Research in Developmental Disabilities: Review Article

Research in Developmental Disabilities 36 (2015) 338–357
Contents lists available at ScienceDirect
Research in Developmental Disabilities
Review article
What is the evidence of impaired motor skills and motor

control among children with attention deficit hyperactivity
disorder (ADHD)? Systematic review of the literature
M.-L. Kaiser a,d,*, M.M. Schoemaker b, J.-M. Albaret c, R.H. Geuze a
a
Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
b
University of Groningen, University Medical Center Groningen, Centre for Human Movement Science, PO Box 30,001, 9700 RB Groningen,
The Netherlands
c
University of Toulouse III – Paul Sabatier, PRISSMH-EA4561, 118 Route de Narbonne, F-31062 Toulouse Cedex 9, France
d
University Hospital of Lausanne, Pierre-Decker 5, 1011 Lausanne, Switzerland
A R T I C L E I N F O A B S T R A C T
Article history: This article presents a review of the studies that have analysed the motor skills of ADHD
Received 10 July 2014 children without medication and the influence of medication on their motor skills. The
Received in revised form 8 September 2014 following two questions guided the study: What is the evidence of impairment of motor
Accepted 10 September 2014
skills and aspects of motor control among children with ADHD aged between 6 and
Available online 6 November 2014
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
Keywords:
ADHD, motor skills and/or handwriting, children, medication. Of the 45 articles retrieved,
Children
ADHD 30 described motor skills of children with ADHD and 15 articles analysed the influence of
DCD ADHD medication on motor skills and motor control. More than half of the children with
Motor skills ADHD have difficulties with gross and fine motor skills. The children with ADHD
ADHD medication inattentive subtype seem to present more impairment of fine motor skills, slow reaction
Systematic review 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.
ß 2014 Elsevier Ltd. All rights reserved.
Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
2. Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340
3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340
3.1. Description of studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340
3.2. Motor skills of ADHD children without medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
* Corresponding author at: University Hospital of Lausanne, Pierre-Decker 5, 1011 Lausanne, Switzerland. Tel.: +41 79 461 76 35.
E-mail address: Marie-Laure.Kaiser@chuv.ch (M.-L. Kaiser).
http://dx.doi.org/10.1016/j.ridd.2014.09.023
0891-4222/ß 2014 Elsevier Ltd. All rights reserved.
M.-L. Kaiser et al. / Research in Developmental Disabilities 36 (2015) 338–357 339
3.2.1. Motor skills of children with ADHD without medication: differences among ADHD subtypes . . . . . . . . . . 347
3.3. Motor control aspects of non-medicated ADHD children. . . . . . . . . . . . . . . . . . . . . . . . .............. . . . . . . . . . 348
3.4. Effect of medication on motor skills of children with ADHD . . . . . . . . . . . . . . . . . . . . . .............. . . . . . . . . . 349
3.5. Effect of medication on motor control aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............. . . . . . . . . . 352
4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............. . . . . . . . . . 352
4.1. Hypothesis of explanation of impairment of motor skills among children with ADHD .............. . . . . . . . . . 353
4.1.1. Comorbidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............. . . . . . . . . . 353
4.1.2. The hypothesis of a deficit of attention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............. . . . . . . . . . 353
4.1.3. The hypothesis of lack of inhibition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............. . . . . . . . . . 354
5. Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............. . . . . . . . . . 354
6. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............. . . . . . . . . . 354
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............. . . . . . . . . . 354
1. Introduction
ADHD children encounter difficulties in their daily living, such as participation at school with a higher risk of school
failure and more difficulties in social life. In fact, they are more often excluded by peers and show poor self-esteem (Harpin,
2005). They may demonstrate difficulties in activities that require motor coordination (Fliers et al., 2008; Harvey & Reid,
2003; Karatekin, Markiewicz, & Siegel, 2003) such as handwriting (Brossard-Racine, Majnemer, Shevell, Snider, & Belanger,
2011; Tseng, Henderson, Chow, & Yao, 2004; Tucha & Lange, 2001) or the use of tools (Scharoun, Bryden, Otipkova, Musalek,
& Lejcarova, 2013). Several studies have found that children with ADHD perform poorly on motor skills tests (Brossard-
Racine, Shevell, Snider, Belanger, & Majnemer, 2012; Fliers, Franke, et al., 2010; Lavasani & Stagnitti, 2011; Pitcher, Piek, &
Hay, 2003; Watemberg, Waiserberg, Zuk, & Lerman-Sagie, 2007).
The articles of this systematic review describe children with ADHD who are most often diagnosed on the basis of the
DSM-IV-TR criteria. These criteria are: (A) Persistent pattern of inattention and/or hyperactivity-impulsivity that is more
frequently displayed and is more severe than is typically observed in individuals at comparable level of development. (B) Some
hyperactive-impulsive or inattentive symptoms must have been present before seven years of age. (C) Some impairment from the
symptoms must be present in at least two settings. (D) There must be clear evidence of interference with developmentally
appropriate social, academic or occupational functioning. (E) The disturbance does not occur exclusively during the course of a
Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorders and is not better accounted for by another mental
disorder (American Psychiatric Association, 2000). The following subtypes are described in the DSM-IV-TR (2000, p. 85): (1)
attention-deficit/hyperactivity disorder predominantly inattentive (ADHD-I); (2) attention-deficit/hyperactivity disorder
predominantly hyperactive-impulsive (ADHD-H) and, (3) attention-deficit/hyperactivity disorder combined type (ADHD-C).
The diagnosis is made most of the time by a medical doctor. Moreover, a questionnaire such as the Conner’s rating scale
(Conners, 2001), is given to the parents and/or the teacher of the child in order to establish that the symptoms of ADHD have
an interference in the daily living of the child.
ADHD affects from 5.9 to 11.4% of the school age children (Willcutt, 2012). The prevalence varies with age, with 11.4%
during the period of 6–12 years, decreasing to 8% in 13–18 years-old and further to 5% from 19 years into adulthood. The ratio
male: female differ slightly across childhood (2.3:1) and adolescence (2.4:1). The prevalence is highest for the ADHD-I, with
5.1% during the age of 6–12 years, 5.7% during the age of 13–18 years- and 2.4% for over 19 years of age. Lower prevalence
rates are observed for the ADHD-C (from 3.3% to 1.1%) and the ADHD-H (from 2.9% to 1.6%) children over this age range. For
the ADHD-C children, the ratio male: female is higher during the age range of 13–18 years (5.6:1) than during the age range
of 6–12 years (3.6:1) compared. Similar findings are described for ADHD-H, going from 2.3:1 to 5.5:1. For the ADHD-I, the
male: female ratio is stable with a ratio of 2.2:1 during the period of 6–12 years, and a ratio of 2:1 during the period of 13–18
years (Willcutt).
