Primary and secondary writing disorders in children

Handwriting is one of the most complex motor proficiencies and is a main scholastic assignment during childhood. Basic skills are required for penmanship such as viso-spatial coordination on top of cognitive abilities such as planning, organizing and reviewing the written text. Illegible handwriting and increased variability both in time and space are some of the components causing poor penmanship. Children with difficulty in handwriting will write in a slower manner and usually produce excessive pressure on the pen and paper leading to early fatigue. Handwriting difficulties could be divided into two main categories: primary, stemming from developmental disorder, and secondary, due to an acquired neurological disease. Primary handwriting difficulty is by far the most common cause of poor penmanship in children language impairment, fine motor coordination problems, learning disabilities and children with attention deficit and hyperactivity disorder are at risk for developing poor primary penmanship. However, children who present loss of handwriting skills may be the presenting symptom of an acquired neurologic disorder. Meticulous background surveys and detailed physical and neurological examination are essential for revealing other underlying motor and non-motor manifestations of the acquired disease. Secondary handwriting difficulty necessitates additional tests and imaging for movement disorders, inflammatory disease, vascular and neurodegenerative diseases according to the clinical presentation. This review presents cases of acquired pediatric handwriting disorders and discussions in recent literature regarding developmental and acquired handwriting difficulties in childhood.