**5. Ahead**

42 Learning Disabilities

parents had negative thoughts during taking care of children with dyslexia, more than 40% had insomnia and depression, and as high as 30% needed to receive professional counseling. Worse still, these psychological issues did not get proper and prompt attention. As for financial aspect, additional expenses are inevitably required for caring children with dyslexia. The same study showed that 80% of families needed to spend extra money for the study skills workshops, tutorial groups, and occupational therapy and/or physiotherapy interventions. The average extra money spent per month ranged from HK \$1001 to \$2000. Families with children with dyslexia are not entitled to receive any financial subsidies from government or EDB. While the New Funding Model grant launched in primary schools adopts a whole-school approach to create a supportive learning environment for dyslexic students (such as special teaching, and accommodations in classes, school examinations and public examinations), no assurance system is developed for measuring the extent that the students can benefit from it such as improvement in academic performance or personal confidence and motivation. Alarmingly, only 13.7% of parents realized that their children were receiving support under the Model. Worse still, as many as 40% of the parents did not find the support useful or simply knew nothing about such school subsidy. Due to such unclear intervention and insufficient communication between schools and parents, parents have to try to seek other sources of support in which community is a choice. In view of this great demand, NGOs and private centers are offering more and more services such as assessment, learning or studying skills tutorials, emotional management programs, self-confidence development programs, potential development programs, and multi-sensory training etc. The trainers are merely social workers and other non-professionals, and the targets are primary school students only but

Unfortunately, the services offered by NGOs are not satisfactory. Despite the fact that only half of the respondents were aware of the services offered by the nearby NGOs, half among those who knew the services refused to use the services due to bad outcomes and poor

There are other drawbacks in current services including but not limited to the followings:

• immaturity of the service models and broken policies in education, medical and

• ineffective and inconsistent support from schools (without good system for monitoring the allocation of the resources to warrant an equal opportunity learning environment for all students with special needs leading to conflicts between schools

Hence, there is a very urgent need to formulate and strictly enforce good school policy. The continuum of support should be made possible where services have to be ranged from preschools, primary schools, secondary schools, vocational training institutes, universities to employment markets. Evidence-based teaching methods and materials for Chinese students with dyslexia would enhance the effectiveness and cost-effectiveness of the interventions. Updated and advanced training has to be provided to the personnel engaged including principals, teachers, educational psychologists, clinical psychologists, occupational

• limitations in the identification tools and teaching materials in Chinese • narrow support to the education system (confining to primary schools)

not including those senior ones.

quality of the trainers.

employment

and parents)

Having gaining the experiences over the past two decades, evidence-based practice is regarded as an important direction for the future development of dyslexic services.

## **5.1 Writing Chinese and English words**

Each written language has its unique characteristics and format according to its origin and development. Alphabetic languages emphasize on smoothness and continuity in their written forms, whereas Chinese characters contain sharp turns of stroke and demand frequent pen lifts (Tseng, 1998). As mentioned earlier, the problem of handwriting would appear to be more critical as Chinese characters are typically characterized by its logographic nature and its complexity with multiple stroke sequence and directions (Lam et al, 2011). The configuration of stroke patterns in Chinese characters do not give any clue in where to start and which stroke to follow while writing a character. Writing in Chinese also involves complex geometric figuration and stroke arrangement within a squared-area. Different composition, proportion and orientation of the parts in Chinese characters can form different characters and carry total different meanings and pronunciation. Therefore, research should focus on evaluation and training of students with dyslexia in writing Chinese characters.

#### **5.2 Objective evaluation of handwriting performance**

In the past decade, educators and health professionals often relied on subjective judgment to comment and assess handwriting performance of students. Some researchers and educators tried to evaluate handwriting performance of students using speed and accuracy as the criteria to define good and bad writing (Tseng & Chow, 2000; Tseng & Hsueh, 1997). Most of these handwriting assessments mainly emphasized on the handwriting speed. They could not provide information regarding the process including pen pressure while writing, writing time, pause time (air time) etc. These factors could reflect the underlying problems of handwriting (Rosenblum et al., 2006a; Rosenblum, et al., 2006b). Researchers in recent years also suggested that the process of handwriting is also an important area to explore the underlying problems in handwriting, which can be helpful in identifying specific handwriting difficulties (Rosenblum et al., 2003).

