The aim of this study was to investigate the detectability of difficulties in visual-motor integration in preschoolers with special educational needs and, at the same time, to study the effect of a pilot intervention program applied to children with such difficulties, with the aim of improving their visual-motor integration.
The results of the study established that there was no significant difference in the scores of the general visual-motor integration test between the preschoolers in the EG and those in CG-1, while, on the contrary, there was a significant difference in the mean score of the general visual-motor integration test between the preschoolers in the EG and those in CG-2. A similar finding was established in a study by Sanghavi & Kelkar [18]where after a 12-week occupational therapy intervention program for children with diagnosed learning disabilities, comparisons of pre- and post-intervention scores on Beery and Buktenica’s Developmental Test of Visual-Motor Integration demonstrated that there was an improvement in scores in both the experimental and control groups consisting of children with learning disabilities.
From the measurements performed on all participants in the study and their results, the first research question is confirmed. That is, there are differences in visual-motor integration between students with special educational needs – either those who received the intervention or those who did not participate in the intervention program – and students from the standard population, before and after the intervention. The findings are confirmed by a quantitative study consisting of 14 participants aged 4–8 years with autism spectrum disorders (ASD) who were compared to fourteen typically developing children. Students with ASD demonstrated less effective eye-hand coordination on all tests and consistently low performance on visual motor integration[13].
Regarding the second research question, i.e., whether there are any differences in visual-motor integration among the EG participants with special educational needs, before and after the intervention, there was stability in performance in visual-motor integration, despite the minimal positive variation in the scores of the EG preschoolers, significant improvement in visual perception performance of the EG preschoolers and finally significant improvement in motor integration performance of the EG preschoolers, after the intervention; a finding also confirmed in a study by Dibek[19]. In a sample of 33 5-year-old children, 17 in the experimental group and 16 in the control group where data were collected with the visual perception (VP), motor coordination (MC) and visual-motor integration (VMI) tests[20], the Visual Motor Skills Enhancement program was applied for 10 weeks and the mean scores obtained before and after the test demonstrated a statistically significant difference with enhanced visual perception and motor integration.
Also, similar research has shown that visual-motor integration is not only the strongest predictor of legible writing[21, 22], but also significantly correlated with school performance in young preschoolers[23]. Researchers agree that there is a solid relationship between a child’s performance of visual-motor skills and school success. One of the areas that early childhood education has focused on from the beginning is pencil and paper activities. Thus, the role that visual-motor skills can play in success during preschool and school age (e.g., copying shapes and writing) is self-evident. In addition, research evidence supports the view that the development of good visual-motor skills is a predictor of good performance in kindergarten and early elementary grades[14, 24]. Developmentally, preschoolers in early childhood refine fine motor and visual perceptual skills, which together enable them to perform activities requiring visual-motor integration, especially writing[14]. A study by Daly[25]) established a strong positive relationship between kindergarten students’ performance on the Beery VMI test and their ability to copy legible letters. The findings of Daly [25]study support, on the one hand, that the Beery VMI test is a useful screening tool for writing ability and, on the other hand, that visual-motor integration is a necessary skill for legible writing.
Similar results were obtained in a survey of a sample of 100 boys and 118 girls aged 7 years, 4 months. The test employed was the Concise Assessment Scale for Children’s Handwriting (BHK), and the quality of writing was assessed in relation to scores on the visual-motor integration, visual perception and motor coordination subtests to determine whether the development of such skills contributed to the quality of writing. The results demonstrated that the better the quality of writing, the better the performance in visual motor integration and motor coordination[26]. Also, a study by Pinto & Incognito [27], in 115 typically developing preschoolers aged 3 to 5 years tested on drawing, writing and visual-motor integration tasks and the Beery Developmental Test of Visual-Motor Integration [28] established that drawing and writing skills also need perceptual skills to develop properly, especially when they first appear.
Both early planning and the implementation of intervention programmes are very important for the development of preschoolers. Precisely because fine motor skills and visual-motor coordination skills are not only essential for the performance of infants in kindergarten but also predictive of their later progress, they require immediate intervention when a difficulty arises[29]. Studies suggest that early intervention is usually the most effective and the one with the most lasting results[30], while it also has a supportive effect on the parent-child relationship and provides a supportive environment for the family[31]. The results of the present study support this view, i.e. the necessity and effectiveness of early intervention. In their study Dankert [32]emphasized that their results demonstrated that intervention can substantially improve the visual-motor skills of preschoolers.
The present study investigated the effectiveness of a short-term intervention program to improve the visual-motor coordination skills of preschoolers with special educational needs. The measurement results support those of Ohl [29], who implemented a ten-week intervention programme also to improve fine motor and visual-motor coordination skills of preschoolers in general education. Hall and Case-Smith [33] implemented an intervention programme with a sample of 10 preschoolers with Sensory Processing Disorder and visual-motor delay to investigate its impact on them. After 12 weeks, participants exhibited significant improvement in sensory profile and sensory processing. Performance in the VMI (visual perception subtest) and ETCH (legible writing) tests also improved. Similar findings were also obtained in a quantitative study conducted on 16 children 9 girls 7 boys of typical development with a mean age of 50 months who participated in a 6-week collaborative occupational therapy intervention in a kindergarten classroom, the pre- and post-test measurements including the Beery Buktenica Developmental Test of Visual Motor Integration (VMI), analyses demonstrated a significant difference in standard scores on the VMI from the first session (M = 101. 44) and the final session (M = 105.94)[34].
Much of the relevant literature confirms the relationship between performance on visual-motor coordination tests and preschoolers' progress in reading and mathematics. In a study, Pérez-Pereira [35]confirmed the existence of a relationship between visual-motor integration and reading, which is also confirmed in a study by Cayir [36]where it also emerged that there is a positive relationship between visual perception skills and reading, writing and arithmetic levels. Such findings are consistent with a correlational study establishing that higher scores in early fine motor skills as assessed in children in kindergarten were associated with higher math and reading scores at the end of first grade[37].
In addition, a total of 155 preschoolers participated in the Sortor and Kulp study [38], of which 42 were in 2nd grade, 55 in 3rd grade and 58 in 4th grade. The researchers concluded that visual perception skills should be considered as one of the factors significantly related to progress in reading and mathematics. However, in a study by Greenburg [39] of 34 4-year-old children, analysis revealed that fine motor skill coordination was associated with significantly better math scores at all three grade levels, but was not associated with better reading performance.
The relationship between visual-motor integration and school performance is also confirmed in a study by Barnhardt[40], the results of which showed that poor performance on the Beery VMI test was associated with difficulty in spatial organization of a written text or a maths exercise. The group of preschoolers with poor visual-motor integration who participated in this study made significantly more mistakes in total than the group of preschoolers with normal visual-motor integration, particularly in the distance between letters and words, as well as in arithmetic problems on one page.
Restrictions – Suggestions
The small sample size of the study's EG and its origin from a single geographical area limits the generalizability of the study. Another limitation that arises is that, because the exercises of the intervention program were implemented with the supervision and assistance of the parents, without the presence of the researcher, it was objectively difficult to control the whole process of their performance by the children, as well as the extent to which the parents closely followed the instructions given to them.
Another limitation of the study is the moderate duration of the intervention, which lasted 10 weeks. In any future work it is suggested that the sample of subjects should be larger and from more geographical areas. It is also suggested that the duration of the intervention programme should be longer and that other intervention tools should be used. In this case, there may be multiple measurements, thus offering stronger results. An essential point on which future work can focus is the use of new technologies. In particular, the test can be digitised and the assessment of children can be performed using, for example, a tablet or touch screen and a writing tablet.