The Mental Effort Allocated in Handwriting Production among Adolescents with Executive Function Deficits

Abstract

This study aimed to compare handwriting-product and -process measures between adolescents with executive function deficits (EFD) and controls and predict group membership. In a secondary analysis with 81 adolescents aged 10–18 years (41 characterized with daily function difficulties and EFD by parent-reported Behavioral Rating Inventory of Executive Function), participants copied 2 paragraphs onto a paper affixed to a digitizer for objective handwriting-process measures. Their written products were scored according to the Handwriting Legibility Scale, which assesses global legibility, overall effort to read the script, layout on page, letter formation, and text alterations. Significant group differences were found in Tasks 1 and 2 (effort, layout) and temporal-process measure (in-air, on-paper time), and Task 2 global legibility, letter formation, and pen-pressure components. Significant within-group differences were found for Tasks 1 and 2 velocity, in-air time, stroke weight, and height measures while the EFD group showed significant within-group differences for global legibility and Task 1 tilt. The discriminant-function analyses identified that product and process measures correctly classified 75% of the groups. Results suggest handwriting production is important to understanding deeper handwriting-product and -process measures. Combining handwriting-product and -process measures may reflect the mental-effort process, emphasizing the complexity of handwriting as a routine daily performance among adolescents with EFD.