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The relationship between visual—motor integration and handwriting skills in Arabic-speaking Egyptian children at the age of 4–6 years



Handwriting is a complex perceptual-motor skill that is dependent on the maturation and integration of a number of cognitive, perceptual, and motor skills.


To examine the relationship between visual–motor skills and handwriting skills (HS) in Arabic-speaking Egyptian children at the age of 4–6 years.

Patients and methods

Overall, 200 typically developing kindergarten and primary school Arabic-speaking children, in the age range of 4–6 years, were tested using a constructed battery for assessment of both visual–motor integration (VMI) and HS.

Results and conclusion

Performance on both VMI and HS tasks improved with age. Moreover, the older the child was, the lesser the duration for completion of the tasks. Copying lines was found to be the best predictor of copying letters, copying words, and copying numbers. Reliability and validity of the designed VMI and HS assessment battery proved to be excellent. VMI is an important prerequisite for Arabic HS.


  1. 1

    Hamstra-Bletz L, Blote AW. A longitudinal study on dysgraphic handwriting in primary school. J Learn Disabil 1993; 26:689–699.

    Article  CAS  Google Scholar 

  2. 2

    Beery KE. The Beery-Buktenica developmental test of visual-motor integration: VMI with supplemental developmental tests of visual perception and motor coordination: administration, scoring and teaching manual. Parsippany, NJ: Modern Curriculum Press 1997.

    Google Scholar 

  3. 3

    Beery KE, Buktenica NA, Beery NA. The Beery-Buktenica developmental test of visual–motor integration. 3rd ed. Cleveland, OH: Modern Curriculum Press; 1989.

    Google Scholar 

  4. 4

    Beery KE. The developmental test of visual–motor integration. 3rd ed. Cleveland, OH: Modern Curriculum Press; 1989.

    Google Scholar 

  5. 5

    Johnson RA, Blair RJ, Zaba J. The visual screening of title I reading students. J Behav Optom 2000; 11:3–6.

    Google Scholar 

  6. 6

    Weil MJ, Amundson SJ. Relationship between visuomotor and handwriting skills of children in kindergarten. Am J Occup Ther 1994; 48:982–988.

    Article  CAS  Google Scholar 

  7. 7

    Choo CM. Prehandwriting activities for young children: early childhood. USA: Academic Therapy Publications; 2009. pp. 156–170.

    Google Scholar 

  8. 8

    Marr D, Cermak S. Consistency of handwriting development in early elementary years: a literature review. Isr J Occup Ther 2001; 10:109–129.

    Google Scholar 

  9. 9

    Graham S, Weintraub N, Berninger VW. The relationship between handwriting style and speed and legibility. J Educ Res 1998; 91:290–297.

    Article  Google Scholar 

  10. 10

    Smits-Engelsman BC, Niemeijer AS, van Galen GP. Fine motor deficiencies in children diagnosed as DCD based on poor grapho-motor ability. Hum Mov Sci 2001; 20:161–182.

    Article  CAS  Google Scholar 

  11. 11

    Overvelde A, Hulstijn W. Handwriting development in grade 2 and grade 3 primary school children with normal, at risk, or dysgraphic characteristics. Res Dev Disabil 2011; 32:540–548.

    Article  Google Scholar 

  12. 12

    Abu-Rabia S, Taha H. Reading and spelling error analysis of native Arabic dyslexic readers. Read Writ 2004; 17:651–689.

    Article  Google Scholar 

  13. 13

    Ramadan M. Preventative program to early diagnosis and remediation of dyslexic pupils in primary school in Egypt. Unpublished PhD thesis, Bani-Seuf University (Egypt) 2009.

  14. 14

    Abu-Rabia S, Sammour R. Spelling errors analysis of regular and dyslexic bilingual Arabic-English students Open J Mod Linguist 2012; 3:58–68.

  15. 15

    Mirdehghan M. Persian, Urdu, and Pashto: a comparative orthographic analysis. Writing Systems Research 2010; 2:9–23.

    Article  Google Scholar 

  16. 16

    Daly CJ, Kelley GT, Krauss A. Relationship between visual-motor integration and handwriting skills of children in kindergarten: a modified replication study. Am J Occup Ther 2003; 57:459–462.

    Article  Google Scholar 

  17. 17

    Beery KE, Buktenica NA, Beery NA. Beery-Buktenica developmental test of visual-motor integration. 6th ed. San Antonio, TX: Pearson; 2010.

    Google Scholar 

  18. 18

    Beery KE, Buktenica NA. Developmental test for visual motor integration. New Jersey: Modern Curriculum Press; 1997.

