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Relationships between fine motorability and handwriting skill in grade five children Iaquinta, Maria 1989

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RELATIONSHIPS BETWEEN FINE M O T O R ABILITY A N D HANDWRIT ING SKILL IN G R A D E FIVE C H I L D R E N by MARIA IAQUINTA B.A., McGi l l University, 1976 Dip. Ed., McGi l l University, 1977 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Department of Educational Psychology) W e accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH C O L U M B I A September 1989 © Maria laquinta, 1989 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at The University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the Head of my Department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. (Department of Educational Psychology) The University of British Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 Date: September 1989 ABSTRACT The primary purpose of this study was to investigate the relationships between fine motor and psychomotor abilities, as measured by a fine motor and psychomotor test battery, and handwriting skill. The secondary purposes were to investigate: relationships between handwriting skill and teacher ratings of achievement; and relationships between handwriting skill and features of penhold and posture. The range of cursive writing legibility and fluency demonstrated by 122 children in grade five was examined and 41 children were selected for membership in the three extreme groups of handwriting skill. The Top group demonstrated above average legibility and fluency. The Bottom group demonstrated below average legibility and fluency. The Slow group demonstrated average legibility and below average fluency. A fine motor and psychomotor test battery and handwriting task were administered and teacher ratings of achievement were obtained for the children in the three handwriting groups. Multiple regression analysis procedures were conducted on the motor test measures. Results indicated significant differences in fine motor and psychomotor ability among handwriting groups for tests which involve the precise manipulation of a pencil-like tool and which evaluate components of movement production or trace. Significance of the Motor Steadiness Battery, especially the Horizontal test, suggests that arm-hand steadiness may contribute to handwriting proficiency. Nondominant hand performance on Motor Steadiness Battery tests was more sensitive to group differences than was dominant hand performance. Analyses of variance procedures were conducted on the teacher ratings of ability and achievement. Ratings of written language, handwriting, and drawing were significantly different for the Top group when compared to the Bottom and Slow ii groups. Ratings of physical education were not significant. Chi-square analysis procedures were conducted on the observed features of penhold and posture. Only differences in proportions of children adopting the inverted wrist position and not placing the paper in the anticlockwise position were significant among groups. Implications of the study are discussed and recommendations for further research are presented. iii TABLE OF CONTENTS ABSTRACT " LIST OF TABLES vi ACKNOWLEDGEMENTS vii Chapter !. INTRODUCTION 1 A. A Developmental Perspective 1 B. An Educational Perspective 4 Chapter II. LITERATURE REVIEW 7 A. Assessment of Handwriting 7 1. Legibility 7 2. Fluency 8 3. Standard Assessment 9 B. Relationship Between Legibility and Fluency 10 C. Non-Motor Correlates of Handwriting 12 1. Age 12 2. Sex and Intelligence 13 3. Writing Hand 14 4. Instruction 15 D. Task Demands of Handwriting as a Motor Skill 16 E. Fine Motor Correlates of Handwriting 19 1. Assessment of Children With Poor Handwriting 19 2. Studies of Fine Motor Abilities in Handwriting 22 3. Penhold Grip and Posture 25 F. Summary 29 Chapter III. STATEMENT OF THE PROBLEM 31 A. Definition of Terms 32 B. Research Questions 34 Chapter IV. RESEARCH M E T H O D O L O G Y 36 A. Selection of Extreme Handwriting Groups. 36 1. Sample 36 2. Data Collect ion 37 3. Rating of Handwriting Samples 37 4. Selection of Extreme Groups 38 B. Comparison of Extreme Handwriting Groups 41 1. Procedure 41 2. Description of Instruments 42 3. Data Analysis 47 Chapter V. RESULTS 49 A. Descriptive Statistics 49 B. Multiple Regression Analyses 51 1. Finger Localization 52 2. Finger Tapping 52 iv 3. Motor Steadiness Battery 54 4. Grooved Pegboard Test 54 5. Motor Speed and Precision 55 6. Bender 55 7. Coding 55 8. Fluency Difference 55 9. Summary 56 C. Analyses of Variance 57 D. Chi Square Analyses 60 1. Crip 61 2. Thumb 61 3. Index 63 4. Hand and Wrist 64 5. Posture 64 6. Summary 65 Chapter VI. DISCUSSION A N D C O N C L U S I O N S 66 A. Summary : 66 B. Discussion of Results 68 1. Measures of Fine Motor and Psychomotor Ability 68 2. Teacher Ratings of Ability and Academic Achievement ... 73 3. Penhold and Posture 75 4. Handwriting Fluency Difference 76 C. C O N C L U S I O N S 77 D. IMPLICATIONS OF THE STUDY 78 1. Screening Handwriting 78 2. Diagnostic Assessment of Fine Motor and Psychomotor Abilities 79 E. RECOMMENDATIONS FOR FURTHER RESEARCH 81 REFERENCES 83 APPENDIX A: CURSIVE WRITING DIAGNOSTIC INVENTORY 90 APPENDIX B: PENHOLD A N D POSTURE CLASSIFICATION INVENTORY 92 APPENDIX C : PROCEDURES FOR COLLECTION OF HANDWRITING SAMPLES 94 APPENDIX D: TEACHER RATING FORM 96 APPENDIX E: MEANS A N D STANDARD DEVIATIONS BY C R O U P O N THE FINE M O T O R A N D P S Y C H O M O T O R TEST BATTERY, FLUENCY DIFFERENCE, A N D TEACHER RATINGS OF ABILITY A N D ACHIEVEMENT 98 APPENDIX F: INTERCORRELATIONS A M O N G VARIABLES USED IN MULTIPLE REGRESSION ANALYSES 101 APPENDIX G: RESULTS OF STRUCTURED MULTIPLE REGRESSION ANALYSES 107 v LIST OF TABLES Table 1: Handwriting Characteristics of 122 Children 39 Table 2: Sample Characteristics for the Three Handwriting Groups 40 Table 3: Characteristics of the Usual and Speeded Samples for the Three Handwriting Groups ...41 Table 4: Classification of Fine Motor and Psychomotor Test Battery 43 Table 5: Significance of Group Difference for Fine Motor Tests and Variability: Summary of Multiple Regressions 53 Table 6: Means and Standard Deviations for Sex by Group on Significant Group Differences for Variables of Sex and SXG2 57 Table 7: Effects of Handwriting on Scholastic Achievement: Summary of Analyses of Variance of Teacher Ratings 58 Table 8: Significance of Group Mean Differences on Teacher Ratings 59 Table 9: Intercorrelations of Ratings of Scholastic Ability and Achievement and Handwriting Legibility for Usual Sample 60 Table 10: Percentages and Frequencies of Children Displaying Nonmodal or Incorrect Penhold and Postural Features by Group with Chi-Square Analyses 62 vi A C K N O W L E D G E M E N T S The writer expresses her appreciation to her advisor, Dr. Julianne Conry, and methodologist, Dr. Robert Conry, for their support and direction throughout this study. She would also like to thank Dr. Ian Franks for his advice in the content areas of fine motor control. A special recognition of thanks is afforded to the school principals, classroom teachers, and students without whose cooperation this study would not have been possible. vii CHAPTER 1. I N T R O D U C T I O N Handwriting serves a dual function in the middle grades. It is both a skill to be learned and a tool for learning. There exists a wide variation of handwriting legibility and fluency among children and it is only within the context of developmental and educational expectations that the standard of handwriting can be determined and the handwriting problem defined. In this chapter, the problem of poor handwriting will be discussed from the developmental perspective and the educational perspective. A. A D E V E L O P M E N T A L PERSPECTIVE The middle grades mark a transition in the child's school experience from an emphasis on passive learning to an increasing demand for active learning and written production. As expectations for efficient work output increase, some children, with no previous history of school difficulty, are identified as having school problems because of low academic output. These children who are able to learn yet do not meet expectations of written output are a poorly understood constituency (Levine, 1984) and stand commonly accused of laziness, poor motivation, emotional disturbance, or attitudinal failure. In a study of children in grades five through nine referred for low levels of productivity in school despite good intelligence, Levine, Oberklaid, and Meltzer (1981) identified a common cluster including difficulties with fine motor function, expressive language, and visual retrieval as defined by form copying tasks from memory. Delayed fine motor function and poor pencil control as displayed in awkward pencil grasp were the most frequently found deficiencies. The authors propose developmental output failure as a conceptual framework for understanding a 1 2 heterogeneous group of students who read well yet whose academic productivity diminishes in the middle school years. Impaired productivity as seen in ineffective written output may result from a weakness in one or more areas of developmental weakness. Handwriting speed and legibility, language utilization, rule application, organization and memory, as displayed in written output, expose multiple integrated neurodevelopmental functions (Myklebust, 1965). Levine (1984) suggests that children who first experience school problems in middle childhood may have relatively mild developmental dysfunctions that failed to manifest themselves while expectations were minimal with regard to the complexity and volume of output demands. In a broad study of visuomotor ability of 810 normal school children, aged eight to nine years, Brenner and Gillman (1966) found that a small group of 56 children with good intelligence and good reading ability but poor visuomotor ability, as measured by their battery, were not progressing as well as would be predicted by their intelligence alone. The characteristics which teachers most often remarked upon for these children were clumsiness in either gait or fine motor control and untidy careless work. A one-year followup of 14 of these children (Brenner & Gillman, 1968) indicated that their scholastic achievement was significantly inferior to that of a control group matched for verbal intelligence. These children were significantly inferior with regard to spatial judgment, manual skills, spelling, writing, and arithmetic. It appears from the results of the study that a combination of adequate verbal intelligence and poor visuomotor ability results in poor or indifferent scholastic success. The authors concluded that both verbal intelligence and perceptual motor abilities are necessary for academic success at 10 to 11 years of age. 3 A number of researchers (Denckla, 1984; Cubbay, 1975, 1979; lllingsworth, 1968; Reuben & Bakwin, 1968) have contributed to a greater understanding of the syndrome of developmental clumsiness and its concommitant problems. Cubbay (1979) defines the clumsy child as the child whose motor coordination is virtually normal by the standards of a routine conventional neurological assessment, yet whose ability to perform skilled purposive movement is impaired. These children may demonstrate a mild delay in the acquisition of developmental motor skills. More frequently they may be reprimanded at school for untidy writing and drawings. Reuben and Bakwin (1968) found that children with developmental clumsiness were unhappy because their school grades suffered owing to poor handwriting and because they were inept at sports. Among the developmental problems associated with clumsiness, Denckla (1984) includes the use of proximal pencil grasp despite proper training and excessive handedness as seen in excessive clumsiness of the nondominant hand. Cubbay (1975) reported almost universal poor writing in a study of children with developmental clumsiness. He suggests that poor writing in clumsy children is most likely a function of associated constructional apraxia, as diagnosed by a standardized battery of motor tests. Cubbay indicates that these children are at educational risk and likely to be accused of laziness because their subtle motor deficits are not easily recognized and their educational difficulties not understood. It is estimated that five percent of normal children have significant problems arising from developmental clumsiness (Cubbay, 1979). This figure correlates well with observations by Brenner and Cillman (1966, 1968) that school children with good intellectual ability but in the lower six or seven percent of visuomotor ability were significantly inferior to intellectual age peers with regard to spatial judgement and manual skills and experienced a variety of educational problems. 4 Children with subtle fine motor deficiencies reveal their shortcomings only when complex fine motor execution is required. Often problems in this area are not revealed until fairly late in a child's academic career (Levine, Brooks, & Shonkoff, 1980). Lengthy rapid writing, a requirement in the middle grades, is often the most challenging and troublesome task. Children are frequently further disadvantaged at school because the nature of their condition remains undiagnosed and neat, legible writing is demanded (Cubbay, 1975; Myklebust, 1965). Poor handwriting achievement emerges as a significant problem among children with subtle fine motor deficits. It may provide an easily observed indication of possible fine motor deficits. Children whose handwriting achievement is significantly below age and grade expectations should be screened for subtle fine motor deficiencies. A diagnosis of developmental clumsiness may lead to increased teacher understanding of school difficulties and a greater willingness to provide educational accommodations and diagnostic handwriting instruction. B. A N EDUCATIONAL PERSPECTIVE Handwriting is a necessary competency in school and represents the medium by which pupils convey to their teachers the progress they have made in what is being taught. It is the most concrete of communication skills providing a permanent record of output which can be directly observed and evaluated. The mastery and automatization of handwriting skills is an important prerequisite to the pupils' development in written communication. Cursive writing difficulties constitute a significant problem in the intermediate elementary grades. Surveys of handwriting ability of nine-year-old children indicate that 21% have writing problems (Alston, 1985) and 12% experience serious 5 difficulties (Rubin & Henderson, 1982). An incidence of 12% is consistent with estimates of children experiencing difficulty with other school subjects. The relationship of handwriting to the development of other language arts has been demonstrated to some extent by research (Peck, Askov, & Fairchild, 1980). Studies have indicated that regardless of content, teachers consistently assign higher scores to papers with handwriting of good quality (Briggs, 1980; Graham & Miller, 1980; Rondinella, 1963). Handwriting speed has been found to significantly predict both language achievement and assignment completion rate (Rice, 1976). Couvillion (1986) has found that performance on a five minute handwriting task significantly predicted report card grade point average and assignment completion scores for students in grades four, five, and six. Strickling (1974) has found that lower mean scores on written spelling tests when compared to scores on oral spelling tests are due to handwriting errors. These studies underscore the influence of good handwriting upon achievement in other academic areas and the disadvantage experienced by students with poor handwriting. Graham (1986b) outlines the major role which school psychologists should adopt in the assessment of handwriting difficulties. He recommends the use of handwriting scales in screening for students in need of instructional assistance. The handwriting skills of these students may then be assessed individually by examining the illegibilities found in the written product and observing the handwriting movements (Otto & Smith, 1980). The early identification of a fine motor problem which may require the early introduction of compensatory strategies and individualized instruction is most often the school psychologist's responsibility. Unfortunately there is little to guide the school psychologist who wishes to conduct a comprehensive assessment of related abilities such as fine motor and psychomotor 6 functions. The selection of instruments to assess the contribution of fine motor function to handwriting problems remains based upon personal preference and experience. It is the purpose of this study to investigate the relationships between fine motor and psychomotor abilities, as measured by a fine motor and psychomotor test battery, and handwriting skill in the middle grades. A practical application of the findings of this study is to guide the selection of instruments for fine motor assessment of children with a handwriting problem. The importance of the early identification of children with subtle fine motor difficulties, often noted in poor handwriting, lies in the need for early diagnostic instruction, a more effective approach than assuming the child will outgrow handwriting difficulties. CHAPTER II. LITERATURE REVIEW Although there has been an increased interest in research in handwriting since 1950 (Otto & Anderson, 1969), there exists a paucity of research in the field of handwriting as a motor skill. It has been suggested that this may be due to the gradual development of the skill (Hagin, 1983) or as a result of the tangible, ordinary nature of handwriting (Otto & Anderson, 1969). The purpose of this chapter is not to present an exhaustive review of handwriting research but rather to analyze critically the literature on motor correlates of skill development in handwriting. The topics of handwriting assessment, the relationship between legibility and fluency, non-motor correlates of handwriting, and the task demands of handwriting are discussed to acquaint the reader with issues which are pertinent to the present study. A. ASSESSMENT OF HANDWRITING 1. Legibility Handwriting has usually been rated on the basis of general legibility of the graphic product, a term which has eluded precise definition (Graham, 1986b). Quant (1946) has defined legibility as the ease with which the handwritten product can be read, and identified good letter formation as the most important factor in determining legibility of handwriting. Graham and Miller (1980) define legibility not as a unitary characteristic but as a composite of simpler elements which are interrelated. Legible handwriting is neat and uniformly arranged, words are evenly aligned, letters are properly formed, spacing within and between words is not extreme and slant is regular. While this definition is specific, it does not delineate 7 8 what degree of each factor or combination of factors constitutes legible handwriting. Rating systems may employ a holistic or analytic approach. Holistic ratings involve scoring the handwriting on a single trait such as legibility while the analytic method involves the analysis and scoring of handwriting on several traits, such as legibility, formation, size, slant, spacing and alignment. Herrick and Erlebacher (1963) considered the use of a general criterion of legibility as the most valid and consistent basis for evaluating handwriting samples. Recent research (Armitage & Ratzlaff, 1985; Rubin & Henderson, 1982; Wann & Jones, 1986) has favored the analytic approach. Since a variety of systematic procedures have been employed and no universally accepted standard of legibility measurement exists, difficulties exist in determining whether a particular scale provides an accurate estimate of a student's handwriting performance (Graham, 1986b). Therefore the instructional applicability of handwriting scales is limited to use as screening devices for locating pupils who require instructional assistance once a local minimum standard has been set (Otto & Smith, 1980). 