title: Graphomotor skills in children with prenatal alcohol exposure and fetal alcohol spectrum disorder: A population-based study in remote Australia.
abstract: OBJECTIVE
  Few studies have examined graphomotor skills in children with prenatal alcohol exposure (PAE) or fetal alcohol spectrum disorder (FASD).
  
  
  METHODS
  Graphomotor skills were assessed in 108 predominantly Australian Aboriginal children aged 7.5-9.6 years in remote Western Australia using clinical observations (pencil grasp; writing pressure) and standardised assessment tools (the Evaluation Tool of Children's Handwriting; and the Miller Function and Participation Scales - The Draw-a-Kid Game). Skills were compared between children (i) without PAE, (ii) PAE but not FASD and (iii) FASD.
  
  
  RESULTS
  Most children used a transitional pencil grasp and exerted heavy handwriting pressure (83.3% and 30.6% of the cohort). The percentage of letters (M = 62.9%) and words (M = 73.3%) written legibly was low. Children with FASD were more likely than children without PAE to use a cross-thumb grasp (P = 0.027), apply heavy writing pressure (P = 0.036), be unable to write a sentence (P = 0.041) and show poorer word legibility (P = 0.041). There were no significant differences between groups for drawing outcomes, although some children with FASD drew pictures that appeared delayed for their age. There were no significant differences between children without PAE and those with PAE but who were not diagnosed with FASD.
  
  
  CONCLUSIONS
  Overall, graphomotor skills were poor in this cohort, but children with FASD performed significantly worse than children without PAE. Findings suggest the need for improved occupational therapy services for children in remote regions and evaluation of graphomotor skills in children with PAE.
authors.affiliation: School of Public Health, Curtin University, Perth, Western Australia, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Doney
authors.affiliation: Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|Poche Centre for Indigenous Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|Physiotherapy Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Barbara R
authors.initials: BR
authors.lastname: Lucas
authors.affiliation: University of Washington, Seattle, Washington, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Jirikowic
authors.affiliation: Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Tracey W
authors.initials: TW
authors.lastname: Tsang
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Rochelle E
authors.initials: RE
authors.lastname: Watkins
authors.affiliation: School of Public Health, Curtin University, Perth, Western Australia, Australia.|Centre for Behavioural Research in Cancer Control, Curtin University, Perth, Western Australia, Australia.
authors.forename: Kay
authors.initials: K
authors.lastname: Sauer
authors.affiliation: School of Public Health, Curtin University, Perth, Western Australia, Australia.|Centre for Behavioural Research in Cancer Control, Curtin University, Perth, Western Australia, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Howat
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Latimer
authors.affiliation: Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: James P
authors.initials: JP
authors.lastname: Fitzpatrick
authors.affiliation: Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia.|University of Notre Dame, Broome, Western Australia, Australia.
authors.forename: June
authors.initials: J
authors.lastname: Oscar
authors.affiliation: Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia.
authors.forename: Maureen
authors.initials: M
authors.lastname: Carter
authors.affiliation: Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|The Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Elliott
mesh_terms: D002648:Child; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000208:ethnology / Q000503:physiopathology*; D006236:Handwriting; D006801:Humans; D009048:Motor Skills / Q000502:physiology*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000208:ethnology / Q000503:physiopathology*; D014904:Western Australia / Q000453:epidemiology
keywords: fetal alcohol spectrum disorder; handwriting; indigenous population; motor skill; psychomotor performance