Journal of Autism and Developmental Disorders

, Volume 48, Issue 9, pp 3093–3100 | Cite as

The Relationship Between Sensorimotor and Handwriting Performance in Chinese Adolescents with Autism Spectrum Disorder

  • Cecilia W. P. Li-TsangEmail author
  • Tim M. H. Li
  • Choco H. Y. Ho
  • Mandy S. W. Lau
  • Howard W. H. Leung
Original Paper


Impaired sensorimotor control, as a common feature of autism spectrum disorder (ASD), could be a driving factor to handwriting problems. This study examined the Chinese and English handwriting and sensorimotor skills of 15 ASD and 174 typically developing Chinese adolescents. Participants with ASD had lower writing speed and poor manual dexterity (MD) than the typically developing participants. MD was a significant mediator between ASD and handwriting speed. Ground time and airtime represent the length of time when the pen touches the paper and is held in air, respectively. Participants with ASD who had better performance in MD showed shorter ground time in Chinese handwriting and shorter airtime in English handwriting. Training for adolescents with ASD on their MD may improve their handwriting performance.


Autism spectrum disorder Chinese Handwriting Sensorimotor 



We thank the Hong Kong Examination and Assessment Authority to support the development of the Computerized Handwriting Speed Test System, Version 2 (CHSTS-2) for secondary school students.

Author Contributions

CWPL and HWHL designed and coordinated the study. TMHL conducted the statistical analyses. TMHL and CHYH interpreted the results and drafted the initial manuscript. MSWL collected data for the study and interpreted the results. All authors critically revised the manuscript and approved the final manuscript as submitted.


This study was funded partly by The Hong Kong Examinations and Assessment Authority, Hong Kong (Grant Number: (13) in T72).

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Research Involving Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors.