A commercial software system "Optimized Action Sequence Interpreter System (OASIS)" was developed to measure the handwriting speed, pen in air and ground time using the tablet (Smits-Engelsman, et al., 2003). However, this system is rather cumbersome and not user friendly. Another software, the Penmanship Objective Evaluation Tool (POET) was developed by Rosenblum and her team in Israel. The POET can be used to capture the data generated from the WACOM tablet to assess the writing speed, ground time, pen in air time, and pen pressure during the process of writing. Nevertheless, the POET software was not commercially available and only meant for conducting research studies in this area because the system adopted the Mathlab software. There is a strong need to validate an objective and

Dyslexia in Hong Kong: Challenges and Opportunities 45

Results indicated that children with dyslexia wrote significantly slower, with greater character size and variation in size (p < .05) than the typical children of same age group. They also wrote with significantly lower accuracy (p < .05), i.e. they made more mistakes in writing. Commonly observed writing errors among the dyslexic group were "missing strokes" meaning missing one or more strokes in one word and "concatenated strokes"

From the discriminant analysis, writing speed and accuracy were found to be the satisfactory discriminators that could discriminate students with dyslexic, with reasonably good classification accuracy of over 70% for every grade. Those students with poor handwriting abilities also had problems of fine motor skills, kinesthetic abilities, visual

Another study was conducted to evaluate the effectiveness of an Interactive Computerized Handwriting Training Programme (ICHTP) on the handwriting performance of the students with handwriting difficulties. The ICHTP was first developed in 2004 through the support of the QEF. It consists of 3 parts for training, namely, training of visual perception, training

A total of 139 students (P1 to P6) with special education need or screened to have handwriting problems by CHAT was recruited to join the ICHTP. They received a series of 8 sessions of training together with the pre-intervention session and the post-intervention

Among the measurements for handwriting performance, handwriting speed was significantly improved after the training for the training group. Significant decrease in average pen pressure was also noted in both groups of management. However, no significant improvement was found in the measures of time ratio, accuracy, character size variation and number of characters exceeding grid. This indicated that children displayed a better force modulation so that they could be less prone to fatigue in handwriting. Visual perceptual and ocular motor skills also showed improvement after training and these are some of the important abilities in recognizing and perceiving word structure. In addition, the training program appeared to improve the ocular motor skills, which also helped in

**5.6 Provision of special examination arrangements for students with dyslexia** 

As mentioned earlier, all Secondary Seven students have to get high grades in HKALE in order to enter universities. The competition is huge and only 15% of the candidates can get the university quota for studies. For students with dyslexia, they would be granted with extra time allowance if they have diagnosis of the dyslexia by educational psychologist. However, to them, by adding extra time to complete the test may not solve their problem of reading and writing for the examination. They may make a lot of mistakes while writing, or

Therefore, a study was conducted to identify factors that might contribute to the handwriting performance of students with dyslexia. Some of the factors which could affect

**5.5 Training of dyslexic students with specific handwriting difficulties** 

assessment under the supervision of a qualified occupational therapist.

of visual motor integration and training of controlled grip.

reducing chance of skipping the lines and words.

they may have very slow handwriting speed.

meaning two strokes were joined together.

perceptual skills and ocular motor control.

user friendly handwriting evaluation tool for local students who write Chinese most of the time.

#### **5.3 Validation of Chinese Handwriting Assessment Tool (CHAT)**

Recently, the Chinese Handwriting Assessment Tool (CHAT) was developed by a group of researchers from two local universities in Hong Kong led by Li-Tsang (2011). The CHAT was built up to assess the handwriting performance of primary school children in Hong Kong. A total of 322 primary school students were invited to participate in the pilot study of CHAT project. It showed that the CHAT is a reliable and valid tool for assessment of the Chinese handwriting performance of young students.

