A staged approach for identifying children with developmental coordination disorder from the population

The purpose of this study was to describe the motor, attention and intellectual characteristics of a population-based sample of children first screened for motor impairment and to discuss the recruitment and identification methods employed. A two stage cross-sectional, school-based survey was conducted to screen for children with motor coordination difficulties and to identify children with an existing diagnosis of attention deficit hyperactivity disorder/attention deficit disorder (ADHD/ADD). The identified children, and a random sample of typically developing children, were assessed to confirm or rule out the presence of developmental coordination disorder (DCD).Six thousand four hundred and seventy five children were invited to participate; 2943 children, with parental consent, completed the initial screening process. Two hundred eighty four children with possible motor impairment were identified. The parents of 113 children consented to a full assessment. Sixty eight children of the 113 children met diagnostic criteria for DCD, and 26 also had ADHD. Twenty eight of the 55 children who screened in with a diagnosis of ADHD were subsequently found to have DCD. The total number of children with confirmed characteristics of DCD was reduced after application of DCD diagnostic criteria. This study differs from others with regard to the additional screening for children with ADHD/ADD. The second stage assessment notably increased the number of children identified with both ADHD and DCD.     

Autism spectrum disorders in children with normal intellectual levels: associated impairments and subgroups

In order to define potential subgroups pertaining to the spectrum of 'high-functioning' pervasive developmental disorders (PDDs) the medical and psychiatric records of 101 children with PDD were reviewed. Ninety-one children had a diagnosis of Asperger syndrome, nine had a PDD not otherwise specified, and one had 'high-functioning' autism. Mean age of the children (71 males, 30 females) was 9 years 8 months (age range 5 to 12 years). Apart from the core dysfunctions of the PDD, i.e. deficient social interaction, communication and repertoires, and restricted interests, 95% had attentional problems, 75% had motor difficulties, 86% had problems with regulation of activity level, and 50% had impulsiveness. About three-quarters had symptoms compatible with mild or severe attention-deficit-hyperactivity disorder (ADHD) or had deficits in attention, motor control, and perception (DAMP), indicating a considerable overlap between these disorders and high-functioning PDD in children of normal or near-normal intelligence. A combination of affective dysregulation, thought disturbance, and severely restricted social interaction, referred to as a multiple complex developmental disorder (MCDD; a condition possibly related to schizoaffective disorder), was recorded in about 8% of the children. Seventeen percent had another major medical diagnosis or medical syndrome, which highlights the importance of completing a neurological assessment of all children with PDDs.     

Developmental coordination disorder in children with attention-deficit-hyperactivity disorder and physical therapy intervention

Although physical therapy (PT) is effective in improving motor function in children with developmental coordination disorder (DCD), insufficient data are available on the impact of this intervention in children with combined attention-deficit-hyperactivity disorder (ADHD) and DCD. This prospective study aimed to establish the prevalence of DCD among a cohort of patients with ADHD, characterize the motor impairment, identify additional comorbidities, and determine the role of PT intervention on these patients. DCD was detected in 55.2% of 96 consecutive children with ADHD (81 males, 15 females), mostly among patients with the inattentive type (64.3% compared with 11% of those with the hyperactive/impulsive type, p<0.05). Mean age was 8 years 4 months (SD 2 y). Individuals with both ADHD and DCD more often had specific learning disabilities (p=0.05) and expressive language deficits (p=0.03) than children with ADHD only. Twenty-eight patients with ADHD and DCD randomly received either intensive group PT (group A, mean age 9 y 3 mo, SD 2 y 3 mo) or no intervention (group B, mean age 9 y 3 mo, SD 2 y 2 mo). PT significantly improved motor performance (assessed by the Movement Assessment Battery for Children; p=0.001). In conclusion, DCD is common in children with ADHD, particularly of the inattentive type. Patients with both ADHD and DCD are more likely to exhibit specific learning disabilities and phonological (pronunciation) deficits. Intensive PT intervention has a marked impact on the motor performance of these children.     

