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MOVEMENT DISORDERS and their effect on educational progress. Sheila E. Henderson, Institute of Education, University of London and University of Leeds.

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Presentation on theme: "MOVEMENT DISORDERS and their effect on educational progress. Sheila E. Henderson, Institute of Education, University of London and University of Leeds."— Presentation transcript:

1 MOVEMENT DISORDERS and their effect on educational progress. Sheila E. Henderson, Institute of Education, University of London and University of Leeds.

2 Children with movement difficulties Experience a range of problems, which vary considerably in severity e.g. From being in a wheelchair to being ambulatory From having no use of the hands to have apparently normal functioning From having no speech to being able to communicate normally. Also, they may have a clear “diagnosis”, no diagnosis, a query, or more than one.

3 Difficulties have an impact on: Progress in the classroom Progress in PE Participation in other school activities (e.g. in the dining room, at clubs). Participation in the playground and other outdoor activities Which in turn affects Self esteem, Social interactions/Peer relationships etc

4 One very common problem: Many of these children will have difficulty with HANDWRITING which is known to have an impact on academic attainment.

5 Outline of the talk Children with handwriting difficulties Handwriting and writing as interacting processes. The assessment of speed of handwriting.

6 Boy with Benign Joint Hypermobility Syndrome aged 7.

7 Girl, age 9, with mild cerebral palsy

8 Boy, age 7, with Developmental Coordination Disorder (DCD) /Dyspraxia.

9 Boy with Dyslexia, age 10

10 Boy, age 9, Asperger's Syndome

11 Typically developing boy age 11

12 Children with movement/handwriting difficulties? - group 1. Movement difficulties are PRIMARY :  Children with Juvenile arthritis  Children with genetic conditions e.g. BJHS.  Children with cerebral palsy (known brain damage) Children with progressive movement disorders e.g. Muscular dystrophy. Children with Developmental Coordination Disorder (DCD) or dyspraxia.

13 Children with movement/handwriting difficulties - group 2. Other developmental disorders in which movement difficulties are SECONDARY :  Dyslexia  Specific Language Impairment  Asperger’s Syndrome  ADHD

14 Group 3: Children who fall into more than one diagnostic category

15 And don’t forget group 4: Typically developing children who have: Not been taught to write systematically. Have missed crucial early lessons in school Who have been absent when joining was being taught Who have changed schools and found a different system in place. Henderson and Rubin, (1982); Barnett, Stainthorp, Henderson and Scheib, (2006);Graham et al, (2009).

16 Why bother with handwriting difficulties – do they matter? I  Computers have not taken over yet in schools.  In many, particularly primary schools, not all children have a computer.  If/when they do, children have to be taught keyboarding – which can be difficult for those with movement difficulties

17 Why bother with handwriting difficulties – do they matter? II Writing : takes up much of the school day (McHale & Cermak, 1992) required across the school curriculum Used for note taking and recording homework Assessed work may still be handwritten required for examinations useful in everyday life

18 Why be concerned about poor handwriting skill - III Work that is difficult to read gets lower marks. (e.g. Briggs, 1970; Sloan & McGinnis (1992), Simner et al., 1996). Most importantly – legibility and speed of handwriting is related to reduced quantity and quality of content (Connelly et al, 2002; 2005; Stainthorp, 2009; Webb, Henderson and Stuart, 2011).

19 Need Further convincing? Go to: www.

20 What is handwriting? Handwriting differs from other motor skills, such as running, jumping, catching a ball, cutting with scissors, in at least three ways.

21 What is handwriting? It has a language base. (It is the recording of thought, through language, on paper). It is an " invented" skill. It is a taught skill.

22 Different languages - different rules

23 Some of the concepts (Rules) behind our writing system The direction of writing is from left to right. Each letter has a correct movement sequence – the strokes must begin in the right place and proceed in the correct direction (s). Letters have specific height differentials. It is essential to have consistent spacing between letters and words. Capital letters and small letters have different uses

24 In sum, Handwriting is a complex skill involving:  Motor  Perceptual  Cognitive and  Linguistic abilities, Linked directly to the processes involved in writing.

25 Links between poor handwriting and writing. Speed of handwriting related to quality of text written: 1. 15% pf the variance in quality of text writing on the TOWL accounted for by handwriting speed (Stainthorp and Rauf (2009) 2. Correlations between legibility and speed of handwriting and quality of text written (grammar, generation of ideas etc) in excess of 0.5 (Webb, 2012).