2. Fluency Although measurement of fluency can be accomplished in a reliable and precise manner, a comprehensive standard of measurement is not presently available (Graham, 1986b). Groff (1961) has criticized traditional norms (Ayres, 1917) as too rapid because the students were permitted to practice the sentences to be copied repeatedly whereas actual classroom practices require students to write material for which they have no set. To rectify this situation, he established norms (Groff, 1961) using a procedure which maintained unfamiliarity with the passage copied. Groff's 9 (1961) norms for an American sample in grades four to six have been confirmed for Australian children (Ziviani, 1984). It is generally accepted that handwriting fluency should be calculated as letters per minute and that the time permitted for a velocity trial should not exceed two minutes. While both copying and free-writing exercises have been utilized in obtaining handwriting samples, it should be noted that copying procedures often yield a better standard of penmanship and fluency. 3. Standard Assessment Handwriting samples should be collected under highly structured and standardized conditions to reduce variability due to writer, assignment or examiner variables. The specific guidelines offered by Graham (1986b) should result in consistent and valid judgements about handwriting samples. Measurement error due to invalid legibility criteria and examiner can be effectively reduced by providing examiners with training and practice in evaluating samples on the basis of a predetermined set of criteria, by having each sample rated by at least two different examiners, and by removing identifying factors before each sample is rated. The ultimate goal of handwriting is to make this skill so automatic that it requires only minimal conscious attention (Graham, 1986a). The goal of handwriting assessment should be to determine whether handwriting is produced with maximum efficiency. Therefore, both legibility and fluency must be considered in an assessment of functional handwriting. 10 B. RELATIONSHIP BETWEEN LEGIBILITY A N D FLUENCY As children progress through the intermediate grades less emphasis is placed upon handwriting appearance, provided the writing is legible, and greater emphasis is placed upon fluency. It seems evident that for any individual there exists a speed/accuracy tradeoff. Herrick and Erlebacher (1963) have postulated an inverse and bipolar relationship for an individual, so that as speed decreases or increases beyond a certain point, legibility decreases. The exact nature of the relationship between legibility and fluency is poorly understood. Studies of this relationship for children in the intermediate grades have yielded no correlation (Kaplan, 1957; Rubin & Henderson, 1982) or a moderate negative correlation (Harris & Rarick, 1963). It may be that differences in procedures utilized to obtain handwriting samples which yield differing standards of legibility and fluency also affect the nature of the relationship. The influence of assessment procedures upon this relationship warrants investigation. Absolute writing time has not been found to discriminate significantly between 9- to 12-year-old children with good or poor legibility (Harris & Rarick, 1963; Rubin & Henderson, 1982; Wann & Jones, 1986). This suggests that speed of writing as it affects legibility is a relative matter for the individual and that writing which is substantially faster than the usual rate is likely to result in a decline in legibility. This may be especially true for children with poor legibility as they showed greater deterioration in writing than children with good legibility when asked to write as fast as they could (Harris & Rarick, 1963). However, Harris and Rarick (1963) have noted a characteristic writing tempo in children regardless of writing condition which they suggest indicates that a set for speed operates as a significant factor in the handwriting act. Therefore, absolute writing time may not provide a direct indication of competence in Handwriting. Wann and Jones (1986) found that variability in writing time from one trial to the next differentiated significantly between children with good and poor writing legibility. They consider variability a more reliable indicator of writing difficulties and a better dependent measure in handwriting research than the traditional assessment of fluency. They suggest that a practical application of the variability measure may be to identify children with fine motor difficulties in handwriting. Researchers have frequently designated children as poor or good writers based on handwriting legibility irregardless of fluency. It is possible that skill designation based on only one variable has obscured the nature of the relationship. Otto and Smith (1980) point out that the production of legible writing below minimum fluency standards is as indicative of poor functional writing as illegible writing produced within average fluency standards. Denckla (1984) emphasizes that for some children "speed and beauty" in writing cannot coexist. It is clear that a researcher who intends to investigate differences between children with good and poor functional writing must consider legibility and fluency as interrelated rather than independent factors. There is no established method in the literature for designating children as good or poor functional writers. Indeed, in only one study (Gates, 1924) has there been an attempt to develop a formula for interrelating these two factors. 12 C. N O N - M O T O R CORRELATES OF HANDWRIT ING 1. Age Acquisition of the motor ability required for handwriting follows a sequential pattern and it is not until nine years of age that the child can use writing as a tool (Ames & llg, 1951). This is the age at which writing becomes smaller, neater, and more uniform in size and slant. Ames and llg noted a slight relation between the subject matter and the maturity of writing with the child's own name written with the preferred hand representing the most mature writing performance. However, it is only after 10 to 12 years of age that motor ability presents no further obstacle to handwriting. In a survey of factors affecting ability in the handwriting of 550 children in grades three to six, Wittier (1929) concluded that rate and quality of handwriting were not related to anatomical age, which was obtained by dividing the sum of the diameters of the carpal bones by the width of the hand at its base. He recommended that motor coordination or muscular control be studied. Although both legibility and fluency have been found to increase with age (Groff, 1961; Jackson, 1971; Thomassen & Teulings, 1983; Ziviani, 1984), there exists considerable variation among children of the same age (Groff, 1961). Comparisons of fluency among children of different ages are more readily available than comparisons of legibility since fluency is easily quantifiable. The rate of increase in fluency is greatest between seven and nine years of age after which it gradually declines until about thirteen years of age when there is little further increase. Surveys of handwriting instruction indicate that educational practices across the United States and Canada are fairly consistent. Herrick and Okada (1963) found that 13 over 70% of schools make the transition from manuscript to cursive writing between the second half of the second grade and the first half of the third grade. Addy and Wylie (1973) reported that instruction in cursive writing in western Canada and 10 American states begins in the third grade. Suen (1975) surveyed educational practices in Canada based on information obtained from language arts and handwriting manuals of various provinces. Most manuals (Ministry of Education, 1983) suggest that the transition from printing to cursive writing occur sometime between the second and fourth grade with extensive functional use of writing in the fourth to the fifth grade. It appears, therefore, that functional use of cursive writing coincides with the age at which children begin to use handwriting as a tool. Nevertheless, the mechanics of writing present difficulties for a significant number of children in the age group. Rubin and Henderson (1982) reported that teachers of 9- to 10-year-olds identified 12% of the children in their classrooms as having serious handwriting problems. Alston (1985) reported that at the same age, 21% of children in Cheshire schools had handwriting difficulties. The fine motor ability of 10- to 12-year-old children can still present an obstacle to handwriting (Myklebust, 1973) and must be considered in evaluating the handwriting skills of children with difficulties. 2. Sex and Intel l igence While there is general agreement that neither legibility nor fluency are significantly related to intelligence (Harris, 1960; Wittier, 1929), this is not so in the case of sex differences. The majority of studies indicate that girls' writing is more legible than boys' writing (Groff, 1963; Harris & Rarick, 1963; Jackson, 1971; Rogers, 1973). There is 14 some suggestion however, that female superiority may be demonstrated at certain ages which mark periods of earlier development. Harris and Rarick (1963) found that significant sex differences were due to the greater progress girls made in legibility at the sixth and tenth grades. Graham (1986a) in an investigation of the reliability and validity of three handwriting measurement procedures, found that none of the three were sensitive to hypothesized differences between males and females in the third and fifth grades. A direction for future research may be to determine whether sex differences in legibility occur across the age span. It is less clear whether the issue of sex is an important factor in fluency. There are as many studies which indicate female superiority (Groff, 1963; Ziviani, 1984) as there are studies which have found no significant differences attributable to sex (Harris & Rarick, 1963; Jackson, 1971; Smith & Reed, 1959). Despite the possibility that males and females write at different rates, commonly used fluency norms do not provide separate norms for males and females. 3. Writing Hand Surveys of the writing hand used by school children in grades one to six (Enstrom, 1962; Peters & Pederson, 1978) indicate that approximately 11% are left-handed for writing with more boys (approximately 12%) than girls (approximately 10%) demonstrating left-handed preference. Teachers routinely provide individualized instruction to left-handed students (Addy & Wylie, 1973). A review of the research (Graham & Miller, 1980) presents conflicting evidence regarding the fluency and legibility of right-handed versus left-handed writers. Graham and Miller suggest that this conflicting evidence may result from differences in instructional technique rather than actual differences. 15 There is some indication that fluency and quality in handwriting may be more related to the technique used in writing with the left hand than to hand preference (Enstrom, 1962). Cillingham and Stillman (1973) found that few left-handed children with handwriting difficulties had a real handicap once remedial training in writing position was provided. 4. Instruction Smith and Reed (1959) found that the schools from which they drew their groups accounted for greater variability in handwriting skill than either the hand used for writing or sex. The authors suggested this implied that environmental factors played a greater part in handwriting achievement than neural differences with their associated musculative, perceptual, and mechanical difficulties. More recent research indicates that school factors may play a smaller role in handwriting skill than had been previously supposed. Forster (1971) found that in the case of transitional handwriting, teacher attitude had little or no effect upon the legibility or fluency of the handwriting of grade three students. While instructional techniques and materials have been found to be significantly related to the quality of manuscript, the relationship is no longer significant once cursive writing is adopted (Ratzlaff & Armitage, 1986). It would appear, based on these two studies, that there is no abiding relationship between instructional techniques or teacher attitude and the quality of handwriting. 16 D. TASK D E M A N D S OF HANDWRIT ING AS A M O T O R SKILL Handwriting is not a mechanical lower level reflex response, but a thinking process entailing activity of the cortical nerve areas (Hildreth, 1947) and it is only with successful practice that the handwriting process becomes internalized, condensed, and transformed into an automatic motor skill. Luria (1973) describes this process: In the initial stages, writing depends on memorizing the graphic form of every letter. It takes place through a chain of isolated motor impulses, each of which is responsible for the performance of only one element of the graphic structure; with practice, this structure of the process is radically altered and writing is converted into a single "kinetic melody" no longer requiring the memorizing of the visual form of each isolated letter or individual motor impulses for making every stroke. The same situation applies to the process in which the change to a highly automatized engram (such as a signature) ceases to depend on analysis of the acoustic complex of the word or the visual form of its letter, but begins to be performed as a single "kinetic melody" (p. 32). Handwriting is not a simple learning task. There are many functions which must be sequentially integrated with handwriting, such as visual scanning, right-left orientation, sequencing, spatial imagery, visual-motor coordination, visual-form recognition, and all or most of the complexities of speech and language development (Gaddes, 1985). A child who must concentrate intensively on the mechanics of writing may not be able to attend to the cognitive components of the written assignment. Hammill and Larsen (1983) contend that the mechanical 17 component of handwriting is a necessary part of the total writing process which must be considered in a comprehensive assessment of written language. They have, therefore, included the Handwriting subtest in the Test of Written Language to assess the graphic product which the authors equate with the motoric aspect of writing. Handwriting, one of the most advanced achievements of the human hand, involves a large variety of different, co-ordinated movements and is subject to visual guidance, or at least to visual monitoring. Writing involves strict requirements with respect to the timing and the force control of co-ordinated movements of arm, hand and fingers (Thomassen & Teulings, 1983). The connection between the manner in which the writing implement is held and the resulting strokes of pencil have been stressed in writing instruction (Sassoon, Nimmo-Smith, & Wing, 1986). The initial focus of handwriting remediation, especially for the left-handed writer, has been the retraining of penhold, slant, and posture to increase handwriting efficiency (Gillingham & Stillman, 1973). An understanding of the relationship between the handwriting movements and writing posture and penhold facilitate the observation of the handwriting act and the process of retraining. Movements of the pencil during handwriting are effected by three muscle/ joint systems that are physiologically capable of independent operation. Wing (1979) describes these systems: Flexion and extension of thumb, index, and second fingers is usually used to give letters their height. Radial abduction and ulnar abduction of the wrist joint are commonly used in giving letters width. (In the case of left-handed writers it should be noted that those writing with the 18 hands in a hooked position above the line of writing exchange the roles of thumb/finger and wrist movements so that the latter is responsible for letter height.) Movement of the upper arm about the shoulder joint relative to the body is largely responsible for gross movement of the pen across the page (p. 290). Thomassen and Teulings (1983) summarize the component sub-skills of handwriting as a motor skill. The writer must be seated in a suitable way with a proper support for the writing arm while the contralateral hand holds the paper stable. The writing instrument must be held in a way to enable the writer to easily move horizontally across the paper and see the tip of the writing instrument during the traverse. The grip should be between the thumb and middle and index fingers with a proper support of the barrel of the writing instrument between the thumb and index finger. The hand should be rotated slightly so that it rests on the two other fingers. Next, the writer must be able to make 'writing-like' movements with the pen. This implies a succession of small movements of the instrument's tip superimposed on progressive horizontal (transport) movements along the line. These movements should be of constant size and result in lines, curves, waves, angular transitions, and loops, which form letters and words. The motor aspects of handwriting are also influenced by culture and education. The introduction of cultural standards such as regularity and neatness, cultural biases such as specific slant and left-to-right transport and constraints such as grip are introduced as the child is taught the motor preliminaries to writing. Thomassen and Teulings (1983) explain that these cultural standards, biases, and restrictions are later difficult to disentangle from natural tendencies which may reflect perceptual or motor trends. 19 For example, the left to right direction of normal writing, both within letters and between letters and words, greatly favors the normal right-handed grip, in which the pen is pulled away from its trace leaving the trace to the left of the pen point unsmudged and unobstructed for visual inspection. Some left-handed children may adopt an awkward grip to permit visual inspection of the pen point and not as a compensation for poor fine motor skills; however, this would be difficult to determine with any certainty once the awkward grip has become a habit. E. FINE MOTOR CORRELATES OF HANDWRITING The current knowledge of the specific relations and motor developmental factors of primary consequence to handwriting has not advanced to a great degree since Myklebust (1973) asserted these had not been well established. Although advanced techniques in the assessment of the dynamic characteristics of handwriting exist, the focus of this research has been on mature handwriting (Wann, 1986). The few studies which have examined children's handwriting as a motor skill have contributed to theoretical knowledge, but practical application of this knowledge is limited by the use of nonecological valid tests (Meulenbrook & van Galen, 1988). Research with children has been restricted mainly to the analysis of the graphic product and to a few studies which included assessment through additional fine motor tasks, rather than appraisal of the handwriting movement. 