title: Underlying mechanisms of writing difficulties among children with neurofibromatosis type 1.
abstract: Writing is a complex activity in which lower-level perceptual-motor processes and higher-level cognitive processes continuously interact. Preliminary evidence suggests that writing difficulties are common to children with Neurofibromatosis type 1 (NF1). The aim of this study was to compare the performance of children with and without NF1 in lower (visual perception, motor coordination and visual-motor integration) and higher processes (verbal and performance intelligence, visual spatial organization and visual memory) required for intact writing; and to identify the components that predict the written product's spatial arrangement and content among children with NF1. Thirty children with NF1 (ages 8-16) and 30 typically developing children matched by gender and age were tested, using standardized assessments. Children with NF1 had a significantly inferior performance in comparison to control children, on all tests that measured lower and higher level processes. The cognitive planning skill was found as a predictor of the written product's spatial arrangement. The verbal intelligence predicted the written content level. Results suggest that high level processes underlie the poor quality of writing product in children with NF1. Treatment approaches for children with NF1 must include detailed assessments of cognitive planning and language skills.
authors.affiliation: Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 31905, Israel. Electronic address: yafitlaytman@yahoo.com.
authors.forename: Yafit
authors.initials: Y
authors.lastname: Gilboa
authors.affiliation: Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 31905, Israel. Electronic address: naomij@research.haifa.ac.il.
authors.forename: Naomi
authors.initials: N
authors.lastname: Josman
authors.affiliation: Pediatric Neurology Unit and the Gilbert Israeli Neurofibromatosis Center (GINFC), Dana Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel. Electronic address: afatal@post.tau.ac.il.
authors.forename: Aviva
authors.initials: A
authors.lastname: Fattal-Valevski
authors.affiliation: Pediatric Neurology Unit and the Gilbert Israeli Neurofibromatosis Center (GINFC), Dana Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel. Electronic address: drtoledano@gmail.com.
authors.forename: Hagit
authors.initials: H
authors.lastname: Toledano-Alhadef
authors.affiliation: Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 31905, Israel. Electronic address: rosens@univ.haifa.ac.il.
authors.forename: Sara
authors.initials: S
authors.lastname: Rosenblum
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006236:Handwriting; D006801:Humans; D007360:Intelligence; D008297:Male; D008568:Memory / Q000502:physiology; D009048:Motor Skills / Q000502:physiology; D019957:Motor Skills Disorders / Q000503:physiopathology* / Q000523:psychology; D009456:Neurofibromatosis 1 / Q000503:physiopathology* / Q000523:psychology; D009483:Neuropsychological Tests; D011597:Psychomotor Performance; D014796:Visual Perception / Q000502:physiology*
keywords: Cognitive planning; Language skills; Neurofibromatosis type 1; Underling mechanisms; Writing