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https://doi.org/10.1177/0022219419892851
Journal of Learning Disabilities
2020, Vol. 53(2) 120 –130
© Hammill Institute on Disabilities 2019
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DOI: 10.1177/0022219419892851
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Special Series: The Interaction of Reading, Spelling and Handwriting
Difficulties with Writing Development–Part 1
The skill of handwriting plays an important role in the over-
all task of writing as there is substantial evidence to support
the relationship between transcription skills (handwriting
and spelling) and the quality of written composition
(Berninger et al., 1994). Handwriting speed (the number of
letters or words written per minute) is thought to reflect
automaticity of writing and has been shown to predict com-
positional quality in children who are developing typically
(Berninger et al., 1994; Graham et al., 1997; Puranik & Al
Otaiba, 2012) and atypically (Connelly et al., 2012; Prunty
et al., 2016; Sumner et al., 2014). If a child has difficulties
with producing handwriting that is fast and legible, it there-
fore may affect their academic performance (Graham et al.,
2000).
One group known for their difficulties with handwriting
are children with developmental coordination disorder
(DCD), which is the term used to describe children who
have motor coordination difficulties unexplained by a gen-
eral medical condition, intellectual disability, or sensory or
neurological impairment (American Psychiatric Association
[APA], 2013). Handwriting difficulties are mentioned in the
formal diagnostic criteria for DCD (APA, 2013) and are fre-
quently reported as the most common reason for referral to
occupational therapy services for this group (Asher, 2006).
In the few studies that have examined handwriting in any
detail in children with DCD, difficulties with both handwrit-
ing speed and legibility were reported (Barnett et al., 2018;
Huau et al., 2015; Prunty et al., 2013; Rosenblum & Livneh-
Zirinski, 2008; Smits-Engelsman et al., 2001). In addition,
some studies examined the handwriting process using writ-
ing tablet technology to explore the real-time movements of
the pen. These have found that children with DCD spend a
greater percentage of time pausing during writing compared
with typically developing (TD) peers (Prunty et al., 2013;
Rosenblum & Livneh-Zirinski, 2008). In our previous work,
we have attempted to characterize this pausing behavior by
analyzing the location of pauses. We found that the children
with DCD produced a higher percentage of within-word
pauses compared with TD peers (Prunty et al., 2014).
According to Kandel et al. (2006), within-word pauses are
an indication of a lack of automaticity or “fluency” in
892851LDXXXX10.1177/0022219419892851Journal of Learning DisabilitiesPrunty and Barnett
research-article2019
1Brunel University London, UK
2Oxford Brookes University, UK
Corresponding Author:
Mellissa Prunty, PhD, Department of Clinical Sciences, Brunel University
London, Mary Seacole Building, Kingston Lane, Uxbridge UB8 3PH, UK.
Email: mellissa.prunty@brunel.ac.uk
Accuracy and Consistency of Letter
Formation in Children With
Developmental Coordination Disorder
Mellissa Prunty, PhD1 and Anna L. Barnett, PhD2
Abstract
Handwriting difficulties are frequently mentioned in descriptions of developmental coordination disorder (DCD). Recent
studies have shown that children with DCD pause more and produce less text than typically developing (TD) peers. This
temporal dysfluency indicates a lack of automaticity in handwriting production. One possible contributing factor is the
accuracy and consistency of letter formation. The aim of this study was to gain a better understanding of handwriting
dysfluency by examining the accuracy and consistency of letter production both within and across different writing tasks.
A total of 28 children aged 8 to 15 years with DCD participated in the study with 28 TD age- and gender-matched control
participants. They completed the alphabet writing and copy fast tasks from The Detailed Assessment of Speed of Handwriting
on a digitizing writing tablet. The accuracy and consistency of letter production were examined. The DCD group had a
higher percentage of errors within their letterforms than did the TD peers. Letter production was also less consistent
between tasks. Children with DCD appear to have difficulties with the “allograph” (motor program) aspect of handwriting
and may require explicit teaching of letter formation.
