Graphomotor Disorders in High-Functioning Children with Autism Spectrum Disorders

Background: Several studies described motor control disorders in children with Autism Spectrum Disorders (ASD), even in groups of high-functioning children with ASD (HFA). Graphomotor skills have not yet been examined in children with ASD, although they are extremely relevant because they are linked to academic achievement.

Objectives: Firstly, it will be explored if graphomotor disorders are more common in children with HFA than in typically developing (TD) children. Secondly, it will be examined if handwriting legibility or speed differs in both groups. Finally, several components of writing (visual-motor integration skills, visual perception skills, reading skills and manual dexterity) will be compared between the two groups.

Methods: Participants 60 children with HFA and 60 TD children between 7 and 12 years old, with an IQ > 80, participated. Groups were matched on age, IQ, gender and hand preference. Children with medical diagnoses interfering with their motor development were excluded.
Materials ‘Systematische Opsporing van Schrijfmotorische stoornissen’ (SOS-test) (Van Waelvelde, De Mey & Smits-Engelsman, 2008) was used to evaluate graphomotor skills. Handwriting quality is determined by evaluating 6 items, with higher scores indicating poorer performance. Handwriting speed is measured by counting up the letters written in 5 minutes. 'Beery-Buktenica Developmental Test of Visual Motor-Integration test' (VMI) (Beery & Beery, 2005) was used to evaluate visual-motor integration and visual perception abilities. ‘One-Minute Reading Test’ (EMT) (Brus & Voeten, 1976) was used to assess reading skills. ‘Movement-Assessment Battery for Children - 2^nd edition’ (M-ABC-II) (Henderson & Sugden, 2007) was used to assess manual dexterity.

Results: Preliminary results show that 82.7% of the children with HFA (n=34) fell below or at the 5^th percentile regarding HW quality, as opposed to merely 22.5% of TD children. None of the TD children scored at or below the 5^th percentile regarding HW speed as opposed to 22.9% of the children with HFA. A significantly poorer quality was found in children with HFA (t(54)=-4,81; p≤.001) due to poor writing fluency (Z=-2,74; p=.006), dysfluent transitions between letters (Z=-2,79; p=.005), larger HW (Z=-3; p=.003), more irregular letter height (Z=-3,68; p≤.001) and irregular lines (Z=-3,45; p=.001). No significant difference in writing speed was found. When comparing components of writing, children with HFA had significantly poorer visual-motor integration skills (t(55)=3,14; p=.003), reading skills (t(55)=3,68; p=.001) and manual dexterity (t(55)=474; p≤.001) than the TD group. No significant difference in visual perception skills was found.

Conclusions: Preliminary results show that there is a high prevalence of graphomotor disorders in children with HFA. Children with ASD have poorer HW quality compared to a matched control group possibly due to poorer visual-motor integration skills, reading skills and manual dexterity. Results and conclusions for the whole sample will be presented at the IMFAR meeting.