Influence of methylphenidate on motor performance and attention in children with developmental coordination disorder and attention deficit hyperactive disorder

Individuals with attention deficit hyperactive disorder (ADHD) often have coexisting developmental coordination disorder (DCD). The positive therapeutic effect of methylphenidate on ADHD symptoms is well documented, but its effects on motor coordination are less studied. We assessed the influence of methylphenidate on motor performance in children with comorbid DCD and ADHD. Participants were 30 children (24 boys) aged 5.10–12.7 years diagnosed with both DCD and ADHD. Conners’ Parent Rating Scale was used to reaffirm ADHD diagnosis and the Developmental Coordination Disorder Questionnaire was used to diagnose DCD. The Movement Assessment Battery for Children-2 and the online continuous performance test were administrated to all participants twice, with and without methylphenidate. The tests were administered on two separate days in a blind design. Motor performance and attention scores were significantly better with methylphenidate than without it (p < 0.001 for improvement in the Movement Assessment Battery for Children-2 and p < 0.006 for the online continuous performance test scores).The findings suggest that methylphenidate improves both attention and motor coordination in children with coexisting DCD and ADHD. More research is needed to disentangle the causality of the improvement effect and whether improvement in motor coordination is directly affected by methylphenidate or mediated by improvement in attention.     

Comorbidity of motor and language impairments in preschool children of Taiwan

Comorbidity of motor and speech/language impairments was investigated in 363 preschool children between the ages of 5 and 6 years (boys: 205, age 6.04 ± 0.48 years; girls: 158, age 5.98 ± 0.53 years). The children were sampled from two municipals of Taiwan, and were determined to present no apparent neurological, musculoskeletal, cardiopulmonary system impairment or mental insufficiency. They were administered with three speech/language tests and a motor test (Movement Assessment Battery for Children, or M-ABC). The results showed a significant correlation between the total score of the motor test and the total score of each of the speech and language tests. Regression analysis that controlled for IQ (C-TONI) further showed that manual dexterity, but not ball skills or balance, of M-ABC was predictive of all scores on the speech and language tests. To determine a deficit on a test, a score at or below the 10th percentile of the norm or a score at or below 1.25 SD from the group mean was established as the cutoff. For the speech/language impairment, a deficit on at least two out of the three tests also applied. Following these criteria, 22 children (6.1%) were identified to have Developmental Speech and Language Disorder (DSLD), and 45 (12.4%) to have Developmental Coordination Disorder (DCD). Comorbid DSLD and DCD were found in six children (1.65%). Chi-square analysis revealed a significant correlation between DSLD and DCD (p < .03). The odds of DSLD was higher (by about three-fold) among the children with DCD than among the children without (0.15 vs. 0.05). Comorbid motor and speech/language impairments in preschool children appear to be a significant clinical condition that requires the attention of the therapeutic community. Manual dexterity, in particular, seems to be an important clue for understanding the shared mechanism of motor and speech/language impairments.     

Mild impairments of motor imagery skills in children with DCD

It has been hypothesized that the underlying mechanism of clumsy motor behaviour in children with Developmental Coordination Disorder (DCD) is caused by a deficit in the internal modelling for motor control. An internal modelling deficit can be shown on a behavioural level by a task that requires motor imagery. Motor imagery skills are suggested to be related to anticipatory action planning, but motor imagery and action planning have not been tested within the same child. In the present study, action planning and motor imagery skills were assessed in 82 children between 7 and 12 years of age. Twenty-one of these children met the criteria for DCD, which was assessed by the McCarron Assessment of Neuromuscular Development and 56 of these children were used in the control group. Motor imagery was tested by a mental rotation task of hands that were shown from a back and palm point of view. The results show that motor imagery is affected in children with DCD but only in conditions with complex task constraints (i.e., rotation of hand stimuli presented in palm view). These results provide partial support for the internal modelling deficit hypothesis. We were not able to elicit motor planning deficits in this group, however, and argue that more complex planning tasks may be needed to identify such deficits.     