Keywords
developmental coordination disorder, legibility, handwriting, allograph, motor program
Prunty and Barnett 121
handwriting. They argue that skilled writers have the ability
to program the spelling and movement components for a
word prior to commencing it, followed by an ability to exe-
cute the word without stopping (Kandel et al., 2006). Given
that children with DCD do not seem to acquire this level of
skill (Prunty et al., 2014), it is important to investigate the
reasons for this to inform clinical practice. In addition, it has
been well documented that DCD can co-occur with an
autism spectrum disorder (ASD; Mari et al., 2003), atten-
tion-deficit/hyperactivity disorder (ADHD; Piek & Dyck,
2004), developmental language disorder (formally specific
language impairment [SLI]; Gaines & Missiuna, 2007), and
dyslexia (Kirby et al., 2008). These co-occurring difficulties
are known to have an impact on the handwriting process in
their own right. For example, children with dyslexia produce
fewer words per minute compared with TD peers (Sumner
et al., 2014) as do children with language impairment
(Dockrell & Connelly, 2013). To understand the role of co-
occurring conditions in the handwriting of children with
DCD in future studies, we need to understand the unique
role of motor difficulties in this group first.
According to Fitts and Posner (1967), a learner becomes
automatic or fluent at a skill following extensive practice of
movement patterns. From 2 to 3 years of age, children pro-
duce “writing” that is generally distinguishable from their
drawing (Mortensen & Burnham, 2012; Treiman, 2017). At
3 years, they produce simple linear strokes, segment (often
pretend) letterforms, and simple written units (small clus-
ters of letters; Puranik & Lonigan, 2011). With the natural
development of language and motor skill, together with for-
mal instruction, these movement patterns become more
refined to express meaning through specific letter shapes.
According to Van Galen’s (1991) theoretical model of hand-
writing, the motor commands required to form a letter are
referred to as “allographs.” This is where activation occurs
for the motor program—which is a set of motor commands
that define the essential details of the action. This requires
knowledge about the movement patterns involved in a let-
terform, including where the letter starts, the sequence of
the strokes, and the direction in which the strokes are
formed (Van Galen, 1991). Problems with allograph selec-
tion may be a contributing factor to handwriting difficulties
in children with DCD as poor letter formation and a ten-
dency to overwrite or add elements to already formed letters
have been reported in the literature (Rosenblum & Livneh-
Zirinski, 2008). There is also evidence that children with
DCD encounter difficulties when learning new motor pat-
terns (Bo & Lee, 2013) including letterforms, which is man-
ifested through variability and inconsistency in the velocity
and trajectory length of pen strokes (Chang & Yu, 2010;
Huau et al., 2015). Indeed, the real-time movement of the
pen can be used to quantify the accuracy and consistency of
letterform production, which may shed more light on allo-
graph selection. By examining the patterns involved in
letterform production, factors such as whether the child
starts a letter in the correct place, moves in the correct direc-
tion, or executes too few or too many letter strokes can be
analyzed. Analyzing handwriting in this way will help to
establish a better understanding of the handwriting process
in children with DCD.
Study Aim
Previous analyses of letterforms in children with DCD have
tended to focus on the handwriting product with either a
global description of handwriting legibility (spatial arrange-
ment; Rosenblum & Livneh-Zirinski, 2008) or an analysis
of the shape of individual letters (Chang & Yu, 2010). To
date, no study has examined each of the individual letters of
the alphabet by taking into account the process of letter pro-
duction. This type of analysis would help determine whether
children with DCD have difficulties with forming specific
letters or letter groups (families) with similar movement
patterns. It would also inform focused interventions and
approaches to teaching in the classroom. The aim of this
study was, therefore, to understand handwriting production
in children with DCD through an examination of the accu-
racy of letter formation using the real-time movement of the
pen. Two letter production tasks were used to allow for an
additional analysis of consistency of letter formation. Our
predictions were that children with DCD produce a higher
percentage of errors in letterform production and are less
consistent in letterform production compared with TD chil-
dren. Our aim was to identify in this exploratory study
which letters in particular were problematic to inform the
teaching of handwriting.
Method
Research Design and Participants
A non-experimental between-group design was used to
evaluate the accuracy and consistency of letter formation in
children with and without DCD on two handwriting tasks. A
total of 56 children aged 8 to 15 years participated in the
study; 28 children with DCD (27 boys, 1 girl) were matched
for age (within 4 months), gender, and handedness with 28
TD controls. To select participants for both groups, we used
the same procedure as described in our earlier studies
(Prunty et al., 2013, 2014, 2017). Children in the DCD
group were recruited through advertising provided at parent
support groups, given to schools, and posted on the research
group website. The four criteria from the Diagnostic and
Statistical Manual of Mental Disorders (5th ed.; DSM-5;
APA, 2013) were used to assess children with DCD in line
with the current European guidelines (Blank et al., 2012).