Developmental coordination disorder in Swedish 7-year-old children.

OBJECTIVE: To estimate the prevalence, comorbidity, and outcome in developmental coordination disorder (DCD). METHOD: In this population study of 7-year-olds undergoing individual examination plus teacher and parent interviews, children were followed up at ages 8, 9, and 10 years. RESULTS: Severe DCD occurred in 4.9% and moderate DCD in another 8.6%. Boy-girl ratios ranged from 4:1 to 7:1. Children with severe and moderate DCD did not differ from each other on any measure, but both groups were clearly separated from children without DCD with respect to associated attention deficit symptoms. Asperger's disorder symptoms, school dysfunction scores, and outcome. Approximately half of all children with DCD had moderate to severe symptoms of attention-deficit/hyperactivity disorder (ADHD). CONCLUSIONS: DCD is a common problem, and it is strongly associated with ADHD symptoms. A diagnosis of DCD at age 7 years predicts DCD at age 8 years and restricted reading comprehension at age 10 years. Clinicians need to acquaint themselves with DCD and its comorbidity so that they can provide better services to affected children.     

Fine and gross motor ability in males with ADHD

In the this study, both fine and gross motor ability of males with attention-deficit-hyperactivity disorder (ADHD) were compared with a group of control children. Three groups of males with the following ADHD subtypes: predominantly inattentive (ADHD-PI; n = 50), hyperactive/impulsive (ADHD-HI; n = 16), or combined (ADHD-C; n = 38) were compared with 39 control males. Mean ages for the control group were 10 years 4 months (SD 1 year 4 months, range 7 years 8 months to 12 years 11 months); for the ADHD-PI group, 10 years (SD 1 year 2 months, range 7 years 10 months to 13 years); for the ADHD-HI group, 9 years 11 months (SD 1 year 2 months), range 7 years 11 months to 12 years 6 months); and for the ADHD-C group 10 years 2 months (SD 1 year 4 months, range 8 to 13 years). The Australian Disruptive Behaviours Scale and Connors' Parent Rating Scale-Revised were used to assess ADHD symptomatology. Verbal IQ was estimated using two verbal subtests of the Wechsler Intelligence Scale for Children, and movement ability was assessed using the Movement Assessment Battery for Children (MABC) and the Purdue Pegboard test. Findings demonstrated that the children with ADHD had significantly poorer movement ability than control children. A high percentage of these children displayed movement difficulties consistent with developmental coordination disorder (DCD). In addition, the current study found that the type and degree of movement difficulty differed between subtypes. The Total Impairment score, as derived from the MABC, was less severe for the ADHD-HI group than the other two ADHD groups, but more severe than for the control group. Males with ADHD-PI and ADHD-C had significantly poorer fine motor ability (p < 0.001) than control males, whereas the ADHD-HI group did not differ significantly from any of the other groups. As children with ADHD only and the control group did not differ significantly on fine motor ability but were significantly better than children categorized with both ADHD and DCD, it was argued that poorer fine motor ability found in children with ADHD could not be attributed to deficits in attention and concentration, but rather to factors relating to their motor ability.     

Fine motor skills and effects of methylphenidate in children with attention-deficit-hyperactivity disorder and developmental coordination disorder

The aims of this study were to investigate fine motor skills of children with both attention-deficit-hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) and those of a control group, and to examine the effects of methylphenidate on these skills. A group of 12 children with ADHD-DCD (11 males, one female; mean age 9y 8mo [SD 1y 7mo]) and 12 age- and sex-matched controls (mean age 9y 7mo [SD 1y 2 mo]) participated. The manual dexterity subtests of the Movement Assessment Battery for Children, the concise assessment method for children's handwriting, and a computerized graphomotor task were used. Results demonstrated that children with ADHD-DCD performed more poorly on the manual dexterity subtests, had poorer quality of handwriting, and drew more rapidly, more fluently, but less accurately than controls on the graphomotor task. On methylphenidate, manual dexterity and quality of handwriting improved, and strokes on the graphomotor task became less fluent but more accurate. ADHD is characterized by persistent symptoms of inattention, impulsivity, and hyperactivity, affecting 3 to 5% of school-age children. Up to 50% of children with ADHD also have motor coordination problems that are severe enough to meet criteria for DCD. In DCD, children demonstrate functional motor performance deficits not explained by the child's (chronological) age or intellect, or by other neurological or psychiatric disorders.     