Similarities and dissimilarities between the Movement ABC-2 and the Zurich Neuromotor Assessment in children with suspected developmental coordination disorder

An established tool for the assessment of motor performance in children with developmental coordination disorder (DCD) is the Movement-ABC-2 (M-ABC-2). The Zurich Neuromotor Assessment (ZNA) is also widely used for the evaluation of children's motor performance, but has not been compared with the M-ABC-2. Fifty-one children (39 males) between 5 and 7 years of age with suspected DCD were assessed using the M-ABC-2 and the ZNA. Rank correlations between scores of different test components were calculated. The structure of the tests was explored using canonical-correlation analysis. The correlation between total scores of the two motor tests was reasonable (0.66; p < 0.001). However, ZNA scores were generally lower than those of M-ABC-2, due to poor performance in the fine motor adaptive component and increased contralateral associated movements (CAM). The canonical-correlation analysis revealed that ZNA measures components like pure motor skills and CAM that are not represented in the M-ABC-2. Furthermore, there was also no equivalent for the aiming and catching items of the M-ABC-2 in ZNA. The two tests measure different motor characteristics in children with suspected DCD and, thus, can be used complementary for the diagnosis of the disorder.     

Motor ability and weight status are determinants of out-of-school activity participation for children with developmental coordination disorder

According to the International Classification of Functioning, Disability and Health model endorsed by the World Health Organization, participation in everyday activities is integral to normal child development. However, little is known about the influence of motor ability and weight status on physical activity participation in children with developmental coordination disorder (DCD). This study aimed to (1) compare motor performance, weight status and pattern of out-of-school activity participation between children with DCD and those without; and (2) identify whether motor ability and weight status were determinants of participation patterns among children with DCD. We enrolled 81 children with DCD (boys, n = 63; girls, n = 18; mean age, 8.07 ± 1.5 years) and 67 typically developing children (boys, n = 48; girls, n = 19; mean age, 8.25 ± 1.6 years). Participation patterns (diversity, intensity, companionship, location, and enjoyment) were evaluated with the Children Assessment of Participation and Enjoyment. Motor ability was evaluated with the Movement Assessment Battery for Children, second edition (MABC-2). Other factors that may influence participation such as age, gender, and body weight were also recorded. Analysis of variance was used to compare outcome variables of the two groups, and significant determinants of activity participation were identified by multiple regression analysis. Children with DCD participated in fewer activities (i.e., limited participation diversity) and participated less frequently (i.e., limited participation intensity) than their typically developing peers; however, companionship, location of participation, and enjoyment level did not differ between the two groups. Children in the DCD group demonstrated significantly worse motor ability as assessed by the MABC-2. Further, a greater proportion of children in the DCD group were in the overweight/obese category compared with their typically developing peers. After accounting for the effects of age and gender, motor ability and weight category explained 7.6% and 5.0% of the variance in participation diversity, respectively, for children with DCD. Children with DCD showed less diverse and less intense out-of-school activity participation than typically developing children. Motor impairment and weight status were independently associated with the lower participation diversity. Interventions aiming at improving participation for children with DCD should target weight control and training in motor proficiency. Further study is needed to identify other factors that may hinder participation in this group of children.     

Psychosocial adjustment and attention in children with developmental coordination disorder using different motor tests

This study examined the consistency between the findings of developmental coordination disorder (DCD) as identified by the Bruininks–Oseretsky Test of Motor Proficiency (BOTMP) and the Movement Assessment Battery for Children (MABC), and explored the psychosocial and attention characteristics of children with DCD identified by the two motor tests, respectively. Participants were 270 children (male: 161, female: 109; age 7.74 ± 0.81 years). The association between DCD status identified by each of the motor tests and psychosocial problems measured by the Child Behavioral Checklist-Chinese version (CBCL-C) was examined using multiple logistic regressions. The results showed that DCD identified by the BOTMP was associated with high scores on the Withdrawn and Social Problems, with a higher proportion of females identified. DCD identified by the MABC was associated with high scores on the Withdrawn and Attention Problems and low score on the Aggressive Behavior. The results reaffirmed the lack of consistency between the motor tests and indicated that children identified by the two motor tests showed different profiles of attention and psychosocial adjustment.     