All children scored below the 10th percentile on the second
edition of the Movement Assessment Battery for Children
122 Journal of Learning Disabilities 53(2)
(MABC-2; Henderson et al., 2007; Criterion A). These
motor difficulties had a significant impact on their activities
of daily living (Criterion B), as reported by their parents and
evident on the MABC-2 checklist. Developmental, educa-
tional, and medical histories were taken from the parents,
which confirmed that there was no history of neurological
or intellectual impairment and no medical condition that
might explain the motor deficit (Criteria C and D).
The control group was recruited through local primary
and secondary schools in Oxfordshire, England. Teachers
were asked to identify children who did not have difficulties
with motor skill, reading, or spelling. All children were
assessed to confirm that they had a score above the 16th
percentile on the MABC-2 and no evidence of a reported
physical, sensory, or neurological impairment. Children
were included in the control group if they scored at the level
expected for their age on all measures outlined below (no
more than 1 SD below the mean).
Exclusion Criteria
Children from both groups with a diagnosis of dyslexia and/
or those who had English as a second language were
excluded from the study. This was to control the confound-
ing role of language (Dockrell & Connelly, 2013) and spell-
ing (Sumner et al., 2014) on handwriting performance and
to ascertain a detailed understanding of handwriting diffi-
culties in children with DCD only. As such, children with a
physical, sensory, or neurological impairment were also
excluded. This was to ensure that handwriting difficulties
could not be attributed to other disorders.
Selection Measures
The MABC-2 was used to identify children with significant
motor difficulties, with performance below the 10th percen-
tile (24 below the 5th, 4 below the 10th) on the test compo-
nent. The MABC-2 examines three components of motor
competency: manual dexterity, aiming and catching, and
balance in children aged 3 to 16 years. These motor difficul-
ties had a significant impact on their activities of daily liv-
ing, as reported by their parents and evident on the MABC-2.
Reliability of the Total Test Score has been reported as good
at .80 (Henderson et al., 2007).
The second edition of the British Picture Vocabulary
Scale (BPVS-2; Dunn et al., 1997) was used to obtain a
measure of receptive vocabulary that correlates highly with
verbal IQ (Glenn & Cunningham, 2005). It is a standardized
test with U.K. norms and is commonly used to examine the
level of receptive vocabulary in children. Reliability of the
BPVS-2 has been reported as good at .86 (Dunn et al.,
1997). Performance on the BPVS-2 was in the average
range for all children, confirming the absence of a general
intellectual impairment.
The Strengths and Difficulties Questionnaire (SDQ;
Goodman, 1997) was also used to note other parent-reported
behavioral difficulties that commonly occur with DCD,
such as attention deficits (Blank et al., 2012). The SDQ was
designed for assessing the psychological adjustment of chil-
dren aged 3 to 16 years. It consists of 25 attributes and uses
a 3-point Likert-type scale to indicate how much an attri-
bute applies to the child. The SDQ has been advocated as a
useful measure in identifying emotional and behavioral dif-
ficulties and has good reliability (internal consistency =
.73) and validity (scores above the 90th percentile predict a
substantially raised probability of independently diagnosed
psychiatric disorders; Goodman, 2001). Seven children in
the DCD group had a “slightly raised” profile in hyperactiv-
ity. However, no child had a diagnosis of ADHD.
The second edition of the British Ability Scales (BAS-II;
Elliott, 1996) was used to examine the performance on sin-
gle word reading and spelling tasks. The BAS-II has U.K.
norms for children aged 5 to 18 years. The reading and
spelling tasks have high internal reliability ( = .84–.95).
The BAS-II revealed that eight children with DCD had lit-
eracy difficulties (one in reading, seven in spelling), as
defined by a standard score of less than 85 on the BAS-II
components, although none had a formal diagnosis of dys-
lexia or other language impairment (see Table 1 for perfor-
mance profiles of both groups).
Handwriting Measures
The Detailed Assessment of Speed of Handwriting (DASH;
Barnett et al., 2007) is a standardized handwriting speed test
with U.K. norms for 9- to 16-year-olds. The product scores
(number of letters/words per minute) for both groups were
reported in Prunty et al. (2014). In this study, two tasks from
the DASH were implemented, both of which were deemed
appropriate for children aged 8 years and older. The inter-
rater reliability for both tasks was .99. The tasks consisted
of the following:
Task 1: Alphabet writing. The child wrote the alphabet
repeatedly from memory as fast as possible for 1 minute.
He or she was instructed to write it in the correct order
using lower case letters, making sure that every letter
was readable.
