寫字為學齡期孩童在學校重要的職能活動，過去有研究發現早產兒在英文書寫的表現較足月的同儕差，然而有鑑於中英文寫字所需能力的差異，早產學齡兒童在中文寫字問題至今仍尚欠缺文獻進行探討，因此本論文的兩項研究旨在:(1) 探討學齡兒童各種生物因子(如出生週數、性別等)、和健康因子(如過去有無接受復健或發展遲緩診斷)、社會因子(如家庭社經地位)對寫字表現的相關性；(2)調查早產與足月產兒童的寫字表現之差異；以及(3)探討早產兒童認知(如智力、注意力)、感覺(如觸覺、運動覺)、視知覺、和精細動作與其寫字表現的相關性。
研究一共有139位7-8歲的國小二年級普通班兒童參加本研究，其中68位為早產兒(出生週數<37週)，71位為出生體重大於2500克的正常發展之足月兒(出生週數≧37週，< 42週)。兩組排除條件相同，如下：(1)有先天器官結構異常、(2)有基因或染色體的異常、(3)聽覺或視覺異常且無法校正到正常、(4)有明顯的神經肌肉問題、(5)曾患有嚴重軀幹或上肢神經、骨骼、肌肉等傷害、與(6)智能不足。採用教師自填式的兒童寫字表現評量表(Chinese Handwriting Evaluation Form, CHEF)來調查兩組兒童的寫字表現。結果顯示，早產兒童的性別與過去有無復健或發展遲緩診斷對於其整體寫字表現和各寫字向度具有顯著的低-中等的相關性(r=0.2-0.5)；足月兒童的性別與家庭社經地位指數與其整體寫字表現和寫字向度具有顯著的低-中等的相關性(r=0.2-0.4)。此外，研究結果顯示，在寫字速度，組別與性別的交互作用呈現統計顯著性(p=0.005); 早產男童的寫字速度比足月男童(p=0.006)為差，而早產女童與足月女童則無明顯差別。在寫字困難人數比例，除了足月女童與男童在方向性向度(p=0.004)有明顯不同外，其餘並未發現早產或性別的差異。研究二共有41位早產兒童參與。收案和排除條件與研究一相同。結果顯示早產兒童的寫字量表總分與視知覺和注意力呈顯著相關；寫字工整性與精細動作和注意力呈顯著相關；寫字正確性與運動覺和注意力呈顯著相關；寫字速度與運動覺和注意力呈顯著相關。在控制兒童性別、出生週數、年齡、與母親的教育程度後，多重迴歸分析結果顯示只有視知覺總分對其整體寫字表現有顯著相關性，具有17.9%的影響力；注意力對於其寫字速度有顯著相關性，具有33.9%的影響力。
總結以上的結果可知，早產兒童中，特別是男童和曾有發展遲緩診斷或早療者將是日後寫字表現不佳的高危險群。此外，視知覺和注意力可能是導致早產兒童寫字不佳的兩項重要因子，因此建議在學齡前的早產兒追蹤計畫可加入這兩項表現的評量，以儘早預防早產兒童在入學後可能產生的寫字問題。

This thesis includes two studies on the handwriting performance of preterm children. In the first study, we aimed to compare handwriting performance of children born preterm and at term children at grade 2. Biological, health, and social factors related to handwriting performance in children were also investigated. Sixty-eight preterm and 71 term children were recruited. Children’s class teachers were asked to complete the Chinese Handwriting Evaluation Form (CHEF).The results showed that gender and an experience of rehabilitation treatment in the early years were significantly related to handwriting performance of preterm children. A significant interaction effect of group (preterm  term) and gender in the handwriting speed was found. Boys born prematurely demonstrated slower handwriting speed compare to boys at term (p=0.006), while no significant differences were found in girls born preterm and at term. In the second study, we aimed to investigate the underlying factors related to the handwriting performance of preterm children. Forty-one preterm children were recruited and their intelligence, attention, visual perception, tactile and kinesthetic sensation were assessed. After controlling for the covariates, the results showed that visual perception was the best predictor of overall handwriting performance (R2=0.17, p=0.025). Attention was the best predictor of handwriting speed (R2=0.339, p=0.04). The present findings indicate that preterm children who are boys, have received a diagnosis of developmental delay, and have had rehabilitation in early years are at high risk for poor handwriting performance. In addition, visual perception and attention are significant predictors related to handwriting performance in preterm children. The evaluation and intervention of visual perception and attention are suggested for preschool children born prematurely may be helpful to improve their handwriting performance in the primary school later.

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