Difficulties with handwriting in primary school children
Authors:   , Duiser Ivonne Hendrina Francyna 
Published: March 2023

Handwriting is a pertinent motor skill that children acquire during their primary school years. Despite the widespread (and increasing) use of keyboards, handwriting remains a necessary skill to fulfil school tasks. Yet, a vast number of children in primary school are considered to have problems producing (legible) handwriting. Many of these children are referred to rehabilitation or therapy. Within rehabilitation, occupational and paediatric physical therapy, the emphasis of research and therapy on understanding and counteracting handwriting problems has been on organismic constraints. We shifted focus to task constraints and examined whether writing between lines would benefit the handwriting in children with unsatisfactory handwriting. Besides that, we examined whether learning to handwrite enables early learning to read, specifically the abilities to recognize and discriminate letters.
We showed that, at an early stage (i.e., after one year of writing tuition; Dutch grade 4), almost a third of the primary school children show unsatisfactory handwriting according to the Concise Assessment Scale for Children’s Handwriting (BHK). Both handwriting quality and speed improved across primary school years. Speed developed gradually, while the increase of handwriting quality was more irregular, with the largest increase taking place between (Dutch) grades 5 and 6. The percentage of children with unsatisfactory handwriting dropped from 33% after one year of writing tuition to 5% after four years of tuition (Dutch grade 7). In general, handwriting quality increases through primary school, with only a small number of children showing unsatisfactory handwriting at the end of primary school. However, prediction of persistent handwriting problems based on handwriting assessments early in primary school was low as only three out of 173 children (1.7%) showed unsatisfactory handwriting across all four years.
We also showed that the organismic constraints associated with fine motor control and coordination abilities (i.e., copying figures and writing between lines) constrained handwriting quality, while those related to recognizing visual forms did not. Although the ability for motor control and coordination accounted for a small percentage of handwriting quality when measured at the same time or in the same year (i.e., 13 to 23%), they did not predict handwriting quality or speed in subsequent years.
Furthermore, we assessed the influence of lining on the handwriting quality in children with satisfactory and unsatisfactory handwriting. With only a baseline, children with satisfactory handwriting after one year of tuition (i.e., Dutch grade 4) wrote smaller and more smoothly than children with unsatisfactory handwriting. Providing support lines affected handwriting in both groups. Children with satisfactory and unsatisfactory handwriting adapted almost similarly to the manipulations of number and separation of lines. Both groups of children wrote smaller, less smooth, and slower between lines with the smaller separation (i.e., 3 mm), irrespective of the number of lines. This suggests that Dutch grade 4 children can write smaller letters to adapt to task constraints. Yet, the prioritization of size went at the expense of writing smoothness and velocity. Overall, children, both with satisfactory and unsatisfactory handwriting showed similar short-term adaptation to the use of lining, and, not in all aspects in a manner that would be considered an improvement in handwriting quality.
And finally, we found that children who received handwriting, touch typing and alphabet tuition, recognized and discriminated more letters after tuition, regardless of the type of tuition. Children thus profited from any form of letter training to recognize and discriminate letters. So, we did not find an indication of the necessity of handwriting or typing in learning to read isolated letters.