Relationship between Handwriting and Visual-Motor Integration in Primary School

Introduction: School-based literacy development involves the acquisition of complex cognitive and motor skills, among which handwriting plays a central role. This study examined the relationship between handwriting performance—quality and speed—and visual-motor integration in Uruguayan schoolchildren. Method: A cross-sectional study was conducted using two-stage probabilistic cluster sampling. Participants included 158 fourth-grade students (50.6% girls) from public schools in Montevideo classified in the fifth quintile according to the National Public Education Administration. Instruments used included the Concise Assessment Method for Children’s Handwriting and the second version of the Bender Visual-Motor Gestalt Test. Cluster analysis was applied as an exploratory tool to identify performance subgroups. Results: Handwriting quality and speed were significantly correlated with visual-motor integration. Cluster analysis revealed four distinct performance profiles integrating handwriting and visual-motor variables. Girls outperformed boys in handwriting legibility, with no significant sex differences in handwriting speed or visual-motor skills. Conclusions: Visual-motor integration is strongly linked to handwriting performance. The identification of heterogeneous performance profiles underscores the importance of moving beyond binary sex-based comparisons to inform early assessment and targeted educational interventions. These findings enhance our understanding of handwriting development in the Uruguayan context.