There are many hypotheses to explain the aetiology of ADHD. Structural differences in the brain have been described.
Cortese (2012) listed the brain anatomy abnormalities such as the frontostriatal areas, the tempoparietal lobes, the basal
ganglia, the corpus callosum, the cerebellum, the thalamus or the amygdala. Depue, Burgess, Bidwell, Willcutt, & Banich
(2010) found, among ADHD adults, that the decrease of the grey matter in the right prefrontal cortex was correlated with
more difficulty to inhibit motor response. Sharma and Couture (2014) also mentioned that the prefrontal cortex, caudate and
the cerebellum have a delay in maturation. These areas seem to show activity or a volume which develop slower than in TD
children. These areas are known to play a role in attention and organisation of thoughts as well as motor planning (Cortese,
2012). A clear understanding of how such structural differences may explain the heterogeneity of symptoms in children with
ADHD has not yet been reached, however.
Other hypotheses explain ADHD symptoms from deficits in neurotransmitters. As described by Sharma & Couture (2014,
p. 10), the activity of the prefrontal cortex area is primarily maintained by neurotransmitters (NTs) dopamine (DA) and
norepinephrine (NE). As the dopamine levels seem to be reduced in children with ADHD, medication given to these children,
such as methylphenidate, enhances the level of dopamine in the prefrontal cortex. The medication is assumed to improve the
control of inhibition and the executive control of attention (Sharma & Couture, 2014). Moreover, methylphenidate has been
reported to improve motor skills (Leitner et al., 2007; Pedersen, Surburg, Heath, & Koceja, 2004; Rubia, Noorloos, Smith,
340 M.-L. Kaiser et al. / Research in Developmental Disabilities 36 (2015) 338–357
Gunning, & Sergeant, 2003; Tucha & Lange, 2001; Wade, 1976). It is difficult to state if the medication influences the motor
skills directly (Stray, Ellertsen, & Stray, 2010) or indirectly (Bart, Podoly, & Bar-Haim, 2010).
ADHD children often show comorbidity with psychiatric disorders such as autism spectrum disorder (Taurines et al.,
2010) or tic disorders (Kadesjo & Gillberg, 2001) as well with neurodevelopmental disorders such as dyslexia (Germano,
Gagliano, & Curatolo, 2010) or DCD (Fliers et al., 2008; Sergeant, Piek, & Oosterlaan, 2006). Moreover, Kadesjo and Gillberg
(1998) found that more than 50% of the ADHD children had DCD and that more than half of the DCD children also met the
criteria of ADHD. Even, when the ADHD children do not meet the criteria of DCD, they show weaker motor skills than TD
children (Pitcher, Piek, & Barrett, 2002; Schoemaker, Ketelaars, van Zonneveld, Minderaa, & Mulder, 2005). Moreover, the
ADHD children overestimated their motor competences when they have mild impairment of motor skills (Fliers, de Hoog,
et al., 2010; Fliers, Franke, et al., 2010). Cantell, Smyth, and Ahonen (1994) described that most of the children with DCD
diagnosed at five years old still showed motor skills impairments at age 15, and had less social leisure and lower academic
performance. Therefore, it seems important to identify motor deficits in order to prevent further consequences.
It is of high interest to review articles on the motor skills of children with ADHD and the influence of medication on motor
skills to understand the relationship between the symptoms of ADHD and motor deficits. To date, there is no systematic
review of the motor problems of children with ADHD. A systematic review on this topic could add to an understanding of
possible mechanisms that underlie the relationship between motor skill deficits and deficits in attention, hyperactivity and
impulsivity.
Two pertinent questions guided this study. What is the evidence of an 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 in children with ADHD?
2. Methodology
The systematic review was conducted by the first author during March 2014 on the following databases: Web of Science,
Medline-PubMed and PsycARTICLES. The first search addressed the topic of motor skills and motor control aspects of
children with ADHD using the following search items: attention disorder and/or ADHD, motor skills and/or handwriting,
children. Inclusion criteria were as follows: (1) the abstract and the article were published in English in a peer-review
journal; (2) participants were school-aged children with a diagnosis ADHD; (3) an objective assessment of motor skills had
been used; (4) a control group of typically developing (TD) children was included for comparison; (5) children with ADHD
were not on medication when the assessment of motor skills and/or aspects of motor control was conducted.
The second search focused on the influence of medication on motor skills and/or aspects of motor control of children with
ADHD. The following terms were introduced in the same databases: attention disorder and/or ADHD, motor skills and/or
handwriting, children and medication. The criteria for inclusion were as follows: (1) the abstract and the article were
published in English in a peer-review journal; (2) participants were school-aged children with ADHD; (3) an objective
assessment of motor skills had been used as an outcome measure. If one of the criteria was not met, the article was rejected.
The first author assessed the articles and rejected articles that did not meet the criteria. The three other authors received the
list of the accepted and rejected articles and based on their expertise, they could complete the lists and they did for one article
(Slaats-Willemse, de Sonneville, Swaab-Barneveld, & Buitelaar, 2005). The references of the articles that were retained were
scanned in order to ensure that no relevant study was missed. One article was then added (Leung & Connolly, 1998). No case
report studies or descriptive reports were found with the criteria of search. The period retained was from 1970 until 2014.
Of the 56 articles identified, 45 met the criteria of which 30 articles addressed the first question and 15 articles addressed
the second question (Fig. 1). Eleven articles identified to address the first question were rejected for various reasons, such as
(1) no analysis comparing the ADHD and TD groups was performed (Dewey, Cantell, & Crawford, 2007; Konicarova, Bob, &
Raboch, 2014; Williams, Omizzolo, Galea, & Vance, 2013); (2) a portion of the children were on medication (Piek, Pitcher, &
Hay, 1999); (3) only subjective measures were used (Harvey et al., 2009; Karatekin et al., 2003; Tervo, Azuma, Fogas, Falls, &
Fiechtner, 2002); (4) some of the children had had brain surgery (Buderath et al., 2009); (5) validation of a sensory-motor
battery (Finch, Davis, & Dean, 2010); (6) no TD group was included (Harvey & Reid, 1997; Polderman, van Dongen, &
Boomsma, 2011).
