Motor Performance
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A disconnect between motor milestone achievement and motor development in Attention Deficit Hyperactivity Disorder; implications for intervention
We are recruiting for this study now! See the flyer for links to the questionnaires. Funding: The Waterloo Foundation Lab Members: Emily Farran, Jenna Lee, Catriona McInnes Collaborators: Elisabeth Hill, Hayley Leonard Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder in childhood. Where studies have investigated motor abilities (balance, ball skills, hand and finger movements), difficulties are reported for this group. Given the importance of motor abilities in everyday life (in social interaction, to produce language, for handwriting and for activities of daily living such as eating), knowledge is surprisingly limited in this area. We explored the motor system in ADHD in the most detailed study to-date. In line with previous findings, we demonstrated that ~50% of children with ADHD have a substantial motor deficit. We also found that children with ADHD who demonstrate a motor deficit in childhood are not delayed in reaching motor milestones (e.g., crawling and walking) as infants. This suggests that the motor deficit observed in childhood is not present from birth but emerges as a developmental consequence of subtle impairments in infancy. This differs from children with Developmental Coordination Disorder (DCD) who are delayed in reaching motor milestones, which suggests that the motor impairments in DCD are present from birth. We propose to investigate motor milestone achievement in children with ADHD and children with DCD within the same study for the first time. We will collect data via online questionnaires. This is a cost effective way of achieving larger sample sizes than is possible with face-to-face testing sessions. If this study demonstrates delayed motor milestone achievement in DCD, but not in ADHD, this raises the possibility that later motor deficits in children with ADHD could be reduced or eliminated through training of the subtle precursors to motor impairment before the impairment emerges. The results of this large-scale proof-of-concept study will feed into our planned future grant application to determine the developmental interactions between the attention and motor domains in infants at risk of ADHD (20% to 40% of children with a sibling with ADHD, present with ADHD themselves). It is crucial to establish the developmental links across different types of behaviour, because it is possible that difficulties in one area (in this case, motor skill in childhood) stem from difficulties in another area (e.g., early attention to motion) that develops earlier in life. Knowledge of the developmental consequences of subtle impairments in infancy in ADHD will enable us to decide when/ how to intervene, to help people with ADHD to achieve their potential in the motor domain. This might, in turn, help with other areas of development. Last updated July 2019 |
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The developmental relationship between motor skills and large scale spatial knowledge
Funding: The Waterloo Foundation
Lab members: Emily Farran, Aislinn Bowler, Leighanne Mayall
Collaborators: Annette Karmiloff-Smith, Elisabeth Hill, Hana D'Souza
Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder in childhood. Where studies have investigated motor abilities (balance, ball skills, hand and finger movements), difficulties are reported for this group. Given the importance of motor abilities in everyday life (in social interaction, to produce language, for handwriting and for activities of daily living such as eating), knowledge is surprisingly limited in this area. We explored the motor system in ADHD in detail.
A developmental consequence of poor motor ability is a poor understanding of large scale space, i.e. navigation, crucial for getting around the environment. We also measured navigation (using virtual reality). We predict that navigation skills will be poor in ADHD. This study was the first to investigate navigation and how it relates to motor deficits in ADHD. It is crucial to establish the developmental links across different types of behaviour, because it is possible that difficulties in one area (navigation) stem from difficulties in another area (motor) that develops earlier in life. Knowledge of the developmental consequences of impaired motor abilities in ADHD enables one to decide when and how to intervene in order to help people with ADHD to achieve their optimal potential, not just in the motor domain, but in other areas, navigation being just one example. ADHD performance
was compared to performance in the typical population. We also compared ADHD to Williams syndrome, a genetically defined neurodevelopmental disorder in which both attention and motor deficits are reported. This was to determine which difficulties and developmental patterns are specific to ADHD.
