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Effects of color stimulation on handwriting performance of children with ADHD without and with additional learning disabilities


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Active behavior problems in children with ADHD are often aggravated in situations which require sustained attention. Building on the 'optimal stimulation' hypothesis, this study explored the effects of color stimulation on graphomotor control in children with ADHD. A sample of 66 children with ADHD ( n = 19 from primary education, n = 28 children with additional speech disorders, n = 19 children with additional learning disabilities) and matched controls participated in the investigation. Subjects performed a copying task on standard white and on colored paper in balanced order across classes. Positive effects of the color stimulation on graphomotor behavior control and, consequently, on qualitative aspects of the handwritings were expected. Results broadly confirm the predictions. Effects are explained as added external stimulation facilitating behavioral inhibition and regulation of selective attention and graphomotor coordination. Reduction of visual stress as an alternative explanation is considered.
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European Child & Adolescent Psychiatry (2004)
13:191198 DOI 10.1007/s00787-004-0371-5
ECAP 371
Accepted: 3 July 2003
Dr. Margarete Imhof
Johann Wolfgang Goethe-University
Institute of Educational Psychology
P. O . Bo x 11 19 32
60054 Frankfurt/Main, Germany
Abstract Active behavior prob-
lems in children with ADHD are of-
ten aggravated in situations which
require sustained attention.Build-
ing on the optimal stimulationhy-
pothesis [43],this study explored
the effects of color stimulation on
graphomotor control in children
with ADHD.A sample of 66 chil-
dren with ADHD (n= 19 from pri-
mary education,n=28 children
with additional speech disorders,
n= 19 children with additional
learning disabilities) and matched
controls participated in the investi-
gation.Subjects performed a copy-
ing task on standard white and on
colored paper in balanced order
across classes.Positive effects of the
color stimulation on graphomotor
behavior control and,consequently,
on qualitative aspects of the hand-
writings were expected.Results
broadly confirm the predictions.Ef-
fects are explained as added exter-
nal stimulation facilitating behav-
ioral inhibition and regulation of
selective attention and graphomo-
tor coordination.Reduction of vi-
sual stress as an alternative expla-
nation is considered.
Key words ADHD – optimal
stimulation – graphomotor
behavior – primary education
learning disabilities
Margarete Imhof
Effects of color stimulation on handwriting
performance of children with ADHD
without and with additional learning
In academic learning environments, the attention prob-
lems in children with ADHD result in a number of be-
havioral characteristics which may interfere with aca-
demic tasks: They have difficulty sustaining attention
over a certain period of time, which would imply both
maintaining an intention for selection and protecting
this intention against distractions. They often forget
what exactly they were supposed to do and fail to com-
plete assignments. Especially in repetitive and (monot-
onous) practicing tasks, their error rates are compara-
tively high and the quality of their work varies greatly
across time, e.g., as far as accuracy or completion are
concerned [13, 17,18, 33].
The etiology of ADHD is unknown, but various ex-
planations have been proposed. It has been suggested
that problems in behavioral inhibition [2,26] and prob-
lems with self-regulation and stimulus control [8,11,12]
caused by dysfunctional cortical activation and subse-
quent variations in stimulus processing may play an im-
portant role [30–32, 43].
Zentall and Zentall [36, 43] focused on the hypothe-
sis that children with ADHD typically tend to display a
chronic state of low cortical activation.Thus,“individu-
als with ADHD require more stimulation. . . to achieve
and maintain an optimal level of arousal in a given con-
text”([24] p. 272f.).Against this backdrop, the excessive
motor activity and other stimulation seeking behavior is
interpreted as compensatory activity to calibrate the op-
timal stimulation level’for efficient functioning. In a se-
ries of experimental studies including children of sev-
eral age and ability groups,Zentall and colleagues found
that both motor activity (e. g.,[1]) and academic perform-
ance (e.g., reading, arithmetic, speaking) of children
with ADHD could be positively influenced when addi-
tional environmental stimulation was present. Learners
192 European Child & Adolescent Psychiatry (2004) Vol. 13, No. 3
© Steinkopff Verlag 2004
with ADHD performed, in many cases, at the same level
as control children, when extra stimulation, such as
background noise [42] or an extra motor task [41], was
included in the learning environment. Initial studies on
the effects of color stimulation, however, yielded mixed
results as the application of color was confounded with
task complexity [35, 37, 40].A case study (n =3 students
with ADHD) reported by Belfiore, Grskovic, Murphy,
and Zentall [4] yielded encouraging results for the effect
of nonspecific color added to a reading task by using
colored typefaces. Lee and Zentall [24] used a series of
single-digit additions to test the effects of color stimula-
tion which was induced by colored computer screens
and animation effects. The authors found that in the
condition of high within-task stimulation, ADHD stu-
dents had more completed problems and more correctly
solved problems than in the low stimulation condition
with black numbers on a grey computer screen.
In our own experimental study with eight children
with ADHD and an equal number of controls from a spe-
cial education setting for children with speech disor-
ders, it was shown that children with ADHD performed
significantly better when color stimulation not affecting
task complexity was added [20, 22]. The children with
ADHD had fewer mistakes and took more time to com-
plete the task when they worked on colored paper than
on standard white paper. In addition, teachers also re-
ported the impression that the quality of the handwrit-
ing had improved on the colored sheets. None of these
effects, however, were visible in the control group.