Task 2: Copy fast. The child copied the sentence “The
quick brown fox jumps over the lazy dog” as quickly as
possible for 2 minutes. This sentence includes all letters
of the alphabet and thus provides an opportunity to
examine each individual letterform.
Apparatus
When completing the two DASH tasks, the participants
wrote with an inking pen on paper placed on a Wacom
Prunty and Barnett 123
Intuos 4 digitizing writing tablet (325.1 mm × 203.2 mm)
to record the movement of the pen during handwriting. The
writing tablet transmits information about the spatial and
temporal data of the pen as it moves across the surface. The
data were sampled at 100 Hz through a laptop computer.
Eye & Pen version 2 software (EP2; Alamargot et al., 2006)
has a video function that allows researchers to replay the
handwriting production in real time on a laptop.
Procedure
The handwriting component of this study took place during
one 60-minute session. Each child was assessed individu-
ally by the first author (M.P.), who is a trained occupational
therapist. During the handwriting tasks, the children were
seated at a height-adjustable table and chair, with knees
positioned at approximately 90 degrees and elbows approx-
imately 2 to 4 cm above the table. The participants were
encouraged to position their paper as they would normally
do in the context of their natural environment; therefore,
they were invited to maneuver the tablet to a position that
was comfortable for them.
Coding Analysis
Accuracy of letter formation. In the United Kingdom, children
may be taught different handwriting styles at school, which
include variations of joined or unjoined letterforms. In this
study, coding of errors in letter formation did not reflect
handwriting style but focussed on universal aspects of letter
formation that apply across all handwriting styles taught in
the U.K. school system. The focus here was to examine the
accuracy of the allograph (Van Galen, 1991); therefore,
handwriting style did not have an impact on analysis.
The handwriting production was viewed by the first
author and coded for accuracy and consistency of letter for-
mation. Letter production was played and replayed in slow
Table 1. Means, Standard Deviations, Ages, and Performance Scores for DCD and TD Groups on Selection Measures.
Selection measure
DCD groupa
M (SD)
TD groupa
M (SD)p-value
Age in years 10.61 (2.23) 10.95 (2.12) .441
MABC-2 test percentile 3.45 (2.96) 43.37 (25.4) <.001*
Manual dexterity 6.41 (8.12) 51.07 (26.82) <.001*
Aiming and catching 21.55 (23.64) 64.67 (20.41) <.001*
Balance 5.98 (4.67) 30.42 (19.85) <.001*
BPVS-2 standard score 108.9 (14.4) 110 (12.2) .655
BAS-II spelling standard score 95.8 (13.7) 111 (12.7) <.001*
BAS-II reading standard score 109.5 (13.8) 122 (12.6) <.001*
Note. DCD = developmental coordination disorder; TD = typically developing; MABC-2 = Movement Assessment Battery for Children (2nd ed.;
Henderson etal., 2007); BPVS-2 = British Picture Vocabulary Scale (2nd ed.; Dunn etal., 1997); BAS-II = British Ability Scales (2nd ed.; Elliott, 1996).
an = 28.
*p ≤ .05.
motion and was paused if needed to allow for accurate cod-
ing of the process. In order to classify the errors in letter
formation, the following categories were used:
Incorrect direction of letter stroke. For example, a clock-
wise rather than anti-clockwise direction when forming
the letter a or o (letters that may have appeared appropri-
ate on paper but when production was replayed, incor-
rect letter stroke directions were revealed);
Incorrect start place. For example, the letters r, n , or i
starting at the baseline rather than in the middle of the
lines;
Letters with missing strokes. For example, the letters t
and f written without the cross stroke or r, n, u completed
with one stroke rather than two;
Letters with added strokes. For example, overwriting on
strokes already formed;
Letter reversals. For example, the letter b appearing as d.
Using these categories, the following variables were cal-
culated for the alphabet task for each child:
1. Percentage of letters with production errors;
2. Percentage of production errors in each category. It
was also noted whether each child displayed pro-
duction errors in more than one of the error
categories.
Consistency of letter formation. The consistency of letter for-
mation was established by comparing the performance on
the alphabet task to the performance on the copy fast task.
Only those letters produced in the alphabet task were exam-
ined in the copy fast task for each child. If a child only pro-
duced the first 14 letters of the alphabet (a to n), for example,
the same 14 letters were examined in the copying task. As
above, the letters were played and replayed in slow motion
to allow for the categorization of errors. The consistency of
124 Journal of Learning Disabilities 53(2)
letter formation was examined for each child by calculating
the following:
1. The percentage of letters with production errors in
the alphabet task that had the same errors recorded
in the copying task;
2. The percentage of letters with production errors in
the alphabet task that had different errors recorded
in the copying task.