Summary of our findings
The ADHD group was split into two groups based on their motor scores. There was a high motor group, ADHD-H group who had average or above average motor skills (based on the Bruininks-Oseretsky Test of Motor Proficiency Second Edition Short Form [BOT2-SF]; Bruininks, 2005) and a Low motor group, ADHD-L who had below or well-below average motor skills (based on the BOT2-SF). Consistent with the literature, 17 / 39 of participants with ADHD displayed impaired motor ability. Profile analysis of the eight BOT2-SF subtests demonstrated that the impairment is not uniform. Both ADHD subgroups displayed atypical motor profiles across the eight BOT2 subtests, relative to typically developing (TD) (N=72) control children. Interestingly, motor milestone achievement was not delayed in either the ADHD-L or ADHD-H group. Few relationships were observed between ADHD core characteristics and motor competence. We conclude that the motor deficit observed in a large proportion of children with ADHD is not inherent to ADHD. The typical achievement of motor milestones in ADHD, and the parallel profile of motor abilities of the ADHD-L and ADHD-H groups, suggests that the motor deficit observed in some children with ADHD is a result of subtle impairments in infancy, which impact motor development. Thus, we propose that whilst a motor impairment is not related to ADHD core characteristics, it is a developmental consequence of ADHD (rather than a completely unrelated co-occurring deficit) which impacts some but not all children with ADHD. The protective factors which attenuate this developmental cascade in children with ADHD and no motor impairment require further research as this has important implications for intervention. This will be the focus of our next study, which will run during 2019/20.
The spatial performance in both ADHD groups, measured through a novel virtual reality maze game, did not differ from that of the TD control group. Results demonstrated a relationship between fine motor ability and spatial navigation in the TD group, which could reflect the developmental impact of the ability to manually manipulate objects, on spatial knowledge. In contrast, no relationships between the motor and spatial domains were observed for the ADHD or WS groups. Indeed, whilst there was evidence of motor impairment in both groups, only the WS group demonstrated an impairment in large-scale spatial navigation. The motor-spatial relationship in the TD, but not the ADHD and WS groups, suggests that spatial cognition can develop via a developmental pathway which bypasses input from the motor domain. Thus, cross-syndrome comparison with the ADHD group demonstrates that poor motor ability does not always predict poor spatial cognition.
Read our lay summaries of motor performance in WS and in ADHD: WS report, ADHD report
Last updated December 2018
Funding: The Waterloo Foundation
Lab members: Emily Farran, Aislinn Bowler, Leighanne Mayall
Collaborators: Annette Karmiloff-Smith, Elisabeth Hill, Hana D'Souza
Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder in childhood. Where studies have investigated motor abilities (balance, ball skills, hand and finger movements), difficulties are reported for this group. Given the importance of motor abilities in everyday life (in social interaction, to produce language, for handwriting and for activities of daily living such as eating), knowledge is surprisingly limited in this area. We explored the motor system in ADHD in detail.
A developmental consequence of poor motor ability is a poor understanding of large scale space, i.e. navigation, crucial for getting around the environment. We also measured navigation (using virtual reality). We predict that navigation skills will be poor in ADHD. This study was the first to investigate navigation and how it relates to motor deficits in ADHD. It is crucial to establish the developmental links across different types of behaviour, because it is possible that difficulties in one area (navigation) stem from difficulties in another area (motor) that develops earlier in life. Knowledge of the developmental consequences of impaired motor abilities in ADHD enables one to decide when and how to intervene in order to help people with ADHD to achieve their optimal potential, not just in the motor domain, but in other areas, navigation being just one example. ADHD performance
was compared to performance in the typical population. We also compared ADHD to Williams syndrome, a genetically defined neurodevelopmental disorder in which both attention and motor deficits are reported. This was to determine which difficulties and developmental patterns are specific to ADHD.
