Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan.
PLoS One. 2018 Jun 19;13(6):e0199355. doi: 10.1371/journal.pone.0199355. eCollection 2018.
First graders born prematurely perform poorly on handwriting speed and legibility. However, whether there are specific legibility factors in which preterm children demonstrate difficulty remains unknown. In addition, handwriting performance beyond the first grade and the influence of sex on handwriting performance in preterm children are still unclear. We aimed to investigate the influence of prematurity and sex on multiple dimensions of handwriting in grade two and to identify the contributors to performance.
Sixty-three preterm (34 boys and 29 girls) and 67 full-term (27 boys and 40 girls) peers in grade two were included. Class teachers were asked to complete the Chinese Handwriting Evaluation Form. A subgroup of 39 preterm children received assessments on intelligence, visual perception, tactile and kinesthetic sensation, and fine motor skills. Their inattention behavior was rated using a maternal self-report with a behavioral scale.
Boys born prematurely exhibited poorer performance in the speed dimension than full-term boys (p = 0.008), whereas there was comparable performance in the two groups of girls (p = 0.221). In the dimensions related to legibility, preterm boys (32.4%) had a higher percentage of children with difficulty in the construction dimension than the other groups (preterm girls: 6.9%, full-term boys: 7.4%, full-term girls: 5.0%). However, no group difference was found in the dimensions of accuracy and directionality. Of the sensory-perceptual-motor factors, attention was the most significant predictor of accuracy in performance (p = 0.046) and speed dimensions (p = 0.001) in preterm children.
Boys appear to be vulnerable to the adverse impacts of preterm birth in terms of performance in the dimensions of speed and construction in grade two. Based on the significant contribution of attention to handwriting performance in preterm children, assessment and intervention in the area of attention is strongly suggested for preterm children with handwriting problems.
早产儿一年级学生的书写速度和清晰度较差。然而，早产儿在哪些特定的清晰度因素上存在困难尚不清楚。此外，早产儿二年级以后的书写表现以及性别的影响在早产儿的书写表现中仍不清楚。我们旨在研究早产儿和性别对二年级学生多个维度的书写表现的影响，并确定影响表现的因素。
共纳入 63 名早产儿（男 34 名，女 29 名）和 67 名足月儿（男 27 名，女 40 名）的二年级同龄人。班主任被要求完成《汉字书写评价表》。早产儿亚组中的 39 名儿童接受了智力、视觉感知、触觉和动觉感知以及精细运动技能评估。他们的注意力不集中行为由母亲使用行为量表进行自我报告评估。
早产儿男孩在速度维度的表现比足月儿男孩差（p=0.008），而两组女孩的表现相当（p=0.221）。在与清晰度相关的维度中，早产儿男孩（32.4%）在结构维度上有书写困难的儿童比例高于其他组（早产儿女孩：6.9%，足月儿男孩：7.4%，足月儿女孩：5.0%）。然而，在准确性和方向性维度上没有组间差异。在感觉-运动-感知因素中，注意力是早产儿在准确性和速度维度上表现的最显著预测因素（p=0.046 和 p=0.001）。
在二年级时，男孩似乎更容易受到早产的不利影响，表现在速度和结构维度上。基于注意力对早产儿书写表现的显著贡献，建议对有书写问题的早产儿进行注意力评估和干预。