Production of letter groups/families. The letters of the Latin-
based alphabet are sometimes grouped together into letter
“families” for the purpose of teaching letter formation
(Department for Education [DfE], 2001). The groups are
usually defined by either the shape of the letters (ascenders
and descenders) or the movements required in forming them
(curves). While there are variations of letter families, this
study applied those recommended by the DfE (2001), which
are grouped according to movement patterns. Figure 1 illus-
trates the four letterform families: c, r, l, and z.
For the final analysis, each letter that was produced on
the alphabet task was examined for accuracy, and the num-
ber of children in each group who made an error in each
letter was calculated. The nature of the errors was catego-
rized and the frequency of the error types was reported for
any letter that yielded a significant group difference.
Interrater Reliability
Since the scoring criteria for identifying errors in the pro-
duction of letterforms were novel, it was important to assess
the reliability of scoring. An acceptable coefficient for
interrater reliability would be above .70, but preferably
above .80 (Landis & Koch, 1977). The first author initially
scored all of the alphabet task files on EP2. To check the
reliability of scoring, 10 files (5 DCD, 5 TD) were ran-
domly selected and scored by an external rater (a psycholo-
gist with particular expertise in children’s writing). The
rater was unaware of the group allocation of the scripts. The
interrater reliability (intraclass correlation coefficient) for
the number of letters in the alphabet task with a process
error was .89.
Statistical Analysis
We used t tests or the Mann–Whitney U test to examine the
differences between the DCD and the TD groups, depend-
ing on the normality of distributions. For categorical data,
chi-square tests of independence were used to examine
group differences in the proportion of production errors.
Significance was set at p < .05 in all cases.
Results
Accuracy of Letter Formation
All children in the DCD group made production errors
compared with (23/28) 82% of the TD group. As shown in
Table 2, the DCD group had a higher median percentage of
production errors in the alphabet task compared with the
TD group (U = 141.0, Z = −4.13, p < .001, 2 = .30).
Analysis of the error categories (see Table 2) showed
higher median scores for the DCD group across all catego-
ries except for Incorrect Start Place, where the TD group
exhibited higher median scores than the DCD group.
However, the only significant group differences were for
Added Strokes (U = 238.5, Z = −3.22, p <.001, 2 = .18)
and Letter Reversals (U = 294.0, Z = −3.22, p =.005,
2 = .18). The percentage of these two types of errors in the
DCD group was lower compared with other error types
that they displayed. Also, no child in the TD group made
Added Strokes or Letter Reversals. There was no effect
of group for Incorrect Direction of Strokes (U = 335.5,
Z = −.961, p =.337, 2 = .02), Incorrect Start Place (U =
346.0, Z = −.764, p =.445, 2 = .01), or Missing Strokes
(U = 311.0, Z = −1.36, p =.172, 2 = .03). There was no
Figure 1. Four families of letterforms.
Prunty and Barnett 125
effect of group for Incorrect Letters, with more than one
error indicating that both groups (DCD, Mdn = 6.50; TD,
Mdn = 0.001) made the same amount of errors within a let-
ter (U = 299.0, Z = −1.75, p =.079, 2 = .05).
Consistency of Letter Formation
There was no effect of group when comparing the percent-
age of letters with errors in the alphabet task to the percent-
age of letters with the same errors recorded in the copying
task (U = 299.0, Z = −1.75, p = .079, 2 = .05). This sug-
gests that when both groups performed a letter incorrectly
in the alphabet task, the same letter was still incorrect in the
copying task. However, the DCD group had a significantly
greater percentage of errors that were different in type
between the alphabet and the copying tasks (U = 182.0, Z
= −4.41, p < .001, 2 = .34). They had a tendency to pro-
duce inconsistent errors within the same letter, between the
two tasks (see Table 3 for medians).