Summary of our findings
The ADHD group was split into two groups based on their motor scores. There was a high motor group, ADHD-H group who had average or above average motor skills (based on the Bruininks-Oseretsky Test of Motor Proficiency Second Edition Short Form [BOT2-SF]; Bruininks, 2005) and a Low motor group, ADHD-L who had below or well-below average motor skills (based on the BOT2-SF). Consistent with the literature, 17 / 39 of participants with ADHD displayed impaired motor ability. Profile analysis of the eight BOT2-SF subtests demonstrated that the impairment is not uniform. Both ADHD subgroups displayed atypical motor profiles across the eight BOT2 subtests, relative to typically developing (TD) (N=72) control children. Interestingly, motor milestone achievement was not delayed in either the ADHD-L or ADHD-H group. Few relationships were observed between ADHD core characteristics and motor competence. We conclude that the motor deficit observed in a large proportion of children with ADHD is not inherent to ADHD. The typical achievement of motor milestones in ADHD, and the parallel profile of motor abilities of the ADHD-L and ADHD-H groups, suggests that the motor deficit observed in some children with ADHD is a result of subtle impairments in infancy, which impact motor development. Thus, we propose that whilst a motor impairment is not related to ADHD core characteristics, it is a developmental consequence of ADHD (rather than a completely unrelated co-occurring deficit) which impacts some but not all children with ADHD. The protective factors which attenuate this developmental cascade in children with ADHD and no motor impairment require further research as this has important implications for intervention. This will be the focus of our next study, which will run during 2019/20.
The spatial performance in both ADHD groups, measured through a novel virtual reality maze game, did not differ from that of the TD control group. Results demonstrated a relationship between fine motor ability and spatial navigation in the TD group, which could reflect the developmental impact of the ability to manually manipulate objects, on spatial knowledge. In contrast, no relationships between the motor and spatial domains were observed for the ADHD or WS groups. Indeed, whilst there was evidence of motor impairment in both groups, only the WS group demonstrated an impairment in large-scale spatial navigation. The motor-spatial relationship in the TD, but not the ADHD and WS groups, suggests that spatial cognition can develop via a developmental pathway which bypasses input from the motor domain. Thus, cross-syndrome comparison with the ADHD group demonstrates that poor motor ability does not always predict poor spatial cognition.
Read our lay summaries of motor performance in WS and in ADHD: WS report, ADHD report
Last updated December 2018
Motor abilities in Williams Syndrome
Funding: ESRC and Williams Syndrome Foundation, UK
Researchers: Leighanne Mayall, Emily Farran
Collaborators: Andrew Tolmie
Motor difficulties are present across a range of neurodevelopmental disorders, impeding on the development of other domains and on overall quality of life. One population that show difficulties with their motor abilities are individuals with Williams Syndrome (WS). The purpose of the study was to investigate the motor profile of 20 individuals with WS, compared to 40 typically developing (TD) children aged 4-7 years, using the Bruininks–Oseretsky Test of Motor Proficiency, second edition (BOT2-SF; Bruininks & Bruininks, 2005) short form. Results indicate that the older children and adults with WS performed at the 4-5-year-old level with respect to overall motor ability. On examination of the motor profile, a relative strength in upper limb control and a relative weakness in balance were identified for this group. Overall, the results suggest that the motor problems that individuals with WS show in childhood persist in to older childhood and adulthood and, akin to the WS cognitive profile, there are relative strengths and weaknesses in the WS motor profile.
Last updated December 2018
Funding: ESRC and Williams Syndrome Foundation, UK
Researchers: Leighanne Mayall, Emily Farran
Collaborators: Andrew Tolmie
Motor difficulties are present across a range of neurodevelopmental disorders, impeding on the development of other domains and on overall quality of life. One population that show difficulties with their motor abilities are individuals with Williams Syndrome (WS). The purpose of the study was to investigate the motor profile of 20 individuals with WS, compared to 40 typically developing (TD) children aged 4-7 years, using the Bruininks–Oseretsky Test of Motor Proficiency, second edition (BOT2-SF; Bruininks & Bruininks, 2005) short form. Results indicate that the older children and adults with WS performed at the 4-5-year-old level with respect to overall motor ability. On examination of the motor profile, a relative strength in upper limb control and a relative weakness in balance were identified for this group. Overall, the results suggest that the motor problems that individuals with WS show in childhood persist in to older childhood and adulthood and, akin to the WS cognitive profile, there are relative strengths and weaknesses in the WS motor profile.
Last updated December 2018