1. Assessment of Children With Poor Handwriting The specific manual skills which should be investigated in the assessment of handwriting as a motor skill have not been well elaborated. Thomassen and Teulings (1983) state that it is difficult to characterize the development of handwriting skill 20 by reference to the abilities required for handwriting performance. As the acquisition of handwriting skill occurs in discontinuous stages (Meulenbrook & van Galen, 1986), there may be a stage where aiming or wrist-finger speed or arm-hand steadiness are abilities contributing to proficiency in writing (Thomassen & Teulings, 1983). As in most motor skills there will be an earlier stage in which non-motor abilities such as verbal, visual, or spatial skills play a part, as well as at a later stage in which a factor specific to the writing task itself is particularly important. Established procedures in the psychometric assessment of children with handwriting difficulties have been based upon clinical experience rather than documented research. Gaddes (1985) recommends that the teacher faced with the problem of poor handwriting and frequent spelling errors should obtain from the student a detailed measure of handedness, manual-motor tests of both hands, measures of writing speed and legibility from standardized handwriting tests, a comparison of cursive writing with manuscript, and a comparison of sample forms from copy and from memory. Myklebust (1973) emphasizes that a fundamental approach to the study of motor maturity in handwriting should include an appraisal of laterality. Levine (1984) has proposed a conceptual model for use in the assessment of children who are suspected of having a 'fine motor problem' because of an unattractive or exceedingly awkward handwriting style. He identifies four common variants of fine motor dysfunction and outlines the impact upon writing. While Levine's model is primarily based upon clinical observation and limited empirical evidence (Levine et al., 1981), it provides an emphasis upon explanation other than poor eye-hand coordination and a concrete basis for testing the model. The child with an eye-hand coordination dysfunction is likely to show 21 impaired dexterity in a wide range of tasks. These children have difficulty attending to, interpreting, and integrating visuospatial inputs. Writing is produced slowly, in a labored fashion with reduced legibility. The child who has difficulty localizing his fingers in space without visual feedback must watch the pencil point carefully when writing, often keeping his eyes very close to the page. This need to visually monitor finger activity as seen in poor finger localization (Levine ef al., 1981) may sharply decrease the rate of written output. These children compensate for impaired feedback by adopting awkward pencil grasps which may cause problems when lengthy and sustained rapid writing is required. These children write at a slow rate and may or may not demonstrate poor legibility. Levine has termed this the proprioceptive-kinesthetic feedback dysfunction although the major feature, poor finger localization, is a test of restricted sensory deficits, tactile sensitivity. The child with a fine motor dyspraxia will find it difficult to facilitate and inhibit selectively and successfully the appropriate small muscle or muscle groups to execute the desired graphomotor pattern. These children will produce a reduced rate of written work with poor planning and use of the page. Children who write with frequent retracings and evident hesitancy are said to have a motor memory dysfunction which affects rapid retrieval of established motor patterns. They demonstrate a preference for manuscript over cursive writing and produce written work of poor legibility. In support of this explanation, Levine cites the motor engrams or "kinetic melodies" described by Luria (1973) for well-automatized practices. This presumes motor planning for the handwriting act has become well-automatized. The relevancy of kinesthetic feedback to handwriting seems evident. Gubbay 22 (1975) explains that because agnosias, the inability to recognize the significance of sensory stimuli, interfere with sensory perception, they also interfere with motor performance and may cause not only delayed motor development but also clumsiness of movement. Thomassen and Teulings (1983) say that while it is generally accepted that skilled movements are possible without kinesthetic feedback, it may be that this only holds for certain highly practiced skills such as walking, which appears to develop without special tutoring, and not for skills involving precise manipulation such as writing. Learning to write requires the ability to distinguish kinesthetic feedback associated with correct responses from that associated with incorrect or inadequate movements. This implies greater proprioceptive involvement of the muscles of the fingers, hand, and arm than that tapped by the finger localization test, a measure of kinesthetic awareness. Gaddes (1985) reports that proprioceptive defects are more seriously impairing than poor finger tactile sensitivity in learning manual-motor classroom skills such as handwriting. This suggests that Levine may be correct in identifying a proprioceptive-kinesthetic dysfunction as a fine motor difficulty in handwriting but has selected an inappropriate or insufficient instrument to identify this dysfunction. 2. Studies of Fine M o t o r Abi l i t ies in Handwri t ing Rowley's (1938) investigation of the relationship between the usual handwriting speed and motor coordination of children in grades four to six as measured by tests of tapping, finger movements, and arm movements is the earliest documented study of fine motor abilities in handwriting. Rowley's results clearly indicated there was no relationship between her tests and handwriting speed. The relationship may be obscured, however, because although groups were significantly different for speed, groups were not discrete. Rowley did not examine legibility in relation to motor coordination nor consider legibility in relation to speed. Harris (1960) has suggested, however, there is some evidence that fine motor coordination as measured by sensitive tests of steadiness in drawing a straight line may be related to handwriting legibility. Strickling (1974) included a paper and pencil test of motor speed and precision in a study designed to determine the effect of handwriting and related skills on the written spelling scores of fifth graders. Significant correlations were found between handwriting speed, motor speed and precision, and incidence of handwriting errors. Sickling's results suggest that fine motor speed and precision is an important ability in functional writing and warrants further investigation. Harris and Rarick (1963) developed a force variation ratio to measure fine motor activity in handwriting since handwriting requires a high degree of control in the application of force. They explained that this conception of motor control in handwriting refers to a vertical dimension of control exerted in the course of writing rather than the horizontal dimension. This was considered a more valid measurement than a horizontal or static dimension of motor control such as might be inferred from handwriting legibility or from specially constructed tasks designed to measure speed and accuracy of motor control independent of the handwriting task. Thirty children in grades five and six were identified as good or poor writers on the basis of writing legibility. They found that fine motor control of good writers was, on the average, superior to that of the poor writers, as indicated by lower mean force variation ratios. The results demonstrated that while good writers have developed a highly coordinated motor set in writing that is flexible and adaptable yet relatively stable, poor writers do not appear to have achieved a 24 corresponding level of stability and adaptability to the varied conditions of the handwriting act. However, these results with respect to motor set must be considered suggestive rather than definitive because they are drawn from a comparison of the performance of the four most and four least legible writers in the sample. Rubin and Henderson (1982) did not find significant differences on five fine motor tasks between 10-year-old children with good and poor writing legibility. They did note, however, that fine motor ability was clearly a factor in the handwriting performance of a few children and that the children with poor legibility obtained a wider range of scores on the tasks suggesting a greater spread of ability in fine motor skills for poor handwriters. The results of this study may be confounded, however, by the procedures used to select the poor and good writers. Teachers from the six participating classrooms were asked to nominate poor writers and identify a matched control for each one so that testing could be done 'bl ind.' Rubin and Henderson indicate that there was overlap between the control and poor group and considerable variability in the range of legibility scores: 15-22 for the poor writers and 6-19 for the control group. The investigators conclude that some teachers may have had difficulty in establishing clear-cut criteria for selecting children with serious handwriting difficulties. An alternate explanation may be that teacher nomination does not provide a valid assessment because o f subjectivity in assessment of legibility and differing abilities represented in each classroom (Rondinella, 1963). Cratty (1973) states that tapping skills are usually found to be relatively independent of manual skills in which finger dexterity or accurate writing and printing behavior are required. Wann (1986) investigated the differences in motor 25 control in handwriting for 32 children in grades four and five, designated as good or poor writers on the basis of handwriting legibility. Although he found no significant differences in tapping rate or variability of tapping rate between good and poor writers, there was a trend observed for grade five children which suggested poor writers exhibited more variability in tapping phases. Studies of the relationship between perceptual-motor ability, as measured by a copying task, and handwriting legibility (Kaplan, 1957; Rogers, 1973; Rubin & Henderson, 1982) have yielded low to moderate correlations, indicating that poor copying does not necessarily predict poor handwriting. However, Gerard and Junkala (1980) have demonstrated that conventional tests of visual-motor integration, if interpreted from an information processing task-analysis model can provide diagnostic information useful in selecting remedial instruction techniques. Students diagnosed as manifesting input, output, or associational problems relative to their performance on standardized tasks and provided with remediation designed to strengthen deficit areas and to exploit intact areas made significant gains in handwriting performance when compared with students in the other treatment groups. 3. Penhold Grip and Posture At the International Conference on Research in Handwriting held at the University of Wisconsin in 1961, Freeman (1963) proposed the need for a study which examined the position of the hand as it grasped the pen in writing in conjunction with the quality of writing. Professionals from the educational and medical fields (Levine ef al., 1980; Rubin & Henderson, 1982) have long recognized the need for the inclusion of a systematic procedure to evaluate handwriting factors such as posture and pencil grip in the assessment of the relationship between 26 handwriting and fine motor difficulties. Yet empirical research on the effects of specific hand positions on writing performance has been limited to a few studies. Enstrom (1962) evaluated the impact 15 postural adjustments in left-handed writing had upon fluency and quality in handwriting. He found that students who used 4 of the 15 postural adjustments generally worked above grade level in both rate and quality. He concluded that fluency and quality of handwriting may be more related to technique used in writing with the left hand than to hand preference. A writing position which has commonly been adopted by left handed writers is referred to as the inverted position, where the hand is actually above the line of writing. This position has been considered to arise as an adaptation to left-handed writing which obscures the line of writing. The incidence of this inverted writing position in left handers is greater for males than females and increases significantly in the fifth and sixth grades (Peters & Pederson, 1978). The authors suggest that this increase may be due to the demand for rapid cursive writing in these grades. As the authors did not examine the incidence of inverted writing for manuscript and cursive separately, this suggestion cannot be evaluated from their results. There are only two studies which have examined the dynamic tripod grip in school age children (Sassoon et al., 1986; Ziviani, 1983). The dynamic tripod grip reflects an important finger posture involving the thumb, index, and middle finger, so that functioning together as a tripod they are able to make small highly co-ordinated movements (Rosenbloom & Horten, 1971). The mature dynamic grip evolves between four and six years of age and at about six years of age the movement of the thumb, index, and middle fingers together with those of the 27 wrist are responsible for the writing product. Ziviani (1983) investigated variations in dynamic tripod grip among 287 normal children between 7 and 14 years of age in order to provide norms. Four components of pencil-grip posture were assessed: a) degree of flexion of index finger; b) degree of forearm pronation; c) number of fingers on the pencil shaft; d) thumb and index finger opposition. Ziviani claimed that her data revealed developmental trends in the refinement of the mature dynamic tripod grip with the greatest change occuring at approximately 10 years of age. A decrease in degree of index-finger flexion and decrease in degree of forearm pronation appeared to be age-related changes while thumb and index finger opposition and number of fingers on the pencil shaft did not appear to be related to either age or sex. These developmental changes would appear to increase the flexibility of the handwriting movement (Wann, 1986). A decrease in proximal interphalangial flexion and distal interphalangial hyperextension with age should increase the potential range of finger movements. A decrease in forearm pronation frees the restrictions that are placed on horizontal movements by limited ulnar deviation of the wrist, and allows horizontal pen shifts by wrist extension. It would seem that patterns of handwriting movement are modified and refined as developmental changes occur which should have an effect upon legibility and fluency. Sassoon ef al. (1986) have investigated changes in penhold and posture as a function of age in 291 school children from 4-, 9-, and 15-year age groups and have examined the relationship between penhold and fluency. They have devised a classification scheme which allows the researcher to describe penholds in a systematic and detailed fashion suitable for quantitative analysis. Three penhold features were found to change with age: a) an increase in supination of the writing 28 hand, a change also noted by Ziviani (1983); b) a decrease in frequency with which the middle finger touches the top or side of the pen; and c) an increase in the number of children who use a "modified tripod" grip. "Modified tripod" grip was defined as one in which the thumb, index and middle finger act as a tripod in the writing movement regardless of the position of the fingers. The findings that in the majority of cases the thumb rather than index finger is closest to the tip of the pen and that there is usually hyperextension at the distal interphalangeal joint of the index finger is of particular interest since these features are not found in the ideal penhold recommended in handwriting manuals. Unlike Ziviani (1983), Sasson ef al. (1986) did not find that hyperextension of the distal interphalangeal joint of the index finger decreased with age. The effects of penhold features on writing speed were evaluated by comparing the writing speed of children adopting the modal value of each penhold feature with the writing speed of the other children. The only significant difference obtained was that 15-year-old children who wrote with the index finger closest to the pen point wrote significantly faster than children who wrote with the thumb closest to the pen point. Sassoon ef al. (1986) concluded that there is little cost in adopting a non-modal penhold feature. investigations of the effect of pencil grip upon handwriting legibility and speed have not yielded significant differences between children with dynamic tripod grip and children with awkward grips (Bailey, 1988; Ziviani & Elkins, 1986). These research studies indicate that a degree of developmental and individual variation in pencil grasp is to be expected and that atypical patterns of pencil grip are not necessarily predictors of poor handwriting. Nevertheless, Ziviani (1987) suggests that some grips may be more facilitative than others over prolonged 29 periods of time, and some, like the inverted position, may place the hand at an anatomical disadvantage. Further investigation of the effect of unconventional pencil grasp is warranted. F. SUMMARY This review of handwriting research has suggested several reasons for the limited knowledge of the specific relations and motor development factors of primary consequence to handwriting. A basic problem in handwriting research is the lack of a standard procedure in the definition and assessment of handwriting legibility and fluency and in the selection of poor and good writers which reduces comparability across studies. With the advent of sophisticated techniques in the assessment of the dynamic characteristics of handwriting, interest in children's handwriting as a motor skill has been renewed. While studies in the field of motor control have contributed to theoretical knowledge, practical application of the knowledge is limited. The few studies which have examined the relationship between fine motor abilities and handwriting skill have not found significant relationships. However, problems in group selection or definition of handwriting skill restricted to the single criterion of legibility or fluency which are common among studies may have obscured the nature of the relationship. Recent research in children's handwriting as a motor skill and