The Handwriting on the Wall

Children with autism spectrum disorder (ASD) often have poor penmanship. In turn, poor penmanship leads to decreased success in communication, failed academics, and a lack of self-esteem. Until now, clinicians and autism experts believed that developmental delays were to blame for inferior handwriting skills, but a new study in Neurology reports that weak motor skills may be the cause. And, more importantly, they may be treatable.

The study examined the handwriting of children with and without ASD. The children completed the Minnesota Handwriting Assessment, as well as the Wechsler Intelligence Scale for Children-IV and the Physical and Neurological Examination for Subtle (Motor) Signs. The children without ASD performed better on handwriting tasks than age- and intelligence-matched children with ASD. Specifically, children with ASD had trouble forming letters, but were able to correctly size, space, and align their letters. The results of the motor skills assessment accurately predicted handwriting skills within the ASD group. Age, gender, intelligence, and visuospatial abilities were not related to handwriting.

Many children with ASD experience impaired motor skills, not just handwriting. Any skilled movement requires basic motor skills, spatial relations, and the ability to plan movement. The inability to perform such tasks — referred to as “dyspraxia” — is prevalent in ASD children. Currently, experts do not know if these deficits in motor skills and execution are a marker of a neurological abnormality underlying ASD. However, similar deficits have been seen in patients with lesions of the cerebellum, implicating the region of the brain responsible for motor coordination and learning in the neurological basis for ASD.

No matter the cause of ASD, the symptoms of dyspraxia — handwriting included — are associated with the underperformance in social, communication, and behavioral skills that have come to define the disorder. These impairments significantly negatively impact quality of life, self-esteem, and academic performance in children with ASD.

Armed with this new research, occupational therapists are now recommending targeted techniques to teach letter formation, as well as general training to improve fine motor control in children with ASD. For example, using the non-writing hand to steady the writing hand might aid in letter formation. A little extra penmanship work may help children with ASD achieve academic success and healthy self-esteem. The curse of bad penmanship does not need to spell out the future for kids with ASD.


Beversdorf DQ, Anderson JM, Manning SE, Anderson SL, Nordgren RE, Felopulos GJ, & Bauman ML (2001). Brief report: macrographia in high-functioning adults with autism spectrum disorder. Journal of autism and developmental disorders, 31 (1), 97-101 PMID: 11439759

Dowell LR, Mahone EM, & Mostofsky SH (2009). Associations of postural knowledge and basic motor skill with dyspraxia in autism: implication for abnormalities in distributed connectivity and motor learning. Neuropsychology, 23 (5), 563-70 PMID: 19702410

Dziuk MA, Gidley Larson JC, Apostu A, Mahone EM, Denckla MB, & Mostofsky SH (2007). Dyspraxia in autism: association with motor, social, and communicative deficits. Developmental medicine and child neurology, 49 (10), 734-9 PMID: 17880641

Frings M, Gaertner K, Buderath P, Christiansen H, Gerwig M, Hein-Kropp C, Schoch B, Hebebrand J, & Timmann D (2010). Megalographia in Children with Cerebellar Lesions and in Children with Attention-Deficit/Hyperactivity Disorder. Cerebellum (London, England) PMID: 20480275

Fuentes CT, Mostofsky SH, & Bastian AJ (2009). Children with autism show specific handwriting impairments. Neurology, 73 (19), 1532-7 PMID: 19901244

Mayes SD, & Calhoun SL (2007). Learning, attention, writing, and processing speed in typical children and children with ADHD, autism, anxiety, depression, and oppositional-defiant disorder. Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence, 13 (6), 469-93 PMID: 17852125

  • Apraxia/dyspraxia is a motor planning impairment and typically today presents as a syndrome just like autism. Apraxia/dyspraxia and autism are unique disorders that require different therapies and placements. While some of the symptoms of each of the diagnosis may overlap (such as sensory) the reasons for not communicating can be 100% different.

    You can note the motor planning deficits in autism, but change the way this is written. For example the first sentence can be changed to: “Children with autism spectrum disorder (ASD) often have poor penmanship due to underlying and typically undiagnosed apraxia/dyspraxia” Otherwise it appears as the motor planning is now just a symptom of autism and ironically it’s just the opposite. While many with autism today have apraxia, most with apraxia do not have autism.

    ABA which is appropriate for therapy for most with autism, is not for example appropriate therapy for neurologically based motor planning deficits in the body, or speech, and can even be detrimental. We need more professionals who are knowledgeable about both diagnosis so less children are misdiagnosed, and more children with autism that also have dyspraxia can be provided appropriate motor planning therapy for that diagnosis as well.

    Lisa Geng
    President CHERAB Foundation
    Communication Help, Education, Research, Apraxia Base
    “Help give our cherubs a smile and a voice”

  • Anonymous

    Enviroment is key and cause of so many illnesses,way over looked on this tobic as well,thanks.

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  • Aneurysm Survivor

    While weak motor skills may be the cause behind poor penmanship I just do not see it leading to low self-esteem and academic failure. It seems to me that other dynamics must certainly be at work there.

  • Anonymous

    cool bro

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  • l.klein

    How important is handwriting to communication when so much is done by computer or keyboard? Does lack of fine motor skills have affects on other areas besides handwriting?

  • There is apparently a bunch to know about this. I believe you made some nice points in features also.

  • It would be really interesting to see how their writing is if they are writing on paper stuck to the wall. This gets them out of their emotions and internal dialogue that is reminding them that they have poor handwriting. Another way is to copy down exactly from something on a board above eye level without looking at the paper you are writing on and without changing the writing to your own. So your eyes watch the board and you don’t look down at the paper, you just copy.

    We have had some amazing results even with children as young as 4 years old, youngsters just lose the belief that they can’t write. Try it out for yourself.

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Jennifer Gibson, PharmD

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.

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