Handwriting Performance of Children with Attention Deficit Hyperactivity Disorder: The Role of Visual-Motor Integration


1 PhD student, Department of Psychology, Sari Branch, Islamic Azad University, Sari, Iran.

2 Professor, Department of Psychology, Sari Branch, Islamic Azad University, Sari, Iran.

3 Assistant Professor, Department of Physical Education and Sport Sciences, Aliabad Katoul Branch, Islamic Azad University, Aliabad Katoul, Iran.


Background: Poor performance in motor skills is common in children with attention deficit hyperactivity disorder (ADHD). However, difficulties of children with ADHD in handwriting and its underlying mechanism have rarely been studied. The purpose of this study was to investigate handwriting performance of children with ADHD with considering the role of visual-motor integration (VMI) as a possible underlying mechanism.
Methods: Present study used a comparative-correlational method which was performed in 2019 in Gorgan. Twenty-four children with ADHD and 24 healthy children performed Persian Handwriting Assessment Tool (PHAT) for primary school-aged children. Children copied words on a paper sheet in which words were printed on top of the paper and child had to copy words as accurately as possible. In dictation part, experimenter read a text loud and children had to write words on a paper sheet as accurately as possible. Legibility (including word formation, size, space, alignment and text slant) as well as speed of handwriting were evaluated in both copying and dictation parts. Beery test was used to measure VMI.
Results: Results showed that children with ADHD were weaker in word formation than healthy children (p < .001), but they had same performances as healthy children in terms of word size, space, alignment and text slant. Speed of handwriting was not significantly different between healthy children and those with ADHD. ADHD children showed significantly lower scores in VMI compared with healthy children (p = .004).
Conclusions: Children with ADHD have weaker handwriting legibility than healthy children which is mainly due to word formation. Moreover, VMI might act as a possible underlying mechanism affecting poor handwriting in ADHD children.