Handwriting in children with Attention Deficient Hyperactive Disorder: role of graphology

Rony Cohen,Ayelet Halevy,Avinoam Shuper,Batia Cohen-Kroitoru,Irena Aizenberg,Sharon Aharoni

doi:10.1186/s12887-019-1854-3

Rony Cohen, Ayelet Halevy + Show 4 more

Open Access

https://doi.org/10.1186/s12887-019-1854-3

Copy DOI

Abstract

BackgroundHandwriting difficulties are common in children with attention deficient hyperactive disorder (ADHD). The aim of our study was to find distinctive characteristics of handwriting in children with ADHD by using graphology to analyze physical characteristics and patterns, and to evaluate whether graphological analysis is an effective ADHD diagnostic tool for clinicians.MethodThe cohort included 49 children aged 13–18 years attending a tertiary neurology and epilepsy center in 2016–2017; 22 had a previous DSM-IV/V diagnosis of ADHD. The children were asked to write a 10–12-line story in Hebrew on a blank sheet of paper with a blue pen over a 20-min period. The samples were analyzed by a licensed graphologist blinded to the clinical details of the children against a predetermined handwriting profile of individuals with ADHD. Each ADHD characteristic identified in each sample was accorded 1 point, up to a total of 15 points. Patients with a graphology score of 9–15 were considered to have ADHD.ResultsThere were 21 boys (43%) and 28 girls (57%) in the cohort; 15 boys (71.4%) and 7 girls (25%) had a DSM-IV/V diagnosis of ADHD. The mean graphology score was significantly higher in the children who had a DSM-IV/V diagnosis of ADHD than in the children who did not (9.61 + 3.49 vs. 5.79 + 4.01, p = 0.002, respectfully). Using a score of 9 as the cutoff, in the girls, graphology had a specificity of 80% (95% CI 59.2–92.8) and a of sensitivity 71.4% for predicting ADHD. Corresponding values in the boys were 75.0 and 76.2%.ConclusionThe handwriting of children with ADHD has specific characteristics. Graphology may serve as a clinically useful tool in the diagnosis of ADHD.

Highlights

Handwriting difficulties are common in children with attention deficient hyperactive disorder (ADHD)
The mean graphology score was significantly higher in the children who had a Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV/V diagnosis of ADHD than in the children who did not (9.61 + 3.49 vs. 5.79 + 4.01, p = 0.002, respectfully)
Using a score of 9 as the cutoff, in the girls, graphology had a specificity of 80% and a of sensitivity 71.4% for predicting ADHD

Summary

Introduction

The aim of our study was to find distinctive characteristics of handwriting in children with ADHD by using graphology to analyze physical characteristics and patterns, and to evaluate whether graphological analysis is an effective ADHD diagnostic tool for clinicians. Handwriting difficulties are common in children with attention deficient hyperactive disorder (ADHD) and have been associated with lower academic achievement and self-esteem [1,2,3]. Tucha and Lange [5] studied the effect of methylphenidate on the quality and fluency of handwriting in children and adults with ADHD but did not evaluate changes in specific handwriting characteristics. Conclusions regarding either specifics or absolutes could not be reached on the basis of a single feature alone It was the combination of several different features interacting in various ways that made it possible for clinicians to achieve a full and clear interpretation

Objectives

Methods

Results

Discussion

Conclusion