Motor and gestural performance in children with autism spectrum disorders, developmental coordination disorder, and/or attention deficit hyperactivity disorder.

Motor and gestural skills of children with autism spectrum disorders (ASD), developmental coordination disorder (DCD), and/or attention deficit hyperactivity disorder (ADHD) were investigated. A total of 49 children with ASD, 46 children with DCD, 38 children with DCD+ADHD, 27 children with ADHD, and 78 typically developing control children participated. Motor skills were assessed with the Bruininks-Oseretsky Test of Motor Proficiency Short Form, and gestural skills were assessed using a test that required children to produce meaningful gestures to command and imitation. Children with ASD, DCD, and DCD+ADHD were significantly impaired on motor coordination skills; however, only children with ASD showed a generalized impairment in gestural performance. Examination of types of gestural errors revealed that children with ASD made significantly more incorrect action and orientation errors to command, and significantly more orientation and distortion errors to imitation than children with DCD, DCD+ADHD, ADHD, and typically developing control children. These findings suggest that gestural impairments displayed by the children with ASD were not solely attributable to deficits in motor coordination skills.     

Functional performance of children with developmental coordination disorder at home and at school

This study investigated the functional performance of daily activities at home and at school in a population-based sample of children with different degrees of motor coordination impairment and competence. Sixteen children (seven males, nine females; mean age 8y, SD 9mo) with developmental coordination disorder (DCD), 25 with suspected DCD ([sDCD] 17 males, eight females; mean age 7y 6mo, SD 8mo), and 63 children without motor problems (39 males, 24 females; mean age 7y 9mo, SD 7mo) were recruited from public schools (Grades 1–3, age 6y 4mo–9y 10mo) using the Chinese version of the Developmental Coordination Disorder Questionnaire, the Movement Assessment Battery for Children, and the Bruininks-Oseretsky Test of Motor Proficiency. Functional performance was assessed using the Chinese versions of the Vineland Adaptive Behavior Scales and the School Function Assessment–Chinese version. The functional performance of children with DCD and sDCD was statistically significantly lower than those without DCD ( p's <0.05). χ² and logistic regression analyses showed significant differences among all groups in the proportion of children scoring at the 'inadequate' adaptive level of home performance ( p's <0.05). There were also significant differences among the groups in the proportion of children scoring below the cut-off in school performance ( p's <0.05). The findings show the pervasive impact of DCD on children's functional performance in daily activities at home and at school.     

Handedness and developmental coordination disorder in Portuguese children: Study with the M-ABC test

This study aimed to examine the probable developmental coordination disorder (DCD) and to identify differences in motor performance according to handedness, sex and age in typically developing Portuguese children not engaged in out-of-school sports. The Movement Assessment Battery for Children (M-ABC) was applied to a convenience sample of 154 right-handed and 119 left-handed children (n = 273), aged 4–12 (mean age = 7.96 years, SD = 2.38). The results suggest that the occurrence rate of probable DCD was 25.3% for right-handers and 36.1% for left-handers. This study showed a significant effect of handedness in age band 2, left-handers exhibited a higher prevalence of probable DCD than right-handers. Sex produced a significant effect, with girls performing better in manual dexterity in age band 1 and boys performing better in ball skills in age bands 2 and 3. The lower motor performances were observed in older children. These findings reinforce for Portuguese children and particularly for left-handers, the need for further investigation involving longitudinal studies and children of different handedness in the motor coordination domain. Moreover, we highlight the importance of developing physical education programmes that emphasize motor coordination parameters, especially in left-handed children.     

