Fuentes Christina T, Mostofsky Stewart H, Bastian Amy J
Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Neurology. 2009 Nov 10;73(19):1532-7. doi: 10.1212/WNL.0b013e3181c0d48c.
Handwriting skills, which are crucial for success in school, communication, and building children's self-esteem, have been observed to be poor in individuals with autism. Little information exists on the handwriting of children with autism, without delineation of specific features that can contribute to impairments. As a result, the specific aspects of handwriting in which individuals with autism demonstrate difficulty remain unknown.
A case-control study of handwriting samples from children with and without autism spectrum disorders (ASD) was performed using the Minnesota Handwriting Assessment. Samples were scored on an individual letter basis in 5 categories: legibility, form, alignment, size, and spacing. Subjects were also tested on the Wechsler Intelligence Scale for Children-IV and the Physical and Neurological Examination for Subtle (Motor) Signs.
We found that children with ASD do indeed show overall worse performance on a handwriting task than do age- and intelligence-matched controls. More specifically, children with ASD show worse quality of forming letters but do not show differences in their ability to correctly size, align, and space their letters. Within the ASD group, motor skills were significantly predictive of handwriting performance, whereas age, gender, IQ, and visuospatial abilities were not.
We addressed how different elements of handwriting contribute to impairments observed in children with autism. Our results suggest that training targeting letter formation, in combination with general training of fine motor control, may be the best direction for improving handwriting performance in children with autism.
书写技能对于学业成功、沟通以及建立儿童自尊至关重要，但已有观察发现自闭症患者的书写技能较差。关于自闭症儿童的书写情况，目前信息较少，且未明确可导致书写障碍的具体特征。因此，自闭症患者在书写方面表现出困难的具体方面仍不为人知。
使用明尼苏达笔迹评估对患有和未患有自闭症谱系障碍（ASD）的儿童的笔迹样本进行病例对照研究。样本按单个字母在五个类别上评分：易读性、形状、对齐、大小和间距。受试者还接受了韦氏儿童智力量表第四版以及细微（运动）体征的体格和神经学检查。
我们发现，与年龄和智力匹配的对照组相比，患有ASD的儿童在笔迹任务上的总体表现确实更差。更具体地说，患有ASD的儿童字母形成质量较差，但在正确调整字母大小、对齐和间距的能力方面没有差异。在ASD组中，运动技能是笔迹表现的显著预测因素，而年龄、性别、智商和视觉空间能力则不是。
我们探讨了书写的不同要素如何导致自闭症儿童出现书写障碍。我们的结果表明，针对字母形成的训练，结合精细运动控制的一般训练，可能是改善自闭症儿童笔迹表现的最佳方向。
