Visual–Motor Integration and Handwriting Performance among Children with Down Syndrome Aged 6–12 Years: A Cross-Sectional Study

Trisna Permana Putra

Authors

Trisna Permana Putra Universitas Indonesia Author

Keywords:

Down syndrome, visual-motor integration, handwriting skills, occupational therapy, Beery VMI

Abstract

Background: Handwriting is a fundamental school-related occupation that requires the integration of visual perception, motor coordination, motor planning, and cognitive processing. Children with Down syndrome commonly experience impairments in visual-motor integration (VMI) and handwriting performance due to neurodevelopmental deficits affecting sensory-motor processing. This study aimed to determine the relationship between visual-motor integration and handwriting skills among children with Down syndrome aged 6–12 years.

Methods: A quantitative correlational study with a cross-sectional design was conducted involving 47 children with Down syndrome aged 6–12 years. Participants were selected using purposive sampling. Visual-motor integration was assessed using the Beery-Buktenica Developmental Test of Visual-Motor Integration Sixth Edition (Beery VMI), while handwriting performance was measured using the Test of Handwriting Skills-Revised (THS-R). Descriptive statistics were used to summarize participant characteristics and study variables. Spearman rank correlation analysis was performed to examine the relationship between VMI and handwriting skills.

Results: The mean Beery VMI score was 49.89 ± 6.89, indicating very low visual-motor integration performance. The mean THS-R score was 56.32 ± 3.31. All participants demonstrated handwriting performance below age expectations. Spearman correlation analysis revealed a strong positive relationship between visual-motor integration and handwriting skills (r = 0.717, p < 0.001). Approximately 51.4% of the variance in handwriting performance could be explained by visual-motor integration ability.

Conclusion: Visual-motor integration is strongly associated with handwriting performance among children with Down syndrome. Occupational therapy interventions should therefore address underlying visual-motor integration processes in addition to handwriting-specific training to improve academic participation and occupational performance.

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