Handwriting difficulties in primary school children: a search for underlying mechanisms.

OBJECTIVE This study investigated the contribution of perceptual-motor dysfunction and cognitive planning problems to the quality or speed of handwriting in children with handwriting problems (HWP). METHOD Twenty-nine children with HWP and 20 classroom peers attending regular schools (grade 2 and grade 3) were tested with regard to visual perception, visual-motor integration, fine motor coordination, and cognitive planning abilities. RESULTS The HWP group scored significantly lower on visual perception, visual-motor integration, fine motor coordination, and cognitive planning in comparison with classroom controls. Regression analyses showed that visual-motor integration was the only significant predictor for quality of handwriting in the HWP group, whereas fine motor coordination (i.e., unimanual dexterity) was the only significant predictor of quality of handwriting in the control group. CONCLUSIONS Results suggest that two different mechanisms underlie the quality of handwriting in children with and without handwriting problems. Poor quality of handwriting of children with HWP seems particularly related to a deficiency in visual-motor integration.