Underlying mechanisms of writing difficulties among children with Neurofibromatosis type 1

• Children with NF1 are less proficient in lower perceptual-motor process.
• Children with NF1 are less proficient in higher cognitive process.
• High level processes underlie the poor quality of writing in children with NF1.
• The problems in spatial arrangement stem form a deficit in cognitive planning.
• The causes for the poor level of content are mainly due to deficits in language.

Writing is a complex activity in which lower-level perceptual-motor processes and higher-level cognitive processes continuously interact. Preliminary evidence suggests that writing difficulties are common to children with Neurofibromatosis type 1 (NF1). The aim of this study was to compare the performance of children with and without NF1 in lower (visual perception, motor coordination and visual-motor integration) and higher processes (verbal and performance intelligence, visual spatial organization and visual memory) required for intact writing; and to identify the components that predict the written product's spatial arrangement and content among children with NF1. Thirty children with NF1 (ages 8–16) and 30 typically developing children matched by gender and age were tested, using standardized assessments. Children with NF1 had a significantly inferior performance in comparison to control children, on all tests that measured lower and higher level processes. The cognitive planning skill was found as a predictor of the written product's spatial arrangement. The verbal intelligence predicted the written content level. Results suggest that high level processes underlie the poor quality of writing product in children with NF1. Treatment approaches for children with NF1 must include detailed assessments of cognitive planning and language skills.