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.     

Working memory, processing speed, and set-shifting in children with developmental coordination disorder and attention-deficit-hyperactivity disorder

It has been suggested that the high levels of comorbidity between attention-deficit-hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) may be attributed to a common underlying neurocognitive mechanism. This study assessed whether children with DCD and ADHD share deficits on tasks measuring working memory, set-shifting, and processing speed. A total of 195 children aged between 6 years 6 months and 14 years 1 month (mean 10y 4mo [SD 2y 2mo]) were included in this study. A control group (59 males, 79 females), a DCD group (12 males, six females), an ADHD-predominantly inattentive group (16 males, four females), and an ADHD-combined group (15 males, four females), were tested on three executive functioning tasks. Children with DCD were significantly slower on all tasks, supporting past evidence of a timing deficit in these children. With few exceptions, children with ADHD did not perform more poorly than control children. These findings demonstrate the importance of identifying children with motor deficits when examining tasks involving a timing component.     

Autistic symptoms in children with attention deficit-hyperactivity disorder

Children with the syndrome of disorders of attention, motor control and perception (DAMP) invariably fill diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and commonly have symptoms of autistic spectrum disorders. This study estimates the rate of autistic symptoms in a sample of children with ADHD by using the parent-rated Autism Criteria Checklist. A high proportion of parents (between 65–80%) reported significant difficulties in social interaction (particularly in empathy and peer relationships), and communication (particularly in imaginative ability, nonverbal communication and maintaining conversation). The nature and relationship between ADHD and pervasive developmental disorders is considered, as well as implications for assessment, diagnosis and treatment. Accepted: 30 April 1998     

Stability of motor problems in young children with or at risk of autism spectrum disorders,ADHD, and or developmental coordination disorder

Aim The aim of this study was to investigate the stability of motor problems in a clinically referred sample of children with, or at risk of, autism spectrum disorders (ASDs), attention‐deficit–hyperactivity disorder (ADHD), and/or developmental coordination disorder (DCD). Method Participants were 49 children (39 males, 10 females; mean age 5y 6mo, SD 10mo) with various developmental problems, a Movement Assessment Battery for Children (M‐ABC) score on or below the 15th centile, and an IQ of 70 or more. Sixteen children were at risk of developing ADHD, 15 children had a diagnosis of, or were at risk of developing ASD, and 18 children had neither diagnosis. Children were reassessed 2 to 3 years later. Results At follow‐up (mean age 7y 11mo; SD 1y), the mean M‐ABC score was significantly increased, and in 22 children was no longer below the 15th centile. A general linear model to compare the difference in M‐ABC scores in the three groups of children demonstrated a significant difference between groups (p=0.013), with the age at the initial assessment as a significant covariate (p=0.052). The group of children with or at risk of ASD showed less improvement in motor performance. Interpretation Motor problems among preschool age children are not always stable, but appear to be so in most children with ASDs.     

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.     

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.     

SIBLINGS AND PARENTS OF CHILDREN WITH AUTISM: A CONTROLLED POPULATION-BASED STUDY

The siblings and parents of 35 children with infantile autism/autistic disorder were compared with those of children with deficits in attention, motor control and perception (DAMP) and of normal children for reported speech and language problems, reading and spelling problems, social deficits and psychiatric disorders. Children with autism tended more often to be the first and only child and there was some support for genetic stoppage in this group. Learning disorders were equally common among siblings and parents of the autism and normal groups, but less common compared with the DAMP group. Asperger syndrome was more common among first-degree relatives of children with autism compared with normal children. There was a tendency for schizo-affective disorder to be more common among mothers of children with autism. The findings are discussed in the context of a genetic model for the development of autism.     