  1. Beery, K. E., Buktenica, N. A., & Beery, N. A. (2010). Beery-Buktenica developmental test of visual-motor integration (6th ed.). Minneapolis, MN: Pearson Assessment.Google Scholar
  2. Bo, J., Colbert, A., Lee, C. M., Schaffert, J., Oswald, K., & Neill, R. (2014). Examining the relationship between motor assessments and handwriting consistency in children with and without probable developmental coordination disorder. Research in Developmental Disabilities, 35(9), 2035–2043.CrossRefPubMedGoogle Scholar
  3. Bruininks, R. H., & Bruininks, B. D. (2005). Bruininks-Oseretsky test of motor proficiency (2nd ed.). Minneapolis, MN: Pearson Assessment.Google Scholar
  4. Cartmill, L., Rodger, S., & Ziviani, J. (2009). Handwriting of eight-year-old children with autistic spectrum disorder: An exploration. Journal of Occupational Therapy, Schools, & Early Intervention, 2(2), 103–118.CrossRefGoogle Scholar
  5. Church, C., Alisanski, S., & Amanullah, S. (2000). The social, behavioral, and academic experiences of children with Asperger syndrome. Focus on Autism and Other Developmental Disabilities, 15(1), 12–20.CrossRefGoogle Scholar
  6. Colarusso, R. P., & Hammill, D. D. (2003). Motor-free visual perception test (3rd ed.). Novato, CA: Academic Therapy Publications.Google Scholar
  7. Dakin, S., & Frith, U. (2005). Vagaries of visual perception in autism. Neuron, 48(3), 497–507.CrossRefPubMedGoogle Scholar
  8. Dockrell, J. E., Ricketts, J., Charman, T., & Lindsay, G. (2014). Exploring writing products in students with language impairments and autism spectrum disorders. Learning and Instruction, 32, 81–90.CrossRefGoogle Scholar
  9. Fuentes, C. T., Mostofsky, S. H., & Bastian, A. J. (2009). Children with autism show specific handwriting impairments. Neurology, 73(19), 1532–1537.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Fuentes, C. T., Mostofsky, S. H., & Bastian, A. J. (2010). Perceptual reasoning predicts handwriting impairments in adolescents with autism. Neurology, 75(20), 1825–1829.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Georgiou, G. K., Parrila, R., & Papadopoulos, T. C. (2008). Predictors of word decoding and reading fluency across languages varying in orthographic consistency. Journal of Educational Psychology, 100(3), 566.CrossRefGoogle Scholar
  12. Hellinckx, T., Roeyers, H., & Van Waelvelde, H. (2013). Predictors of handwriting in children with autism spectrum disorder. Research in Autism Spectrum Disorders, 7(1), 176–186.CrossRefGoogle Scholar
  13. Holm, S. (1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics, 6(2), 65–70.Google Scholar
  14. Hoy, M. M., Egan, M. Y., & Feder, K. P. (2011). A systematic review of interventions to improve handwriting. Canadian Journal of Occupational Therapy, 78(1), 13–25.CrossRefGoogle Scholar
  15. Hurst, C. M. (2013). Behavioural optometry: Learning difficulties and the visual process. International Journal of Ophthalmic Practice, 4(3), 127–135.CrossRefGoogle Scholar
  16. Kellogg, R. T. (2008). Training writing skills: A cognitive developmental perspective. Journal of Writing Research, 1(1), 1–26.CrossRefGoogle Scholar
  17. Kenny, L., Hattersley, C., Molins, B., Buckley, C., Povey, C., & Pellicano, E. (2016). Which terms should be used to describe autism? Perspectives from the UK autism community. Autism, 20(4), 442–462.CrossRefPubMedGoogle Scholar
  18. Kostrubiec, V., Danna, J., & Zanone, P. G. (2013). Co-variation between graphic pattern stability and attentional cost: A clue for the difficulty to produce handwritten traces. Human Movement Science, 32(5), 1010–1025.CrossRefPubMedGoogle Scholar
  19. Kushki, A., Chau, T., & Anagnostou, E. (2011). Handwriting difficulties in children with autism spectrum disorders: A scoping review. Journal of Autism and Developmental Disorders, 41(12), 1706–1716.CrossRefPubMedGoogle Scholar
  20. Lam, H. C., Ki, W. W., Chung, A. L. S., Ko, P. Y., Lai, A. C. Y., Lai, S. M. S., et al. (2004). Designing learning objects that afford learners the experience of important variations in Chinese characters. Journal of Computer Assisted Learning, 20(2), 114–123.CrossRefGoogle Scholar
  21. Li-Tsang, C. W. P., Wong, A. S., Leung, H. W. H., Cheng, J. S., Chiu, B. H., Linda, F. L., & Chung, R. C. (2013). Validation of the Chinese handwriting analysis system (CHAS) for primary school students in Hong Kong. Research in Developmental Disabilities, 34(9), 2872–2883.CrossRefPubMedGoogle Scholar
  22. Mayes, S. D., & Calhoun, S. L. (2007). Learning, attention, writing, and processing speed in typical children and children with ADHD, autism, anxiety, depression, and oppositional-defiant disorder. Child Neuropsychology, 13(6), 469–493.CrossRefPubMedGoogle Scholar
  23. Molloy, C. A., Dietrich, K. N., & Bhattacharya, A. (2003). Postural stability in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 33(6), 643–652.CrossRefPubMedGoogle Scholar
  24. Myles, B. S., Huggins, A., Rome-Lake, M., Hagiwara, T., Barnhill, G. P., & Griswold, D. E. (2003). Written language profile of children and youth with Asperger syndrome: From research to practice. Education and Training in Developmental Disabilities, 362–369.Google Scholar
  25. Re, A. M., & Cornoldi, C. (2015). Spelling errors in text copying by children with dyslexia and ADHD symptoms. Journal of Learning Disabilities, 48(1), 73–82.CrossRefPubMedGoogle Scholar
  26. Richman, J. E. (2015). Development eye movement (DEM), Version 2.5, examiner’s Manual, IN Bernell Corp.Google Scholar
  27. Rosenblum, S., Parush, S., & Weiss, P. L. (2003). The in air phenomenon: Temporal and spatial correlates of the handwriting process. Perceptual and Motor skills, 96(3), 933–954.CrossRefPubMedGoogle Scholar
  28. Ryckman, D. B., & Rentfrow, R. K. (1971). The Beery developmental test of visual-motor integration: An investigation of reliability. Journal of Learning Disabilities, 4(6), 333–334.CrossRefGoogle Scholar
  29. Wang, M., Perfetti, C. A., & Liu, Y. (2005). Chinese–English biliteracy acquisition: Cross-language and writing system transfer. Cognition, 97(1), 67–88.CrossRefPubMedGoogle Scholar
  30. World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines (Vol. 1). Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Cecilia W. P. Li-Tsang
    • 1
    Email author
  • Tim M. H. Li
    • 1
  • Choco H. Y. Ho
    • 1
    • 2
  • Mandy S. W. Lau
    • 1
  • Howard W. H. Leung
    • 2
  1. 1.Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHong KongChina
  2. 2.Department of Computer ScienceCity University of Hong KongHong KongChina

Personalised recommendations