As five articles described the motor skills of the ADHD children both before medication and while on medication, their
results are presented in both parts of the review (Brossard-Racine et al., 2012; Klimkeit, Mattingley, Sheppard, Lee, &
Bradshaw, 2005; Leitner et al., 2007; Pedersen et al., 2004; Rubia et al., 2003).
3. Results
3.1. Description of studies
With the exception of one study (Chen et al., 2013), the majority of the participants in the studies were male. In fact,
fifteen studies included only boys. When studies included both genders, the ratio of male and female varied from one study
to another. When considering the usual ratio of 2.3 boys to 1 female during childhood, some studies have a higher ratio, for
example 6 males to 1 female (Tseng et al., 2004) or a lower ratio with 1 male to 1.5 females in the study of Klimkeit et al.
(2005). No specific gender analysis was done in these studies.
56 articles found
41 articles on motor 15 articles on the

skills and motor influence of medication
control on motor skills and
motor control
11 articles on motor 30 articles on motor 15 articles on the

skills and motor control skills and motor control influence of medication
rejected retained on motor skills and
motor control retained
45 articles included
in the review
Fig. 1. Process of selection of the review.
The intellectual quotients (IQs) of the participants were reported in 29 of the articles. Of the 30 studies on motor skills and
motor control, 22 articles mentioned measurement of IQ. The studies on the influence of medication less often reported the
IQs of the participants. In fact, seven studies among the fifteen studies measured IQ. The IQ cut-off of 80 was clearly
mentioned in 8 studies and in 7 studies, no cut-off was mentioned but the means and SD’s make it very likely that IQ was
higher than 80. In 3 studies only the verbal IQ was assessed with a cut-off of 80. In almost all of the studies, the medical
diagnoses of ADHD were established on the basis of the DSM-IV criteria combined with information from parents. In two
studies, the diagnoses were based on the DSM-III criteria. Questionnaire information from teachers was used to a lesser
extent.
While some studies excluded children with comorbidity, the types of comorbid disorders that were excluded varied from
one study to another. Some only excluded DCD (Langmaid, Papadopoulous, Johnson, Phillips, & Rinehart, 2013; Schoemaker,
Ketelaars, van Zonneveld, Minderaa, & Mulder, 2005), others excluded autistic disorders (Papadopoulos, Rinehart, Bradshaw,
& McGinley, 2013), Tourette or Asperger syndrome (Stray et al., 2010); neurologic or orthopaedic disorders such as cerebral
palsy, neuropathic diseases, limb fractures, head trauma (Shorer, Becker, Jacobi-Polishook, Oddsson, & Melzer, 2012) or
learning disabilities (Tucha & Lange, 2001).
Among studies that investigated motor skills of ADHD children who were without medication, six studies investigated
whether these children met the diagnostic criteria for developmental coordination disorder (DCD). The diagnosis for DCD
was made on the basis of the DSM-IV-TR criteria (2000): (1) a delay in motor coordination based on the results of a motor
skills test that are well below average. The cut-off mentioned in the recommendations for diagnosis, assessment and
intervention of the European Academy of Childhood and Disability is a score on a motor coordination test that is 15th
percentile (Blank, 2012). (2) The impairment of motor coordination impacts daily activities. (3) No medical conditions
explain the motor impairment. (4) If mental retardation is present, the motor deficit is more important than those usually
associated with it. The term ‘probable DCD’ is used when only the first criterion has been assessed (Coverdale et al., 2012).
When the score of the MABC is between the 5th and the 15th percentiles, various labels are used to describe the diagnosis
such as moderate motor difficulties (Schoemaker, Lingam, Jongmans, van Heuvelen, & Emond, 2013), probable DCD (Lingam
et al., 2010) or borderline DCD (Geuze, Jongmans, Schoemaker, & Smits-Engelsman, 2001).
To assess gross motor skills and fine motor skills, in 13 studies, a standardised battery such as the Movement Assessment
Battery for Children (MABC; Henderson & Sugden, 2000), the Bruininks-Oseretsky Test of Motor Performance (BOTMP;
Bruininks, 1978) or the Test of Gross Motor Development-2 (TGMD-2; Ulrich, 2000) was administered. Three studies used a
neurodevelopmental examination such as the Zurich Neuromotor Assessment (Largo, Fischer, & Caflisch, 2002) or the
Physical and Neurological Examination for Subtle Signs (PANESS, Denckla, 1985). Finally, the remaining studies assessed one
particular motor component such as balance or sequential opposition of thumb-fingers. The majority of the studies used
parametric tests such as an ANOVA or t-test, and 15 studies reported effect size or partial effect size (Table 1).
3.2. Motor skills of ADHD children without medication
Among samples of children with ADHD, the prevalence of children who present a probable risk of DCD with a score below
the 15th percentile on the MABC varies as follows: 51.5% (Pitcher et al., 2003), 65% (Fliers, de Hoog, et al., 2010; Fliers, Franke,
et al., 2010) and 73.5% (Brossard-Racine et al., 2012). In this last study, if the 5th percentile had been applied, the proportion
342
Table 1
Studies on motor skills and aspects of motor control among ADHD children.