26 Learning to Write Writing to learn Handwriting is a tool

27 Our objectives as teachers: All children should be able to write: Legibly Fluently Fast enough. Flexibly and comfortably

28 Provide extra help in the classroom Seek help from outside Apply for other help – ACCESS ARRANGEMENTS. To help with this - What if they can’t or won’t?

29 We need a tool to: Identify those with difficulties QUANTIFY THE LEVEL OF DIFFICULTY Describe the difficulty in detail Evaluate intervention programmes Aid research

30 What was wrong with existing tests? Main problem: Only one task used Norms not up-to-date Don’t differentiate different types of difficulty. Reliability and validity data not adequate

31 Detailed Assessment of Speed of Handwriting (DASH and DASH 17+) Anna Barnett, Sheila Henderson, Beverly Scheib & Joerg Schulz. Published by Pearson Assessment

32 DASH & DASH 17+ Range of writing tasks (5) Age range: 9-16 years; 17-25 years Properly representative sample Psychometrically sound Alongside revision of Movement ABC (Henderson & Sugden, 1992) for 3-16 year olds

33 5 tasks in the DASH (and 17+) 1. Alphabet task 2. Copy best 3. Copy fast 4. Free writing 5. Graphic speed.

34 Alphabet Writing Alphabet writing for 1 minute Write out the letters of the alphabet continuously (lower case). Write as quickly as possible but make sure that every letter is readable Scoring. Number of correctly sequenced lower case letters written.

35 Copying a sentence Copy for 2 minutes. Divided into 1-minute periods. Two conditions: Copy Best – write in your best handwriting. Copy Fast - write as quickly as possible but make sure every word is readable. Scoring. Words per minute. Copy difference score

36 Handwriting Samples

37 Background Alex Age: 11 years 8 months Handedness: Left School: Year 7 Referral : EP Reason: Difficulty producing handwritten work; illegibility Billy Age: 11 years 8 months Handedness: Left School: Year 7 Referral : SENCO Reason: Difficulty producing handwritten work; illegibility

38 Alex

39 Billy

40 Difference Between Best and Fastest for Alex and Billy

41 Free writing Task Task which represented ‘every day’ writing for the child : ‘My Life’, ideas given, one minute thinking/ planning time. Ten minutes total with 2 minute markers Scoring. Number of legible words between time marks. Detailed scoring criteria.

42 Ideas for writing about ‘My Life’ music My Life sports holidaysbirthdays friends school hobbies dance clubs fashion pets television

43 An example of ‘free writing’

44 Graphic Speed Making Xs in circles for 1 minute. Demonstration to emphasize the ‘rules’: write an X not a cross (+), lines must extend to at least touch inner circle, lines must not extend beyond outer circle, intersection must be within inner circle, work quickly but accurately Practice with feedback Scoring. Number of correctly produced Xs. Scoring is strict

45 Quantitative data from DASH tasks. Standard scores for each task (mean 10, SD 3) Profile across tasks Total DASH score - sum of ‘language-based’ tasks, converted to Total Standard Score (mean 100, SD 15) with percentile equivalents Cut off points: 5 th /15 th percentile for Total DASH standard score

46 Supplementary scores  Copy Difference score  Free Writing Profile.  Graphic Speed score > Movement ABC test??

47 Qualitative information from the DASH Factors affecting performance attitude to the tasks/motivation attention/concentration Observations during testing (the 4 Ps) Posture, pen grip, paper position, pressure & fluency Observations of the writing scripts (the 7 Ss) Shape/formation, spacing words/letters, size, slant/slope, site, stringing together, shakiness

48 Individual vs. group testing – free writing

49 The National Handwriting Association ( Aims: Raise awareness of handwriting as a crucial component of literacy Promote and foster good practice in the teaching of handwriting Provide support for those working with children and adults who have handwriting difficulties


51 DSM–IV Criterion A for DCD Performance in daily activities that require motor coordination is substantially below that expected given the person’s CA and measured intelligence. This may be manifested by marked delays in achieving motor milestones (e.g., walking, crawling, sitting), dropping things, “clumsiness”, poor performance in sports, or poor handwriting. International consensus statements on DCD Polatajko et al. (1995), Sugden (2006) European guidelines (EACD, 2011) to be adapted for the UK

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