Iovino,Fletcher, Breitmeyer, and Foorman [23] detected
a similar trend in their study on the effects of colored
overlays used to facilitate reading. The ADHD group in
their sample improved on their word recognition and
reading comprehension performance when they used
the overlays, whereas none of the other groups were af-
fected.Taken together,there is evidence that individuals
with ADHD react to color stimulation in a very specific
manner. Further exploration of the utility of color stim-
ulation would be of practical relevance, because this
rather unobtrusive form of stimulation would be easily
compatible with a variety of learning contexts in a typi-
cal classroom.
The current study was designed to validate previous
findings with a larger sample including both normal
controls and ADHD children with comorbid speech dis-
orders (SD) and learning disabilities (LD) to evaluate
more closely the qualitative aspects of the handwriting.
It is expected that the characteristics of the handwriting
of children with ADHD improve with the added color
stimulation,due to a better control over (grapho)motor
behavior. This expectation is based on the assumption
that changes in cortical activation, which are elicited by
the color stimulation, have an influence on behavioral
inhibition and facilitate motor coordination [6], atten-
tion regulation [27],and the effective monitoring of cog-
nitive functions, such as working memory and motiva-
tional regulation [2, 3].
Participants came from various second and third grade
classes in a South German school district.In this partic-
ular federal state, students are assigned to categorical
schooling when specific problems arise. The general
idea is to provide a school environment which is tailored
more closely to the learning needs, e. g., of children with
speech disorders and learning disabilities. These arise
typically during the first year of elementary school (RE).
After a sound diagnosis, an individual education plan is
developed which includes transfer to a different type of
school. Schools for children with normal intelligence
and speech disorders (SD) cater to those who display ex-
pressive language and articulation problems. They are
taught the same curriculum as children in regular edu-
cation, but in smaller classes. In addition, they receive
remedial language instruction. Children with learning
problems and below normal intelligence scores (but not
retarded) are assigned to yet a different type of schools
(LD). Their instruction also follows the identical cur-
riculum, but the material is covered over a considerably
longer period of time, e.g., the content of the first two
years in RE is spread out over a three-year period in LD
schools. The rationale for using the same core curricu-
lum in all schools is to keep the doors open for every-
body to return to RE schooling.
To avoid exposing “problem children”, entire classes
with an ADHD child were asked to take part in the ex-
perimental tasks which were actually treated like regu-
lar class work. Thus, a total of 144 girls and boys from
regular primary education (RE, 2
grade), 103 children
from schools for children with speech disorders (SD,2
grade), and 73 students from schools for children with
learning disabilities (LD, 3
grade) participated in the
study. The numbers of children with an ADHD diagno-
sis within the total sample were n=19 children in RE,
n= 28 from SD schools, and n= 19 from LD schools. All
children with ADHD had been diagnosed based on
DSM-IV criteria by a child psychiatrist and a school psy-
chologist, and had been unanimously reported by their
teachers and their parents on the Conners scale ([9],
German translation of the short version, adapted for
teachers and parents,respectively) to have active behav-
ior problems.Data of children who were known to be on
medication for ADHD and of those who were of the pre-
dominantly inattentive type had been excluded from
further processing, because differential patterns in ex-
ecutive functions are known for different subtypes of
ADHD [19] and no predictions could be made on how
M. Imhof 193
Effects of color stimulation on handwriting performance of children with ADHD
these conditions would interact with the color stimula-
tion.Also, the data for the remaining girls (n= 4) were
eliminated, because the data base for group compa-
risons with reference to gender would lack power.So,the
final sample consisted of 44 boys with ADHD and in-
cluded 12 pairs of boys from RE,20 from SD,and 12 from
All participating children with ADHD had had at
least one interview with a school psychologist prior to
the experiment.Data of children who were known to be
on medication for ADHD were excluded from further
processing.The mean age of the RE and SD students was
between 7 and 8 years, whereas the LD children were
about one year older. Information on the general cogni-
tive abilities of the participants was available through
the records of school entrance assessments and later as-
sessments of individual educational needs. For the RE
and SD children, general IQ measures (Kaufman-Test)
were found to be within the norm (IQ>90), whereas
children from the LD schools were tested below average
(75< IQ < 90). The distribution of IQ measures reflects
the general policies for the assignment to the different
categories of schooling in this particular federal state.
Each boy with ADHD was matched with a non-ADHD
partner on the basis of gender, class, and time used for
the task in the neutral condition.All statistic procedures
involving group comparisons were performed based on
this selection.
As part of the regular spelling instruction, students
would on a regular basis, according to the mandatory
curriculum,work extensively with series of 10 ‘words of
the week. It was part of the classroom routines that, at
the end of each week, practice was concluded by having
the students copy a coherent text, in which the target
words were embedded, from an overhead projection
onto a worksheet. For the experimental study, this same
far copying task was employed. In addition to spelling
skills, the copying task demanded a high degree of se-
lective attention,perceptual and memory skills, percep-
tive and semantic segmentation of the stimulus mate-
rial, and coordination of visual and motor functions.
