Lopez Clémence, Vaivre-Douret Laurence
Unit 1018-CESP, PsyDev/NDTA Team, National Institute of Health and Medical Research (INSERM), Faculty of Medicine, University of Paris-Saclay, UVSQ, 91190 Villejuif, France.
Department of Medicine Paris Descartes, Faculty of Health, Université Paris Cité, 75006 Paris, France.
Children (Basel). 2023 Sep 6;10(9):1512. doi: 10.3390/children10091512.
Handwriting disorders (HDs) are prevalent in school-aged children, with significant interference with academic performances. The current study offers a transdisciplinary approach with the use of normed and standardized clinical assessments of neuropsychomotor, neuropsychological and oculomotor functions. The aim is to provide objective data for a better understanding of the nature and the etiology of HDs. Data from these clinical assessments were analyzed for 27 school-aged children with HD (first to fifth grade). The results underline a high heterogeneity of the children presenting HDs, with many co-occurrences often unknown. However, it was possible to highlight three levels of HDs based on BHK scores: mild HD not detected by the BHK test (26% of children), moderate HD (33%) and dysgraphia (41% of children). The mild nature of the HDs not detected by the BHK test appears to occur at a relatively low frequency of the associated disorders identified during clinical evaluations. On the contrary, dysgraphia appears to be associated with a high frequency of co-occurring disorders identified in the clinical assessment, with a predominance of oculomotor disorders (55% of children), leading to visual-perceptual difficulties and a high level of handwriting deterioration. Finally, children with moderate HD have fewer co-occurrences than children with dysgraphia, but have more difficulties than children with mild HD. This highlights the importance of differentiating between different degrees of HDs that do not respond to the same semiologies. Our findings support the interest in performing a transdisciplinary and standardized clinical examination with developmental standards (neuropsychomotor, neuropsychological and oculomotor) in children with HD. Indeed, HDs can therefore be associated with a multitude of disorders of different natures ranging from poor coordination of the graphomotor gesture to a more general and more complex impairment affecting perceptual-motor, cognitive and/or psycho-affective functions.
书写障碍（HDs）在学龄儿童中很常见，对学业成绩有显著干扰。本研究提供了一种跨学科方法，运用了对神经心理运动、神经心理和动眼功能的标准化临床评估。目的是提供客观数据，以便更好地理解书写障碍的本质和病因。对27名患有书写障碍的学龄儿童（一至五年级）的这些临床评估数据进行了分析。结果强调了患有书写障碍的儿童具有高度异质性，许多并发情况往往不为人知。然而，根据布伦斯维克书写能力测试（BHK）分数，可以突出书写障碍的三个级别：BHK测试未检测到的轻度书写障碍（26%的儿童）、中度书写障碍（33%）和书写困难（41%的儿童）。BHK测试未检测到的轻度书写障碍，其相关疾病在临床评估中出现的频率相对较低。相反，书写困难似乎与临床评估中发现的高频率并发疾病相关，其中动眼障碍占主导（55%的儿童），导致视觉感知困难和高水平的书写恶化。最后，中度书写障碍的儿童并发情况比书写困难的儿童少，但比轻度书写障碍的儿童有更多困难。这突出了区分不同程度书写障碍的重要性，因为它们对相同症状的反应不同。我们的研究结果支持对患有书写障碍的儿童进行基于发育标准（神经心理运动、神经心理和动眼）的跨学科和标准化临床检查。事实上，书写障碍可能与多种不同性质的疾病相关，从书写动作的协调性差到影响感知运动、认知和/或心理情感功能的更普遍、更复杂的损伤。
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