writings based on clinical experience emphasize the significance of and provide the direction for further research in this area. The assessment of the graphic product, movement during its production and a clinically based test battery are necessary components of a comprehensive study of the relationship of fine motor abilities and handwriting skill. A fine motor and psychomotor test battery for use in the assessment of 30 children with handwriting difficulties is suggested in the clinical literature. The investigation of penhold grip and variability in writing merits further study. CHAPTER III. STATEMENT OF THE P R O B L E M Weak fine motor skills and visuomotor ability (Alston, 1985; Hildreth 1947; Kaminsky & Powers, 1981; Lemer, 1981; Levine, 1984; Myklebust, 1965) are the most frequently advanced explanations for poor handwriting; yet research in this area is meagre. Otto and Smith (1980) state that their personal experience has demonstrated that handwriting problems are frequently caused by perceptual and personality factors rather than physiological and motor factors. Myklebust (1973) cautions that although it is apparent from observations that motor ability and facility with handwriting are related, the specific relations and the developmental factors of primary consequence have not been well established. It is not uncommon for professionals to assume that a child who has illegible writing must also have fine motor problems, yet this is not necessarily the case (Levine et al., 1980). Cubbay (1975) administered a standardized motor battery and obtained teacher reports of. handwriting ability and sporting ability for 922 school children aged 8 to 12 years. Fifty-six of the children were identified as clumsy on the basis of the motor test battery. While significant differences were noted between the performance of the clumsy children and all other children on the supplementary motor test and the teacher questionnaire, Gubbay reported that differences regarding teacher reports of handwriting (p<0.05) were less significant than teacher reports of sporting ability (p<0.001), clumsiness (p<0.001), or poor academic performance (p< 0.001). The explanation offered was that there probably are other important factors concerned in the formulation and neatness of handwriting apart from adroitness of hand control. It is evident from a comparison of the 5% incidence reported for developmental clumsiness (Cubbay, 1979) and 12% incidence reported for serious handwriting difficulties (Rubin & Henderson, 1982) that 31 32 not all normal school children with poor handwriting have subtle fine motor deficits. It becomes necessary to identify those children whose handwriting difficulties arise from subtle fine motor deficits so that an understanding of children's difficulties will result in appropriate expectations and the early provision of remedial training. Most frequently, the school psychologist will be called upon to assess children with poor handwriting who are suspected of having fine motor problems. Yet the school psychologist is ill equipped to conduct such an assessment since the fine motor abilities related to handwriting have not been delineated and there is nothing, aside from personal experience and preference, to guide the school psychologist in a selection of assessment instruments. It is the primary purpose of this study to investigate the relationships between fine motor and psychomotor abilities, as measured by a fine motor and psychomotor test battery, and handwriting skill for 10 to 11-year-old children. The secondary purposes of this study are to examine: the relationships between teacher ratings of academic achievement and handwriting skill; and the relationships between penhold and postural features and handwriting skill. A. DEFINITION OF TERMS Throughout the study various terms will be used as defined below. Handwriting Skill The term handwriting refers to any accepted model of cursive writing with the exception of italic script. The graphic product will serve as the sole determinant of legibility and fluency in the handwriting assessment. Legibility and fluency are the sole determinants of handwriting skill. 33 Legibil ity The concept of legibility has escaped precise definition. Quant (1946) regarded legibility as a composite of the simpler elements of letter formation, spacing, alignment, slant and quality of line and defined by readability or ease of reading. Otto and Smith (1980) refer to quality in handwriting as a global concept that cannot readily be described in concrete, quantifiable terms. A variety of handwriting scales have been produced to assess legibility in a standard, concrete manner. For the purpose of this study legibility is defined according to the Cursive Writing Diagnostic Inventory (see Appendix A) developed by Armitage and Ratzlaff (1985). Legibility is defined as a composite of the seven facets of letter formation, letter size, uniformity of slant, spacing of letters, spacing of words, word alignment and neatness. The examiner uses a Likert type scale to analyze and score the handwriting sample on each of the seven facets. Fluency Functional handwriting is fluent. Fluency, or speed in writing, is calculated by dividing the number of letters produced within the alloted time limit by the number of minutes allowed for writing. Fluency is given as the number of letters written per minute. Fine Moto r and Psychomotor Abi l i ty For the purposes of this study, fine motor and psychomotor ability are defined as the abilities assessed by the fine motor and psychomotor test battery. The Benton Finger Localization (Benton, Harrsher, Varney, and Spreen, 1983), the Finger Tapping Test (Trites, 1981), the Klove Matthews Motor Steadiness Battery 34 (Trites, 1981), the Grooved Pegboard (Trites, 1981), the Motor Speed and Precision subtest of the Detroit Test of Learning Aptitude (Baker & Leland, 1967), the Bender Visual Motor Gestalt Test (Bender, 1938), and the Coding subtest of the Wechsler Intelligence Scale for Children—Revised (Wechsler, 1974) are the measures included in the test battery. Penhold and Posture Penhold is the manner in which the pencil is held while writing. The penhold classification inventory (see Appendix B, items 1-5) adopted in this study, has been developed by Sassoon ef al. (1986). The classification scheme provides a detailed quantifiable description of finger and hand position. Posture refers to the position and movement of the body during the act of writing (see Appendix B, items 6-14). Fluency Difference Fluency difference is the absolute difference in writing time in seconds between the two individually administered standardized handwriting trials. B. RESEARCH QUESTIONS The following research questions have been established to address the purposes of the study. 1. Which measures of fine motor and psychomotor abilities account for significant group differences in handwriting skill when sex differences are controlled? 2. What is the relationship between handwriting skill and teacher ratings of academic achievement? 35 Are improper features of penhold and posture during handwriting more frequent in poor handwriting groups? Does handwriting fluency difference account for significant group differences in handwriting skill? CHAPTER IV. RESEARCH METHODOLOGY This exploratory study of the relationship between fine motor abilities, as assessed by a fine motor and psychomotor test battery, and handwriting skill of grade five children, was conducted in two phases. First, the range of cursive writing skill demonstrated by grade five children was examined in order to select children for inclusion in the extreme handwriting groups. Second, the performance of the extreme handwriting groups on the fine motor and psychomotor test battery, penhold and postural features, and teacher ratings of academic ability were compared. A. SELECTION OF EXTREME HANDWRITING GROUPS 1. Sample Four schools in the Burnaby School District of British Columbia were selected for participation based on principal and teacher interest in handwriting. All 122 children enrolled in grade five in the four schools were included in the selection phase. The 61 boys and 61 girls had a mean age of 10 years 8 months with an age range of 9 years 7 months to 11 years 11 months. The majority, 111 children, had an age range of 10 years 2 months to 11 years 2 months. The handwriting characteristics of the eight classrooms from which the children were drawn met the required criteria of a) extensive functional use of cursive writing for 6 months, b) instruction in the use of the looped cursive writing style, c) whole class writing instruction provided for 20 to 40 minutes per week for 4 months, and d) incidental individual instruction provided. 36 37 2. Data Collection A standardized group collection procedure (see Appendix C) was used to obtain two handwriting samples, usual and speeded, from each child for a total of 244 samples. The two sentences provided for copy were administered in counterbalanced order so that condition of administration could not be identified by raters. The two sentences selected have been widely used in handwriting assessment and are considered equivalent (Otto, Askov, & Cooper, 1967; Otto & Smith, 1980). 3. Rating of Handwriting Samples Each sample was rated for legibility by three raters with graduate training in assessment procedures and with elementary teaching experience. The raters were provided with training in the use of the Cursive Writing Diagnostic Inventory and were instructed to consider the seven facets of handwriting legibility in the Q sort process used to rate the handwriting samples. A similar procedure was used by Otto et al. (1967) without significant bias in magnitude of judges' reliability ratings when scales were discontinued. The intraclass correlation coefficient obtained among the three raters (.76) was judged sufficiently high to justify this procedure. The Q sort process combined the 244 usual and speeded samples randomly into eight packets. The packets were rated independently in varied sequence. The samples were coded so that all identifying information could be witheld. The raters were instructed to rate samples along a forced "nine point Q sort distributed according to stanine percentages with category 1 representing lowest legibility and category 9 representing the highest legibility. Once all packets had been rated, all the samples from the six extreme categories were removed and visually inspected for changes within the extreme categories. The legibility rating assigned to each 38 sample was the sum of the Q sort ratings made by the three raters with a possible range from 3 for the poorest legibility to 27 for the best legibility. Pearson correlation coefficients between the total Q sort legibility rating and each individual rater's Q sort legibility rating ranged form .86 to .92 and were judged sufficient to proceed with the selection of children with poor and good legibility. The fluency ratings were assigned by the examiner and given as letters per minute. 4. Selection of Extreme Groups The very low positive correlations between legibility and fluency scores for usual handwriting samples (.19) and between legibility and fluency scores for speeded samples (.13) is consistent with the relationships found in the literature (Kaplan, 1957; Rubin & Henderson, 1982). Significant correlations between legibility scores for usual and speeded conditions (.63, p<0.01) and between fluency scores for usual and speeded conditions (.66, p<0.01) suggest that stability in handwriting exists across conditions. It was concluded, therefore, that legibility and fluency should be considered independently in the selection of poor and good writers and that selection could be based upon the legibility and fluency ratings of samples obtained under either condition. The cutoff scores for legibility and fluency ratings selected for inclusion in the extreme groups were derived form the legibility and fluency characteristics of the 244 samples obtained from 122 children. The handwriting characteristics of the 122 children are summarized in Table 1. Cutoff scores were selected to represent approximately one standard deviation from the mean for legibility or fluency. Both legibility and fluency criteria were required for inclusion in one of the three groups 39 studied. The top handwriting group consisted of children who obtained legibility ratings greater than 20 and fluency ratings greater than 63 letters per minute. The bottom handwriting group consisted of children who obtained legibility ratings less than 12 and fluency ratings less than 37 letters per minute in the case of a usual sample or less than 46 letters per minute in the case of a speeded sample. In addition to the extreme top and bottom groups, a slow group was chosen for the study because despite average legibility, these children could not be considered to demonstrate satisfactory functional writing because of the absence of adequate speed. The slow handwriting group consisted of children who obtained legibility ratings between 12 and 19 and fluency ratings less than 38 letters per minute. Table 1 Handwriting Characteristics of 122 Children1 Condition Usual & Speeded Usual Speeded Characteristic Mean S.D. Mean S.D. Mean S.D. Legibility Female 16.20 5.68 18.18 4.35 14.22 6.18 Male 13.73 4.74 15.73 4.46 11.73 4.15 Combined 14.97 5.36 16.95 4.56 12.98 5.39 Fluency Female 56.00 13.41 51.11 12.82 60.88 12.24 Male 54.50 14.77 50.26 13.92 58.73 14.48 Combined 55.25 14.10 50.50 13.29 60.00 13.31 1 There was a significant sex difference (p<0.01), in favour of females, for legibility but no sex difference for fluency. 40 In total 44 children were selected for inclusion in the three groups. Three of the children selected, two from the bottom group and one from the slow group, did not participate in the second phase of the study because parental consent was not given. The sample characteristics for the three groups are summarized in Table 2. Table 2 Sample Characteristics for the Three Handwriting Croups Characteristics Number Legibility Fluency Croup Female Male Mean Range Mean Range Top 13 3 22.8 21-27 70.3 63-84 Bottom 5 5 8.5 6-11 35.1 26-44 Slow 10 5 15.1 12-19 32.8 29-38 Analysis of variance for the legibility and fluency of the samples obtained under usual and speeded conditions from the 41 children selected for inclusion in the extreme handwriting groups was significant (p<.000) and confirmed that the groups were discrete. Characteristics for the usual and speeded samples are summarized in Table 3. 41 Table 3 Characteristics of the Usual and Speeded Samples for the  Three Handwriting Groups Usual Speeded Legibility Fluency Legibility Fluency Group Mean S.D. Mean S.D. Mean S.D. Mean S.D. Top 22.12 3.59 60.93 13.11 20.43 3.57 69.31 8.30 Bottom 11.90 4.55 36.30 8.60 7.90 2.01 41.90 8.42 Slow 16.53 3.15 33.80 5.28 14.86 5.37 45.80 9.48 B. COMPARISON OF EXTREME HANDWRITING GROUPS 1. Procedure Forty-one children were included in three groups representing the extremes of handwriting skills at the grade five level. Sixteen children in the Top group with above average legibility and fluency formed the group with good handwriting skill. Ten children in the Bottom group with below average legibility and fluency formed the group with poor handwriting skill. Fifteen children in the Slow group with adequate legibility and below average fluency formed an additional group with poor functional handwriting skill. All children were screened for near point vision with the Walton Modified Telebinocular Technique of Vision screening near point items and performed satisfactorily and were therefore included in the second phase of the study. The hand preference test from the Harris Test of Lateral Dominance (Harris, 42 1974) was administered to collect hand preference information which might assist in interpreting individual performance on the fine motor and psychomotor test battery. An individually administered one hour test battery and brief handwriting task which permitted observation of the penhold and postural features were administered in two half hour testing sessions, according to standardized procedures, and in invariant order. In addition, teacher ratings of ability and achievement were obtained for each child. 2. Description of Instruments a. Fine Motor and Psychomotor Test Battery Motor ability is an inference derived from observing performance across similar kinds of movement tasks (Keogh & Sugden, 1985). Manual dexterity in middle and late childhood has not been studied systematically via factor analytic methods (Cratty, 1979; Keogh & Sugden, 1985) and therefore the test battery was constructed from directions indicated in the clinical (Levine, 1984; Caddes, 1985) and handwriting literature (Harris, 1960; Strickling, 1974). Tests of fine visual motor coordination and manual dexterity for children have been found to form a single factor in the few factor analytic studies conducted (Keogh & Sugden, 1985). The fine motor and psychomotor test battery was selected to represent a continuum of fine motor abilities ranging from simple to complex (Cratty, 1973) and can be classified by test demands for manipulation of a pencil-like tool, precision, speed, and reproduction. Combined male and female norms are provided for the individual tests on the battery. The individual measures are classified and presented in order of increasing complexity in Table 4 and described below. 43 Table 4 Classification of Fine Motor and Psychomotor Test Battery Classification Tool Test Manipulation Precision Time Reproduction Finger Tapping none none speeded none MS-Maze stylus tracing as needed none Horizontal stylus tracing as needed none Holes stylus static fixed none Grooved Pegboard pegs placement speeded none Motor Speed & Precision pencil production speeded none Bender pencil production as needed form Coding pencil production speeded symbol association 1) Finger Localization (Benton, 1979; Benton ef al., 1983) This test of tactile-perceptual awareness is a sensory rather than a fine motor test. The 60 item test consists of three parts: i) with the hand visible, localization of single fingers touched by the examiner with pointed end of a pencil (10 trials each hand); ii) with the hand hidden from view, localization of single fingers touched by the examiner (10 trials each hand); iii) with the hand hidden from view, localization of pairs of fingers simultaneously touched by the examiner (10 trials each hand). 2) Finger Tapping (Knights & Moule, 1967; Trites, 1981) The child depresses a mechanical finger tapper using the index finger. The maximum oscillation rate of the index finger is the mean of the scores obtained for the five—ten second trials. 