For the purpose of the experimental study, two texts
were composed which contained the 10 target words of
the respective weeks and which were matched for a
number of criteria: The texts consisted of 140 and 141
characters respectively to be copied (counting individ-
ual letters and punctuation marks). One text contained
28 words and 45 syllables,the other 29 words and 43 syl-
lables. The number of possible impulsivity ‘traps’ was
also adjusted for the two texts,namely (a) one long word
made up of eleven letters; (b) eight times the letter ‘t
which often leads children to omitting the horizontal
line; (c) ten diphthongs and (d) three double consonants
which are all considered to be particular problems in
German spelling.
The texts were presented in cursive handwriting on an
overhead transparency in the same manner that the stu-
dents were accustomed to. The instruction for the chil-
dren was to copy the text both correctly and completely
and to make sure to mind the ‘words of the week’ just as
carefully as the remainder of the text.They were allowed
to choose their preferred type of writing utensil.All chil-
dren in RE and SD classes had advanced to cursive writ-
ing, whereas some of the LD children still printed their
letters. No time limit was set for the task. When a child
was obviously no longer working after a period of 15
minutes, the task was considered completed.
The independent variable of the investigation was the
intensity of color stimulation by the worksheets. The
children received either standard white paper or were
free to select colored paper ranging from a variety of
pastel to fluorescent colors.It had been found in an ear-
lier study [20] that ADHD children had a preference for
saturated and very bright colors. All papers were ruled
with the standard supporting lines which were used in
class on a regular basis for all kinds of writing tasks.The
dependent variable was the quality of the childrens
handwriting which should be taken as an indicator for
graphomotor control.
The two texts were given one week apart in order to
avoid practice transfer. It was also taken care that the
students had done some other classwork with the col-
ored paper before to mitigate the novelty effect, e. g.,
make their own invitation cards for a birthday party us-
ing the colored paper.This step was important especially
in the light of the strong reaction of children with ADHD
to novel situations.To control for serial effects, the order
of colored and white paper was counterbalanced across
classes.The classes were assigned the order of color pre-
sentation,before the day of testing,so that no individual
preferences would come into the picture.The texts,how-
ever, were presented in the same order in all classes;
thus, each text appeared for part of the sample on the
standard white paper and for the other part on the col-
ored paper, so that possible effects of text difficulty
would be washed out.All writing tasks were given in the
second period in the morning to ensure that participat-
ing children were at a comparable level of mental alert-
ness. The experimental task was instructed by the
teacher with a neutral observer being present in the
194 European Child & Adolescent Psychiatry (2004) Vol. 13, No. 3
© Steinkopff Verlag 2004
Children with ADHD typically have problems to control
and fine-tune motor behavior [28, 29], which may im-
pede the execution of pertaining tasks, such as hand-
writing [25]. If the effect of the enhanced color stimula-
tion on attention processes is mediated through cortical
stimulation, and since efferent motor functions and se-
lective attention have been shown to interact [10, 21], it
is reasonable to assume that, as a consequence, motor
regulation is facilitated,which may become visible in the
characteristics of the handwriting.
The following hypotheses can be stated:
1. Children with ADHD produce a more coherent and
legible handwriting when writing on colored paper
than on standard white paper.
2. This effect is not present for control children.
Building on the results from earlier studies, the hy-
potheses and related statistical tests are administered
one-tailed, because the children with ADHD are ex-
pected to benefit from the color stimulation.
A system of descriptive categories to evaluate the qual-
ity of the handwriting was developed. Based on earlier
research, the following aspects were considered [15]:
Letter formation. Deficient letter formation was
scored when the writer failed to clearly mark individual
letters,e. g., when letters were formed in a way that they
might be confused with others; fell apart and each part
would create a distinct grapheme; were blurred and pos-
sibly misread to represent a different sound;or were cor-
rected in a way that resulted in degraded legibility.
Alignment. Whenever one of the horizontal support-
ing lines or the end of a line was crossed, an error was
Slant. Frequent changes of slant are taken as an indi-
cator of problems with graphomotor control. In a sam-
ple of 10 words taken from the text, the number of
changes from a left slant to a right slant within a single
word was counted.
Spacing. The number of deviations from the conti-
nuity of the writing flow was scored.All stops performed
within a single letter or word, resulting in an inappro-
priate space, and all visible marks of subsequent weld-
ings applied to fill the space were counted in.
Neatness. The impression of neatness was rated on a
four-point Likert scale, the low score being defined as
containing smudges, strikeouts, incomplete erasures,
spots, wrinkling of the paper. The high score was used
when none of these characteristics were present.
The size of the letters was not considered (as suggested
by [15]),because all children used ruled paper with sup-
porting lines supplied to limit letter size. Letter forma-
tion was evaluated with reference to the standard letter
forms that were mandatorily taught in all schools [16].
In contrast to the procedure suggested by Graham etal.
[15], the criteria were operationalized as countable fea-
tures, except for neatness.
