寫字為語言與知覺動作能力整合之複雜歷程，亦是書寫發展重要的基礎能力。過去研究顯示書寫困難是注意力不足過動症(ADHD)學童在學業活動中經常面臨之問題，然而關於ADHD學童中文寫字相關因子之研究相對較少。本研究旨在探究ADHD伴隨寫字困難學童之寫字相關因子表現與寫字錯誤類型。本研究參與學童包含30名國小低年級ADHD學童和30名與ADHD學童年齡、性別、慣用手配對之典型發展(TD)學童。參與學童接受托尼非語文智力測驗(TONI-4)、修訂畢保德圖畫詞彙測驗(PPVT-R)、字形覺知測驗、布魯茵克斯－歐西瑞斯基動作量表第二版測驗(BOT-2)和基本讀寫字綜合測驗評量，以了解學童之寫字能力與寫字相關因子表現。本研究主要發現為：(1) ADHD伴隨寫字困難學童在讀字能力顯著低於ADHD未伴隨寫字困難學童和TD學童，而精細動作和視動整合能力則顯著低於TD學童；(2) ADHD伴隨寫字困難學童的讀字能力與寫字表現具顯著正相關，而ADHD未伴隨寫字困難學童則是精細動作、視動整合能力與寫字表現具顯著關聯；(3) ADHD伴隨寫字困難學童以字形相似錯誤和字音相似錯誤為常見寫字錯誤類型。針對研究結果本文進行討論並於文末提出結論與建議。

Purpose

Chinese character writing is a complex process involving linguistic and perceptual-motor abilities, and is also an important foundation for writing development. Several longitudinal studies have reported the relationships between early writing skills and later writing development; therefore, early detection of writing problems and identifying correlated factors of character writing play critical roles for children with writing difficulties. Previous studies have revealed that writing difficulties are common challenges faced by children with ADHD in academic activities. However, studies on the correlated factors of Chinese character writing in children with ADHD are relatively scarce. Chinese as a logographic language differs from alphabetic language in phonological and orthographic nature; therefore, more research on Chinese character writing in children with ADHD is needed. This study aimed to investigate the correlated factors and common error types of Chinese character writing in children with ADHD accompanied with writing difficulties. Three specific goals of this study are: (a) to compare the differences among children with ADHD accompanied with writing difficulties, children with ADHD without accompanied with writing difficulties, and typically developing children in the performance of correlated factors of Chinese character writing; (b) to investigate the relationship between correlated factors of Chinese character writing and character writing performance in children with ADHD accompanied with writing difficulties and children with ADHD without accompanied with writing difficulties; and (c) to analyze the error types of Chinese character writing in children with ADHD accompanied with writing difficulties.

Method

Thirty 1st- and 2-graders with ADHD participated in this study, and were paired with 30 normal peers with same age, gender and preferred hand. All participants attended public schools and had normal intelligence development. Thirty children with ADHD were further divided into two groups according to their character writing abilities: ADHD accompanied with writing difficulties (ADHD-D) (n = 9) and ADHD without accompanied with writing difficulties (ADHD-ND) (n = 21). In order to assess their orthographic awareness, fine-motor ability, visual-motor integration, Chinese character reading and writing abilities, all participants in three groups (ADHD-D, ADHD-ND, and TD) received a series of tests: (a) orthographic awareness test, (b) the Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2), and (c) the Battery of Chinese Basic Literacy (BCBL). Statistical analyses were conducted using IBM SPSS 23.0 software. The distribution of data was evaluated using the Kolmogorov-Smirnov test for normality, which showed a non-normal distribution of some of the obtained results. Therefore, the non-parametric tests were used to analyze the data. In order to answer the research questions, the Kruskal-Wallis test was first conducted to test the group differences in the correlated factor measures and error types of Chinese character writing. If there was a statistically significant difference, the Mann-Whitney U test was used for post hoc analysis. The Spearman’s rank correlation coefficient was then used to examine the relationships between correlated factor measures and character writing measures in the ADHD-D group and the ADHD-ND group. Finally, the error types of Chinese character writing in three groups were analyzed, and frequency and percentage of each error type were calculated and reported.

Results

Three major findings were found in this study. First, we compared the differences among three groups in the performance of correlated factors of Chinese character writing, and found that there were significant differences among these three groups. The ADHD-D group scored significantly lower than the ADHD-ND group and the TD group on character reading, and scored significantly lower than the TD group on fine-motor abilities and visual-motor integration. Second, we investigated the relationship between correlated factors measures and character writing in the ADHD-D group and the ADHD-ND group, and found the relationship between correlated factors measures and character writing were different between these two groups. Character reading abilities were statistically positive correlated with character writing in the ADHD-D group, and fine-motor abilities and visual-motor integration were statistically correlated with character writing in the ADHD-ND group. Third, we analyzed the error types of character writing in children in the ADHD-D group, and found the most common error types of character writing in the ADHD-D group were graphemic similar errors and phonetic similar errors.

Discussions and suggestions

This study demonstrated that there were discrepancies in correlated factors of Chinese character writing in children with ADHD with different writing abilities. Among the correlated factors of character writing, character reading abilities of the ADHD-D group were significantly weaker than the ADHD-ND group and the TD group. Character reading abilities were also significantly correlated with character writing performance in the ADHD-D group. The findings of this study suggested a critical relationship between character reading and character writing in children with ADHD accompanied writing difficulties, and evaluation of character reading abilities was needed to be considered for children with ADHD accompanied writing difficulties. Regarding error types of character writing, the results indicated that graphemic similar errors and phonetic similar errors were the most common error types in the ADHD-D group. Previous studies conducted by Adi-Japha et al. (2007) and Lee et al. (2014) demonstrated that children with ADHD made more graphemic buffer errors than their typically developing peers. Adi-Japha et al. (2007) and Lee et al. (2014) considered that attention deficit in children with ADHD might be a factor for the error type. In the present study, graphemic similar errors and phonetic similar errors were also common error types in children with ADHD accompanied writing difficulties, which might reflect the insufficiency of knowledge of grapheme-phoneme-semantic connection and inattention. Although the present study provided important information about correlated factors of Chinese character writing in children with ADHD accompanied writing difficulties, this study still had some limitations. First, some cognitive factors, such as executive function or working memory, were not included in the correlated factors of character writing; however, some researchers proposed that cognition plays an important role in the writing process. Further studies could investigate the relationship between cognitive abilities and character writing to enrich the understanding about relevant factors of Chinese character writing. Second, the sample size was small, which might affect the generalizability of the results. Third, this study was a cross-sectional study, which could not reflect the influence of growth. Therefore. we suggest that future studies could conduct a longitudinal study with larger sample size to aid in acquiring more information about Chinese character writing in children with ADHD.