Motor skills,visual perception,and visual-motor integration in children and youth with Autism Spectrum Disorder

BackgroundMotor skill deficits are prevalent among children with Autism Spectrum Disorder (ASD) however, little is known about the underlying mechanism of these deficits. In response to this gap, this study investigated how visual perception (VP) and visual-motor integration (VMI) are associated with motor skills among children and youth with ASD.MethodsSixty-seven individuals with ASD and sixty-seven age- and gender-matched individuals without ASD (age range: 9.83–15.13 years) participated. Motor skills were assessed with the Movement Assessment Battery for Children-2 (MABC-2) and VP and VMI with the respective components of the Beery-Buktenica Developmental Test of Visual-Motor Integration-6 (Beery VMI-6).ResultsSignificantly more children and youth with ASD were in the red and orange zone of the MABC-2 traffic-lighting system for the total MABC-2 and the Aiming and Catching and Balance components compared to the children and youth without ASD. Both groups did not differ on the VP and VMI components of the Beery VMI-6. Pearson correlations between VP and VMI, and motor skills were weak but significant for the individuals without ASD, but not for the ASD group.ConclusionThe current study added to the evidence about motor skill deficits among children and youth with ASD. VP and VMI were not related to motor skills, suggesting that these functions – as measured in the current study – are no underlying mechanisms of motor skill deficits of children with ASD and average intelligence. Diagnostic implications are provided for the evidence of motor skill deficits among children and youth with ASD.     

Motor imagery training enhances motor skill in children with DCD: A replication study

BackgroundChildren with impaired motor coordination (or DCD) have difficulty using motor imagery. We have suggested that this difficulty is explained by the internal modeling deficit (IMD) hypothesis of DCD. Our previous training study lent support for this hypothesis by showing that a computerized imagery training protocol (involving action observation, and mental- and overt-rehearsal) was equally effective to perceptual-motor therapy (PMT) in promoting motor skill acquisition.AimsThe study presented here was designed to replicate and extend this finding, targeting a select group of children with moderate-to-severe DCD.Methods and ProceduresAll 36 children with DCD who participated were referred to the study and scored below the 10th percentile for their age on the Movement Assessment Battery for Children (MABC). Using a randomized control trial, the referred children were assigned randomly to one of three groups using a blocked procedure: imagery training, perceptual-motor training (PMT), and wait-list control. Motor proficiency was measured using the MABC, pre and post-training. Individual training consisted of 60-min sessions, conducted once a week for 5 weeks.ResultsResults showed that the imagery protocol was equally effective as PMT in promoting motor skill acquisition, with moderate-to-large effect sizes. Individual differences showed that the majority of children in the two intervention groups improved their motor performance significantly.ConclusionsOverall, these results further support the use of motor imagery protocols in the treatment of DCD, and tentative support for the IMD hypothesis. Developmental and dose issues in the implementation of imagery-based intervention are discussed.     

Obesity and motor coordination ability in Taiwanese children with and without developmental coordination disorder

The purpose of this study was to investigate the associations between obesity and motor coordination ability in Taiwanese children with and without developmental coordination disorder (DCD). 2029 children (1078 boys, 951 girls) aged nine to ten years were chosen randomly from 14 elementary schools across Taiwan. We used bioelectrical impedance analysis to measure percentage of body fat (PBF) and the Movement Assessment Battery for Children test (MABC test) to evaluate the motor coordination ability. Using cut-off points based on PBF from past studies, boys and girls were divided into obese, overweight and normal-weight groups, respectively. In boys, total impairment scores and scores on balance subtest in the MABC were significantly higher in the obese and overweight groups when compared against the normal-weight group. Girls in the obese and the overweight groups had higher balance impairment scores than those of the normal-weight group. Among boys, the prevalence of obesity was highest in the DCD group, when compared to the borderline DCD and TD boys. A higher percentage of DCD girls were overweight and obese than TD girls. Obesity may be associated with poor motor coordination ability among boys and girls, and particularly in relation to balance ability. Children with DCD may have a higher risk to be overweight or obese in Taiwan.     

