Comprehensive search for assessment indicators that influence the level of handwriting difficulties among children in educational settings.

Handwriting difficulties are a major public health problem among school-aged children worldwide, as they seriously interfere with their academic performance and well-being. Teachers' assessments of handwriting difficulties determine whether a child should be subsequently referred for medical or professional assistance. However, very few studies focused on teachers' perception of handwriting difficulties and the relationship between such perception and direct assessments of children's relevant abilities. As a result, the direction of support in educational settings remains vague and less focused. In this study, we investigate the relationship between teachers' perceptions of children's handwriting difficulties and children's abilities relevant to their handwriting skills in three main areas: (1) handwriting process, (2) legibility of written letters, and (3) the cognitive and motor functions. The findings suggest that the presence of handwriting difficulties is related to clumsiness of foundational motor skills and the severity of handwriting difficulties is related to lack of carefulness. In addition, somatosensory and visuomotor integration were found to important indicators that characterize handwriting difficulties. These results can provide guidance to teachers and professionals who support children with handwriting difficulties, with individualized and optimal strategies.