Nov. 10, 2009 -- For most kids, learning handwriting can be dull and repetitive, but it's a task mastered midway through elementary school.
For many children with autism, though -- even those with higher IQs than most -- handwriting becomes an arduous chore, because the very act of writing letters takes them so long to do.
A new study out this week in the journal Neurology explains some of the reasons for that phenomenon -- and why bad handwriting might even lead to nonverbal communication problems.
While researchers may have realized that many autistic children have bad handwriting, they did not know if it related to their autism, or whether it was a problem understanding the forming of words, or whether it had to do with motor skills.
Barbara Wagner, a mother of two boys with autism spectrum disorders, enrolled her older son, Austin, 14, in the study, although she knew beforehand there was something different about how he wrote.
"When they print, they don't like you and I do," she said. "They actually draw their letters. It's really slow," explaining that when she watches her son, he is very deliberate.
Wagner said enrolling her son in the study will help with the rest of his education. She has had conflicts in the past with administrators at Austin's school over his Individualized Education Program -- a set of goals for a child with a disability. She said the study has helped get more attention paid to occupational therapy and improving Austin's writing.
Additionally, Wagner said she has started her younger son, Ian, 7, on occupational therapy to help him avoid having similar handwriting problems later on.
For the study, which was done at the Kennedy Krieger Institute in Baltimore, researchers gave a handwriting test to 14 children with autism (ages 8 to 13) who had normal IQs and 14 children with normal development.
"What we were interested in is understanding whether a problem of something as important as handwriting, which folks need for school and general life, whether that deficit is really due to a problem with controlling movement, versus some other problem," said Amy Bastian, an author of the study and director of the motion analysis lab at Kennedy Krieger. "What we found is these kids have handwriting problems that really correlate with their motor findings."
While handwriting may seem a relatively minor problem, it can greatly affect an autistic child who is otherwise functioning at the expected or a better-than-expected level.
"We've not had any kind of educational issues," said Wagner of Austin, who is in tenth grade, a year ahead of other 14-year-olds. But handwriting can set him back.
However, she wrote in a statement to Kennedy Krieger, "An assignment that would take him 15-20 minutes if he could dictate the answers would often take up to an hour and a half to two hours if he was required to do the physical writing himself (versus keyboarding or allowing me to act as his scribe). To this day, Austin swears that he simply cannot print."
Motors and Mirrors
One popular theory about autism may provide an explanation for why so many autistic children have handwriting problems.
The notion is that mirror neurons -- where the brain recognizes another person's activity as if one was doing it itself -- is impaired in people with autism. That leads to an inability to recognize fully the actions and cues of others, explaining many of the characteristic behaviors of autism.
In this case, said Bastian, a lack of certain fine motor skills may inhibit an autistic person's ability to understand some of the nonverbal communication cues sent by others.
Bastian cautioned that while it was an interesting theory, it was far from proven.
Lori Warner, a psychologist and director of the HOPE center for autism at Beaumont Children's Hospital in Royal Oak, Mich., said that studies have gone both ways on mirror neuron theories.
While many of the children she works with are younger than the children in the Baltimore study, she said they have fine motor problems too. They have trouble coloring pictures and lacing beads.
To be sure, while many children with autism have poor penmanship, some do not. Warner pointed out that some people who have autism also have incredible artistic and writing abilities.
"I don't think you could say every single child with autism is going to have poor handwriting," she said.
Skills to Succeed
While many parents of a child on the autism spectrum would say handwriting is a low priority, it is a bigger issue for relatively high-functioning children. It may be one of the biggest obstacles to their full integration into the classroom.
"It's really more of a question of how functional is this person going to be," said Warner. "We find that we're working on lots of skills that aren't core autistic features."
And having a study may also provide ammunition to parents like Barbara Wagner, who have trouble getting schools to address all of their concerns.
"When you have a disconnect between a parent's priority…and the school's priority, I think it is important to have something to back you up," said Warner, who has dealt with many schools with widely-varying approaches to autism. "It gives you more of a stronger position to talk to the school from."
Bastian said that variability may allow some kids to succeed, but others will be left behind if educators don't notice that handwriting can present a big obstacle to an intelligent, autistic child.
"In some schools, kids with autism are given a keyboard or a computer, and that helps them as well, but not all kids have these opportunities," she said. "And if they're having to focus so hard on handwriting…it's hard for them to listen in class, understand, and interact. And so this is actually a pretty serious problem in a group that is already in a vulnerable position."