Motor and cognitive performance differences between children with and without developmental coordination disorder (DCD)

The current study adopts the PASS theory of information processing to investigate the probable differences in specific motor and cognitive abilities between children with and without developmental coordination disorder (DCD). Participants were 108 5- and 6-year-old preschoolers (54 children with DCD and 54 children without DCD). The Movement Assessment Battery for Children assessed motor function. Running speed and agility were measured using the Bruininks-Oseretsky Test of Motor Proficiency. Finally, the Planning, Attention and Simultaneous Scales from the Das-Naglieri Cognitive Assessment System evaluated cognitive ability. Children with DCD differed significantly from those without DCD performing at a lower level on all motor and cognitive tasks. A correlation analysis revealed significant relationships between cognitive processes and motor skills. Simultaneous cognitive processing and manual dexterity were significantly correlated for both groups. Furthermore, a significant relationship was revealed between planning cognitive processing and balance for the non-DCD group. Thus, early assessment might identify specific cognitive-motor difficulties. Furthermore, early intervention might prevent some of the developmental comorbidities in the academic and everyday lives of children with movement difficulties.     

Deficient motor timing in children with neurofibromatosis type 1

Neurofibromatosis type 1 (NF1) is one of the most common single-gene disorders affecting fine and visual-motor skills. This case–control study investigated motor timing as a possible related performance deficit in children with NF1. A visual-motor reaction time (VRT) test was administered in 20 NF1 children (mean age 9 years 7 months) and 20 age- and gender-matched typically developing (TD) children. Copying and tracing performance were evaluated using the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI). Children with NF1 responded with an increased reaction time (RT) to temporally predictive stimuli compared to TD children, whereas RT at unpredictive stimuli did not differ between groups. Motor timing indexed by the RT decrease at predictive stimuli significantly associated with the Beery VMI copy and tracing outcomes. Deficient motor timing as an actual symptom may add to further research on the pathogenesis of NF1-associated motor impairment and the development of more effective treatment.     

Motor skills of children newly diagnosed with Attention Deficit Hyperactivity Disorder prior to and following treatment with stimulant medication

Motor difficulties are common in children with Attention Deficit Hyperactivity Disorder (ADHD). Although preliminary evidence has suggested that methylphenidate can improve the motor skills in children with ADHD and Developmental Coordination Disorder (DCD), the effect of stimulant medication on motor performance in children newly diagnosed with ADHD with or without motor impairment remains unclear. A cohort study of 49 medication-naïve children (39 male; mean age 8.4 ± 1.3 years) with ADHD was conducted. Children were evaluated using the Movement Assessment Battery for Children and the developmental test of visual motor integration at diagnosis and again three months following daily treatment with a stimulant medication. Motor difficulties were highly present at baseline (73.5%) but resolved in a subset after treatment with stimulant medication, suggesting that their motor difficulties may be attributed in part to their attentional problems. Nevertheless, motor impairment persisted in 55.1% of the sample. The severity of the behavioural symptoms was significantly associated with balance skills in children without motor impairments (r² = 0.30, p < 0.01) and with visual motor integration skills in children with persisting motor difficulties (r² = 0.27, p < 0.01). Attentional difficulties negatively affect the motor skills of children with ADHD. Following the use of stimulant medication, an important subset continued to demonstrate motor difficulties. The improvement in behaviour was insufficient to resolve motor problems and these children should therefore be targeted for rehabilitation services.     