All analyses were performed on the original material
produced by the children in order to avoid any contam-
ination by photocopying. The handwriting samples
were rated independently by graduate students who had
been trained in handling the criteria. The students had
normal or corrected to normal vision. None of them re-
ported symptoms, such as headaches or blurred letters
when working on the colored paper. They had been in-
structed to take regular breaks in order to avoid eye
strain and to control observer drift to more and more
meticulous evaluation of the handwriting samples.They
received the colored and white papers in separate stacks
so that they would not be able to identify corresponding
pieces by the same participant.Reliability measures ob-
tained from independent ratings of selections of the
samples with raters blind to both hypotheses and diag-
nostic status of the subjects yielded satisfactory results
with coefficients (Pearson product-moment correla-
tions) ranging from r =0.79 to r= 0.97 for inter-rater
agreement (calculated for the LD and SD samples) and
from r = 0.81 to r= 0.99 for intra-rater agreement (cal-
culated for the RE sample).
Before the results of the graphomotor analysis are pre-
sented, some specifications need to be made. The analy-
sis of the handwritings from LD had to be separated
from that of RE and SD due to specifics of the LD group:
First,while data from RE and SD were evaluated by para-
metric procedures, non-parametric statistical tests had
to be used for the LD data to accommodate for the de-
viance from normal distribution of the raw scores.Con-
sequently, for the LD group the Wilcoxon test was ad-
ministered for within group and the Mann-Whitney
U-test for between groups comparisons. Second, be-
cause some LD students had been taught to print letters,
the spaces criterion did not apply and was omitted.
Third, in the same line, the continuity of slant could not
be measured, but was replaced by a five-point rating of
overall legibility (low score: very clearly legible; high
score: very poorly legible). Fourth, as it turned out too
late in the process to be amended, the ruled lines on the
colored paper for the LD group were slightly off the right
M. Imhof 195
Effects of color stimulation on handwriting performance of children with ADHD
angle and some sheets contained an extra line which had
certainly been confusing, so that the line transgressions
had to be excluded from scoring the LD childrens hand-
Prior to hypothesis testing, the graphomotor perfor-
mance of the groups in RE and SD was analyzed using a
2 ANOVA procedure with types of schools (RE and
SD) and diagnostic status (hyperactive vs. normal con-
trol) as between subjects factors.As it turned out that the
handwriting characteristics of the children ADHD in RE
and SD were not statistically different for letter forma-
tion, alignment, and neatness, the data from these two
groups were collapsed for these categories. The evalua-
tion of the childrens handwriting in the combined
group validated the a priori assumption that children
with ADHD in RE and SD performed more poorly in the
control condition (standard white paper) than their
peers concerning letter formation, alignment, and neat-
ness (Table 1).
The hypotheses were tested for the three criteria let-
ter formation, alignment, and neatness in the combined
RE and SD sample using a MANOVA procedure with pa-
per type (standard white paper vs. colored paper) as
within subjects factor and diagnostic status (hyperac-
tive vs. normal control) as between subjects factor. Re-
sults show a significant main effect for color stimulation
and a significant interaction for color stimulation with
diagnostic condition for all three criteria (Table 2).
Closer inspection using post hoc t-tests reveals an
improvement for the children with ADHD under the
condition of working with color as compared to stan-
dard white paper. The handwriting samples of children
with ADHD writing on the colored paper contained
fewer poorly marked letters (t (31)= 4.46, p< 0.001),
fewer line transgressions (t (31)= 3.94, p < 0.001), and
the worksheets were also rated to be superior in neat-
ness (t (31)=–4.34, p< 0.001). The same comparisons
for the control group yielded no significant results (all
F-values were returned with p> 0.05), which means that
the handwriting performance of the children with
ADHD was differentially affected as compared to the
control children.
Analysis for those two criteria for which RE and SD
samples could not be collapsed, yielded similar results.
Due to the relatively low number of students in RE,how-
ever, statistical analysis was restricted to within group
comparisons. For children in RE with ADHD, paired t-
tests yielded significant differences both in the number
of inappropriate spaces (t(11) = 3.36,p <0.01) and in the
variability of slant (t (11) = 2.11, p < 0.05). The control
children performed equally well in both conditions with
no significant differences being observed.
