Factors affecting the Chinese handwriting performance of children in Hong Kong

Abstract

Background: Handwriting has long been an effective means to record information, transmit message and project feelings (Chu, 1997) for communication among people. Performance in written production has been used to identify children who have risk of academic failure (Moore & Rust, 1989) and found to be linked with children's academic achievement (Opper, 1996), their school participation and social integration (Mancini & Coster, 2004), and also the adulthood development (Sutton Hamilton, 2002). Understanding on the crucial factors that affect children's handwriting performance is essential in formulating effective helping strategies and treatment. Through analysis of the performance components, handwriting demanded a child's cognitive and executive function, neuromuscular control, kinesthetic and tactile sensitivities, visual motor co-ordination and visual perceptual skills (Feder, 2005; Rosenblum, Weiss & Parush, 2003; Ziviani & Watson-Will, 1998). Research aims & Methodology: This study aimed to find out the crucial factors which would affect, or predict, children's performance in writing Chinese under the social and learning culture of Hong Kong. There are 3 phases in the study. Phase I of the study aimed to validate an assessment for Chinese handwriting performance in terms of time, length, speed, pressure, and legibility, hand strength, ocular motor control, visual perceptual skills and visual motor integration. 10 children, 6 girls and 4 boys, studying in Primary 1 in Hong Kong (mean age=7.3, SD=0.5) recruited via convenience sampling were assessed twice at 1 week interval to evaluate the test-retest reliability, inter and intrarater reliability, internal consistency and construct validity of the tools. Reliability analysis (ICC), Cronbach's alpha, Mann Whitney U Test and discriminant analysis were used for these reliability tests respectively. Phase II of the study aimed to investigate the crucial factors affecting handwriting performance with use of multiple regression analysis. 240 children, with 118 (49.2%) girls and 122 (50.8%) boys, studying in Primary 1 (mean age=6.5, SD=0.4) were recruited from three randomly drawn primary schools. The same procedure was applied as in Phase I while evaluation of fine motor skills was added into the assessment protocol. Phase III of the study aimed to evaluate an intervention derived from the findings in Phase II. 30 children (aged 7-10) with specific learning difficulties were recruited via convenience sampling. They were provided with ocular motor control training, visual perceptual and visual motor integration skills training, or no training as control. Their Chinese handwriting performance in terms of time, length, speed, pressure, and legibility, ocular motor control (including fixation, regression and excursion), visual perceptual skills and visual motor integration were assessed before, after, and one-month after the training. Besides the descriptive data, ANOVA tests under general linear model were used in analyzing the within group and between group effects of the ocular motor control training program and the visual perceptual/ visual motor integration training program as compared with the control group. Results & Discussion: Several major findings were obtained in this thesis. The result of the reliability tests in Phase I suggested that the current assessment protocol should be reliable for the evaluation of Chinese handwriting among children in Hong Kong. The result of Phase II revealed that visuo-motor skills including the visual perceptual skills, visual motor integration, and ocular motor control were the main factors affecting Chinese handwriting performance. The visual perceptual skills were found as predictors for the time factors including total time, in air time, and the ground to air time ratio in the model (|b| ranged from 0.140 to 0.189, p ranged from 0.004 to 0.035), with an R-square of 0.020, 0.036, and 0.024 respectively. Moreover, eye movement reflected by the Developmental Eye Movement Test (DEM) time was found to be a significant factor for significantly predicting length, speed, and pressure during handwriting, with a |b| ranging from 0.132 to 0.320 (p ranged from 0.000 to 0.046). Besides the DEM, both the VMI and BO scores were also found predictive to the speed. Beta value was 0.214 (p=0.001) and 0.139 (p=0.037) for mean of speed, while it was -0.175 (p=0.009) and 0.156 (p=0.023) for speed variation respectively. Predictors for legibility (discriminant function> 0.40) revealed by discriminant analysis were the Developmental Test of Visual Motor Integration (VMI) score (0.696), gender (0.667) and the Motor-free Visual Perceptual Test-Reised (MVPT-R) socre (0.543). Hence, preliminary 5-week 10 sessions training protocols for ocular motor control and for visual perception and visual motor integration were produced and conducted respectively in Phase III. Results from the Phase III showed children who had received ocular motor training demonstrated significant differences in handwriting performance including pen in air time, speed and pressure. They also presented a higher legibility score after training. However, no statistically significant difference was observed in the general linear model (p>0.05) when compared with both the VP/VMI group and the control group, though, subjective feedbacks from parents reflected improvement in attention and sustainability in doing homework. Therefore, these qualitative findings need further standardized investigation for verification. Conclusion: The current results suggested that besides visual perceptual and motor skills, ocular motor control was another crucial factor in writing Chinese characters. While the importance of perceptual and motor skills has been frequently reported in previous literature, the identification of ocular motor control as being important might reflect the unique requirement of eye fixation and tracking in writing Chinese. Prelim findings also suggested the effect of ocular motor control training on handwriting performance. Further investigation is needed to verify the current findings and modification on the training protocol should be made in the future studies based on the results obtained in this study.