Motor competence assessment in children: Convergent and discriminant validity between the BOT-2 Short Form and KTK testing batteries

This study investigated convergent and discriminant validity between two motor competence assessment instruments in 2485 Flemish children: the Bruininks-Oseretsky Test of Motor Proficiency 2 Short Form (BOT-2 Short Form) and the KörperKoördinationsTest für Kinder (KTK). A Pearson correlation assessed the relationship between BOT-2 Short Form total, gross and fine motor composite scores and KTK Motor Quotient in three age cohorts (6–7, 8–9, 10–11 years). Crosstabs were used to measure agreement in classification in children scoring below percentile 5 and 15 and above percentile 85 and 95. Moderately strong positive (r = 0.44–0.64) associations between BOT-2 total and gross motor composite scores and KTK Motor Quotient and weak positive correlations between BOT-2 Short Form fine motor composite and KTK Motor Quotient scores (r = 0.25–0.37) were found. Levels of agreement were fair to moderate. Therefore, some proof of convergent and discriminant validity between BOT-2 Short Form and KTK was established in this study, underlining the notion that the evaluation of motor competence should not be based upon a single assessment instrument.     

What is the evidence of impaired motor skills and motor control among children with attention deficit hyperactivity disorder (ADHD)? Systematic review of the literature

This article presents a review of the studies that have analysed the motor skills of ADHD children without medication and the influence of medication on their motor skills. The following two questions guided the study: What is the evidence of impairment of motor skills and aspects of motor control among children with ADHD aged between 6 and 16 years? What are the effects of ADHD medication on motor skills and motor control? The following keywords were introduced in the main databases: attention disorder and/or ADHD, motor skills and/or handwriting, children, medication. Of the 45 articles retrieved, 30 described motor skills of children with ADHD and 15 articles analysed the influence of ADHD medication on motor skills and motor control. More than half of the children with ADHD have difficulties with gross and fine motor skills. The children with ADHD inattentive subtype seem to present more impairment of fine motor skills, slow reaction time, and online motor control during complex tasks. The proportion of children with ADHD who improved their motor skills to the normal range by using medication varied from 28% to 67% between studies. The children who still show motor deficit while on medication might meet the diagnostic criteria of developmental coordination disorder (DCD). It is important to assess motor skills among children with ADHD because of the risk of reduced participation in activities of daily living that require motor coordination and attention.     

Motor impairments screened by the Movement Assessment Battery for Children-2 are related to the visual-perceptual deficits in children with Developmental Coordination Disorder

This study was to examine to what extent the motor deficits of children with Developmental Coordination Disorder (DCD) verified by the Movement Assessment Battery for Children-2 (MABC-2) are linked to their visual-perceptual abilities. Seventeen children with DCD and seventeen typically developing children (TD) aged 5–10 years screened from a total of 250 children were recruited. The assessments included MABC-2, traditional test of visual perceptual skills (TVPS-R), and computerized test for sequential coupling of eye and hand as well as motion coherence. The results indicated that children with DCD scored lower than TD in MABC-2, and their total scores were highly correlated with manual dexterity component scores. DCD group also showed poor visual-perceptual abilities in various aspects. The visual discrimination and visual sequential memory from the TVPS-R, the sequential coupling of eye and hand, and the motion coherence demonstrated a moderate or strong correlation with the MABC-2 in the DCD rather than the TD group. It was concluded that the motor problems screened by MABC-2 were significantly related to the visual-perceptual deficits of children with DCD. MABC-2 is suggested to be a prescreening tool to identify the visual-perceptual related motor deficits.     

Association between visual perceptual deficits and motor deficits in children with developmental coordination disorder

This study explored the relation between a motor-free visual perceptual deficit, different visual-motor integration deficits, and different motor skills in children with developmental coordination disorder (DCD). Thirty-six children (22 males), aged 9 or 10 years, with DCD and a control group (n=36), matched for age and sex, were assessed with the Movement Assessment Battery for Children (MABC), a ball-catching test, a jumping test, a timed response task to a visual moving stimulus, and the Beery-Buktenica Developmental Test of Visual-Motor Integration, incorporating copying, visual discrimination, and tracing tasks. Children with DCD performed significantly worse than the control group on all measures. The visual discrimination task did not correlate significantly with any of the motor tasks. The visual timing task correlated significantly with the ball-catching test in the DCD group. The copying test was significantly correlated with the MABC in the DCD group. The association between visual-perceptual deficits and motor tasks was shown to be task specific.