44 3) The Motor-Steadiness Battery (Klove, 1963; Knights & Moule, 1968; Trites, 1981) i) Maze Test - In this test of dynamic steadiness, the child is required to run a stylus through a maze which is placed at a 70° angle and has the blind alleys filled. Three scores are obtained for the dominant hand (hand used in handwriting) and the nondominant hand: the number of contacts with the side of the maze, the duration of these contacts, and the time required to complete the task. ii) Horizontal Groove Steadiness Test - In this test of dynamic steadiness, the child runs a stylus along the centre of a horizontal groove. Three scores are obtained for dominant and nondominant hand: the number of contacts with the side of the groove; the duration of these contacts; and the time required to complete the task. iii) Holes Resting Steadiness Test - In this test of static steadiness, the child rests his arm and hand on the table in a comfortable position, fits, and is then required to hold the stylus in the centre of a small hole for three 15 second periods without contacting the edge. Two scores are obtained for the dominant and nondominant hand: the number of contacts with the edge and the duration of these contacts. The contact and duration scores for the Motor-Steadiness Battery are electronically recorded. 4) Grooved Pegboard Test (Klove, 1963; Knights & Moule, 1968; Trites, 1981) In this test of manipulative dexterity involving speeded transport of pegs, the child is required to fit keyhole-shaped pegs into similarly shaped holes with varying orientation on a 4 inch by 4 inch board beginning at the left side for the right hand and at the right side with the left hand. Three scores are obtained for the dominant, nondominant and both hands: the length of time required to complete the task, the number of pegs placed, and the number of pegs dropped. 45 5) Motor Speed and Precision Subtest from the Detroit Test of Learning Aptitude (Baker & Leland, 1967) In this paper and pencil test, the child is required to place crosses in a series of progressively smaller circles, as quickly as possible without going outside of the circle boundaries. The child receives a credit of one point for each cross correctly placed in each circle and receives cumulative scores at 1, 2, 3, and/or 4 minutes according to age/grade placement. The grade five child receives a cumulative score at 2 minutes. 6) Bender Visual Motor Gestalt Test (Bender, 1938) In this test of visual motor coordination, the child copies each of nine individually presented geometric figures onto a blank sheet of paper. The Developmental Bender Scoring System for Children (Koppitz, 1975) was used to assign a total error score for the nine figures. 7) Coding Subtest of the Wechsler Intelligence Scale for Children—Revised (Wechsler, 1974) In this paper and pencil test, the child is required to select from a key the geometric symbols paired with digits and copy these symbols as quickly as possible within a two minute time limit. A scaled score, with a mean of 10 and standard deviation of 3, is derived from the raw score of number of symbols correctly produced. b. Penhold and Posture Classification Inventory Each child was individually observed during a handwriting task in which two handwriting samples were obtained. For each sample, the child was asked to write the sentence, 'The quick brown fox jumps over the lazy dog.", twice at his usual 46 rate. This permitted the examiner to observe and classify the handwriting movement according to the Penhold and Posture Classification Inventory (see Appendix B). The penhold classification inventory (items 1-5) has been developed by Sassoon et al. (1986). The posture classification inventory (items 6-14) has been derived from desciptions of postural problems in handwriting (Gillingham & Stillman, 1973; Otto & Smith, 1980). A fluency difference (item 18) was calculated as the absolute difference in writing time in seconds between the two handwriting samples. Wann and Jones (1986) have suggested that greater variability in writing time from one trial to the next may be indicative of fine motor difficulties and that this measurement may have a practical classroom application. Simple observation and measurement procedures are more readily adopted by the busy classroom teacher; therefore, a difference rather than a variability score was calculated. c. Teacher Ratings of Ability and Achievement A rating form (see Appendix D) was used to obtain teacher ratings of ability and achievement for each child who participated in the second phase of the study. Ratings were obtained prior to administration of the fine motor and psychomotor test battery and observation of handwriting for the penhold and posture classification inventory. Information regarding group membership of the individual children was withheld until administration of test battery and classification inventory had been completed and teacher ratings obtained. 47 3. Data Analysis All instruments in the fine motor battery were scored according to standardized procedures. Scaled scores were used in analysis of the Coding subtest. Raw scores were used in the analysis of all other tests. Subprograms from the Statistical Package for the Social Sciences: SPSS (SPSS Inc., 1988) were used to tabulate descriptive statistics and to calculate correlations between independent and dependent variables. A structured multiple regression equation was used to test for differences in handwriting group performance on measures in the fine motor and psychomotor battery and the measure of handwriting fluency difference. The independent variables were sex, handwriting group membership, and the interactions between sex and group membership, identified as Sex by Croup Contrast 1 (SXG1) and Sex by Croup Contrast 2 (SXG2). The regression model tested was: Y = u + / M i + [/3 2X 2 + /3 3X 3] + [/3»{X 1 /X 2} + 0 5 { X i , X 3 } ] where: is sex X2 is Croup Contrast 1 X 3 is Group Contrast 2 Orthogonal coding was used for the contrast variables to allow for directly interpretable contrasts of group mean differences. Group Contrast 1 (X2) contrasts the mean of the Top Group with the average of the means of the Bottom and Slow Groups. Group Contrast 2 (X3) contrasts the means of the Bottom and Slow Groups. Statistical control was obtained by two methods. Age effect was controlled by using a sample of children of the same age, with a mean age of 10 years 8 months and a standard deviation of 4.5 months. Fine motor performance is not 48 considered to vary significantly within this age span. Sex effect was controlled by forcing the independent variable of sex to enter the multiple regression equation first. This was done because sex mediated group membership due to the main effect for sex upon legibility which was found in the first phase of the study. Therefore, membership in the Top and Slow groups was predominantly female. The independent variable of group membership was forced to enter the equation second and the interaction variables, SXC1 and SXC2, were allowed to enter the equation on the basis of their ability to account for variability in the dependent variables; with the result that SXC2 was entered third and SXG1 was entered fourth. Analyses of variance were used to test for handwriting group differences on the teacher ratings of ability and achievement. Chi square analyses were used to test for handwriting group differences on penhold and posture classification features and on the hand preference test from the Harris Tests of Lateral Dominance. CHAPTER V. RESULTS The organization of this chapter parallels the four data analysis steps outlined in Chapter 4: (1) descriptive statistics concerning group performances on the fine motor and psychomotor test battery, fluency difference, and teacher ratings of ability and achievement, (2) regression analyses of the tests in the fine motor and psychomotor battery and measure of fluency difference, (3) analyses of variance of the teacher ratings of ability and achievement, and (4) chi-square analyses of the features in the Penhold and Posture Classification Inventory. A. DESCRIPTIVE STATISTICS Tables of means and standard deviations for the fine motor and psychomotor test battery, measure of fluency difference, and teacher ratings of ability and achievement are presented for each of the three groups of handwriting skills: Top, Bottom, and Slow (see Appendix E). Interpretation of performance depends upon scoring direction. Finger Localization, Finger Tapping, Motor Speed and Precision, and Coding tests yield scores which indicate superior performance as scores increase. The Motor-Steadiness Battery, Grooved Pegboard, Bender, and measure of fluency difference yield scores which indicate inferior performance as scores increase. Higher ability ratings indicate superior performance while lower achievement ratings indicate superior performance. The sum of two rather than three trials for the Holes Resting Steadiness was used in the analysis because of missing data for the third trial. The Grooved Pegboard measures of pegs dropped and pegs correct were eliminated from the analysis since the total sample correctly placed all 25 pegs and very few children dropped pegs. Test performance results are based on the total sample with the 49 50 exception of the Motor Speed and Precision Test. Because of examiner error, this test was administered in a nonstandard fashion to 12 of 41 children. These test scores were therefore eliminated from the analysis. The analysis is based on a subsample of 29 children: 9 of 16 comprised the Top group, 10 of 10 comprised the Bottom group, and 10 of 15 comprised the Slow group. Teacher ratings are based on the total sample with the exception of the Written Language and Physical Education ratings for which the ratings of a child in the Bottom group were unavailable. Inspection of the fine motor and psychomotor test battery results for below average performance according to normative data for normal age peers was only possible for the Finger Localization, Motor Speed and Precision, Bender and Coding tests. Although the Finger Tapping Test, Motor Steadiness Battery, and Grooved Pegboard were administered according to the standardized procedures outlined by Trites (1981), the normative data provided by Trites could not be used in the normative interpretation of test results. Trites' norms have been collected on a clinical population and are, therefore, not applicable to a normal population. While Knight and Moule (1967, 1968) have provided normative data for a normal population, these norms could not be used because of differences in administration procedures. Few children obtained below average results, defined as more than one standard deviation below the mean, on the four tests for ~~which normative comparison was possible. One child in the Top group obtained a below average score on the Bender test. Two children in the Bottom group obtained a below average score on the Motor Speed and Precision test, four obtained a below average score on the Bender test, and one obtained a below average score on the 51 Coding test. Two children in the Slow group obtained a below average score on Finger Localization, three on the Motor Speed and Precision test, six on the Bender test and two on the Coding test. Intercorrelations for the fine motor and psychomotor test battery and measure of fluency difference are presented in Table F1 (see Appendix F). Correlation coefficient values may be attenuated for all variables because of restrictions of range of handwriting skills represented in the sample. A smaller sample size for the Motor Speed and Precision Test and deletion of the third trial for the Holes Resting Steadiness may also have resulted in attenuated correlation coefficient values. The correlations between the independent and dependent variables in the multiple regression analyses are presented in Table F2 (see Appendix F). B. MULTIPLE REGRESSION ANALYSES Structured multiple regression analyses were conducted to determine whether there was a significant effect for the independent variables in combination or in isolation. A multiple regression analysis procedure was conducted for each performance measure on the fine motor and psychomotor test battery and for the measure of fluency difference. The significance of the multiple regression equation, the effect of the four independent variables in combination, was determined by testing the F ratio. The regression coefficients were used as indices of the effects of each independent variable while controlling for the effects of the remaining independent variables and were tested for significance at the p_0.05 level. Results of the multiple regression analyses on the Fine Motor and Psychomotor Test Battery and fluency difference 52 measure are presented in Appendix G. A summary of the significance of the multiple regression analyses is presented in Table 5. For purposes of the results and summary tables, the two group vectors have been combined. The significance of the regression equation and the significance of each regression coefficient for the independent variables of sex, handwriting group membership, sex by group contrast 2, and sex by group contrast 1 are presented in Table 5. The group means involved in the contrasts for variables that show significant effects can be found in Table E1. 1. Finger Localization There was a significant effect for sex on the finger localization total score, and an effect for sex approaching significance on the finger localization right and left scores. The multiple regression equation is significant for the finger localization total and right scores. There were no significant effects for group membership, or for the interactions between sex and group contrasts on the Finger Localization Test. 2. Finger Tapping While there were no significant effects for the multiple regression equation or any independent variable for the Finger Tapping test, the sex effect for the nondominant hand approaches significance. 53 Table 5 Significance of Croup Difference for Fine Motor Tests and Fluency Difference: Summary of Multiple Regressions Independent Variables1 Dependent Variables Hand Sex Group SXG2 SXG1 Equation 1) Finger Localization Total Both .021* .127 .552 .074 .039* Right .066 .075 .736 .079 .029* Left .053 .477 .210 .244 .204 2) Finger Tapping DOM .232 .230 .393 .800 .549 NDOM .066 .315 .695 .490 .255 3) Motor Steadiness Battery i) Maze Time DOM .985 .063 .223 .248 .408 NDOM .527 .051 .395 .379 .231 Contact DOM .116 .114 .418 .388 .356 NDOM .714 .049* .740 .914 .104 Duration DOM .125 .195 .792 .391 .455 NDOM .576 .045* .630 .731 .113 ii) Horizontal Time DOM .844 .060 .644 .533 .289 NDOM .520 .043* .268 .582 .166 Contact DOM .788 .060 .274 .782 .130 NDOM .942 .015* .370 .799 .065 Duration DOM .975 .044* .543 .839 .106 NDOM .442 .008* .160 .588 .081 iii) Holes Resting Contact DOM .460 .654 .053 .304 .018* NDOM .183 .023* .782 .682 .136 Duration DOM .898 .183 .286 .612 .056 NDOM .592 .072 .645 .884 .341 4) Grooved Pegboard Time Both .792 .195 .253 .838 .664 DOM .432 .507 .027* .901 .241 NDOM .288 .103 .915 .808 .419 5) Motor Speed & 1 minute DOM .711 .059 .509 .915 .101 Precision 2 2 minutes DOM .843 .031* .146 .559 .012* 3 minutes DOM .716 .066 .296 .429 .034* 4 minutes DOM .939 .175 .331 .308 .070 6) Bender DOM .824 .048* .326 .341 .320 7) Coding DOM .127 .033* .238 .761 .009* Fluency Difference DOM .557 .082 .086 .382 .044* 1 p values are reported. 2 Top group: n = 9, Bottom group: n = 10, Slow group: n = 10 54 3. Motor Steadiness Battery i) Maze Steadiness Test There were no significant effects for the multiple regression equation or any independent variable for the dominant hand measures of the Maze Steadiness Test. There were significant effects for group membership, however, on the contact and duration measures for the nondominant hand. The group membership effect for the time measure of the nondominant hand approached significance. ii) Horizontal Steadiness Test There were significant group membership effects for the time, contact, and duration measures of the nondominant hand and for the duration measure of the dominant hand. The effect of group membership for the time and contact measures of the dominant hand approached significance. iii) Holes Resting Steadiness Test There was a significant group membership effect for the contact measure of the nondominant hand, and for the multiple regression equation on the time measure for the dominant hand. The effect of the interaction between sex and group contrast of the Bottom and Slow Croups (SXC2) approached significance for the dominant contact measure as did the effect of the multiple regression equation for the dominant duration measure. 4. Grooved Pegboard Test The was a significant effect was for the interaction between sex and group contrast of the Bottom and Slow Groups on the dominant time measure. 55 5. Motor Speed and Precision There was a significant effect for group membership on the two minute measure and the group membership effect for the one and three minute measures was in a similar direction. The effects of sex and of the interaction between sex and group contrasts were not significant. The multiple regression equation was significant for the two and three minute measures and was in the direction of significance for the four minute measure. 6. Bender The only significant effect on the Bender error score was for group membership. 7. Coding There was a significant effect for group membership and a highly significant effect for the regression equation on the Coding Test. 8. Fluency Difference The independent variables in isolation did not have a significant effect but the multiple regression equation was significant. The two variables of group membership and the interaction between sex and contrast of Bottom and Slow Groups (SXG2) seemed to account for the significance of the equation. 56 9. Summary The results of the multiple regression analyses indicate that a few measures of fine motor and psychomotor abilities account for significant differences in handwriting skill for this sample when sex differences are controlled. They are: Maze Steadiness duration and contact for the nondominant hand, Horizontal Steadiness time, contact and duration of contacts for the nondominant hand and duration of contacts for the dominant hand, Holes Resting Steadiness contact for the nondominant hand, the Motor Speed and Precision two minute score, the Bender error score, and the Coding scaled score. Nondominant hand measures of fine motor abilities account for more significant differences than do dominant hand measures of fine motor abilities. The Motor Steadiness Battery (nondominant hand), two minute Motor Speed and Precision, Bender and Coding discriminated significantly among Top, Bottom, and Slow groups of handwriting skill. Handwriting groups did not account for significant differences in handwriting fluency difference for this sample. Means and standard deviations for sex by group are presented in Table 6 for variables on which significant or borderline significant effects were found for sex, or sex by group contrast interactions. There was a significant sex effect for Finger Localization both and left hand scores with females obtaining higher scores. There was a sex by group contrast interaction borderline significant effect for the dominant Holes Resting contact with the females in the Bottom and Slow Groups achieving significantly better than males in those groups. There was a significant sex by group contrast interaction effect for the Grooved Pegboard time with the females of the Bottom group more closely resembling the males of the Slow group. 