Studies Sample Mean age Gender IQ (SD) Diagnosis of Motor test Data analysis Results of ADHD children
(SD) ADHD comorbidity compare to those of TD
children for motor skills and
motor control
Whitmont and 24 ADHD 9.1 (1.3) 19M; 5F 103 (20) -Medical Diagnosis (MD) on -Fine motor composit of t-test Poorer fine motor skills on the
Clark (1996) 24TD 9.22 (0. 9) 18M; 6F 101 (16) DSM-III criteria the Bruininks–Oseretsky BOTMP and at the KAT (errors
-Conners’ Rating Scale – Parent Test of Motor and precision)
-Comorbidity NR Proficiency (BOTMP)
Kinaesthetic Acuity Test
(KAT)
Carte et al. 43 ADHD 9.6 (1.9) Only M 110 (17) -MD diagnosis Time To Do 20 (TDD-20) ANCOVA TDD-20 with legs differentiate
M.-L. Kaiser et al. / Research in Developmental Disabilities 36 (2015) 338–357

(1996) 31 TD 9 (2) 119 (16) -Conners’ parents Q with legs and arms MANCOVA the two groups but not the TDD-
VIQ -Child Behaviour Checklist Effect size 20 with arms
(CBCL) parents
-Parent ratings on a DSMIII-TR
symptoms checklist
-Inclusion if oppositional
defiant disorder
Leung and 20 ADHD-H 7.7 (0.4) Only M 107 (11) -Diagnosis on DSM-IV Choice reaction time on MANOVA No difference between groups on
Connolly (1998) 12 ADHD + CD 7.8 (0.4) 110 (15) -Conners’ teachers Q a keyboard any measures
18 CD 7.8 (0.4) 101 (12) -Parents and teacher strengths -Response initiation
22 TD1 7.8 (0.4) 108 (13) Questionnaires (PACS) time:
IQ> 80 -Exclusion if autistic, physical or -Variability of response
neurological disorders. Conduct initiation time
disorder included Movement time
-Variability of
movement time
Steger et al. 22 ADHD 10.9 19M; 3F IQ > 80 -Interview based on DSM-II-TR -Neuromotor ANCOVA -Sequential opposition thumb-
(2001) 20 TD 10.6 17M; 3F -CBCL parents and teacher Assessment Battery Regression analysis fingers slower
-No comorbid disorders except (NAB) -No difference in RT and peak
oppositional defiant disorder -Reaction time test with force
pinch used of index- -Longer time from force onset to
thumb force peak
-In bilateral condition; greater
variability of peak force
Pitcher et al. 50 ADHD-I 10 (1.2) Only M 101 (20) Australian disruptive -MABC (15th ANOVA -ADHD-I and ADHD-C: greater
(2002) part 1 16 ADHD-H 9.9 (1.2) 100 (20) behaviours scale (ADBS) percentile) Effect size RT and peak force
38 ADHD-C 10.2 (1.3) 100 (19) parents or guardian -Tapping apparatus with -ADHD-H greater RT variability
39 TD 10.3 (1.3) 111 (18) No information about index finger
VIQ only comorbidity
tested
Pitcher et al. 49 ADHD 9.9 (1.3) Only M 103 (18) Australian disruptive -MABC (15th ANOVA -ADHD children: greater
(2002) part 2 55 ADHD + DCD 10.2 (1.2) 98 (20) behaviours scale (ADBS) percentile) Effect size variability of peak force
31 TD 10.2 (1.4) 111 (18) parents or guardian -Tapping apparatus with -DCD children: difficulties in
VIQ only index finger force control
tested
Yan and 10 ADHD 9.6 (1.6) Only M Not MD diagnosis of ADHD Pursuit task MANOVA -No difference in RT between
Thomas (2002) 10 TD 9.8 (1.3) Reported Exclusion if neurologic or groups in simple movements
(NR) psychiatric diagnosis -Slower in complex movement;
more variable in movement
timing; more jerky movements
Pitcher et al. 50 ADHD-I 10 (1.2) Only M 102 (20) Australian disruptive -MABC (15th ANCOVA -ADHD-I and ADHD-C: poorer
(2003) 16 ADHD-H 9.1 (1) 99 (20) behaviours scale (ADBS) percentile) Chi-square test results in MABC and in manual
38 ADHD-C 10.2 (1.4) 99 (19) parents or guardian -Purdue Pegboard Test Effect size dexterity and ball skills than
39 TD 10.4 (1.4) 111 (18) Comorbidity NR (PPB) ADHD-H
VIQ only -ADHD-I: weaker results at PPB
tested compare to the two other
subtypes
Rubia et al. 13 ADHD 8 (2) Only M IQ > 80 -MD diagnosis on DSM-IV -Free tapping Planned t-tests More variable on a synchronised
(2003) 11 TD 9.4 (2) criteria -Synchronised tapping Effect size tapping task
-CBCL task
-Teacher Report form -Sensorimotor
No comorbid disorder except anticipation task
conduct disorder
Tseng et al. 42 ADHD-C 8.2 (1.2) 36M; 6F 25 (6) -MD on DSM-IV criteria BOTMP t-test Correlation Poorer fine and gross motor skills
(2004) 42 TD 8.3 (1.1) 36M; 6F 24 (11) -Activity level Rating Scales Stepwise

Raven’s completed by parents and regression analysis
coloured teachers
Progressive Exclusion if comorbid mood or
Matrices anxiety disorders, conduct
disorders, or oppositional defiant
disorder
Eliasson 25 ADHD 11.6 (1.1) Only M IQ: 73–122 -Multidisciplinary team -MABC (<10th ANOVA -More absolute and variable
et al. (2004) 25 TD NR diagnosis on DSM-III criteria percentile) errors but not constant errors
-Yale children inventory based -Tracking target task -No difference in movement
on DSM-IV time with visual feed-back
Exclusion if neurological -Slower MT without visual feed-
symptoms, reading difficulties back
and behavioural symptoms
Pedersen 16 ADHD-C 12.8 (NR) Only M VIQ > 80 -MD diagnosis on DSM-IV-TR -Lower limb apparatus Mixed ANOVA Significant difference in
et al. (2004) 19 TD 12.6 (NR) criteria with Electromyography Effect size premotor time but not in
-Interview with parents and movement time
teachers
Exclusion of DCD
Klimkeit 15 ADHD 9.3 (1.6) 10M; 15F IQ > 80 MD on DSM-IV criteria Selective reaching task ANOVA Effect size -Longer RT in the reach and no
et al. (2005) 15 TD 9.3 (1.5) 10M; 5F Inclusion of children with reach condition
disruptive behaviour disorder, -No difference in movement
learning disorder, anxiety time
disorder
Schoemaker 16 ADHD 8.4 (1.1) 11M; 5F IQ > 80 -MD on DSM-IV criteria Graphic task on a tablet ANOVA -Less accurate in 6 mm condition
et al. (2005) 20 TD 8.4 (1.2) NR If DCD excluded on 4 and 6 mm than in 4 mm condition
conditions -No difference between groups
in RT; in movement time
-Axial pen pressure higher in
6 mm condition
Slaats-Willemse 25 ADHD 12.2 (2.2) 23M; 2F 101 (13) -Conners’ parents and teachers Two computerised ANCOVA -No difference for movement