The research team was further funded by the Quality Education Fund (QEF), Hong Kong Special Administrative Region to support a project to build up the local norm for primary school students in Hong Kong. The objectives of this project were to (1) develop an objective CHAT for assessing handwriting performance and collect the normative data of local Chinese children aged between 6-10 years; (2) screen and assess the handwriting performance and performance components of children with handwriting difficulties using the CHAT system; (3) identify specific deficits of children in the areas of phonological and morphological function, visual motor function, visual perceptual function and sensorymotor function, using standardized assessments; and (4) transfer the training program to teachers and parents if proven effective.

A total of 1136 primary school students were recruited using stratified sampling methods. Six schools were selected from the list of primary schools downloaded from the website of the EDB. In each school, one class (around 30 students in each class) from each grade (Grade 1 to Grade 6) was selected to join the study. Upon the consent of parents/guardians, the students were invited to join the assessment. There were 642 boys (56.5%) and 494 girls (43.5%). The age of the participants varied from 6.06 to 14.20 years. Between Grade 1 and Grade 6, the distribution of subjects was quite even, with a variation of 15.3% to 19.7% of the sample. Handwriting speed, total handwriting time, ground time, air time, mean pen pressure, standard deviation of pen pressure in copying, size of characters and its variation were recorded for each student during the data collection. Results indicated that P6 students wrote faster than P1 students. There was a steady progression of handwriting speed from P1 to P6. No gender difference was found in terms of the handwriting performance. The normative data was subsequently obtained for students studying from P1 to P6 level. The normative data was then published in the CHAT: Process Tool User Manual (Li-Tsang, 2011).

#### **5.4 Handwriting performance of primary school students with and without dyslexia**

A recent study was conducted to investigate the Chinese handwriting performance of typical children and children with dyslexia in Hong Kong primary school, and to examine whether speed and accuracy of handwriting could reliably discriminate these two groups of children. A total of 137 children with dyslexia and 756 typical children were recruited from main stream primary schools. They were requested to copy 90 Chinese characters using the CHAT. The process of handwriting was recorded and the stroke errors in writing were analyzed using the CHAT system (Lam et.al, 2011)

user friendly handwriting evaluation tool for local students who write Chinese most of the

Recently, the Chinese Handwriting Assessment Tool (CHAT) was developed by a group of researchers from two local universities in Hong Kong led by Li-Tsang (2011). The CHAT was built up to assess the handwriting performance of primary school children in Hong Kong. A total of 322 primary school students were invited to participate in the pilot study of CHAT project. It showed that the CHAT is a reliable and valid tool for assessment of the

The research team was further funded by the Quality Education Fund (QEF), Hong Kong Special Administrative Region to support a project to build up the local norm for primary school students in Hong Kong. The objectives of this project were to (1) develop an objective CHAT for assessing handwriting performance and collect the normative data of local Chinese children aged between 6-10 years; (2) screen and assess the handwriting performance and performance components of children with handwriting difficulties using the CHAT system; (3) identify specific deficits of children in the areas of phonological and morphological function, visual motor function, visual perceptual function and sensorymotor function, using standardized assessments; and (4) transfer the training program to

A total of 1136 primary school students were recruited using stratified sampling methods. Six schools were selected from the list of primary schools downloaded from the website of the EDB. In each school, one class (around 30 students in each class) from each grade (Grade 1 to Grade 6) was selected to join the study. Upon the consent of parents/guardians, the students were invited to join the assessment. There were 642 boys (56.5%) and 494 girls (43.5%). The age of the participants varied from 6.06 to 14.20 years. Between Grade 1 and Grade 6, the distribution of subjects was quite even, with a variation of 15.3% to 19.7% of the sample. Handwriting speed, total handwriting time, ground time, air time, mean pen pressure, standard deviation of pen pressure in copying, size of characters and its variation were recorded for each student during the data collection. Results indicated that P6 students wrote faster than P1 students. There was a steady progression of handwriting speed from P1 to P6. No gender difference was found in terms of the handwriting performance. The normative data was subsequently obtained for students studying from P1 to P6 level. The normative data was then published in the CHAT: Process Tool User Manual (Li-Tsang, 2011).

**5.4 Handwriting performance of primary school students with and without dyslexia**  A recent study was conducted to investigate the Chinese handwriting performance of typical children and children with dyslexia in Hong Kong primary school, and to examine whether speed and accuracy of handwriting could reliably discriminate these two groups of children. A total of 137 children with dyslexia and 756 typical children were recruited from main stream primary schools. They were requested to copy 90 Chinese characters using the CHAT. The process of handwriting was recorded and the stroke errors in writing were

**5.3 Validation of Chinese Handwriting Assessment Tool (CHAT)** 

Chinese handwriting performance of young students.

teachers and parents if proven effective.

analyzed using the CHAT system (Lam et.al, 2011)

time.

Results indicated that children with dyslexia wrote significantly slower, with greater character size and variation in size (p < .05) than the typical children of same age group. They also wrote with significantly lower accuracy (p < .05), i.e. they made more mistakes in writing. Commonly observed writing errors among the dyslexic group were "missing strokes" meaning missing one or more strokes in one word and "concatenated strokes" meaning two strokes were joined together.

From the discriminant analysis, writing speed and accuracy were found to be the satisfactory discriminators that could discriminate students with dyslexic, with reasonably good classification accuracy of over 70% for every grade. Those students with poor handwriting abilities also had problems of fine motor skills, kinesthetic abilities, visual perceptual skills and ocular motor control.

#### **5.5 Training of dyslexic students with specific handwriting difficulties**

Another study was conducted to evaluate the effectiveness of an Interactive Computerized Handwriting Training Programme (ICHTP) on the handwriting performance of the students with handwriting difficulties. The ICHTP was first developed in 2004 through the support of the QEF. It consists of 3 parts for training, namely, training of visual perception, training of visual motor integration and training of controlled grip.

A total of 139 students (P1 to P6) with special education need or screened to have handwriting problems by CHAT was recruited to join the ICHTP. They received a series of 8 sessions of training together with the pre-intervention session and the post-intervention assessment under the supervision of a qualified occupational therapist.

Among the measurements for handwriting performance, handwriting speed was significantly improved after the training for the training group. Significant decrease in average pen pressure was also noted in both groups of management. However, no significant improvement was found in the measures of time ratio, accuracy, character size variation and number of characters exceeding grid. This indicated that children displayed a better force modulation so that they could be less prone to fatigue in handwriting. Visual perceptual and ocular motor skills also showed improvement after training and these are some of the important abilities in recognizing and perceiving word structure. In addition, the training program appeared to improve the ocular motor skills, which also helped in reducing chance of skipping the lines and words.

#### **5.6 Provision of special examination arrangements for students with dyslexia**

As mentioned earlier, all Secondary Seven students have to get high grades in HKALE in order to enter universities. The competition is huge and only 15% of the candidates can get the university quota for studies. For students with dyslexia, they would be granted with extra time allowance if they have diagnosis of the dyslexia by educational psychologist. However, to them, by adding extra time to complete the test may not solve their problem of reading and writing for the examination. They may make a lot of mistakes while writing, or they may have very slow handwriting speed.

Therefore, a study was conducted to identify factors that might contribute to the handwriting performance of students with dyslexia. Some of the factors which could affect

Dyslexia in Hong Kong: Challenges and Opportunities 47

Berninger, V., Mizokawa, D., & Bragg, R. (1991). Theory-based diagnosis and remediation of

Campbell, D. D. (1973). Typewriting contrasted with handwriting: A circumvention study of learning disabled children. Journal of Special Education, 7(2), 155–168. Department of Social Work and Social Administration (2005). Towards Building an

Harris, S. J., & Livesey, D. J. (1992). Improving handwriting through kinaesthetic sensitivity

Hong Kong Christian Service (2005). The First Teachers' Survey on the Problems of Students

Hong Kong Department of Health (2011). Child assessment service. Retrieved on September

Ip, B. (2010). Educating children with dyslexia: What we have achieved together in the past

Koziatek, S. M., & Powell, N. J. (2003). Pencil grips, legibility, and speed of fourth-graders' writing in cursive. American Journal of Occupational Therapy, 57(3), 284-288. Lam, S.S.T., Au, R.K.C., Leung, H.W.H., Li-Tsang, C.W.P. (2011). Chinese handwriting

Li-Tsang, C.W.P. (2011). QEF Report for the Project "A Chinese handwriting Assessment

Lockhart, J., & Law, M. (1994). The effectiveness of a multisensory writing programme for

Ngan-Keung, I.W.L. (2008). Public awareness, community services and parent support.