Production of Letter Families
Table 4 reports the percentage of children in each group
who made a production error in each letter. As can be seen,
a higher percentage of children in the DCD group made
errors in 11 letters across the four letter families. These
were as follows:
l family
i: 2(1, N = 56) = 6.72, p = .010, 2 = .346
j: 2(1, N = 56) = 4.08, p = .043, 2 = .270
c family
a: 2(1, N = 56) = 4.30, p = .038, 2 = .277
d: 2(1, N = 56) = 16.04, p ≦ .001, 2 = .535
g: 2(1, N = 56) = 5.49, p = .019, 2 = .313
r family
r: 2(1, N = 56) = 5.40, p = .020, 2 = .325
n: 2(1, N = 56) = 7.52, p = .006, 2 = .377
m: 2(1, N = 56) = 12.34, p ≦ .001, 2 = .478
h: 2(1, N = 56) = 4.38, p = .036, 2 = .280
b: 2(1, N = 56) = 6.17, p = .013, 2 = .332
z family
z: 2(1, N = 56) = 9.55, p = .002, 2 = .437
From Table 4, it seems that it was within the r family that
a greater proportion of children with DCD showed errors,
with five of the seven letters more affected in this group
compared with the TD group. Table 5 reports the percentage
of error types within the 11 troublesome letters. The most
common type of error was Incorrect Starting Place in nine
Table 2. Median (Interquartile Range) Percentage of Errors in the Alphabet Task for DCD and TD Groups.
Measure
Median (interquartile range) %
p-valueDCD groupaTD groupa
Letters with production errors 28.72 (11–40) 7.69 (4–12) <.001*
Incorrect direction of strokes 25.00 (0–40) 0.001 (0–45) .337
Incorrect start place 40.00 (10–53) 50.00 (0–71) .445
Missing stroke 39.00 (5–58) 12.50 (0–50) .172
Added stroke 0.001 (0–16) 0 <.001*
Letter reversals 0.001 (0–9.75) 0 .005*
Note. DCD = developmental coordination disorder; TD = typically developing.
an = 28.
*p ≤ .05.
Table 3. Median (Interquartile Range) Percentage of Production Errors on Both Tasks for DCD and TD Groups.
Measure: incorrect letters
Median (interquartile range) %
p-valueDCD groupaTD groupa
Similar errors in both tasks 90.01 (67–100) 63.33 (25–100) .070
Different errors in both tasks 10.01 (0–23) 0.00 <.001*
Note. DCD = developmental coordination disorder; TD = typically developing.
an = 28.
*p ≤ .05.
126 Journal of Learning Disabilities 53(2)
of the 11 letters, followed by Incorrect Direction of Strokes
and Missing Strokes in seven of the nine letters.
Discussion
In this study, we used a novel analysis to code and categorize
errors in handwriting production through an analysis of the
real-time movement of the pen. From a theoretical perspec-
tive, we were interested in examining the level of the allo-
graph (the motor commands that define essential details of
letter production) in Van Galen’s psychomotor model of
handwriting in children with DCD. As predicted, our find-
ings revealed that children with DCD produced a signifi-
cantly higher percentage of production errors compared with
TD peers. This indicated some difficulties with producing
standard motor patterns required for letter formation. While
this may not fully explain their difficulties with handwriting,
it may contribute to some of the issues described in the lit-
erature, including poor letter formation and a tendency to
overwrite on letters (Prunty et al., 2016; Rosenblum &
Livneh-Zirinski, 2008).
We attempted to categorize the types of errors performed
during the production of letterforms, which revealed a simi-
larity in error types between both groups. The most com-
mon error made by both groups was the non-standard start
position of a letter, while missing letter strokes was the sec-
ond most common in the DCD group. Indeed, the issue of
start position is interesting as it seems most of the errors in
the TD group occurred in this category. One possible reason
for this could have been attributed to the letter x where an
error was coded if the participant started from the right side
rather than the left side as outlined by the DfE (2001). On
reflection, this criteria may have been too strict as the letter
x appeared to pose the most issues for the TD group.
Subsequently, this may have inflated the errors in start posi-
tion reported for the TD group. However, an alternative
explanation for this finding may relate to a possible lack of
emphasis by classroom teachers on the correct starting posi-
tion for letters. Although a description of classroom practice
surrounding letter formation was beyond the scope of this
study, it would be useful to explore this in future to help
understand the influence of teaching practices on letter for-
mation. In the United Kingdom, the statutory guidelines
surrounding handwriting in the National Curriculum state
that children should receive explicit teaching on handwrit-
ing. Therefore, future studies should take instruction into
consideration to build a more complete picture.
An interesting finding in the DCD group was the high
percentage of errors in the missing stokes category. It seems
that some letters which started in the incorrect place (i.e., m)
also contained fewer letter strokes. While this is not a
method taught in schools (DfE, 2001), it occurred more fre-
quently in the DCD group. This may have been related to
difficulties in learning the correct sequence of the letters
(Bo & Lee, 2013); however, it may have been an “eco-
nomic” strategy employed by the DCD group to compen-
sate for their movement difficulties. Future studies should
examine this in more detail because it may have implica-
tions for the teaching and learning of handwriting in this
group.