et al. (2005) 25 non 12.1 (2.9) 7M; 18F 100 (11) Q tasks: tracking and Effect size completion
affected 12.1 (2.5) 14M; 34F 102 (14) -Parents and teacher strengths pursuit tasks -Poorer accuracy and stability of
sibling Questionnaires (PACS) the movement
48 TD Inclusion of children with
anxiety disorders, oppositional
defiant disorder, mood disorders,
16% tic disorders
343
344
Table 1 (Continued )
motor control
Meyer and 264 ADHD 6–13 For all IQ > 80 -Disruptive Behaviour -Grooved Pegboard (GP) ANOVA Poorer performance at GP and
Terje (2006) 264 TD group: -Disorders Questionnaire -Maze Coordination maze coordination; not at finger
378M; teacher Task tapping
150F Exclusion if neurological disorder -Finger Tapping Test
Miyahara 11 ADHD 7–13 NR NR Australian disruptive -Tracing task of MABC ANOVA -Accuracy of drawing was not

et al. (2006) 10 ADHD + behaviours scale (ADBS) and of BOTMP influenced by the diagnosis of
DCD parents or guardian -Dual tasks: ADHD but by the diagnosis of
16 DCD For diagnosis of DCD: Counting backward, DCD
23 TD Tracing task of MABC additional noise, name -No difference for speed between
Other comorbidity not reported the animal shown on a groups
picture
Rommelse 350 ADHD 12 (2.8) 265M; IQ > 70 -Conners’ parents and teachers Two computerised Pairwise comparison -Tracking task and pursuit task:
et al. (2007) 195 non 11.5 (3.6) 85F Q tasks: tracking and Mixed model No difference with the dominant
affected 11.6 (3.2) 88M; 107F -Parents and teacher strengths pursuit tasks hand. With the non-dominant
sibling 12.10 (0.5) 110M; 161F Questionnaires (PACS) hand; less precise
271 TD 12.23 (0.4) Exclusion if autism, epilepsy, -Regardless of the hand; faster
learning disorders, neurologic movement at tracking task
disorders
Adi-Japha 20 ADHD Only M IQ > 85 MD on DSM-IV criteria Kinematic analysis of Mann Whitney test -More correction of letters; more
et al. (2007) 20 TD Exclusion if reading disability handwriting substitution or omission errors
-Longer air-time when writing
complex letter or word
-On graphic task; faster
movements but less accurate
Leitner 16 ADHD 11.9 (1.8) 11M; 5F NR -MD on DSM-IV criteria for -Walking during 4 min -t-test -ADHD: longer stride time
et al. (2007) 18 TD 12.5 (2.1) 15M; 3F both groups -Dual task: -Chi-sQuare test -On DT; reduction gait speed for
-Conners’ parents and teachers Walk and listen to a -Mixed model both group and for ADHD; less
Q story and count a variability of gait speed
Exclusion if learning disabilities, specific word
neurological, orthopaedic,
psychiatric disorders
Watemberg 96 ADHD 8.4 (2) 81M; 15F NR -MD diagnosis on DSM-IV MABC (<15th Chi-square test Prevalence of DCD among:
et al. (2007) -Criteria parents and teachers percentile) ADHD = 55.2%; ADHD-I = 64.3%;
Q ADHD-C = 58.9%; ADHD-H = 11%
Exclusion if neurological disorder
Licari and 13 ADHD 7.4 (0.9) Only M NR -MD diagnosis on DSM-IV -McCarron Assessment ANOVA -No difference at the MAND and
Larkin (2008) 13 DCD 7.3 (0.7) Exclusion if an comorbidity of -Neuromuscular the NZA between ADHD and TD
10 ADHD 7.4 (0.8) Development (MAND) children
DCD 7.3 (0.9) -Zurich Neuromotor -Significant difference between
15 TD Assessment (ZNA) the ADHD DCD and TD
children
Fliers, de Hoog, 32 ADHD 11 (2.4) 27M; 5F IQ > 70 -MD diagnosis MABC (<15th -Chi-square test 63% ADHD scored <15th at
et al. (2010) 18 non 10.2 (2.3) 8M; 10F -Conners’ parents and teachers percentile) -Linear mixed model MABC
and Fliers, affected 9.1 (0.3) 29M; 21F Q
Franke, et al. sibling -PACS
(2010) 50 TD Exclusion if neurological or
physical disorders
Lavasani and 26 ADHD 6–10 Only M NR DSM-IV criteria used for -Purdue Pegboard t-test Weaker results at all the
Stagnitti (2011) 29 TD diagnosis -Fine motor skills test measures with dominant hand
Exclusion if neurological or and non-dominant hand
physical disorders
Borella et al. 15 ADHD 9.3 (1.4) 12M; 3F 102 (7) -MD diagnosis on DSM-IV Writing ‘le’ during 180 s ANOVA The intravariability was the

(2011) 15 dyslexic 9.3 (1.4) 9M; 6F 103 (9) criteria same between groups at the
15 TD 9.4 (1.4) 12M; 3F 103 (8) -Conners’ Rating Scale – Parent beginning; then an increase is
Exclusion if neurological, observed for the ADHD and the
physical or psychiatric disorders dyslexic group
Inclusion if conduct disorder
Wang, Huang, 25 ADHD 6.5 (1.2) 19M; 6F IQ = 82 (15) MD diagnosis on DSM-IV MABC (<15th Non statistical 64% ADHD scored <15th at
and Lo (2011) 24TD 6.4 (1.2) 18M; 6F NR Criteria percentile) analysis MABC
Exclusion if neurological,
physical or psychiatric disorders
Exclusion if DCD
Brossard-Racine 49 ADHD 8.4 (1.3) 39M; 10F IQ > 80 -MD diagnosis based on DSM- -MABC <15th percentile Wilcoxon signed 73.5% ADHD scored 10 children
et al. (2012) IV -VMI: copying forms rank test with MABC score <15th
-Parents’ Conners’ Q Spearman percentile; 26 children with
-Global Index Interview with Simple linear MABC score <5th percentile
teachers regression
Exclusion if neurological or
physical disorders
Egeland et al. 41 ADHD-C 12.5 (2.3) 21M; 20F 97 (14) -MD diagnosis -VMI: 3 parts ANCOVA ADHD-C and ADHD-I: lower
(2012) 24 ADHD-I 13.5 (1.8) 16M; 8F 92 (15) -Achenbach Scale for parents -GP Effect size score in VMI; GP and FT
60 TD 12.3 (1.9) 28M; 32F 100 (10) and teachers -Halstead Finger
Estimated IQ Exclusion if neurological Tapping (FT)
disorder, inclusion of psychiatric
disorders
Klotz et al. 19 ADHD 10.5 (1.6) 11M; 8F IQ = 103 (NR) MD diagnosis on DSM-IV -Physical and -t-test -Poor results at PANESS
(2012) 16 TD 11.4 (1.5) 10M; 6F IQ = 109 (NR) criteria Neurological -Wilcoxon Signed -Speed of sequential opposition
Conners’ parents Q Examination for Subtle Rank test slower, even more in non-
Exclusion if reading disorders, Signs (PANESS) dominant hand
psychiatric or developmental -Sequential opposition
disorders thumb-fingers
Shorer et al. 22 ADHD 9.3 (1.4) 20M; 2F IQ > 70 -MD on DSM-IV criteria for -Postural stability -t-test -Greater sway in mediolateral
