Handwriting development in grade 2 and grade 3 primary school children with normal, at risk, or dysgraphic characteristics

The wide variation in prevalence of dysgraphic handwriting (5-33%) is of clinical importance, because poor handwriting has been identified as one of the most common reasons for referring school-age children to occupational therapy or physiotherapy, and is included as an criterion for the diagnosis of Developmental Coordination Disorder. This study aimed to map the development and improvement in handwriting during the early grades to differentiate between temporary and consistent dysgraphic handwriting. In this longitudinal and cross-sectional study, children in grade 2 (age 7-8 years, n=169) and grade 3 (8-9 years, n=70) took handwriting (Concise Assessment Method for Children's Handwriting; acronym BHK) and visuomotor integration (BeeryVMI) screening tests twice within one school year. Dysgraphia decreased strongly from 37% to 17% in grade 2 and diminished further to a low and stable rate of 6% in grade 3. Stability in handwriting quality only occurred in the children whose scores were within the normal range. The at risk and dysgraphic children continued to show significant and substantial improvement during grades 2 and 3. BeeryVMI was inappropriate as a screening instrument for handwriting problems. It was concluded that handwriting must be consistently dysgraphic before making any decisions about a diagnosis of dysgraphia or referral for therapy.