Children with ADHD have been found to be more likely to have less legible handwriting, make more spelling errors, more insertions and/or deletions of letters and more corrections. In children with these difficulties, the letters tend to be larger with wide variability of letters, letter spacing, word spacing, and the alignment of letters on the baseline. Variability of handwriting increases with longer texts. Fluency of the movement is normal but children with ADHD were more likely to make slower movements during the handwriting task and hold the pen longer in the air between movements, especially when they had to write complex letters, implying that planning the movement may take longer. Children who have ADHD were more likely to have difficulty parameterising movements in a consistent way. This has been explained with motor skill impairment either due to lack of attention or lack of inhibition. To anticipate a change of direction between strokes constant visual attention is essential. With inattention, changes will occur too late, resulting in higher letters and poor alignment of letters on the baseline. The influence of medication on the quality of handwriting is not clear.
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