Children spend an average of 31 to 60% of their school time performing handwriting and other fine motor tasks [
1]. Difficulties in fine motor tasks represent a common complaint among children in the general school population, and 11–12% of female students and 21–32% of male students are estimated to have handwriting difficulties, with a global prevalence of 10–34% of school-aged children [
2,
3]. Handwriting is indicated as an important school readiness skill and a predictor of the academic success [
4,
5,
6], and it can be included among the core symptoms of the developmental coordination disorder (DCD) [
7,
8], with potential consequences in the academic progress, emotional well-being, and social functioning of the individual [
9,
10,
11]. In fact, according to the DSM 5 [
8], the DCD includes among its diagnostic criteria the delayed acquisition of motor milestones, with clumsiness, slowness, and inaccuracy in the performance of motor skills, both on the gross motor side and on the fine motor side. In addition, this motor skills deficit starts in the developmental age, and it significantly interferes with daily living activities. However, the DSM 5 does not discriminate between different subtypes of DCD, although individuals could be predominantly impaired in the gross motor skills as well as in fine motor skills, such as handwriting, which seems to have a predictive validity with respect to the diagnosis of DCD itself [
12,
13,
14]. Moreover, handwriting difficulties affect daily living activities [
15] and persist noticeably into adulthood [
16], being frequently considered the reason for referral to occupational therapy [
1,
17] and task-based training [
18]. Therefore, handwriting competence is commonly affected in these children, with frequent repercussions on the legibility and speed of written texts. Furthermore, handwriting has proven to be remarkably discriminative in children at risk of DCD at the Movement Assessment Battery for Children-2 (MABC-2) [
19], which was validated in children aged 4–12 years and is currently considered the gold standard assessment tool used to identify impairments or delays in motor development. In particular, the MABC-2 includes 24 subtests and three domains (manual dexterity, balls skills, and balance). Results are usually interpreted as percentiles, with ≤5 percentile pinpointing a definite motor impairment, whereas ≤15 percentile suggests a borderline motor impairment. Another assessment instrument employed in clinical and research settings is the Developmental Test of Visual–Motor Integration (VMI) [
20], which provides information about the visual and motor abilities of the subject, being considered a useful screening tool for DCD. In particular, the VMI contains three subtests oriented to explore different aspects of the symptom: visual motor integration, visual perception, and motor coordination. Results are interpreted as percentiles, with ≤5 percentile suggesting a clinical impairment which is worthy of a deeper evaluation. However, these tests are not devoted to handwriting and MABC-2 explores primarily gross motor skills; thus, other motor competences such as handwriting should be assessed separately through different standardized and psychometrically sound measures [
21].
In order to assess handwriting skill in clinical practice and in experimental settings, the Concise Assessment Scale for Children’s Handwriting (BHK) is often used in a few countries [
3,
22,
23,
24,
25,
26]. It represents an analytic scale that provides a quick evaluation of handwriting quality and speed through a copying text. It can be used as a screening tool, as well as a diagnostic test. Instructions and normative values are derived from the Dutch original version [
22]; references for normative values on quality of handwriting are available for children in grade two (age 7–8 years) and three (8–9 years), while references on speed are available for all grades [
23]. The Dutch norms for writing speed derived from handwriting samples collected from 895 school children in first to sixth grade (ages roughly ranging between 78 and 150 months) [
22]. The psychometric properties of the BHK were investigated by extensive research, and the scale was also adapted and validated for the French school population [
25]. Other diagnostic tools are available in Italian for the assessment of handwriting skills, but they usually do not assess handwriting quality and investigate only writing speed. For example, the BVSCO explores writing speed of disyllables, single words, and numbers [
27]. Furthermore, the BHK is preferred to the BVSCO due to its good psychometric properties, which were widely investigated in the literature, along with differences between boys and girls in handwriting quality and the deterioration of the form aspects of writing along the different grades of the primary school [
28]. Moreover, in contrast to other tools, the BHK explores both handwriting quality and speed, and it is used in different languages and teaching methods, and, therefore, is able to be used extensively in clinical and research settings. A short version is the Systematic Screening for Handwriting Difficulties Test (SOS) [
29], for which, however, sensitivity and specificity should also be investigated.
Considering the differences that are likely to occur between the Dutch, the French, and the Italian teaching methods in handwriting, the aim of the present study was to validate the Italian adaptation of the BHK [
26] in a representative primary-school population in order to gather handwriting parameters values and provide Italian norms, comparing them with Dutch and French ones. The BHK demonstrated to be suitable for describing changes in the handwriting characteristics during the intervention monitoring [
32], distinguishing between skilled writers and poor hand writers, but it has a broad borderline range. Previous authors labeled scores between 22 and 29 as at risk of poor handwriting [
23] or ambiguous handwriting [
32]. Secondly, the present study was aimed at exploring the distribution scores of the general population in order to suggest a cut-off score which allows through Z-scores for a better understanding of the level of impairment of the individuals in relation to the mean performances on the scale.