ADHD children controls
Paper type white colored white colored
Regular primary education
Letter formation 10.83 7.21 7.17 6.63 7.50 5.74 6.75 5.03
Alignment 40.75 31.99 22.75 12.09 30.25 19.05 31.83 22.29
Spaces 16.17 7.15 11.25 5.40 17.42 6.64 14.50 8.34
Slant 4.17 3.86 2.67 4.23 3.33 4.03 3.08 4.01
Neatness 2.33 0.78 3.33 0.78 2.92 0.90 3.08 0.90
Children with speech disorders
Letter formation 11.15 7.80 6.05 3.93 5.90 3.99 4.70 3.88
Alignment 50.15 27.49 39.10 21.00 29.80 25.23 29.05 20.71
Spaces 43.25 19.68 29.00 17.34 35.60 16.62 27.80 17.30
Slant 11.35 9.13 8.45 6.53 9.25 7.48 8.25 6.86
Neatness 2.40 0.75 2.90 0.64 2.95 0.76 3.00 0.73
Children with learning disabilities
Letter formation 26.33 8.35 16.37 7.69 22.29 12.69 21.42 15.17
Alignment (does not apply)
Spaces (does not apply)
3.37 0.91 2.92 0.56 3.00 1.13 2.88 1.00
Neatness 1.71 0.40 2.08 0.67 1.75 0.62 2.13 0.71
Legibility scores for this group represent average ratings on a five-point Likert scale
Table 1 Assessment of handwriting criteria of
ADHD and control children in the different categori-
cal samples and experimental conditions
Table 2 Multivariate analysis of variance for effects of color (repeated measure)
and on handwriting characteristics of ADHD and control children from RE and SD
Criteria Source df df
Letter formation color 1 62 22.81 0.000 0.269
color ADHD 1 62 9.09 0.004 0.128
Alignment color 1 62 10.50 0.002 0.145
ADHD 1 62 10.89 0.002 0.149
Neatness color 1 62 13.89 0.000 0.183
ADHD 1 62 8.02 0.006 0.115
196 European Child & Adolescent Psychiatry (2004) Vol. 13, No. 3
© Steinkopff Verlag 2004
In the SD group, a main effect of color on the hand-
writing was also visible with respect to slant (F
(1,38)= 4.15, p <0.05) and inappropriate spaces (F
(1,38)= 44.77, p < 0.001). In this case, however, the inter-
action with diagnostic status was not significant, so it
must be concluded that both SD children with ADHD
and SD controls improved on spaces and slant in the
color condition.
Results from the LD sample mirror the pattern as re-
ported above. The handwriting performance of LD stu-
dents with ADHD improved significantly on colored pa-
per as compared to their performance on white paper.
Letter formation was clearer (Z =–2.94, p < 0.01), and
overall legibility was rated more favorably (Z=–1.84,
p< 0.05), as well as neatness (Z =–1.91,p < 0.05).No sig-
nificant differences were returned for the LD students
without ADHD (all Z-values with p> 0.05). Between
groups comparisons for the scores for the handwriting
samples of children without and with ADHD from the
LD sample did not yield significant differences in either
Discussion and conclusions
In this study, an attempt was made to check on possible
effects of added external stimulation on graphomotor
control of children with ADHD and two different co-
morbidities. The handwriting quality of second-grade
students in regular primary education and in schools for
children with speech disorders and third graders in
schools for children with learning disabilities was as-
sessed in two different conditions, using a set of criteria
which are assumed to be indicators of motor control
processes. Results show that typical features of hand-
writing improve with the colored writing paper and lead
to a better overall legibility of the work. This supports
the conclusion that some control or monitoring
processes must have been exerted more efficiently than
in the standard situation. The predictions which had
been based on results from earlier studies could be
largely confirmed and are in line with other empirical
evidence suggesting more efficient information process-
ing in the presence of increased stimulation, especially
through the visual channel [2, 5, 7, 8, 14]. In particular,
the results are in line with results reported from other
studies using color as a means of external stimulation.
Iovino etal.[23] found an advantage in both word recog-
nition and reading comprehension when children with
ADHD used colored overlays in a reading task.Similarly,
Lee and Zentall [24] found color and animation effects
in the presentation of math problems to be beneficial for
both behavior and performance.
In the present study, children in the SD group also
seem to respond to the color in some way as seen in the
inappropriate spaces and slant categories. This may
question the exclusive susceptibility of children with
ADHD to color. If this observation is not attributed to a
chance significance, it may be plausible to assume that
color stimulation has an unspecific effect on cortical ac-
tivation and attention regulation.Based on this assump-
tion, it would not really be surprising when children in
SD classes, though not fully diagnosed as ADHD, might
still benefit from the added color, because part of their
problems may actually be located in the areas of atten-
tion regulation and extend to motor timing. This, of
course, needs further investigation.
According to research on the effects of colored over-
lays on reading performance (cf. [34] for an overview),
the facilitating effects of the colored paper could also be
explained from a completely different angle, namely in
terms of a reduction of visual stress. Color should miti-
gate strong contrasts of black print in a white page and
thus puts less strain on the eyes and prevents tiring on
the task. On the one hand, this might be a viable alter-
native route to explain the observed effects.The basic as-
sumption here would be that for individuals with visual
hyperexcitability perception is facilitated as the inten-
sive contrasts are alleviated. On the other hand, this ex-
planation would be somewhat incompatible with the ob-
servation that ADHD children select the papers with
fluorescent colors which usually ‘flicker’ as one is fo-
cussing on them for a while, thus creating additional vi-
sual stimulation instead of smoothing visual perception.
The stress reduction hypothesis would also challenge
the results from those studies that show improved be-
havior control and performance in the presence of
added external stimulation other than color, e. g., class-
room noise [42], motor activity [41], movement effects
[24], and increased self-attentional focus [39]. Addi-
tional research pitting the conflicting explanations
would probably benefit from a sound operationalization
of“level of arousal”and an identification of valid and re-
liable neuropsychological indicators for effects of diffe-
rent levels of stimulation.
From the current study, the conclusion can be drawn
that children with ADHD across different comorbidity
groups respond to the color stimulation with improved
control of attention and motor processes. The effects
have been described for a spelling and handwriting ex-
ercise and it is open to further research if the effect gen-
eralizes to other academic or non-academic skills areas.