(2012) 15 TD 9.1 (1.7) 13M; 2F both groups control on platform -ANOVA direction in single task
-Conners parents and teachers -Dual task: -Pearson correlation -On DT: lower value of sway
Q Listening to 6 songs in parameters for both groups
Exclusion if neurological, order to memorise
physical or psychiatric disorders
Chen et al. 10 ADHD 9.65 (1.27) 5M; 5F NR MD diagnosis Rope jumping constant -Mann Whitney U test More variability of time between
(2013) 10 TD 9.33 (1.54) 4M; 6F Comorbidity NR rate and variable rate on -Effect size the movement of the arms and
a force place the jump
345
346
Table 1 (Continued )
motor control
Langmaid 14 ADHD 10.9 (2) Only M 97 (12) -Interview on DSM-IV criteria Kinematic analysis of t-test -In the 40 mm condition; smaller
et al. (2013) 14 TD 10.6 (2.3) 101 (10) -Conners’ Rating Scale – parent four l’s in cursive in letter and less accurate and no
Exclusion if neurological, 10 mm and 40 mm variability of the production
physical disorders conditions -Faster movements and excess of
movements

Goulardins 34 ADHD 7–11 NR NR MD diagnosis on DSM-IV-TR Motor Development -t-test 12% of ADHD children had lower
et al. (2013) 32 TD Exclusion if comorbidity Scale -Mann Whitney U test score and none of the TD children
Inclusion if conduct disorder Significant difference between
groups
Papadopoulos 16 ADHD 10.7 (1.6) Only M 97 (12) -MD diagnosis on DSM-IV MABC-2 -t-test -No difference between groups
et al. (2013) 16 TD 10.6 (2.6) 105 (16) criteria -Correlation analysis on the MABC-2
-Conners’ Rating Scale – Parent -Relationship between
Exclusion if autistic disorder inattention symptoms and
motor deficit
-poor results in ball skills is
related to inattention symptoms
Rosch et al. 28 ADHD 10.2 1.4) Only M IQ > 80 -MD diagnosis on DSM-IV Sequential opposition ANOVA Speed was slower; but no
(2013) 23 TD 10.8 -Conners parents and teachers thumb-fingers difference between hands
1.3 Q More variability
Exclusion if neurological or
Inclusion if conduct disorder
Scharoun 58 ADHD 10.1 (9.11) NR NR -MD on ICD-10 criteria Fine and gross motor ANOVA Poor performance at most of the
et al. (2013) 58 TD 10.1 (9.11) -The Strengths and skills task items
Difficulties Q
Comorbidity NR
of DCD children would have been 53%, which approaches the 55.2% prevalence reported by Watemberg et al. (2007).
Goulardins, Marques, Casella, Nascimento, and Oliveira (2013) found a lower percentage with 41% of the ADHD children who
had lower results than the mean at the Motor Development Scale (MDS) developed in Brazil, Searching for difference
between ADHD group and TD group, different results are found. Carte, Nigg, and Hinshaw (1996) used the Time to do
20 battery of Denckla (1974) which measures motor skills automatization. This battery requires slapping hand 20 times on
the thigh and then 20 times with alternating pronation and supination of forearm. The same procedure is done for the foot,
with toe-tapping on the ground and then, tapping with alternating heel and toe. They found that foot items discriminated
better the ADHD children from the TD children, ADHD children being significantly slower. Recently, Papadopoulos et al.
(2013) did not find a difference at the MABC-2 scores between both groups. Using the McCarron Assessment of
Neuromuscular Development (McCarron, 1982) and the Zurich Neuromotor Assessment (Largo et al., 2002), Licari and Larkin
(2008) did not find any difference in motor scores between the children with ADHD without motor problems and the TD
children. Nevertheless, when the comparison was conducted between children with ADHD-DCD and the TD children, the
difference was significant between these groups.
Without making a formal diagnosis of DCD, specific components have been investigated in several studies. Some of these
studies, which used different assessments, described an impairment of balance among ADHD children. Tseng et al. (2004)
found that children with ADHD scored significantly lower than the TD children on the balance subscore of the BOTMP, and
Harvey et al. (2007) confirmed these results for the locomotor part of the TGMD-2.
The results for fine motor skills are almost convergent. While ADHD children performed a sequential oppositional-
thumb-finger task more slowly than the TD children (Steger et al., 2001), they were not slower when performing a simple
oppositional thumb-digit task (Meyer & Terje, 2006). The fine motor subscore of the BOTMP was significantly lower for the
group of ADHD children than for the group of TD children (Tseng et al., 2004; Whitmont & Clark, 1996). Lavasani and Stagnitti
(2011), using a fine motor assessment that was validated for Iranian children, determined that boys with ADHD performed
more poorly than boys without ADHD. These results were confirmed by Scharoun et al. (2013), who found that children with
ADHD performed fine motor tasks, such as spiral tracing, dot filling, tweezers and beads, more slowly than children without
ADHD.
Regarding the quality of the movement, compared to TD children, ADHD children have less precise and less stable
movements during a tracking task (Slaats-Willemse et al., 2005) and during a pursuit task (Rommelse et al., 2007).
Consistent with these results, Yan and Thomas (2002) observed more online corrections of the movements and more jerky
movements.
Studies further find that children with ADHD have a less legible handwriting (Tucha & Lange, 2001). Compared to TD
children, ADHD children made more spelling errors, more insertions and/or deletions of letters as well as more letter
corrections. The letters tended to be larger (Adi-Japha et al., 2007; Shen, Lee, & Chen, 2012). The variability in the production
of letters, however, is probably the main concern, as children demonstrate variability in the height of the letters (Adi-Japha
et al.), in letter spacing, in word spacing, as well as in the alignment of the letters on the baseline (Tucha & Lange, 2001).
