Doney Robyn, Lucas Barbara R, Jirikowic Tracy, Tsang Tracey W, Watkins Rochelle E, Sauer Kay, Howat Peter, Latimer Jane, Fitzpatrick James P, Oscar June, Carter Maureen, Elliott Elizabeth J
School of Public Health, Curtin University, Perth, Western Australia, Australia.
Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Aust Occup Ther J. 2017 Feb;64(1):68-78. doi: 10.1111/1440-1630.12326. Epub 2016 Sep 19.
BACKGROUND/AIM: Few studies have examined graphomotor skills in children with prenatal alcohol exposure (PAE) or fetal alcohol spectrum disorder (FASD).
Graphomotor skills were assessed in 108 predominantly Australian Aboriginal children aged 7.5-9.6 years in remote Western Australia using clinical observations (pencil grasp; writing pressure) and standardised assessment tools (the Evaluation Tool of Children's Handwriting; and the Miller Function and Participation Scales - The Draw-a-Kid Game). Skills were compared between children (i) without PAE, (ii) PAE but not FASD and (iii) FASD.
Most children used a transitional pencil grasp and exerted heavy handwriting pressure (83.3% and 30.6% of the cohort). The percentage of letters (M = 62.9%) and words (M = 73.3%) written legibly was low. Children with FASD were more likely than children without PAE to use a cross-thumb grasp (P = 0.027), apply heavy writing pressure (P = 0.036), be unable to write a sentence (P = 0.041) and show poorer word legibility (P = 0.041). There were no significant differences between groups for drawing outcomes, although some children with FASD drew pictures that appeared delayed for their age. There were no significant differences between children without PAE and those with PAE but who were not diagnosed with FASD.
Overall, graphomotor skills were poor in this cohort, but children with FASD performed significantly worse than children without PAE. Findings suggest the need for improved occupational therapy services for children in remote regions and evaluation of graphomotor skills in children with PAE.
背景/目的：很少有研究考察产前酒精暴露（PAE）儿童或胎儿酒精谱系障碍（FASD）儿童的书写运动技能。
在西澳大利亚偏远地区，对108名年龄在7.5至9.6岁之间、主要为澳大利亚原住民的儿童进行了书写运动技能评估，采用临床观察（握笔方式；书写压力）和标准化评估工具（儿童笔迹评估工具；以及米勒功能与参与量表 - 画小孩游戏）。对（i）无PAE的儿童、（ii）有PAE但未患FASD的儿童和（iii）患FASD的儿童的技能进行了比较。
大多数儿童采用过渡性握笔方式，书写压力较大（分别占队列的83.3%和30.6%）。能清晰书写的字母（中位数 = 62.9%）和单词（中位数 = 73.3%）的比例较低。与无PAE的儿童相比，患FASD的儿童更有可能采用拇指交叉握笔方式（P = 0.027）、书写压力大（P = 0.036）、无法写出完整句子（P = 0.041）且单词清晰度较差（P = 0.041）。尽管一些患FASD的儿童所画的画在年龄上显得滞后，但在绘画结果方面各群体之间没有显著差异。无PAE的儿童与有PAE但未被诊断为FASD的儿童之间没有显著差异。
总体而言，该队列儿童的书写运动技能较差，但患FASD的儿童表现明显比无PAE的儿童差。研究结果表明，偏远地区儿童需要改善职业治疗服务，并且需要对PAE儿童的书写运动技能进行评估。