Another type of error explored in this study was letter
reversal because there is anecdotal evidence that children
with DCD produce reversals in their writing (Benbow,
2002). This was not one of the main errors seen in the cur-
rent study, however. Although the DCD group appeared to
make slightly more letter reversals and produce additional
strokes compared with their TD peers, these errors did not
occur frequently and not at all in the controls. This was an
interesting finding because these two categories were the
Table 4. Percentage of Children in Each Group Who Made
Production Errors in Individual Letters.
Letter family and letters DCD groupaTD groupa
l family
l 28.57 14.29
i* 21.4 0.0
u 39.1 25.0
t 18.2 10.7
y 13.0 3.57
j* 21.5 3.6
c family
c 3.57 0.0
a* 14.29 0.0
d* 57.14 7.14
g* 17.86 0
q 21.7 7.14
o 11.5 7.4
e 0.0 0.0
s 8.70 3.60
f 35.7 25.0
r family
r* 43.5 14.29
n* 44.0 10.71
m* 50.0 7.14
h* 28.6 7.14
b* 53.57 21.43
k 25.90 14.29
p 40.0 21.43
z family
z* 30.4 0.0
x 68.2 53.2
v 8.7 0.0
w 8.7 0.0
y 13.0 3.57
Note. DCD = developmental coordination disorder; TD = typically
developing.
an = 28.
*p ≤ .50.
Prunty and Barnett 127
only two that yielded a statistically significant group differ-
ence but occurred less frequently than any other error type.
As such, this raises a general point about the implications of
our findings on practice: while high-frequency errors did
not yield significant group differences, the errors that were
statistically different might have been too infrequent to war-
rant attention in the classroom.
For determining consistency of letter production, we
compared letter formation across the two writing tasks.
Although not all children produced the full alphabet within
the 1-minute time limit, it was evident that letters that were
incorrectly formed on the alphabet task were also incor-
rectly formed in the copying task in both groups. However,
the types of errors produced in the DCD group were not
always consistent. For example, if a letter was performed in
an incorrect way in the alphabet task, it was likely to remain
incorrect in the copying task for both groups; however, the
type of error made within the letter sometimes differed in
the DCD group. This inconsistency may have implications
for handwriting fluency given that acquiring automaticity in
a skill requires that similar movement patterns be executed
consistently (Fitts & Posner, 1967).
The reasons for the lack of accuracy and consistency of
letter production in children with DCD are unclear.
Proponents of one theory within the literature have sug-
gested deficits related to motor sequence learning (Bo &
Lee, 2013). Wilson et al. (2013) suggested that children
with DCD can learn simple sequential movements, but
handwriting involves 26 different letterforms of varying
style (joined, unjoined, and capitalized); therefore, it may
be more difficult for children with DCD to learn and retain
such a variety of letterforms. This may be reflected in the
types of errors that the DCD group made because they were
more likely to perform errors associated with the initial pat-
tern of letter formation (start position and missing strokes)
rather than errors such as adding unnecessary strokes. It
seems that they failed to learn the basic sequence of move-
ments required for correct letter formation. Further investi-
gation of the relationships among different errors may also
help in understanding the characteristics of the errors seen.
For example, it may be that once a letter is incorrectly
started, there is a reduced likelihood of (or opportunity for)
the addition of strokes, or that children with DCD are less
likely to detect and/or correct errors. Huau et al. (2015) also
reported difficulties with consistency in children with DCD
when learning a new letterform. They found that despite a
lengthy learning period, children in the DCD group exhib-
ited more variability and inconsistency in performance
(Huau et al., 2015). According to the authors, this instability
of the motor program may be related to neuromotor noise in
the system, preventing and disturbing the correct execution
of motor patterns (Huau et al., 2015; Smits-Engelsman &
Wilson, 2013). Further research is needed to explore this
issue in more detail.
One important environmental factor to consider is the way
in which children are taught handwriting in schools. Although
handwriting is of growing importance in the U.K. educa-
tional system (DfE, 2013), the way in which it is taught can
vary widely (Barnett et al., 2007). Given that practice and
correct movement patterns are key elements in skills acquisi-
tion (Fitts & Posner, 1967), it is important to capture this
when studying handwriting difficulties. Despite some emerg-
ing literature on difficulties with motor sequence learning in
the DCD population (Wilson et al., 2013), it is not clear
whether some of the issues explored in this study were linked
to differences in teaching and opportunities for practice.