Developmental coordination disorder in a child with ADHD; is DCD a DSM-IV diagnosis that is not recognised by child psychiatry?

A five-year-old boy received treatment for attention deficit hyperactivity disorder (ADHD). In connection with his motor problems he was referred to a rehabilitation centre specialising in the study and treatment of developmental coordination disorder (DCD). When treating a patient with ADHD, doctors should ask regularly about the patient's motor functioning and, if necessary, arrange a referral. In the first instance a young patient should be referred to a paediatric physiotherapist or, if the problems are complex, referral should be to a paediatric rehabilitation doctor. A combination of ADHD and DCD has a poorer prognosis than ADHD alone.     

On the role of prefrontal cortex glutamate for the antithetical phenomenology of obsessive compulsive disorder and attention deficit hyperactivity disorder

1. The objective of the present study was to compare the phenomenology and pathophysiology of obsessive compulsive disorder (OCD) and attention deficit hyperactivity disorder/deficits in attention, motor control and perception (ADHD/DAMP). 2. Through detailed studies of the literature on OCD and ADHD/DAMP, the phenomenology of these two conditions is compared, and possible underlying pathophysiological mechanisms involving interactions between glutamate, dopamine, serotonin and acetylcholine are discussed, with emphasis on OCD. The present paper also discusses possible mechanisms of action for current pharmacological treatments of OCD and ADHD, as well as possible future treatment strategies for these disorders. 3. OCD and ADHD/DAMP are common neuropsychiatric conditions which in many regards appear to be each other's antipodes with respect to clinical manifestations, associated personality traits and brain biochemistry, notably prefrontal cortical glutamate activity. Future pharmacological treatments of these disorders may involve manipulations with glutamate, dopamine D , serotonin 2A and nicotine receptors. 4. It appears that OCD is a hyperglutamatergic and ADHD a hypoglutamatergic condition, with prefrontal brain regions being especially affected.     

Foster placed children prenatally exposed to poly-substances

Abstract. This paper reports on a prospective, longitudinal study of children prenatally exposed to poly-substances, who were reared under minimal postnatal risk conditions. The aim of the study was to examine whether the substance-exposed group exhibited a higher level of attention-related problems than a group of age-matched, nonexposed children. The substance-exposed children (n = 42) evinced significant elevated levels of impulsivity and attention problems on the CBCL and on the ADHD rating scale at ages 2 and 4 1/2 as compared to the non-exposed peers (n = 50). The severity of the attention problems in the substance-exposed group was related to dysfunction in the area of perceptual performance and motor abilities assessed on the McCarthy scales. This finding lends support to the hypothesis of a neurological basis of the behavioral problems. The combination of attention problems and specific cognitive deficits indicates that the children exposed to poly-substances in utero had symptoms associated with ADHD/DAMP. The study suggests that even if children experience adequate care after birth, the accumulation of risk factors associated with prenatal substance exposure is still a potential contributor to impulsivity and attention-related problems in preschool children.     

Deficient coordination of associated postural adjustments during a lifting task in children with neurodevelopmental disorders

Precision grip and concomitant anticipatory postural adjustments were investigated in 11 children (three females, eight males; mean age 9 years 1 month, SD 11 months) with attention-deficit-hyperactivity disorder (ADHD); 12 children (three females, nine males; mean age 9 years, SD 7 months) with developmental coordination disorder (DCD), and 13 children (two females, 11 males; mean age 9 years 9 months, SD 11 months) with a combination of ADHD and DCD (ADHD+). There were two comparison groups: an age-matched group (four females, 11 males; mean age 9 years 1 month, SD 14 months) and a younger age group (five females, six males; mean age 6 years 5 months, SD 8 months). Adaptation to different weights was evaluated by lifting a specialized grip instrument monitoring grip force, load force, and centre of foot pressure displacements. Children with ADHD+ showed: (1) excessive grip forces, (2) decreased amplitude and prolonged onset of postural adjustments, and (3) reduced ability to adapt the motor output. Children with ADHD and DCD did not scale manual and postural forces in amplitude and time domains. Children with DCD also differed in delayed timing of postural adjustments. Results indicate that children with ADHD and DCD show a spectrum of neural dysfunctions underlying poor motor coordination, which are not specific to the clinical disorder.     

