impairment. Journals of Gerontology Series B Psychological Sciences and Social Sciences, 61(4), 228–236. https://doi.org/10.1093/geronb/61.4.p228
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 Disorder, 70(1),101471. https://doi.org/10.1016/j.rasd.2019.101471
Acknowledgements
The authors are grateful to the Autism Fund in the Netherlands for their contribution to the Handwriting Study which helped to cover the costs of materials for the data collection in the Netherlands. The authors thank the undergraduate and graduate students of the Center of Human Movement Sciences and the Inclusive and Special Needs Education Unit of the University of Groningen for their outstanding assistance during data collection. The authors also thank the two reviewers whose feedback substantially increased the quality of this paper.
Funding
Partial financial support was received from the Autism Fund from the Netherlands, under Grant Agreement No 190326.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to declare that are relevant to the content of this article.
Ethics Approval
Approval was obtained from the ethics committees of the Faculty of Social Welfare and Health Sciences, University of Haifa (Israel) and the Department of Pedagogical and Educational Sciences, University of Groningen (the Netherlands). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
Consent to participate
Active written informed consent was obtained from legal guardians of all individual participants included in this study. After data collection was finished, all personal identifiers were deleted from any data sampled during the Handwriting Study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
van den Bos, N., Houwen, S., Schoemaker, M. et al. Using Structural Equation Modeling to analyze handwriting of children and youth with Autism Spectrum Disorder. J Autism Dev Disord 54, 155–167 (2024). https://doi.org/10.1007/s10803-022-05741-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10803-022-05741-6