It also needs to be borne in mind that participants in this
investigation were relatively young writers. The ques-
tion is if the additional stimulation can have a direct im-
pact once learners have automatized the writing process
more perfectly and personalized their handwriting
more strongly. It is also not known how long the color
stimulation would carry over time and if habituation to
the color eliminates the demonstrated effect.
Since color comes with a variety of attributes (hue,
saturation, brightness), more research is needed to clar-
M. Imhof 197
Effects of color stimulation on handwriting performance of children with ADHD
ify the differential impact of these presentation modes.
As seen in the research on visual stress and the Irlen
Syndrome, it should be worthwhile to further investigate
the effects of color perception on different neuropsy-
chological conditions.
Practical implications of these findings are, quite ob-
viously,to provide children with ADHD with additional,
non-intrusive stimulation to support the regulation of
attention. If children with ADHD respond positively to
color stimulation, this may be used as diagnostic infor-
mation and for intervention planning. If the results pre-
sented here hold, one might even expect that children
with ADHD score differently on paper-and-pencil tests
when they are printed on colored paper.
Since penmanship is not an end in itself, but a means
to an end [18], it is appropriate to ask what improved
mechanics of handwriting do for a child. Depending on
the overall situation, it is quite feasible that improved
handwriting may contribute to an encouraging experi-
ence for children with ADHD who are often frustrated
by not being able to complete an assignment or by not
being able to decipher their own notes which they have,
undoubtedly, produced with some subjectively per-
ceived effort.
To offer students with ADHD colored sheets to write
on may be only one option. Some children might prefer
other kinds of stimulation and they might come up with
their own ideas of how to create additional stimulation.
Furthermore,it goes without saying that an intervention
as described here can only represent one aspect of a
more comprehensive individual education plan and that
multiple interventions are needed to accommodate the
range of learning needs of children with ADHD. If,how-
ever, children with ADHD respond to color stimulation,
this is a convenient tool to facilitate performance on
tasks which require selective and sustained attention,
and motor control.
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... Um adaptives Unterrichtshandeln (Abb. 1) zu systematisieren, unterscheiden wir die zu bewältigenden Handlungsanforderungen danach, welche Prozesse -die des Lernens, des Lehrens oder des Planens -den Kern der Adaption bilden: (Casale et al., 2017;Glaser et al., 2010). Imhof (2004) weist zudem Vorteile visueller Aktivierung beim Einhalten schriftsprachlicher Normen bei Störungen der Impulskontrolle und Lernbeeinträchtigungen nach. Im Rahmen des Förderschwerpunkts ‚Körperlichmotorische Entwicklung' sind sowohl motorische Prozesse der Graphomotorik als auch großmotorische Schreibbewegungen (Schulter, Ellenbogen) zu berücksichtigen. ...
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Die Bedeutung von Selbstwirksamkeit für professionelles Handeln im Unterricht ist gut dokumentiert (z. B. Klassen & Tze, 2014). Gerade im Kontext der Einführung inklusiver Lernumgebungen ist Selbstwirksamkeit als professionelle Ressource hoch relevant. Aus der Bildungsforschung liegen bereits diverse Skalen und Studien zum Einfluss und zur Entwicklung der Selbstwirksamkeit von Lehrpersonen vor. Dabei bleibt der Fokus auf Selbstwirksamkeit bisher generisch, obwohl Forschungen für andere Unterrichtsfächer zeigen können, dass durch einen fachdidaktischen Ansatz wertvolle Erkenntnisse erwartet werden können. Wir schlagen daher ein lernbereichsspezifisches Modell der Selbstwirksamkeitserwartungen für den Schreibunterricht in inklusiven Lernumgebungen vor, auf dessen Basis ein Online-Fragebogen entwickelt wurde. Der Fragebogen wurde im November 2020 in einer Pilotierungsstudie an der Bergischen Universität Wuppertal eingesetzt (N = 201, Analysestichprobe: N = 164). Die Ergebnisse weisen auf ein geeignetes Instrument zur Messung von Selbstwirksamkeit im inklusiven Schreibunterricht hin und bestätigen eine achtdimensionale Struktur mit spezifisch lernbereichsbezogenen latenten Konstrukten.
... One of the issues that is less considered in the color design of learning environments is taking students' own color preferences into account. According to studies conducted, there is a relationship between color preferences and students' academic performance (Imhof, 2004;O'Connor et al., 1990). Several studies have indicated that the color preferences of different people are different Schloss et al., 2015), and also the color preference changes according to the individual's age (Beke et al., 2008;Read & Upington, 2009). ...
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Colors in the learning environment are likely to affect students’ memory. In addition, each individual’s interest and attitude towards colors change over time under the influence of different factors. Thus, this very question arises “what is the relationship between color preferences and effects of colors on memory on students’ learning in learning environment?” This study focuses on the simultaneous evaluation of color preferences and the effect of colors on memory with the aim of improving the quality of learning of grade1 primary school students who are at the beginning of the learning path. A total of 180 students of both genders (male and female) from the grade-1 primary school were evaluated. In the first test, 8 copies were prepared from the modeled image of the interior of a classroom. The students were then asked to recall images of 9 objects placed on colored backgrounds after observing each copy. In the second test, they were asked which colors they would prefer to paint the classroom interior using the same copies but this time without images of objects and in the form of a qualitative questionnaire. The results were evaluated by SPSS, Friedman ranking test and Pearson’s correlation test. It was observed that there is a significant relationship between color preferences and color effects only in some colors. Moreover, the results indicated that, for achieving the desired results in terms of color selection of learning environments, the component of color preferences and color effects are required to be evaluated simultaneously and along with one another.