    Google Scholar 

  19. 19

    Van der Zee F. Occupational therapy report and discussion. Visual integration skills. Available at: [Accessed 4 July 2010].

  20. 20

    Will EJ. An introduction to forensic document examination instrumentation: the college of microscopy. Instructional course at the college of microscopy. Westmont, IL; 2001.

    Google Scholar 

  21. 21

    Reynolds CR, Pearson NA. Developmental test of visual perception: adolescent and adult. Austin, TX: PRO-ED Inc.; 2002.

    Google Scholar 

  22. 22

    Klein S, Guiltner V, Sollereder P, Cui Y. Relationships between fine-motor, visual-motor, and visual perception scores and handwriting legibility and speed. Phys Occup Ther Pediatr 2011; 31:103–114.

    Article  Google Scholar 

  23. 23

    Ritchey K. The building blocks of writing: learning to write letters and spell words. Read Writ 2008; 21:27–47.

    Article  Google Scholar 

  24. 24

    Asher A. Handwriting instruction in elementary schools. Am J Occup Ther 2006; 60:461–471.

    Article  Google Scholar 

  25. 25

    Lindsay G, McLennan D. Lined paper: Its effects on the legibility and creativity of young children’s writing. Br J Educ Psychol 1983; 53:364–368.

    Article  Google Scholar 

  26. 26

    Ziviani J. Qualitative changes in dynamic tripod grip between seven and fourteen years of age. Dev Med Child Neurol 1983; 25:778–782.

    Article  CAS  Google Scholar 

  27. 27

    Karlsdottir R, Stefansson T. Problems in developing functional handwriting. Percept Mot Skills 2002; 94:623–662.

    Article  Google Scholar 

  28. 28

    Hill S. Developing early literacy: in assessment and teaching. 2nd ed. Parhan, Victoria, Australia: Eleanor Curtain Publishing; 2006. pp. 414–425.

    Google Scholar 

  29. 29

    Benbow M. Sensory and motor measurements of dynamic tripod skill. Boston: University, Boston; 1987.

    Google Scholar 

  30. 30

    Schneck CM, Henderson A. Descriptive analysis of the developmental progression of grip position for pencil and crayon control in non-dysfunctional children. Am J Occup Ther 1990; 44:893–900.

    Article  CAS  Google Scholar 

  31. 31

    Dennis JL, Swinth Y. Pencil grasp and children’s handwriting legibility during different-length writing tasks. Am J Occup Ther 2001; 55:175–183.

    Article  CAS  Google Scholar 

  32. 32

    Graham S, Harris KR, Mason L, Fink-Chorzempa B, Moran S, Saddler B. How do primary grade teachers teach handwriting? A national survey. Read Writ 2008; 21:49–69.

    Article  Google Scholar 

  33. 33

    Oliver C. A sensori-motor program for improving writing readiness skills in elementary-age children. Am J Occup Ther 1990; 44:111–116.

    Article  CAS  Google Scholar 

  34. 34

    Benbow M, Hanft B, Marsh D, Royeen CB. Handwriting in the classroom: improving written communication. Bethesda, MD: American Occupational Therapy Association; 1992. pp. 5–60.

    Google Scholar 

  35. 35

    Søvik N. Developmental cybernetics of handwriting and graphic behavior. Norwage: Oslo University; 1975.

    Google Scholar 

  36. 36

    Cornhill H, Case-Smith J. Factors that relate to good and poor handwriting. Am J Occup Ther 1996; 50:732–739.

    Article  CAS  Google Scholar 

  37. 37

    Volman MJM, Van Schendel B, Jongmans MJ. Handwriting difficulties in primary school children: A search for underlying mechanisms. Am J Occup Ther 2006; 60:451–460.

    Article  CAS  Google Scholar 

  38. 38

    Feder KP, Majnemer A. Handwriting development, competency, and intervention. Dev Med Child Neurol 2007; 49:312–317.

    Article  Google Scholar 

  39. 39

    Goyen TA, Duff S. Discriminant validity of the developmental test of visual-motor integration in relation to children with handwriting dysfunction. Aust Occup Ther J 2005; 52:109–115.

    Article  Google Scholar 

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Correspondence to Tamer Abou-El-Saad.

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Abou-El-Saad, T., Afsah, O., Baz, H. et al. The relationship between visual—motor integration and handwriting skills in Arabic-speaking Egyptian children at the age of 4–6 years. Egypt J Otolaryngol 33, 663–669 (2017).

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  • Arabic language
  • handwriting skills
  • learning disability
  • visual–motor integration