Motor sequencing in autism spectrum disorder: a kinematic study of handwriting in school-aged children

Handwriting is commonly identified as an area of weakness in children with autism spectrum disorder (ASD), but precise deficits have not been fully characterised. In order to address gaps in the ASD/handwriting evidence base, the current study aimed to: (1) further characterise handwriting performance in children with ASD using a series of digitised tasks and advanced quantitative descriptive measures; (2) characterise how children with ASD plan and control their handwriting movements, with particular focus on how this may relate to existing cognitive styles associated with ASD; and (3) examine the relationships between handwriting variables and clinical symptoms, including severity of intellectual, ASD, attention and motor symptoms. Forty-three boys aged between 8-12 years participated in the Hands in Motion research study; 23 with ASD (M=10.58 years) and 20 age-matched controls (M=10.85 years). A series of digitised handwriting tasks were used to quantitatively and objectively assess handwriting performance using a range of advanced descriptive and kinematic measures. Task design and analysis was completed using MovAlyzer software (version 6.1.0.0, NeuroScript Pty Ltd). Taken together, the current study findings indicate that children with ASD have considerable difficulties planning, controlling and regulating their handwriting sequences. Parent reports indicate that handwriting difficulties appear to impact a large proportion of these children on a daily basis, and are significant enough to warrant handwriting intervention. Further investigations of handwriting in ASD revealed that children with more severe ASD, motor and/or attentional symptoms are likely to have a higher incidence of handwriting impairment.