Moreover, the variability increases when longer texts must be written. This suggests that ADHD children will have more
difficulty producing a stable handwriting when writing for a long period of time (Borella, Chicherio, Re, Sensini, & Cornoldi,
2011).
A lack of accuracy with respect to handwriting is found in three of the studies. In the first study, children had to write a
cursive ‘‘l’’ in two conditions: 10 mm and 40 mm. Children with ADHD were less accurate than the TD group as they missed
the target (upper line) more often, but only in the condition of 40 mm (Langmaid et al., 2013). In the second study, a graphic
task was used under two conditions (4 mm and 6 mm). The results indicated that children with ADHD were less accurate in
the 6 mm condition than in the 4 mm condition as they did not even reach the margin lines when drawing forms
(Schoemaker et al., 2005). In the third study, children with ADHD were faster but less accurate than the TD group when
drawing an ellipse (Adi-Japha et al., 2007).
There is good evidence that children with ADHD have weaker motor skills than their peers. Some researchers (Carte et al.,
1996; Harvey et al., 2009) have affirmed that gross motor skills are more often impaired among children with ADHD, while
others (Whitmont and Clark, 1996) have postulated that fine motor skills are more affected. When administering the MABC-
2, Brossard-Racine et al. (2012) found that manual dexterity was more often below the normal range. However, other studies
that used MABC did not report the number of children who scored below the 15th percentile.
Some studies have investigated whether children with various subtypes of ADHD differ in the way their motor skills are
affected (Egeland, Ueland, & Johansen, 2012; Meyer & Terje, 2006; Pitcher et al., 2003; Watemberg et al., 2007). The results
are presented below.
3.2.1. Motor skills of children with ADHD without medication: differences among ADHD subtypes
Two studies investigated the presence of probable DCD (a score between the 5th and the 15th percentile) among ADHD
subtypes (Pitcher et al., 2003; Watemberg et al., 2007). The proportion of probable DCD among ADHD-I children was the
highest, with 58% in the first study and 64.3% in the second study. For the combined type, the percentages were 47.3% and
58.9%. The children with ADHD-H were found to be the least impaired with percentages of 49% and 11%. Egeland et al. (2012)
found that, compared to the TD children, children with ADHD-I scored significantly poorer on the Grooved Pegboard. The
same was found for the Purdue Pegboard Test. With respect to the manual dexterity subscore on the MABC (Pitcher et al.,
2003), while the ADHD-I group differed from the TD control group, no significant differences were found between the three
subtypes of ADHD. The ADHD-I group also scored significantly poorer at ball skills than did the TD group, but the results for
the ADHD-I group did not differ from those of the ADHD-C group (Pitcher et al., 2003).
The children with ADHD-C also tended to have fine motor skill deficits. In fact, they recorded the lowest scores on the
Grooved Pegboard Test in the study of Meyer and Terje (2006) and (2) the Visual Motor Integration Test (VMI; Beery, 1997) in
the study of Egeland et al. (2012). With respect to the ADHD-H group, Pitcher et al. (2003) did not find any difference
regarding manual dexterity, ball skills or balance compared to the TD group. Thus, it is concluded that the ADHD-H group is
less impaired in terms of motor skills than the other two other groups as they demonstrate a more severe impairment of fine
motor skills.
3.3. Motor control aspects of non-medicated ADHD children
The aspects of motor control that were analysed involved a broad spectrum of tasks among which were included studies
on balance and walking followed by studies on reaction time, timing, movement time and the kinematics of handwriting.
Balance was analysed using a single force platform. The results indicated that ADHD children had significant larger
mediolateral excursion of the centre of pressure than did TD children during a single task (Shorer et al., 2012). In dual
tasks, children with ADHD performed better than their peers on balance tasks. In fact, Shorer et al. (2012) showed that
balance parameters improved more in dual tasks for the ADHD group than they did for the control group. Leitner et al.
(2007) came to a similar conclusion in a study on gait analysis, finding that ADHD children had a less rhythmic and less
automatic walk in a single task. In a dual task condition, children with ADHD as well as TD children tended to slow down
and walk more rhythmically and with less stride time variability in the dual task condition than the TD children (Leitner
et al., 2007).
Many studies have investigated reaction time (RT) among children with ADHD. Reaction time can be a measure of
sustained attention in a model of attention as well as a measure of the preparation of the movement in a model of motor
control. The present review is limited to articles that analysed RT from the perspective of motor control. Pedersen et al.
(2004) used a lower extremity response time apparatus that required the subject, while in a sitting position, to move the
dominant leg to the right, middle or left depending on the stimulus. Using an EMG analysis, they differentiated the reaction
time in two parts. The first one is the premotor time that is defined as the time from the stimulus to the reaction of the
muscle. The second one is the movement time that is the time from the reaction of the muscle to the initiation of the
movements. They found that children with ADHD had a slower movement preparation. With respect to the upper limb, when
the movements were simple such as a one-finger tapping task (Meyer & Terje, 2006; Rubia et al., 2003), and simple choice
reaction time (Leung & Connolly, 1998) or a simple graphic task (Schoemaker et al., 2005), there were no differences between
the ADHD and the TD groups on RT. However, when the movement was complex, such as in a sequential opposition thumb to
finger task, it was found that the RT for the ADHD group was longer than it was for the TD group (Klotz, Johnson, Wu, Isaacs, &
Gilbert, 2012). Similarly, on a choice-reaching task the ADHD children had a slower RT than the TD children (Klimkeit et al.,
2005). Pitcher et al. (2002) analysed the results of three groups of children on RT and force peak during a tapping index finger
task. The three groups included children with ADHD and DCD, children with ADHD but not DCD and TD children. They found
that children with ADHD but not DCD did not differ on RT from the TD children, while children with ADHD-DCD had
significantly slower RT and lower peak force than the TD group. Furthermore, both ADHD-DCD and ADHD groups had a
greater inter-tap interval than the TD group. Based on the results, Pitcher et al. (2002) suggested that the variability of the
speed of the movement was more a characteristic of ADHD whereas poor recruitment of force and slower reaction time are
associated more with DCD.
