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Handwriting Performance in Children with ADHD：Kindergarten through Early Grades
The aims of this study were to: (1) investigate accuracy and quality of dictation and copying tasks in ADHD children and TD children followed from kindergarten to second grade; (2) identify underlying correlating factors and regression prediction models of the writing performance in the ADHD and TD groups respectively; (3) compare performance across ADHD children with writing difficulty, ADHD children with normal writing ability and TD children based on the above-mentioned correlating factors. Sixteen kindergarten ADHD children and sixteen first grade ADHD children with normal cognitive and language development and an equal number of age, gender and preferred hand matched controls were recruited. All participants received TONI-4, PPVT-R, BOT-2, word recognition test, self-designed orthographic awareness test and self-designed writing test(dictation and copying tasks); after six months, BOT-2, word recognition test, self-designed orthographic awareness test, self-designed writing test and the Basic Reading and Writing Comprehensive Test(BRWCT) were administered to the same participants. Three methods of analysis were conducted: one-way ANOVA with repeated measures used to analyze the effects of group and age factors on writing performance; Pearson Product-Moment correlation and hierarchical regression model used to identify the correlating factors and prediction models of writing performance; one-way ANOVA used to compare the performance on the correlating factors across ADHD children with writing difficulty, ADHD children with normal writing ability and TD children. The results showed that ADHD children and TD children had developed rapidly in writing performance from kindergarten through second grade. There were significant group, age and group×age interaction effects on dictation performance in kindergarten and first grade children. Significant group and age effects on dictation performance in first and second grade children were also found, which indicated that ADHD children showed significant improvement in dictation from kindergarten through second grade, though still fell behind their TD peers. There were significant group, age and group×age interaction effects on copying tasks in kindergarten and first grade children, while no significant effects were found in first and second grade children. These results suggested that copying performance in ADHD children, though not as good as their TD peers, improved significantly from kindergarten through first grade. However, there was no significant difference in copying performance between ADHD and TD children in second grade. As for writing quality, ADHD children have significantly more problems in maintaining proportionate character size and component size. Orthographic awareness, word recognition, fine motor precision, fine motor integration and manual dexterity were significantly correlated with writing performance in ADHD children and TD children. Orthographic awareness was the most important predictor for dictation and manual dexterity was an important predictor for far-point copying. Both ADHD children with and without writing difficulty had poorer visual-motor integration than TD children while only ADHD children with writing difficulty had poorer fine motor precision and manual dexterity than TD children, which revealed that fine motor ability was worse in ADHD children with writing difficulty. Discussion about the results and suggestions for further research were provided. Keywords: ADHD, fine motor, handwriting, orthographic awareness, visual-motor integration
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