57 Table 6 Means and Standard Deviations for Sex by Group on Significant Group Differences for Variables of Sex and SXG2 Test Hand Significant Variable Sex M/SD Top Groups Bottom Slow Finger Localization Both Sex M M 53.66 55.80 55.70 SD 3.79 2.78 3.23 F M 58.23 58.20 55.80 SD 2.42 1.92 2.17 Left Sex M M 26.67 27.20 28.20 SD 2.30 1.64 1.40 F M 28.77 29.00 28.00 SD 1.96 1.41 1.58 Holes Resting Contact DOM SXG2 M M 0.33 1.40 6.30 SD 0.58 1.34 6.43 F M 1.46 0.80 2.60 SD 2.57 1.09 2.41 Grooved Pegboard Time DOM SXG2 M M 73.00 79.80 69.10 SD 5.29 12.72 9.42 F M 70.69 68.00 74.80 SD 5.78 7.58 12.05 C. ANALYSES OF VARIANCE Oneway analyses of variance procedures were conducted to determine whether the differences among the Top, Bottom, and Slow handwriting group means on the Teacher Ratings of Ability and Achievement were statistically significant. Significance was set at the .05 level. Table 7 presents a summary of the analyses of variance. Teacher ratings were significantly different among groups for written language (p = 0.042), drawing (p = 0.000), arithmetic achievement (p = 0.042), and handwriting (p = 0.019). While not significant, ratings for reading and ability were also in the direction of significance. 58 Table 7 Effects of Handwriting on Scholastic Achievement: Summary of Analyses of Variance of Teacher Ratings Rating Source of Variance df SS MS F P Ability Between Croups 2 10.40 5.20 2.51 .093 Within Croups 38 78.47 2.06 Reading Between Groups 2 6.86 3.43 3.13 .054 Achievement Within Groups 38 41.57 1.09 Written Language Between Groups 2 9.36 4.68 4.43 .018 Achievement Within Groups 37 39.03 1.05 Arithmetic Between Groups 2 6.84 3.42 3.42 .042 Achievement Within Groups 38 37.93 0.99 Physical Education Between Groups 2 1.56 0.78 2.00 .149 Achievement Within Groups 37 14.43 0.39 Drawing Between Groups 2 5.20 2.60 8.55 .000 Achievement Within Groups 38 11.57 0.30 Handwriting Between Groups 2 6.36 3.18 4.40 .019 Achievement Within Groups 38 27.43 0.72 Post hoc analysis using the Tukey test was conducted for the achievement ratings which were significant at the .05 level and the results are presented in Table 8. With the exception of Arithmetic ratings for which no significant group comparison differences were found, the Top group was significantly different from both the Bottom and Slow groups on the achievement ratings for written language, drawing, and handwriting. Examination of group means on ability and achievement (presented in Appendix E) indicates the the Top group received teacher ratings which were on the average superior to those received by the Bottom and Slow groups for ability and achievement. 59 Table 8 Significance of Group Mean Differences on Teacher Ratings Significance1 of Rating Groups Compared x.-x. ' J Tukey Statistic Written Language 1 vs 2 1.15 SIG Achievement 1 VS 3 0.84 SIG 2 VS 3 0.31 ns Arithmetic 1 VS 2 0.83 ns Achievement 1 VS 3 0.83 ns • 2 VS 3 0.00 ns Drawing 1 VS 2 0.91 SIG Achievement 1 VS 3 0.44 SIG 2 VS 3 0.46 ns Handwriting 1 VS 2 0.91 SIG Achievement 1 VS 3 0.71 SIG 2 VS 3 0.20 ns 1 a = 0.05 Intercorrelations for Teacher Ratings of Ability and Achievement and the Legibility Rating given the handwriting sampl e collected during group selection are presented in Table 9. It can be seen that teacher ratings of ability and achievement, with the exception of physical education, are significantly correlated with teacher rating of handwriting and the legibility rating of the handwriting sample. This is a stronger relationship than would be expected for ability, reading, language, and arithmetic achievement, but as objective measures of ability and achievement were not obtained, the validity of this correlation cannot be determined. 60 Table 9 Intercorrelations1 of Ratings of Scholastic Ability and Achievement2 and Handwriting Legibility for Usual Samp! e Written Physical Sample Variable Ability Reading Language Arithmetic Education Drawing Handwriting Legibility Ability 100 87** 81** 80** 11 46* 47* * 59** Reading 100 92** 86** 18 54** 48** 51** Written Language 100 85** 03 50** 54** 59** Arithmetic 100 19 46* 50** 54** Physical Education 100 31 12 23 Drawing 100 60** 54** Handwriting 100 50** Sample Quality 100 1 Correlation coefficients are shown at two significant places and decimals omitted. 2 Scales of measurement for achievement have been reflected so that a high score indicates superior achievement. * p^.01 ** p<.001 D. CHI SQUARE ANALYSES Four of the 41 children in the total sample, 2 females in the Top group and 2 males in the Bottom group, were left-handed for writing. This is consistent with the 10-11% estimate of left-handedness in the school population (Peters & Pedersen, 1978). Three of the 41 children in the total sample demonstrated mixed hand preference on the Harris Hand Preference Test. Two children, one from each of the Top and Bottom groups, were left-handed for writing while the third child, from 61 the Bottom group, was right-handed for writing. The observations in the Penhold and Posture Classification Inventory were classified as modal/nonmodal (Sassoon ef al., 1986) or proper/improper (Cillingham & Stillman, 1973). The chi square test of association was conducted to determine whether observed proportions of features differed significantly among handwriting groups. Observations for left-handed writers were not included in the analysis of paper orientation because the correct position of the paper is determined by the hand used for writing. The frequencies and percentages of children in each group displaying nonmodal or improper penhold and postural features are presented in Table 10. A small number of observations are missing due to examiner error. Sample size for missing observations are indicated by footnotes to Table 10. 1. G r i p The modal and correct pencil grip is the tripod grip in which the thumb and index finger are on the pencil barrel and the middle finger is below the barrel. While all children in the Top group adopted this grip, 2 children from the Slow group and 2 children from the Bottom group did not. These differences in grip were not significant. 2. Thumb The modal position for the thumb is on the side of the barrel but almost half the children in the entire sample adopted a position in which the thumb is over the index finger. As the majority were in the Top group, it is presumed this nonmodal position can be adopted without adverse effect on the handwriting product. 62 Table 10 Percentages and Frequencies1 of Children Displaying Nonmodal or Incorrect Penhold  and Postural Features by Group with Chi-Square Analyses"2 Croups Features Top Bottom Slow (n = 16) (n = 10) (n = 15) Grip: Middle finger on barrel 0 ( 0) 10 (1) 13 ( 2) 0.337 Middle & ring finger on barrel 0 ( 0) 10 (1) 0 ( 0) 0.204 Thumb: Positioned over index finger 62 (10) 30 (3) 26 ( 4) 0.090 Not second from pencil tip 44 ( 7) 30 (3) 33 ( 5) 0.737 Not flexed at interphalangeal joints 25 ( 4) 20 (2) 7 ( D 0.383 Index: Positioned at top of barrel 81 (13) 80 (8) 73 (11) 0.855 Not leading 37 ( 6) 40 (4) 40 ( 6) 0.512 Hyperextension of distal joint 44 ( 7) 50 (5) 60 ( 9) 0.661 Hand and Wrist: Inverted 0 ( 0) 20 (2) 0 ( 0) 0.038 Pronated 0 ( 0) 0 (0) 7 ( D 0.425 Observed pressure on pencil3 19 ( 3) 12 (1) 15 ( 2) 0.921 Observed tiring" 19 ( 3) 37 (3) 43 ( 6) 0.337 Posture: Not upright 56 ( 9) 90 (9) 80 (12) 0.126 Body shifted5 33 ( 5) 60 (6) 36 ( 5) 0.364 Writing elbow not on desk 0 ( 0) 10 (1) 0 ( 0) 0.297 Other hand not stabilizing paper 6 ( D 0 (0) 7 ( D 0.711 Paper not anticlockwise6 0 ( 0) 37 (3) 46 ( 6) 0.020 2df=2 3 Bottom group: n = 8, Slow group: n = 13 "Bottom group: n = 8, Slow group: n = 14 5 Top group: n = 15, Slow group: n = 'Bottom group: n = «, MOW group: n= i4 5 Top group: n = 15, Slow group: n = 14 6Top group: n = 14, Bottom group: n = 8, Slow group: n = 13; observations for right handed writers only 63 The correct but nonmodal placement for the thumb is second in proximity to the pencil tip but over one third of the entire sample did not adopt this position. It appears that children can adopt an incorrect placement of the thumb without cost to the handwriting product. The correct and modal thumb shape is flexion of both interphalangeal joints during writing. This was the modal category for this sample. Differences in thumb position, proximity, or shape were not significant among groups. 3. Index While the modal position for the index is at the side of the pencil barrel, the majority of children positioned the index at the top of the pencil barrel. It is presumed that this position does not adversely affect the handwriting product. Over a third of the children adopted an incorrect but modal placement in which the index finger is not closest to the pencil tip but rather second in proximity. Hyperextension of the distal interphalangeal joint of the index finger indicates the pencil is held too tightly and limits the smooth movement of the pencil tip. Approximately half the children in each group adopted this grasp which although incorrect has been found to be the modal shape of the index finger. Differences in postion, proximity or shape of the index finger were ""not significant. 64 4. Hand and Wrist Inverting the wrist so that the hand is above the line of writing is a nonmodal and decidedly incorrect wrist postion and is commonly thought to adversely affect handwriting. Two left-handed males from the Bottom group adopted this position which is more common among the left-handed and more common for left-handed males than females (Peters & Pedersen, 1978). Pronation of the wrist during writing limits the extension of the wrist and hand resulting in decreased fluency. Two children from the Slow group adopted a pronated wrist position. Informal observations of tiring, such as shaking the hand after writing, and visible pressure on the pencil, such as white knuckles, were relatively infrequent for Top and Bottom groups. As might be expected, 43% of children in the Slow group demonstrated tiring during handwriting. Differences for inverted writing position were significant but differences for pronation, pencil pressure, and tiring were not significant among groups. 5. Posture The correct, modal posture during handwriting is upright with arm and hand extending to reach the end of the line of writing. The majority of children did not adopt an upright posture. While most children properly stabilized the writing paper with the nonwriting hand and placed their writing elbow on the writing surface, a number of children from the Bottom and Slow groups did not correctly place their paper in the anticlockwise orientation. Placing the paper in the anticlockwise direction permits smooth extension of the arm and hand during writing. Differences for paper 65 orientation were significant among groups. 6. Summary It can be seen that in general there is no cost to adopting a nonmodal or improper feature of penhold or posture during handwriting. Only differences in proportions of children adopting the inverted wrist position and not placing the paper in the anticlockwise orientation were significant among handwriting groups. CHAPTER VI. DISCUSSION A N D C O N C L U S I O N S This study was motivated by the lack of instrumentation for precise definition and differentiation of handwriting difficulties due to fine motor variables. Differentiation from handwriting difficulties due to instructional or motivational variables is necessary because children with subtle motor deficits are at educational risk if their specific needs are not identified and understood. Legible speed writing appears to be equally as important to academic productivity in the middle grades as accurate speed reading (Levine ef al., 1980). Poor handwriting, an almost universal feature of developmental clumsiness, is often the only observable symptom of a subtle fine motor deficit. Identification of children with subtle fine motor deficits should result in academic accommodations: early provision of remedial handwriting training, appropriate expectations for quality and quantity of written work, and teacher acceptance of the presence of a genuine "disability." A. S U M M A R Y The purposes of this study were to investigate the relationships between handwriting skill in grade five children and: fine motor and psychomotor abilities, as measured by a test battery; teacher ratings of ability and achievement; observed features of penhold and posture; and the fluency difference between two handwriting trials. The range of cursive writing legibility and fluency demonstrated by 122 grade five children was examined in order to select children for inclusion in the extreme groups of handwriting skill. The Top group, comprised of 16 children, demonstrated above average legibility and fluency. The Bottom group, comprised of 10 children, demonstrated below average legibility and fluency. The Slow group, comprised of 15 66 67 children, demonstrated average legibility and below average fluency. Analysis of the cursive writing skills of 122 children revealed no sex differences for fluency but females produced significantly more legible cursive writing than males. Therefore, the Top and Slow groups were predominently female in composition. A fine motor and psychomotor test battery, selected to represent a continuum of fine motor abilities ranging from simple to complex, was administered to the 41 children in the extreme groups. The tests were classified by demands for manipulation of a pencil-like tool, precision, speed, and reproduction (see Table 4). The individual tests were: Finger Localization, Finger Tapping, Maze Steadiness, Horizontal Steadiness, Holes Resting Steadiness, Grooved Pegboard, Motor Speed and Precision, Bender, and Coding. Structured multiple regressions with sex as the first variable, group membership as the second variable, and the interaction between sex and group contrasts as the third and fourth variables were used in the analyses of group performances on individual test measures. Teacher ratings of ability and achievement were obtained for children in extreme groups and oneway analyses of variance and pearson correlations were conducted in the analyses of ratings. The Penhold and Posture Classification Inventory was used in the observation of features of penhold, posture and fluency difference during an individually administered handwriting task. Chi-square analyses were used in the analyses of penhold and posture. The structured multiple regression equation was used in the analysis of the measure of fluency difference. The results of the study will be summarized and discussed in terms of the four research questions posed in chapter 3. 68 B. DISCUSSION OF RESULTS 1. Measures of Fine Motor and Psychomotor Ability A summary of the significance of group differences for the fine motor and psychomotor ability measures is presented below. Significant • Maze Nondominant: Contact, Duration • Horizontal Nondominant: Time, Contact, Duration • Horizontal Dominant: Duration • Holes Resting Steadiness Nondominant: Contact • Motor Speed and Precision: 2 minute score • Bender error • Coding scaled score Nonsignificant • Finger Localization: Both, Right, Left • Finger Tapping: Dominant, Nondominant • Maze Nondominant: Time • Maze Dominant: Time, Contact, Duration • Horizontal Dominant: Time, Contact • Holes Resting Steadiness Dominant: Contact, Duration • Holes Resting Steadiness Nondominant: Duration • Grooved Pegboard • Motor Speed and Precision: 1 minute, 3 minute, 4 minute scores 69 a. Test Specificity Test specificity to a handwriting-like movement and the manner in which test performance is evaluated differentiate tests which yield significant group differences from those which do not yield significant differences. Only tests which combine arm and finger movement in the precise manipulation of a pencil-like tool yield significant differences. This finding concurs with Cratty's (1979) suggestion that it is more useful to select motor tests that rather exactly correspond to the specific kinds of motor skills to be explored for children beyond five to six years of age. It can be inferred from this finding that precise manipulation of a pencil-like tool is a motor ability which underlies handwriting skill. Test performance may be evaluated by documenting maximal output with the use of a single score or by analyzing the components of performance and documenting the manner in which the movements are performed. Only tests which permit analysis of the components of the movement production yield significant differences among groups. The Motor-Steadiness Battery contact and duration measures document the manner in which the movement is performed while the Motor Speed and Precision, Bender and Coding scores include a component analysis of the movement trace. This finding is consistent with group selection procedures which included a component analysis of the movement trace, handwriting legibility. Findings of nonsignificant group differences for the Finger Tapping and Grooved Pegboard measures are consistent with previous research (Cratty, 1973; Wann, 1986). Wann has suggested that traditional tapping paradigms are not effective in highlighting the nature of timing required by complex motor acts such as handwriting. Finger Tapping and Grooved Pegboard measures, limited to a single score representing maximal output over a relatively short time period, do not tap 70 the timing process involved in the handwriting movement. The nonsignificant result for Finger Localization does not support the inclusion of a difficulty in finger localization in Levine's (1984) conceptual model of fine motor dysfunction and handwriting difficulties. Levine suggested that the need to visually monitor finger activity could be seen in poor finger localization and this need could sharply decrease the rate of written output and perhaps legibility. This result, however, does support Gaddes' (1985) contention that poor finger tactile sensitivity does not seriously impair learning of handwriting. Finger Localization does not tap proprioceptive function, therefore, investigation with a more appropriate instrument such as the Stereognosis Test may provide empirical support for a proprioceptive-kinesthetic dysfunction as a fine motor difficulty in handwriting (Gaddes, 1985; Levine, 1984). b. Sensitivity of Nondominant Hand Measures The most important and striking finding of the study is the significance of the Motor Steadiness Battery nondominant hand measures. While the sensitivity of nondominant hand measures is an area which has not received any attention in handwriting research, neuropsychological research provides some evidence for the more significant discriminating ability of motor measures of nondominant over dominant hand. Denckla (1974) found that right-handed children with developmental learning disabilities" when compared with normal children show excessively slow, clumsy left-sided coordination. Reitan (1971, 1972) found that brain-damaged children show a greater magnitude of preferred hand superiority on tactile-perceptual, motor and psychomotor tasks, including handwriting skill than do normal children. Excessively clumsy nondominant hand performance, among the developmental 71 problems associated with clumsiness (Denckla, 1984), provides empirical support for Gaddes' (1985) recommendation to obtain manual-motor tests of both hands. Fine motor asymmetry for normal right-handed children is greatest for motor tasks which involve distal flexion-extension movements (Denckla, 1974). However, by about