Neural circuitry engaged during unsuccessful motor inhibition in pediatric bipolar disorder

OBJECTIVE: Deficits in motor inhibition may contribute to impulsivity and irritability in children with bipolar disorder. Studies of the neural circuitry engaged during failed motor inhibition in pediatric bipolar disorder may increase our understanding of the pathophysiology of the illness. The authors tested the hypothesis that children with bipolar disorder and comparison subjects would differ in ventral prefrontal cortex, striatal, and anterior cingulate activation during unsuccessful motor inhibition. They also compared activation in medicated versus unmedicated children with bipolar disorder and in children with bipolar disorder and attention deficit hyperactivity disorder (ADHD) versus those with bipolar disorder without ADHD. METHOD: The authors conducted an event-related functional magnetic resonance imaging study comparing neural activation in children with bipolar disorder and healthy comparison subjects while they performed a motor inhibition task. The study group included 26 children with bipolar disorder (13 unmedicated and 15 with ADHD) and 17 comparison subjects matched by age, gender, and IQ. RESULTS: On failed inhibitory trials, comparison subjects showed greater bilateral striatal and right ventral prefrontal cortex activation than did patients. These deficits were present in unmedicated patients, but the role of ADHD in mediating them was unclear. CONCLUSIONS: In relation to comparison subjects, children with bipolar disorder may have deficits in their ability to engage striatal structures and the right ventral prefrontal cortex during unsuccessful inhibition. Further research should ascertain the contribution of ADHD to these deficits and the role that such deficits may play in the emotional and behavioral dysregulation characteristic of bipolar disorder.     

Undertreatment of Motor Problems in Children with ADHD

Background: Motor problems occur in 30% to 50% of children with ADHD, and have a severe impact on daily life. In clinical practice there seems to be little attention for this comorbidity with the possible consequence that these motor problems go undertreated. Method: Clinical interview and questionnaire survey of treatment by physiotherapy and factors predicting treatment of motor problems in 235 children with ADHD and 108 controls. Results: Half of motor‐affected children had received physiotherapy. Treated children had more severe motor problems, and less frequently presented with comorbid anxiety and conduct disorder. Treated and untreated children were similar in age, and rated similarly on ADHD inattentive and hyperactive‐impulsive scales and parental socio‐economic status. Conclusion: Currently, undertreatment of motor problems in ADHD occurs. Behavioural factors play a role in referral and intervention.     

On the role of cortical glutamate in obsessive-compulsive disorder and attention-deficit hyperactivity disorder, two phenomenologically antithetical conditions

OBJECTIVE: The objective of the present study was to compare the phenomenology and pathophysiology of obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder/deficits in attention, motor control and perception (ADHD/DAMP). METHOD: Through detailed studies of the literature on OCD and ADHD/DAMP the phenomenology of these two conditions is compared, and possible underlying pathophysiological mechanisms involving interactions between glutamate, dopamine, serotonin and acetylcholine are discussed, with emphasis on OCD. The present paper also discusses possible mechanisms of action for current pharmacological treatments of OCD and ADHD, as well as possible future treatment strategies for these disorders. RESULTS: OCD and ADHD/DAMP are common neuropsychiatric conditions which in many regards appear to be each other's antipodes with respect to clinical manifestations, associated personality traits and brain biochemistry, notably prefrontal cortical glutamate activity. Future pharmacological treatments of these disorders may involve manipulations with glutamate, dopamine D1, serotonin 2A and nicotine receptors. CONCLUSION: It appears that OCD is a hyperglutamatergic and ADHD a hypoglutamatergic condition, with prefrontal brain regions being especially affected.