Chen et al. (2013) found that children with ADHD encountered more difficulties following variable rates than constant
rates on a jump rope task, and thus, they concluded that motor timing performance is impaired among ADHD children. Yan
and Thomas (2002) also found that the timing of movements of the ADHD group was more variable than was the timing of
the TD children. When performing a tapping task, compared to the TD children, the children with ADHD were slower and
showed greater variability between the sequences (Rosch, Dirlikov, & Mostofsky, 2013). However, a difference between the
ADHD group and the TD group also was noted when they performed a synchronised taping task, ADHD children were more
variable (Rubia et al., 2003). Finally, on a tapping task that required strength, the results of children with ADHD did not differ
from the TD children with respect to peak force (Steger et al., 2001).
With respect to movement time, the results vary. No differences were found between groups of children with ADHD and
without ADHD on a lower limb task (Pedersen et al., 2004) or on a reaching task (Klimkeit et al., 2005). In the latter study,
even when a distractor was added, the ADHD group was not slower than the TD group. On a tracking task, no differences for
the completion time were found between the ADHD children and the TD children (Slaats-Willemse et al., 2005). Similarly,
Rommelse et al. (2007) found that the speed of the children with or without ADHD did not differ on a tracking task and a
pursuit task. On an aiming task, however, Yan and Thomas (2002) found that children with ADHD were slower than their
counterparts when the movement required more complex motor coordination. This result was confirmed by Klotz et al.
(2012) who found that the speed was slower for children with ADHD than for TD children on a sequential opposition of
thumb to fingers task. Eliasson, Rosblad, and Forssberg (2004) nuanced the results. In fact, when the tracking task was
performed with visual feedback, there were no differences between groups with respect to movement time. However, when
the same task was performed without visual feedback, a difference between the groups was found. When the researchers
controlled for the deficit in motor skills, the ADHD children who scored below the 10th percentile on the MABC were
particularly slower than the control group, which was not the case for the ADHD children who scored above the 10th
percentile.
In some studies, the results for the non-dominant hand have also been analysed. Rommelse et al. (2007), found that
children with ADHD were much slower on the tracking task and pursuit task with the non-dominant hand than the TD
children. Klotz et al. (2012) also found a difference of speed with the non-dominant hand at the sequential thumb-fingers
opposition compare to TD children. On the other hand, Rosch et al. (2013) did not find any difference between hands on the
sequential opposition thumb-fingers task between groups of children with ADHD and without ADHD.
Regarding the kinematic features of handwriting products, the fluency of the movement did not differ between groups of
ADHD children and TD children on a handwriting task (Tucha & Lange, 2001) or on a graphic task (Schoemaker et al., 2005).
Adi-Japha et al. (2007) compared the results of a graphic task with those of a handwriting task and found that, compared to
TD children, the ADHD children made faster movements during the graphic task and slower movements during the
handwriting task. Shen et al. (2012) have found that children with ADHD hold the pen longer in the air between movements
than do TD children. Adi-Japha et al. (2007), however, reported that the pen was only in the air longer when ADHD children
had to write complex letters. This finding may imply that the planning of the movement takes longer. On a graphic task in
different dual task conditions such as counting backwards or listening to a specific sound, or with additional noise, no
differences were found between children with ADHD, with ADHD and DCD and TD children (Miyahara, Piek, & Barrett, 2006).
The results of these studies provide sufficient evidence that children with ADHD tend to have slower reaction time when
the movements are complex and that they have difficulty with motor timing. Regarding movement time, there may be
differences between children with and without ADHD when the movements are complex or when there is no visual feedback
(Table 2).
3.4. Effect of medication on motor skills of children with ADHD
Two types of medication are common in the treatment of ADHD: stimulants such as methylphenidate and nonstimulants
such as atomoxetine. Methylphenidate is the most commonly used and it is known to improve attention (Sharma & Couture,
2014). The nonstimulant medication still needs more investigations in order to confirm its efficacy. Nevertheless, the
medication has an influence on the symptoms of ADHD such as hyperactivity, impulsivity, antisocial behaviours and
attention (Rubia et al., 2003). Side-effects of the medication such as physical growth, sleep or digestion have been described
but Sharma and Couture did not draw any definitive conclusion, in their systematic review. We do not think that these side-
effects have a direct influence on motor skills. The medication however could have an indirect influence on motor skills as
will be described further on.
The results of studies on the effects of methylphenidate on the motor skills of children with ADHD are not homogenous.
Rather, they depend on the tests used and on the severity of the motor skill deficits. Bart, Daniel, Dan, and Bar-Haim (2013)
tested 30 children diagnosed with ADHD and coexisting DCD using the MABC and found an improvement into the normal
range for 67% of the children when they were on medication compared to when they were off medication. Four children
approached the borderline range, while six retained the DCD diagnosis. In an earlier study of 18 children with comorbid
ADHD and DCD, Bart et al. (2010) reported that among the 18 children with ADHD who scored below the 5th percentile on
the MABC, five improved their scores on the MABC to above the 15th percentile and 11 scored above the 5th percentile.
Brossard-Racine et al. (2012) included 49 children who had been newly diagnosed with ADHD and for whom medication had
been recommended. Of the ten children with scores between the 6th and 15th percentiles, seven improved their scores to the
normal range on the MABC when on medication. However, among the 26 children with a total score below the 5th percentile
on the MABC, only two children moved to the normal range and six to the borderline range while on medication. With
respect to the TGMD-2, Harvey et al. (2007) found an improvement to the normal range for 12 out of 22 children after
medication, but the improvement was not statistically significant at the group level. The differences in the results among
these studies could be explained by the differences in the tests used. In fact, the TGMD-2 contains six items on ball skill
performance, whereas the MABC has only two items, and the TGMD-2 contains six items on locomotor skills, most of which
assess balance, whereas the MABC has three items that assess balance. In addition, the TGMD-2 is a test that evaluates the
quality of movement performance, whereas the MABC evaluates the outcome of movement. In the study of Harvey et al.,
there were no items to assess fine motor skills, whereas the MABC had three items on manual dexterity. This may suggest
that fine motor skills are more sensitive to improvement due to medication than are ball skills and balance.
The results for balance are convergent. After medication, an improvement in dynamic balance is found, but there is no
improvement in static balance. Wade (1976) found an improvement in balance on a hanged board after medication.
Brossard-Racine et al. (2012) found improvement in the balance subscale of the MABC, but these significant improvements
were the result mainly of improvements in dynamic balance because the measure of balance on the MABC is composed of
two items that assess dynamic balance and one item that assesses static balance. