Developing a nomogram model to predict the risk of poor Chinese handwriting in first grade

Importance: Few predictive models for later handwriting difficulties have been developed for kindergarteners. Objective: To develop a nomogram for the purpose of detecting the risk of later poor Chinese handwriting among Taiwanese kindergarteners. Design: One-year prospective longitudinal, observational study. Setting: Kindergarten and elementary school. Participants: One hundred fifty-six kindergarteners were included. In first grade, they were grouped into the normal and poor handwriting groups on the basis of handwriting performance in first grade. Outcomes and Measures: Participants received fine motor (FM), visual-perceptual (VP), and visual-motor integration tests in kindergarten and handwriting assessments in first grade. Results: Logistic regression results indicated that younger age at school entry and lower scores on measures of FM and VP in kindergarten increased the risk for later poor handwriting. The area under the receiver operating characteristic curve in the nomogram built with these risk factors was.75, indicating that the nomogram had acceptable diagnostic value. Conclusions and Relevance: This nomogram could be used as a screening tool to detect kindergarteners at risk of poor Chinese handwriting in first grade. What This Article Adds: This study is the first to establish a nomogram constructed with significant predictors in kindergarten of a child's probability of poor handwriting later in first grade. This predictive nomogram may help occupational therapists, educators, and parents identify at-risk kindergarteners early for the purpose of early interventions to prevent later poor Chinese handwriting.