eight years of age, left-sided function has improved so that there is a very small mean right superiority within the individual. Comparisons of dominant and nondominant hand performance may reveal fine motor or psychomotor asymmetries which may have neuropsychological significance. The Motor-Steadiness Battery requires precise distal flexion-extension movements and may be particularly sensitive to motor asymmetry. Gaddes (1985) states that children with apraxia require more repetitions to acquire the cortical muscular pattern and correlative symbolic spatial patterns necessary to a required motor act. Awkwardness in carrying out a transitive act, such as precise manipulation of a pencil-tool, may be present until children have acquired the sequence of complex cortical and neuromuscular processes necessary to the act. As the Motor Steadiness Battery represents a novel motor act, especially for the nondominant hand tasks, this may provide an alternate explanation for the greater sensitivity of nondominant hand performance. Children who are slow in acquiring cortical-muscular patterns will perform more poorly with the nondominant hand which has had little practice in manipulation of pencil-like tools. c. Interpretation of Significance The Bender and Coding are most similar in process to the handwriting movement and are sensitive to group differences; but because they are heterogeneous tests, poor performance on these tests provides less diagnostic 72 information than does poor performance on homogeneous tests. A deficiency in any one of the component subskills such as spatial visualization, eyehand coordination, short-term memory, visual-spatial memory, and fine motor ability can be responsible for poor performance. The significance of the Bender is consistent with results obtained by Rubin and Henderson (1982). Poor performance on the Motor Steadiness Battery, a fine motor test, is readily interpretable as tremor or problem in arm-hand steadiness. The emergence of the Horizontal Test as the most sensitive to group differences is consistent with suggestions that sensitive tests of steadiness in drawing a continuous straight line are related to handwriting (Harris, 1960; Stott, Henderson, & Moyes, 1987). The finding of significance for 7 measures and the trend towards significance for 5 measures of the 16 measures in the Battery provides empirical support for Thomassen and Teulings' (1983) suggestion that there is a stage in which arm-hand steadiness contributes to writing proficiency. It is of interest that the Slow group obtained on average larger contact and duration scores and faster time scores on the Motor-Steadiness Battery than did the Bottom or the Top groups. Time, that is speed in completing the movement, is negatively correlated with the contact and duration scores. The children in the Slow group seemed unable to control the speed of the tracing movement in order to reduce mistakes. Time norms for the Maze Test indicate that time taken for task completion does not markedly decrease with age but that precision of movement increases with age (Knights & Moule, 1968). The Slow group may represent children for whom "speed and beauty cannot coexist" (Denckla, 1984, p. 254) and whose legible handwriting can only be produced at the expense of fluency. Significance of the Motor Speed and Precision 2 minute measure is 73 consistent with previous research findings that performance on this test significantly predicts handwriting fluency (Couvillion, 1986) and correlates significantly with . handwriting fluency and legibility (Strickling, 1974). Significance of the 2 minute measure and nonsignificance of the 1, 3, and 4 minute measures confirm the standardized administration procedure which recommends only administration of the 2 minute measure as a developmentally appropriate task at the grade five level. Unlike previous studies of fine motor skills in handwriting (Rowley, 1938; Rubin & Henderson, 1982), significant differences in handwriting group performance on fine motor tests are obtained in this study. Whereas in this study groups were discrete and both legibility and fluency measures were considered in group selection, this was not the case in either Rowley's or Rubin and Henderson's research. The use of extreme groups highlights differences in fine motor performance. Since clumsy children have subtle motor deficits which are frequently only noted in poor handwriting (Cubbay, 1975; Myklebust, 1973), it is possible that group differences on fine motor performance are observed only when groups are discrete and extreme groups of handwriting skill are compared. 2. Teacher Ratings of Ability and Academic Achievement Results of the analyses of variance and Tukey tests indicate that teacher ratings of written language, handwriting, and drawing are significantly different for the Top group when compared to the Bottom and Slow groups. While the analysis of variance for the rating of arithmetic achievement is significant, the Tukey test does not yield significant differences between groups. Ratings of ability and reading achievement are in the direction of significance and ratings of physical education are not significant. 74 Since the teacher rating of handwriting is not significantly different for the Bottom and Slow groups, it can be inferred that teachers of grade five do emphasize speed as well as legibility in handwriting achievement (Herrick & Okada, 1963; Otto & Smith, 1980) and that rapid writing is a requirement in functional handwriting. This result supports the selection of the Slow group as a group with poor functional handwriting. Teacher rating of physical education is not significantly different for handwriting groups nor are correlations with the teacher handwriting rating and legibility rating of the handwriting samples significant. Two possible explanations can be offered. The teacher rating of physical education may not reliably reflect gross motor skill because teachers do not view physical education as an academic subject and may not take note of subtle differences in motor functioning. Physical education, taught outside the classroom without written assignments, cannot be judged by the written product. This result is consistent with research which indicates that subtle motor deficits are: most observable in instances where expectations for skilled performance is maximal as in handwriting (Levine, 1984); limited to fine motor abilities (Myklebust, 1973); and poor sporting ability is noted by less than 50% of teachers of clumsy children (Cubbay, 1975). The correlation between the teacher rating of ability and legibility rating of the handwriting samples is higher than would be expected from the finding in handwriting research that intelligence and handwriting are not related (Harris, 1960). It is possible that the teachers have based their rating of ability upon pupil achievement. At the grade five level, achievement is mainly evaluated from written tests and assignments so that handwriting skill is a major component of classwork. A significant group difference for written language achievement is consistent 75 with reports that teachers assign higher scores to papers with handwriting of good quality (Briggs, 1980; Graham & Miller, 1980; Rondinella, 1963; Strickling, 1974) and that handwriting rate predicts language achievement (Rice, 1976). Significant correlations between teacher rating of handwriting and subject achievement are consistent with Couvillion's (1986) finding that handwriting rate predicted assignment completion and grades on report cards. Whether these results are simply due to a handwriting problem caused by poor fine motor ability (Denckla, 1984; Gubbay, 1975; Reubin & Bakwin, 1968) or to a more encompassing problem such as developmental output failure (Levine ef al., 1981), which may also include difficilties with sequential memory, visual retrieval, or expressive language, cannot be evaluated in the absence of objective ability and achievement measures. Moderate correlations between subject achievement and handwriting indicate that while there is a relationship, not all poor writers have difficulty in other subject areas. This sample of children may be comprised of a heterogeneous group: some may have academic difficulties related to handwriting; some may have academic difficulties because of a more encompassing problem which includes poor handwriting; and some may have no academic difficulties other than handwriting. The inclusion of objective intelligence and achievement measures is recommended in research which examines the relationships among ability, achievement, and handwriting. 3 . P e n h o l d a n d P o s t u r e Results of the chi-square analyses indicate that, in general, there is no cost to adopting a nonmodal or improper feature of penhold or posture during handwriting. Only differences in proportions of children adopting the inverted wrist 76 position and not placing the paper in the anticlockwise position for right handed writers are significant among the groups. These results are consistent with studies which indicate that individual variation in penhold and posture can be adopted without cost to handwriting (Bailey, 1988; Sassoon et al., 1986; Ziviani & Elkins, 1986). However, investigation of static application of penhold over a short time period may not identify the impact of improper penhold and posture over time upon fatigue and handwriting product. Investigation of the dynamic application of penhold and impact over time is recommended. The effect of the inverted hand position and the effect of incorrect paper placement upon handwriting efficiency has previously been documented (Enstrom, 1962; Gillingham & Stillman, 1973). Gillingham and Stillman indicate that retraining of penhold and paper placement, especially for the inverted hand position, leads to immediate gains in handwriting. If this were the case for children in the Bottom and Slow groups who have adopted the inverted hand position or improper paper placement, it would seem that their inclusion in this study would confound the results of analyses of the fine motor and psychomotor battery. Selection of handwriting groups, following a period of remediation for poor hahdwriters, might well result in more discrete groups. 4. Handwriting Fluency Difference While the results of the multiple regression analysis indicate that the fluency difference is not significantly different among groups, the result is in the direction of significance for sex and for group membership. Wann and Jones (1986) have suggested that variability in writing fluency might be a reliable indicator of legibility 77 problems. The fluency difference scores are on average greatest for the Bottom group with the poorest legibility and smallest for the Top group with the best legibility. The trend towards significance for sex may reflect the significant legibility superiority for females in this study. The use of a difference rather than variability score may likely have limited significance. C. CONCLUSIONS The following conclusions are drawn from the results of the study for extreme groups of handwriting skill at the grade five level. 1. There are significant differences in fine motor and psychomotor ability among groups with above average fluency and legibility, with below average fluency and legibility, and with average legibility and below average fluency. These differences may only be noted in tests which involve the precise manipulation of a pencil-like tool and which evaluate the manner in which the movement is produced or the product of the movement trace. 2. Children with poor handwriting may demonstrate excessively clumsy performance of the nondominant hand on fine motor tasks. Nondominant hand performance should be evaluated in the assessment of fine motor ability of children with poor handwriting. 3. It is probable that arm-hand steadiness contributes to handwriting proficiency at this age. Performance on the Horizontal test, a sensitive measure of steadiness in producing a continuous straight line, appears to be closely related to handwriting skill. 4. Few normal children with poor handwriting demonstrate below average performance on fine motor and psychomotor tests. It would appear that fine 78 motor deficits are quite subtle and within a low average performance range. 5. Teachers appear to consider both legibility and fluency in rating handwriting achievement. Writing which is legible but of below average fluency is as problematic as illegible writing of below average fluency. It is probable that children with poor functional handwriting are academically disadvantaged. 6. Individual variation in penhold and posture do not appear, in general, to affect the handwriting product. However, children with an inverted hand position or improper paper placement may have limited handwriting efficiency because of penhold or posture and not subtle motor deficits. D. IMPLICATIONS OF THE STUDY This study sought to identify tests of fine motor and psychomotor performance for which performance of extreme handwriting groups in grade five would be significantly different. External validation of clumsiness is necessary in differentiating handwriting difficulties due to fine motor variables from those due to instructional or motivational variables. Implications will be discussed in relation to the practice of school psychology. 1. Screening Handwriting This study suggests that children with poor functional handwriting have poorer academic achievement than children with good handwriting, especially in written language. While teachers can identify poor writing, it is the cause of poor handwriting which is problematic. Identification of children whose poor handwriting is a consequence of clumsiness or poor fine motor abilities is necessary for educational accommodation and diagnostic teaching. There is a low correlation 79 between teacher ratings of handwriting and physical education, which suggests that teachers may not consider motor difficulties a problem for the child with poor handwriting. This study has shown that a group of children with legible writing of below average fluency performs more poorly on measures of fine motor abilities than do a group of above average writers and in some cases more poorly than do a group of illegible writers with below average fluency. Screening of handwriting with the use of local legibility and fluency norms (Graham, 1986b) and individual observation of handwriting (Otto & Smith, 1980) will identify these children who may otherwise not be referred for handwriting/motor difficulties. A direct observation of penhold and posture may reveal faults of inverted hand position or paper placement which may contribute to handwriting difficulties. A period of remediation will indicate whether the child benefits from retraining. The fine motor abilities of children who do not benefit from retraining should be assessed. 2. Diagnostic Assessment of Fine Motor and Psychomotor Abilities This study indicates that test specificity to the precise manipulation of a pencil-like tool and test evaluation of components of performance should guide the selection of assessment instruments. Specific measures for assessment of fine motor and psychomotor abilities were identified. However, practical application of the results of the study to individual assessment presents a number of problems. Normal children with handwriting difficulties represent a heterogeneous group with respect to motor abilities as do clumsy children (Stott et al., 1987). Identification of subtle motor deficits is complicated by the problem of locating 80 valid norms and the performance patterns of clumsy children. In this study, normal children with serious handwriting difficulties usually performed within the low average range and rarely obtained below average scores on the well standardized tests which were sensitive to group handwriting differences. This implies that the psychologist should look for a pattern of low average to below average performance on a number of well standardized fine motor instruments including the Bender Test and Coding Subtest. No child performed within the levels of the clinical population for the Motor Steadiness Battery (Trites, 1981) and a slight difference in administration rendered the normal population norms invalid (Knights & Moule, 1967, 1968). While a number of Motor Steadiness test measures, especially nondominant hand measures and the Horizontal test, were sensitive to group differences and arm-hand steadiness seems to contribute to writing proficiency, valid norms and well standardized administration procedures must be established before these tests are utilized in individual assessment of normal children. The superior sensitivity of nondominant hand measures suggests that manual-motor tests of both hands should be included in the assessment of children with handwriting difficulties (Gaddes, 1985). While practical application of this finding is limited by the availability of valid norms, intraindividual comparison of nondominant hand performance with dominant performance may provide valuable information. Evidence of difficulty on fine motor tasks other than handwriting provides external validation of fine motor problems which permits the diagnosis of handwriting disability (Stott et al., 1987). However, external validation is difficult to obtain for children with subtle fine motor deficits. The results of this study seem to warrant the inclusion of the Motor Steadiness Battery nondominant hand 81 measures and Horizontal test measures in a battery for external validation of fine motor problems. The collection of normative data for this purpose is strongly recommended. The academic consequences of poor functional writing must also be considered in the diagnostic assessment. It is probable that children with poor functional handwriting are academically disadvantaged. The extent to which this disadvantage is due to a handwriting disability should be determined. Thus, assessment recommendations can address diagnostic teaching, educational accommodations, and classroom evaluation procedures. E. RECOMMENDATIONS FOR FURTHER RESEARCH The recommendations for further research are based upon the conclusions and suggestions made for improving this study. 1. This study suggests that membership of handwriting groups must be discrete for identification of subtle motor differences. This implies the use of standardized collection and evaluation of handwriting samples in future handwriting research and selection of children who have not benefited from remedial instruction. 2. This study suggests that arm-hand steadiness, especially in drawing a line, contributes to handwriting proficiency. Further investigation of the relationships among arm-hand steadiness, handwriting skill, and age or grade would extend knowledge of the role of steadiness in handwriting. 