Office of The Ombudsman (2008). Direct Investigation on Special Examination

Oliver, C. E. (1990). A sensorimotor program for improving writing readiness skills in elementary-age children. American Journal of Occupational Therapy, 44, 111–116. Rogers, J., & Case-Smith, J. (2002). Relationships between handwriting and keyboard

Rosenblum, S., Chevion, D., Weiss, P. L. T. (2006a). Using data visualization and signal

Rosenblum, S., Dvorkin, A. Y., Weiss, P. L. T. (2006b). Automatic segmentation as a tool for

Educational and Assessment Accommodation Service Model for Children with Specific Learning Disabilities (SLD) and Their Families. Hong Kong: The University

with Dyslexia in Hong Kong. Hong Kong: Hong Kong Christian Service School

performance of primary school children with dyslexia. Research in Developmental

Tool (CHAT) for Assessing & Evaluating Handwriting Performance of Primary

improving cursive writing ability in children with sensorimotor difficulties.

Arrangements for Students with Specific Learning Difficulties. Hong Kong: Office

perforamcen of sixth-grade students. The American Journal of OCcupationl

processing to characterize the handwriting process. Pediatric Rehabilitation, 9, 404–

examining the handwriting process of children with dysgraphic and proficient

writing disabilities. Journal of School Psychology, 29, 57–79.

practice. Australian Occupational Therapy Journal, 39, 23–27.

ten years. Hong Kong Journal of Paediatrics, 15, 285-288.

Canadian Journal of Occupational Therapy, 61, 206–214.

handwriting. Human Movement Science, 25, 608–621.

Hong Kong Journal of Paediatrics, 13, 213-217.

**8. References** 

of Hong Kong.

Social Work Service.

Disabilities 32: 1745-1756.

of The Ombudsman.

Therapy, 56(1), 34-39.

417.

School Children in Hong Kong".

15, 2011: http://www.dhcas.gov.hk

the handwriting performance, namely gender, grades, types of subjects selected, were also analyzed. Fifty participants (age range: 15–19-years-old) were recruited from one mainstream secondary school and 20 participants (age range: 17–24-years-old) were recruited from two secondary schools for students with dyslexia. They were asked to perform three consecutive handwriting tasks: copying 90 characters using the computerized CHAT, an English passage copying task, and a Chinese passage copying task. The data indicated that students with dyslexia were significantly slower in copying both Chinese and English characters in passages when compared to the typical students.

Significant differences in the measures of writing speed, air/ground time ratio, standard deviation of speed, standard deviation of size per character, and number of stroke errors measured by the CHAT were found between the two groups of students. Further analysis on the data of typical students indicated no significant difference in handwriting speed among students from different classes (i.e. arts or science) on copying Chinese and English passages, and on individual Chinese words (from CHAT). It was interesting to note that no significant correlation was found in their handwriting speed measured by the three writing tasks, i.e. Chinese, English and individual words.

In short, the CHAT is found to be a valid and reliable tool for assessment and documentation. Local normative data has been collected from 1136 students. In addition, the CHAT can be used to identify students who are at risk of handwriting difficulties, particularly for students with dyslexia. With the normative data for comparison, those students with specific handwriting difficulties can be identified and screened at a much earlier stage when they enter the primary education system. Once a student is identified with handwriting challenge, suitable therapeutic and training program can help to enhance their handwriting skills such that they can better cope with the academic work at schools. Through the systematic training on visual perception, visual motor integration and force modulation, students' handwriting abilities can be improved.

The CHAT should further be developed into an objective evaluation tool to explore the handwriting accuracy such that most of the errors can be identified and corrected through professional training or specific intervention by therapists. The results can also help to provide more objective evidence to make recommendations for making special examination arrangements for students with dyslexia or other special needs.