With regard to an applied perspective, we tried to ascer-
tain whether specific letters were more problematic than
others to inform intervention and strategies for teaching
children with DCD. We found that children with DCD had
particular issues with the r family of letters, with five of the
seven letters affected. The main issue with these letters
Table 5. Breakdown of the Percentage of Errors Attributed to an Error Type for the DCD Group.
Error type
Percentage of errors per letter
a b d g r h i j m n z
Direction 75.0 33.3 12.5 60.0 — 25.0 — — 7.7 9.1 —
Start place — — 37.5 40.0 10.0 25.0 100.0 16.7 7.7 9.1 14.3
Missing stroke — 33.3 18.8 — 10.0 12.5 — — 23.1 9.1 14.3
Added stroke — — — — — 12.5 — 16.7 7.7 — —
Letter reversals — 13.3 6.3 — — — — 66.7 — — 71.4
Start and
direction
25.0 6.7 6.3 — — 25.0 — — — — —
Start and missing
stroke
— 6.7 6.3 — 70.0 — — — 53.8 72.7 —
Start and added
stroke
— — 6.3 — 10.0 — — — — — —
Note. DCD = developmental coordination disorder.
128 Journal of Learning Disabilities 53(2)
tended to be a combination of an incorrect starting place,
missing stoke (letters n, m, r), or incorrect direction of
strokes (b, h). The c family was the second most affected,
with a, d, and g mainly affected. Here, issues with direction
were most apparent in a and g followed by the correct start-
ing place for d. This type of information may serve as useful
guidance for teachers and therapists when deciding on
where to focus interventions.
Study Limitations
One limitation of this study is the ability to generalize the
findings to children with DCD who have co-occurring dis-
orders. While this study controlled for factors such as read-
ing ability, spelling ability, language, and attention, future
research needs to consider children with co-occurring disor-
ders, given the constraints of language on handwriting pro-
duction (Connelly et al., 2012; Sumner et al., 2014). This
study was also limited in terms of ethnic diversity and sam-
ple size and had a smaller proportion of females than
reported in other studies (Rosenblum & Livneh-Zirinski,
2008). In addition, the lack of information surrounding how
the children in this study were taught handwriting at school
could be noted as a limitation. Finally, our focus here was
on two short writing tasks from the DASH, limiting some
aspects of the analyses and generalization of findings. The
1-minute alphabet task was not sufficient for all children to
complete the full alphabet, and the 2-minute copying task
had more constraints than a longer free writing task. In
addition, the participants completed the handwriting tasks
in a once-off session, which may not have been a true reflec-
tion of their handwriting performance.
Implications of Findings
One implication of this study relates to the importance of
observation skills in educators and clinicians who work
with children with DCD. While the use of digitizing tablets
in this study allowed us to replay participants’ handwriting
in real time, traditional measures of handwriting do not
allow for this. It, therefore, is imperative that educators and
clinicians observe children as they handwrite. By simply
watching how a child produces letters, teachers could facili-
tate early identification and remediation of letter formation
issues, which would support the development of handwrit-
ing speed later on.
This study also has implications for future research.
While it revealed difficulties at the allograph level (Van
Galen, 1991) in children with DCD, future research needs
to investigate the levels of spelling, semantic retrieval, and
syntax (language). Since DCD often co-occurs with diffi-
culties in language, attention, reading, and spelling, addi-
tional studies are needed to provide insight into the role of
these factors on the handwriting process of this group. A
more comprehensive understanding of co-occurring condi-
tions would go some way in informing more tailored inter-
ventions in the future.
Conclusion
Previous research has examined the quality of letter forma-
tion in children with DCD using the handwriting product,
which is an approach widely used in practice both in the
classroom and in the clinical settings. This exploratory
study was the first of its kind to examine the accuracy of
letter formation by analyzing handwriting production in
real time. The findings went some way in categorizing
issues with letter formation for children with DCD in a
novel way. Further research is needed to refine and develop
this method further. It does seems apparent that (a) this pop-
ulation demonstrates difficulties with particular letterforms
and (b) explicit teaching of the skills should be considered
in clinical and educational settings.
Acknowledgments
The authors would like to thank all of the families and children
who took part in this research.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
ORCID iD
Mellissa Prunty https://orcid.org/0000-0001-5149-9153
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