3. This study suggests that performance of the nondominant hand may be more sensitive than the performance of the dominant hand in identifying clumsy children. Further investigation of the relationship of nondominant hand 82 performance and manual-motor asymmetries with handwriting skill would contribute to an understanding of the relevance of comparison of manual motor performance. This study has suggested that tests which involve the precise manipulation of a pencil-like tool may be related to extremes of handwriting skill. Further investigation of the nature of the relationship of these tests with the range of handwriting skill at different ages is necessary. Collection of normative data for the Motor Steadiness Battery is necessary for meaningful interpretation of research results and for practical application in diagnostic assessment. Examination of the dynamic application of penhold during the writing movement may be more relevant than analysis of static penhold. 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Suen, C Y . (1975). Handwriting education in Canada. Saskatchewan Journal of  Educational Research and Devlopment, _5, 46-52. Thomassen, A.J.M.W., & Teulings, H.L.H.M. (1983). The development of handwriting. In M. Matthew (Ed.), The psychology of written language: Developmental  and educational perspectives (pp. 179-213). New York: Wiley. Trites, R.L (1981). Neuropsychological test manual. Montreal: Technolab. Wann, J.P. (1986). Handwriting disturbances: Developmental trends. In M . Wade & H.T. Whiting (Eds.), Themes in motor development (pp. 207-226). Dordrecht: Martinus Nyhoff Publishers. Wann, J.P., & Jones, J . C (1986). Space-time invariance in handwriting: Contrasts between primary school children displaying advanced or retarded handwriting acquisition. Human Movement Science, _5, 275-296. Wechsler, D. (1974). Wechsler Intelligence Scale for Children - Revised. New York: The Psychological Corporation. Wing, A . M . (1979). Variability in handwritten characters. Visible Language, 13, 283-298. Wittier, M. (1929). Factors affecting ability in handwriting. School and Society, 29, 847-850. 89 Ziviani, J. (1983). Qualitative changes in dynamic tripod grip between seven and fourteen years of age. Developmental Medicine and Chi ld Neurology, 25, 778-782. Ziviani, J. (1984). Some elaboration on handwriting speed in 7- to 14-year-olds. Perceptual and Motor Skills, 58, 535-539. Ziviani, J. (1987). Pencil grasp and manipulation. In J. Alston & J. Taylor (Eds.), Handwriting: Theory, research and practice (pp. 24-39). New York: Nichols. Ziviani, J., & Elkins, J. (1986). Effects of pencil grip on handwriting speed and legibility. Educational Review, 38, 247-257. APPENDIX A CURSIVE WRITING D I A G N O S T I C INVENTORY 90 91 Pupil Number Diagnostic Inventory Cursive Quality Evaluation Good 1. Letter Formation 2. Letter Size 3. Uniformity of Letter Slant 4. Spacing of Letters 5. Spacing of Words 6. Alignment 7. Neatness 8. Overall Level Assigned Medium Poor Initials: 1. Letter formation -2. Letter size 3. Letter slant -4. Spacing of letters 5. Spacing of words 6. Alignment -7. Neatness -Diagnostic Inventory Quality of Legibility Guidelines uniformity of formation of letters identity of each letter should be obvious all similar letters should be of the same height and in proportion to all other letter forms letters should be uniformly slanted with the up stroke consistent and the down strokes parallel should be uniform, should be reasonable - not crowded or spaced so far apart that a lower case 'o' could be inserted should be uniform should approximate the space taken up by a lower case 'o' letters all rest on the baseline letters of the same size are even in height overall impression APPENDIX B PENHOLD AND POSTURE CLASSIFICATION INVENTORY 92 93 HAND R/L 1. Penhold Classification: Contact Thumb 1: on barrel Index 1: on barrel Middle 1: on barrel Ring 1: on barrel Baby 1: on barrel 2. Penhold Classification: Position Thumb 1: side 2: top Index 1: side 2: top Middle 1: side 2: top P u p i l n o . Pen 2: not on or below barrel 2: not on or below barrel 2: not on or below barrel 2: not on or below barrel 2: not on or below barrel on Pen 3: half over 4: right over 3: half over 4: right over 3: half over 4: right over 3. Penhold Classification: Proximity to Pen Tip Thumb Index Middle nearest/ 2 nearest/ 2 nearest/ 2 equal nearest/ 3 equal nearest/ 3 equal nearest/ 3 second/ 4 second/ 4 second/ 4 equal second/ 5 equal second/ 5 equal second/ 5 third third third 4. Penhold Classification: Shape of Digit (distal, proximal) Thumb Index Middle ext;ext/ 2: hypext;flex/ 3 ext;ext/ 2: hypext;fiex/ 3 ext;ext/ 2: hypext;flex/ 3 flex;flex/ 4 flex;flex/ 4 flex;flex/ 4 ext;flex/ 5 ext;flex/ 5 ext;flex/ 5 tucked in tucked in tucked in 5. Hand Rotation 1: slightly flattened 2: somewhat flattened (on edge) 6. Wrist Position 1: inverted, above line 2: below line 7. Upper Body Posture 1: upright 4: bent right 2: body left, head right 3. bent left 5: sits sideways 6: bent over top 8. Other Hand 1: stabilizes paper 2: does not stabilize paper 9. Writing Elbow 1: at side . 2: not at side 10. Paper Orientation 1: anticlockwise 2: square 3: clockwise 11. Body shifted to reach opposite side of page 1: no 2: yes 12. Evidence of hand/arm tiring 1: no 2: yes 13. Tremor 1: observable 2: none observable 14. Excessive pencil pressure - digits 1: no 2: yes 15. Time sentence 1: 2: APPENDIX C PROCEDURES FOR COLLECTION OF HANDWRITING SAMPLES 94 95 Procedures for Co l lec t ion of Handwri t ing Samples Sentences Used in Collecting Samples A. The quick brown fox jumps over the lazy dog. B. The quick brown fox just came over to greet the lazy poodle. The sentences were administered in counterbalanced order so that half the children used sentence A for the usual sample and half the children used sentence B for the speeded sample. The usual sample was always obtained before the speeded sample and children were given a 10 minute rest period between handwriting samples. Each child was given a copy of the sample sentence which had been written in cursive style by his teacher. This was done to eliminate, as far as possible, factors related to far-point copy, associative memory, and familiarity with script style. Paper and pencils without erasers were provided by the examiner. Children were permitted to practice copying each sentence once before the handwriting trials for usual or speeded samples. Instructions for the usual sample were: "I would like you to write this sentence several times. Try to work as you usually do. Do not erase. I will give you three minutes and then tell you to stop." Instructions for the speeded sample were: "I would like you to write this sentence several times. Write as fast as you can and still have your teacher be able to read your writing. Do not erase. I will give you three minutes and then tell you to stop." All handwriting samples were obtained on the same day by the researcher. APPENDIX D TEACHER RATING FORM 96 97 Teacher Rating Form Cursive Writing Study Pupil No. 1. In comparison to other children you have observed in this school context, please rate the child's overall ability to learn school materials. Use the Seven Point Scale shown below; Please circle one number between 1 and 7. Average Below Average Above Average Lowest 5% 10% 20% Middle 30% 20% 10% Highest 5% 2. Compared to other children of the same age as this child, how does his/her achievement rate in the following areas? Above Average Average Low Average Below Average A. Reading B. Written Language C. Arithmetic D. Physical Education E. Drawing Skills F. Handwriting 2 2 2 2 2 2 4 4 4 4 4 4 APPENDIX E MEANS AND STANDARD DEVIATIONS BY GROUP ON THE FINE MOTOR AND PSYCHOMOTOR TEST BATTERY, FLUENCY DIFFERENCE, AND TEACHER RATINGS OF ABILITY AND ACHIEVEMENT 98 99 Table E1 Means and Standard Deviations1 by Croup on the Fine Motor and Psychomotor Test Battery and Fluency Difference Test Hand Top (n = 16) Group Bottom (n = 10) Slow (n = 15) 1) Finger Localization Total Both 57.38( 3.16, 57.00( 2.58) 55.73( 2.84) Right 29.00( 1.79) 28.90( 1.10) 27.60( 1.91) Left 28.38( 2.13) 28.10( 1.73) 28.13( 1.41) 2) Finger Tapping DOM 46.34( 5.90) 41.94( 7.11) 44.43( 6.20) NDOM 40.14( 6.49) 38.50( 4.49) 37.5K 5.83) 3) Motor Steadiness Battery i) Maze Time DOM 98.50(29.89) 99.30(24.76) 87.06(23.29) NDOM 106.94(32.47) 106.00(31.46) 85.40(20.90) Contact DOM 7.69( 5.94) 5.80( 4.05) 8.80( 7.86) NDOM 16.31(11.93) 16.70( 8.64) 29.80(14.99) Duration DOM 1.00( 0.76) 0.65( 0.51) 1.12( 1.06) NDOM 2.44( 1.81) 2.29( 1.11) 4.20( 1.89) ii) Horizontal Time DOM 55.38(22.62) 56.10(18.80) 39.13(17.84) NDOM 64.25(28.04) 55.20(24.41) 44.53(18.84) Contact DOM 2.38( 2.45) 5.50( 6.93) 7.00( 5.87) NDOM 6.38( 4.50) 12.10( 7.50) 14.60( 9.85) Duration DOM 0.29( 0.40) 0.69( 0.86) 1.10( 1.01) NDOM 0.86( 0.62) 1.59( 1.03) 1.89( 1.63) iii) Holes Resting Contact DOM 1.25( 2.35) 1.10( 1.20) 5.07( 5.61) NDOM 5.13( 8.00) 8.40( 9.38) 13.60(12.74) Duration DOM 0.28( 0.28) 0.13( 0.18) 0.65( 0.72) NDOM 0.66( 1.10) 1.31( 1.37) 1.78( 1.93) 4) Grooved Pegboard Time Both 148.56(12.18) 150.90(22;05) 155.00(20.89) DOM 71.13( 5.60) 73.90(11.67) 71.00(10.31) NDOM 77.44( 7.40) 77.00(12.86) 84.00(12.28) 5) Motor Speed & 1 min DOM 69.44( 9.14) 62.01(10.02) 56.50( 9.68) Precision 2 2 min DOM 135.89(16.56) 113.70(17.15) 110.80(10.58) 3 min DOM 191.22(26.64) 165.00(21.23) 160.40(12.79) 4 min DOM 243.11(36.23) 206.80(25.96) 208.20(17.36) 6) Bender DOM 1.06( 1.06) 1.80( 1.23) 1.87( 1.46) 7) Coding DOM 13.50( 2.67) 9.50( 2.17) 10.40( 2.13) Fluency Difference DOM 5.13( 4.29) 16.10(10.82) 12.93(10.93) 1 Standard deviations are shown in parentheses. 2 Top Group: n = 9, Bottom Group: n = 10, Slow Group: n = 10. 100 Table E2 Means and Standard Deviations1 by Croup on the Teacher Ratings of Ability and Achievement Croup Ratings Top Bottom Slow (n = 16) (n = 10) (n = 15) Ability 5.31(1.57) 4.30(1.49) 4.26(1.22) Achievement Reading 1.69(0.87) 2.60(1.26) 2.47(1.06) Written Language2 1.62(0.96) 2.78(1.20) 2.47(0.99) Arithmetic 1.56(0.89) 2.40(1.17) 2.40(0.98) Physical Education2 1.81(0.66) 2.33(0.71) 2.00(0.53) Drawing 1.69(0.48) 2.60(0.70) 2.13(0.52) Handwriting 1.68(0.60) 2.60(1.08) 2.40(0.91) 1 Standard deviations are presented in parentheses. 2 Bottom Croup: n = 9. APPENDIX F INTERCORRELATIONS AMONG VARIABLES IN MULTIPLE REGRESSION ANALYSES 101 Appendix F Explanation of Abbreviations Used in Tables FIN LOC Finger Localization FIN TAP Finger Tapping Motor Steadiness Battery M A Z TIM Maze Time M A Z C O N Maze Contact M A Z DUR Maze Duration HOR TIM Horizontal Time HOR C O N Horizontal Contact HOR DUR Horizontal Duration HOL C O N Holes Resting Steadiness Contact HOL DUR Holes Resting Steadiness Duration CRD PEC Grooved Pegboard M O T SP 1,2,3,4 Motor Speed & Precision: 1, 2, 3, 4 minutes FL DIFF Fluency Difference Hand Used B Both Right & Left R Right L Left D Dominant N Nondominant Table F1 Intercorrelations1 Among Fine Motor Test and Fluency Difference Variables' Variable 1 2 3 4 5 6 7 8 9 10 1 1 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 .FIN LOC B 100 83 82 14 03 05 14 -16 -35 -08 -32 05 02 -16 -08 -12 -07 00 -23 07 -23 -21 -24 -15 -06 -03 00 06 -27 09 -08 2.FIN LOC R 100 37 06 09 -06 01 02 -20 06 -21 -09 -09 -12 00 -20 02 -05 -08 00 -09 -18 -14 -19 02 -02 -04 -06 -29 17 -12 3.FIN LOC L 100 17 -03 16 22 -30 -38 -21 -32 18 14 -13 -14 00 -14 05 -30 1 1 -29 -16 -26 -05 -12 -02 05 16 -16 -01 -01 4.FIN TAP D 100 74 00 -07 12 -01 1 1 -07 -07 -09 18 -05 35 -06 05 -01 08 01 -17 -06 -23 38 50 61 66 -15 08 -12 5.FIN TAP N 100 1 1 -10 1 1 -15 10 -29 01 -07 00 -19 07 -20 04 -16 03 -06 -09 08 -23 61 65 69 60 -30 16 -04 6.MAZ TIM D 100 82 -56 -53 -51 -49 78 79 -20 -20 -24 -16 14 -23 06 -27 -05 -07 -02 51 41 35 24 -13 09 01 7.MAZ TIM N 100 -50 -50 -45 -42 78 89 -25 -14 -32 -10 00 -17 -09 -17 00 -05 03 42 32 26 19 -12 20 08 8.MAZ CON D 100 67 94 55 -48 -40 41 30 32 34 26 52 31 58 33 33 27 -06 01 -05 -08 -04 19 01 9.MAZ CON N 100 61 90 -53 -41 54 49 49 43 46 67 45 75 39 39 37 -29 -27 -30 -31 25 -10 1 1 10.MAZ DUR D 100 50 -42 -36 39 27 33 30 34 48 34 53 33 32 28 03 13 01 -02 -07 22 -02 1 1 .MAZ DUR N 100 -47 -36 36 37 42 34 38 49 43 54 38 26 41 -28 -33 -40 -41 31 -14 03 12.HOR TIM D- 100 89 -27 -25 -28 -20 -08 -28 -19 -33 02 07 01 36 35 28 24 -19 14 -03 13.HOR TIM N 100 -31 -20 -37 -15 00 -13 -09 -17 12 10 11 32 31 24 22 -19 25 00 14.HOR CON D 100 66 84 64 40 56 37 58 28 25 25 -02 03 01 00 26 -18 19 15.HOR CON N 100 58 93 28 71 29 66 31 23 32 -13 -20 -22 -28 37 -21 34 16.HOR DUR D 100 57 31 44 31 41 16 12 16 -04 05 00 01 39 -28 08 17.HOR DUR N 100 26 66 31 55 36 30 35 -1 1 -16 -17 -20 41 -16 29 18.HOL CON D 100 35 92 44 35 22 39 00 -06 -16 -26 05 -05 26 19.HOL CON N 100 32 92 36 25 38 -06 -05 -09 -14 24 -06 27 20.HOL DUR D 100 39 38 24 43 -09 -14 -21 -28 20 -06 23 21.HOL DUR N 100 38 29 38 -04 -05 -08 -16 17 -05 38 o Table F1 cont inued Var iable 1 2 3 4 5 6 7 8 9 10 1 1 12 13 14 15 16 17 18 19 2 0 21 2 2 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 31 2 2 . G R D P E G B 100 87 92 - 0 1 - 0 4 - 1 4 - 1 9 2 2 - 0 8 14 2 3 . G R D P E G D 100 62 0 2 0 0 - 0 3 - 0 6 13 - 0 7 01 2 4 . G R D P E G N 100 - 0 3 - 0 7 - 2 1 - 2 7 26 - 0 7 2 3 2 5 . M O T S P 1 D 100 87 78 53 0 9 42 - 1 2 2 6 . M O T S P 2 D 100 91 77 - 1 2 50 -27 2 7 . M O T S P 3 D 100 93 - 1 7 44 -28 2 8 . M O T S P 4 D 100 - 1 9 33 -35 2 9 . B E N D E R D 100 -44 0 7 3 0 . C O D I N G D 100 19 3 1 . F L DIFF D 100 C o r r e l a t i o n c o e f f i c i e n t s are s h o w n at t w o s igni f icant f igures and dec imals omi t ted . Coe f f i c i en t s appearing in bo ld face are signif icant at .05 level . V a r i a b l e s have n = 4 1 e x c e p t f o r mo to r s p e e d and p r e c i s i o n w h e r e n = 2 9 . The cr i t ical values fo r corre la t ion c o e f f i c i e n t s are .26 fo r n = 41 and .31 fo r n = 2 9 . o Table F2 Correlat ions 1 of Fine Motor Tests and Fluency Difference With Sex, Croup  Membership, and Sex by Croup Contrasts 2 Independent Variables Dependent Variables Sex Group SXG1 SXG2 FIN LOC B -39 -24 -04 -07 FIN LOC R -37 -34 00 -24 FIN LOC L -28 -06 -07 11 FIN TAP D 12 -13 10 06 FIN TAP N 17 -20 17 -13 M A Z TIM D -05 -18 -02 06 M A Z TIM N -20 -31 09 -05 M A Z C O N D 21 07 07 -07 M A Z C O N N 12 42 -22 -24 M A Z DUR D -21 05 09 00 M A Z DUR N 09 40 -18 26 HOR TIM D -15 -33 12 -10 HOR TIM N -22 -34 15 -02 HOR C O N D 19 37 -27 03 HOR C O N N 18 44 -23 09 HOR DUR D 18 42 -27 11 HOR DUR N 03 36 -15 00 HOL C O N D 29 40 -34 43 HOL C O N N -04 34 13 12 HOL DUR D 21 43 -30 34 HOL DUR N 05 31 -16 08 CRD PEC B 01 15 -07 -08 GRD PEG D 09 00 -02 -30 GRD PEG N -05 26 -10 10 106 Table F2 Cont inued Independent Variables Dependent Variables Sex Group SXG1 SXC2 M O T SP1 D -13 -49 36 -14 M O T SP2 D -25 -55 49 -04 M O T SP3 D -15 -51 48 -06 M O T SP4 D -17 -45 48 -02 BENDER D 12 27 -05 01 C O D I N G D -39 -47 34 -08 FL DIFF D 23 36 -34 -06 1 Correlation coefficients are with boldface coefficients shown at two significant at .05 significant figures level. and decimals omitted 2 Variables have n = 41 except for motor speed and precision where n = 29. The critical values for correlation coefficients are .26 for n = 41 and .31 for n = 29. APPENDIX G RESULTS OF STRUCTURED MULTIPLE REGRESSION ANALYSES 107 Table C l Results of Structured Multiple Regression Analyses Test Hand Variable B SeB T Significance 1) Finger Localization Total Both Sex -2.264 0.942 -2.402 .021 Croup -1.080 0.692 -1.560 • .127 SXC2 0.490 0.816 0.600 .552 SXG1 -2.468 1.343 -1.838 .074 Right Sex -1.077 0.569 -1.893 .066 Group -0.765 0.418 -1.832 .075 SXC2 -0.167 0.493 -0.056 .736 SXC1 -1.465 0.810 -1.808 .079 Left Sex -1.187 0.595 -1.994 .053 Croup -0.314 0.437 -0.719 .477 SXG2 0.657 0.515 1.274 .210 SXG1 -1.003 0.848 -1.183 .244 2) Finger Tapping D O M Sex 2.738 2.256 1.214 .232 Croup -1.978 1.657 -1.194 .240 SXC2 1.689 1.954 0.864 .393 SXC1 0.817 3.213 0.254 .800 N D O M Sex 3.758 1.983 1.895 .066 Croup -1.482 1.457 -1.018 .315 SXC2 -0.678 1.718 -0.395 .695 SXC1 1.970 2.825 0.697 .490 3) Motor Steadiness Battery i) Maze Time D O M Sex 0.165 9.192 0.018 .985 Group -12.951 6.752 -1.918 .063 SXG2 9.875 7.964 1.240 .223 SXG1 -15.351 13.096 -1.172 .248 N D O M Sex -6.449 10.104 -0.638 .527 Group -14.957 7.421 -2.015 .051 SXG2 7.528 8.754 0.860 .395 SXG1 -12.812 14.394 -0.890 .379 Contact D O M Sex -3.520 2.189 -0.608 .116 Group 2.602 1.608 1.618 .114 SXG2 -1.551 1.897 -0.818 .418 SXG1 2.725 3.119 0.874 .388 109 Table C1 continued Test Hand Variable B SeB T Significance N D O M Sex -1.687 4.584 -0.368 .714 Group 6.851 3.367 2.034 .049 SXG2 1.324 3.972 0.333 .740 SXG1 0.706 6.531 0.108 .914 Duration D O M Sex -0.462 0.294 -1.570 .125 Group 0.285 0.216 1.319 .195 SXG2 -0.067 0.254 -0.265 .792 SXG1 0.364 0.419 0.868 .391 N D O M Sex -0.353 0.626 -0.564 .576 Group 0.952 0.460 2.070 .045 SXG2 0.263 0.543 0.485 .552 SXG1 0.308 0.892 0.345 .731 ii) Horizontal Time D O M Sex -1.436 7.278 -0.197 .844 Group -10.371 5.345 -1.940 .060 SXG2 2.935 6.305 0.466 .644 SXG1 -6.515 10.368 -0.628 .533 N D O M Sex -5.482 8.450 -0.649 .520 Group -12.974 6.207 -2.090 .043 SXG2 8.237 7.321 1.125 .268 SXG1 -6.674 12.038 -0.554 .582 Contact D O M Sex 0.488 1.811 0.270 .788 Group 2.582 1.330 1.941 .060 SXG2 -1.741 1.569 -1.110 .274 SXG1 -0.717 2.580 -0.278 .782 N D O M Sex 0.194 2.689 0.072 .942 Group 5.025 1.975 2.544 .015 SXG2 -2.112 2.329 -0.907 .370 SXG1 0.981 3.831 0.256 .799 Duration Dom Sex 0.008" " 0.280 0.032 .975 Group 0.428 0.205 2.080 .044 SXG2 -0.149 0.242 -0.614 .543 SXG1 -0.081 0.399 -0.205 .839 N D O M Sex -0.314 0.405 -0.776 .442 Group 0.836 0.297 2.808 .008 SXG2 -0.503 0.351 -1.432 .160 SXG1 0.315 0.577 0.546 .588 Table C1 continued 110 Test Hand Variable B SeB T ! significance iii) Holes Resting Contact D O M Sex 0.963 1.291 0.746 .460 Group 0.428 0.948 0.452 .654 SXG2 2.235 1.118 1.998 .053 SXG1 -1.915 1.839 -1.041 .304 N D O M Sex -4.856 3.584 -1.355 .183 Group 6.231 2.632 2.367 .023 SXG2 -0.865 3.105 -0.279 .782 SXG1 2.109 5.106 0.413 .682 Duration D O M Sex 0.022 0.174 0.128 .898 Group 0.173 0.127 1.356 .183 SXG2 0.163 0.150 1.083 .286 SXG1 -0.126 0.247 -0.510 .612 N D O M Sex -0.291 0.539 -0.541 .592 Group 0.732 0.395 1.851 .072 SXG2 -0.216 0.467 -0.463 .645 SXG1 0.112 0.767 0.147 .884 4) Grooved Pegboard Time Both Sex -1.705 6.430 -0.265 .792 Group 6.225 4.723 1.318 .195 SXG2 -6.462 5.571 -1.160 .253 SXG1 1.881 9.160 0.205 .838 D O M Sex 2.440 3.076 0.794 .432 Group 1.511 2.259 0.669 .507 SXG2 -6.105 2.665 -2.291 .027 SXG1 0.544 4.382 0.124 .901 N D O M Sex -4.146 3.845 -1.078 .288 Group 4.714 2.824 1.669 .103 SXG2 -0.357 3.331 -0.107 .915 SXG1 1.336 5.477 0.244 .808 5) Motor Speed & 1 minute D O M Sex 1.504 4.012 0.375 .711 Precis ion 1 Group -7.534 3.807 -1.979 .059 SXG2 2.279 3.405 0.669 .509 SXG1 0.613 5.708 0.107 .915 2 minutes D O M Sex 1.237 6.196 -0.200 .843 Group -13.477 5.879 -2.292 .031 SXG2 7.901 5.259 1.502 .146 SXG1 5.214 8.814 0.592 .559 Table C1 continued Test Hand Variable B SeB T Significance 3 minutes D O M Sex 3.158 8.582 0.368 .716 Croup -15.636 8.144 -1.920 .066 SXC2 7.780 7.284 1.068 .296 SXG1 9.810 12.209 0.804 .429 4 minutes D O M Sex 0.885 11.458 0.077 .939 Croup -15.181 10.873 -1.396 .175 SXC2 9.640 9.725 0.991 .331 SXC1 16.962 16.300 1.041 .308 6) Bender D O M Sex 0.099 0.444 0.224 .824 Croup 0.665 0.326 2.041 .048 SXC2 -0.382 0.384 -0.995 .326 SXG1 0.610 0.632 0.964 .341 7) Coding D O M Sex -1.380 0.885 -1.560 .127 Group -1.437 0.650 -2.211 .033 SXC2 0.918 0.766 1.198 .238 SXC1 0.385 1.260 0.305 .761 Fluency Difference D O M Sex 1.830 3.088 0.593 .557 Croup 4.045 2.268 1.784 .082 SXC2 -4.722 2.675 -1.765 .086 SXC1 -3.887 4.399 -0.884 .382 1 n = 29 Top Group = 9, Bottom Group = 10, Slow Group = 10 

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