Enhancing Handwriting Performance in Autistic Children: A Randomized Crossover Study on the Effectiveness of a Spatial-Structured Handwriting Intervention Program.

Handwriting is an essential skill for school-aged children. Research indicates that autistic children often demonstrate poor handwriting fundamentals, which significantly affect their handwriting performance. These children also often exhibit weak central coherence (WCC), a cognitive visual processing characteristic that impairs their ability to integrate details into a cohesive whole in writing tasks. This challenge is particularly pronounced in logographic handwriting, where spatial relationships between radicals are essential for legibility, adding another layer of complexity. The modified geometric-based handwriting intervention program was designed to improve fundamental skills while addressing the spatial demands of logographic characters and the impact of WCC for autistic children. Twenty-two first- and second-grade autistic students were recruited and received a 12-h one-on-one handwriting intervention. Assessments of handwriting performance (legibility and speed), fundamental skills (visual perception, fine motor coordination, and visual-motor integration), and acceptability (motivation and satisfaction) were collected for data analysis. Results showed significant improvements in handwriting legibility, visual perception, and fine motor coordination, with high acceptance ratings from both participants and caregivers. This study provides evidence that the program effectively enhances handwriting legibility and foundational skills while maintaining high motivation levels in autistic children.