... Colors remind different emotions in each person, and they have psychological effects on people. The relationship between color and emotion (Imhof, 2004;Zentner, 2001) is closely related to color preferences, in other words, whether the color evokes a positive or negative emotion in the individual. Research on color psychology has shown that there is a relationship between colors and emotions (Terwogt & Hoeksma, 1995;Uzunboylu & Evram, 2017) and although there is no clear reason to explain how colors can affect emotions exactly, they affect individuals' emotions, attention, judgments and decisions. ...
... 47 Imhof showed that the handwriting performance of individuals with ADHD was better on improved on colored paper than TDs. 48 Li-Tsang et al assessed the handwriting process and readability in both Chinese and English. They found that individuals with ADHD had higher pen pressure, larger pen pressure variations, and lower readability than TDs. ...
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Background: The development of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs) has various influences on physical abilities. Identification of specific physical abilities of people with ADHD/ASDs as biomarkers for diagnosing these conditions is necessary. Therefore, in the present review, we aimed firstly to extract the difference in physical abilities of people with ADHD or ASDs compared to those of normal individuals. Secondly, we aimed to extract the specific physical ability characteristics for identifying potential diagnostic biomarkers in people with ADHD/ASDs. Methods: A systematic literature review was performed. The databases were searched for relevant articles on motor function deficits and characteristics of ADHD or ASD. Results: Forty-one cross-sectional studies and three randomized controlled trials were identified, comprising 33 studies of ADHD, 10 studies of ASDs, and 1 study of both ADHD and ASDs. The quality of studies varied. Three types of physical activities/exercises were identified, including coordinated movement, resistance-type sports, and aerobic-type sports. People with ADHD/ASDs generally exhibited poorer physical abilities for all types of activities, possibly because of low levels of physical activity. Specifically, we found temporal discoordination of movement in ADHD and integration or synchronization of separate movements in ASDs. Conclusion: Specific deficits in physical ability may be attributed to ADHD/ASDs. However, there is not enough research on the physical abilities of people with ADHD and ASDs to clarify the specific deficits. Investigation of specific motor functions that characterize ADHD/ASDs should be facilitated.
... Like the study described, others have used color highlighting to promote and maintain selective (e.g., Belfiore et al., 1996;Kercood & Grskovic, 2009;Kercood et al., 2012;Zentall et al., 1985) and sustained attention (e.g., Zentall & Dwyer, 1988;Zentall & Kruczek, 1988), and to establish mathematical (e.g., Kercood & Grskovic, 2009;Kercood et al., 2012) and verbal repertoires (e.g., Belfiore et al., 1996;Imhof, 2004;Zentall et al., 2000;Zentall et al., 1985). These investigations aimed to reduce the probability of problem behaviors, thus having a preventive character (Kern et al., 2002). ...
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Behavioral interventions in classroom are relevant to the educational process of students with ADHD. It is in this context that typical disorder’s behaviors are especially problematic and contribute to high rates of school failure and dropout. The aim of the present study was to analyze the effect of word highlighting on inattention and hyperactivity/impulsivity of three elementary students with ADHD. A multiple baseline design combined with a reversal design was used. Reduction in the frequency of the behaviors of interest and higher frequency of correct answers in school tasks were observed when words were highlighted. The results replicate and extend data of previous studies. The application of the intervention with different contents and tasks is proposed.
... In sum, reduced executive control seems to present one of the main underlying factors of fine motor impairments in children with ADHD [21] and leads to a decreased behavioral inhibition [8]. The stimulation deficit hypothesis provides an additional explanation for motor abnormalities in children with ADHD [58][59][60]. ...
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Background Motor deficiencies are observed in a large number of children with ADHD . Especially fine motor impairments can lead to academic underachievement, low self-esteem and frustration in affected children. Despite these far-reaching consequences, fine motor deficiencies have remained widely undertreated in the ADHD population. The aim of this review was to systematically map the evidence on existing training programs for remediating fine motor impairments in children with ADHD and to assess their effectiveness. Methods The scoping review followed the PRISMA-ScR guidelines. In March 2020, PsycINFO , MEDLINE (PubMed) , Web of Science , Google Scholar and The Cochrane Database of Systematic Reviews were searched for evidence. The eligibility criteria and the data charting process followed the PICO framework, complemented by study design. The investigated population included children with a formal ADHD diagnosis (either subtype) or elevated ADHD symptoms aged between 4 and 12 years, both on and off medication. All training interventions aiming at improving fine motor skills, having a fine motor component or fine motor improvements as a secondary outcome were assessed for eligibility; no comparators were specified. Results Twelve articles were included in the final report, comprising observational and experimental studies as well as a review. Both offline and online or virtual training interventions were reported, often accompanied by physical activity and supplemented by training sessions at home. The training programs varied in length and intensity, but generally comprised several weeks and single or multiple training sessions per week. All interventions including more than one session were effective in the treatment of fine motor deficiencies in children with ADHD and had a wide range of additional positive outcomes. The effects could be maintained at follow-up. Conclusions Fine motor training in children with ADHD can be very effective and multiple approaches including specific fine motor and cognitive training components, some kind of physical activity, feedback mechanisms, or multimodal treatments can be successful. Training programs need to be tailored to the specific characteristics of the ADHD population. A mHealth approach using serious games could be promising in this context due to its strong motivational components.
Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological condition that often affects school children. A major symptom is short attention span, which may negatively influence their academic performance, specifically in those tasks that require concentration. Extending the attention span for those children could help them do better in school and in life. In this work, we propose a novel gaze-based visual attentive interface designed with the three common text color schemes of highlighting, contrast, and sharpening/blurring for the purpose of extending ADHD children’s attention span in performing reading tasks. This design is based on the optimal stimulation theory stating that children with attention and hyperactivity disorders seek the optimum stimulation and attend to the task presenting extra stimulation. Children’s attention state is monitored by a webcam for eye tracking, while mouse tracking was used as the second modality for gaze prediction because some children had difficulties in maintaining the calibration of webcam. Visual color schemes are applied to evaluate different ways of maintaining attention in the process of reading. This study aims to evaluate the efficacy of such a novel interface with two fixation-based metrics – the number of read words and the total time spent in reading text – to measure attention span. The results show that these children performed better in the presence of any color scheme in comparison with using no color, with highlighting the most effective, followed by contrast and then sharpening/blurring. These findings are independent of the tracking modalities and confirm the viability of using a gaze-based attentive user interface designed with adaptive color schemes to extend ADHD children’s attention span.
It is the responsibility of schools and educators to utilize appropriate assistive technology to meet the educational needs of students with disabilities within the least restrictive environment. The use of assistive technology enables educators to adapt content and activities within the curriculum to meet the specific needs of students, and it promotes learning, self-confidence, independence, and a higher quality of life for students with special needs. This chapter explores how educators can utilize assistive technology in the general education classroom setting to support students with disabilities, specifically those with sensory, motor, and cognitive limitations. Diverse types of assistive technology devices that students with disabilities can use to overcome barriers to written language, reading, listening, memory, and mathematics are discussed.
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There is considerable evidence that organisms can moderate incoming sensory stimulation so as to more closely approach optimal levels of arousal. When normal individuals are exposed to unusually high or low sensory input they tend to show "disordered" behavior similar to that of certain chronically disordered populations, for example, hyperactive and autistic children. It is proposed that at least some of the deviant behavior displayed by such disordered children represents a functional set of homeostatic response to condition of abnormal sensory input. Attempts to correct chronic imbalances in arousal through antecedent manipulations of chemical and sensory stimulation have been relatively successful and may provide not only appropriate treatment but also a better understanding of the mechanisms underlying many kinds of disordered behavior.
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Conducted a theoretically based investigation of color stimulation effects on hyperactivity. Moderating variables likely to be important in investigating these effects were identified as the nature of the task (learning and sustained attention), task factors that could provide changes in level of stimulation (task exposure, temporal placement of added stimulation), and child characteristics (sex). 66 hyperactive and 80 normal 1st–6th graders were administered a concept task and a vigilance task under 1 of 3 conditions: no stimulation added, stimulation added early, or stimulation added late. Findings show that stimulation added early or late to a sustained attention task could normalize the performance of hyperactive Ss and reduce their activity. When the task involved acquisition of new information, stimulation added late reduced the activity of the hyperactive Ss. Stimulation effects on concept task performance were, however, less interpretable due to task floor-effects. (33 ref)
Comparing visually evoked potentials at rest and during higher states of attentiveness 6 of our 27 normal intelligent boys and 32 of our 37 boys with poor mental performances were suspected of having rustained MBD during early childhood. Mean latencies of the P 2 and N 3-component were found to be generally larger in the group wit5 MBD. The medio-thal-ano-frontocortical activation system is suggested to work poorly in those Ss. Some additional evidence in support for this hypotheses is reported.
The aim of this chapter is to link the advances in our understanding of Attention-Deficit/Hyperactivity Disorder (ADHD) delineated in this book to evolving models of brain function and dysfunction. The model presented here is a compendium and elaboration of others proposed over the past three decades. For economy, comprehensive reviews are cited rather than primary sources whenever possible, since the principal goal is to outline broad areas of previous work and directions for future studies, rather than to claim the status of a complete theory.
Behavioral symptoms of children diagnosed with ADD-H can be explained in terms of regulation deficits at various levels. For some children, problem behavior is aggravated in situations which are rather low in stimulation and require sustained attention. Using three independent samples of ADD-H subjects (n = 19 from regular primary education, n = 28 children with additional speech dysfunctions, and n=19 children with additional learning disability, including an equal number of normal controls), an earlier study was replicated which had shown a positive effect of task-irrelevant color stimulation on error rates and working time during a copying exercise. At large, the results could be confirmed in the three samples. This effect is explained as additional stimulation facilitating regulation of selective attention and graphomotor coordination.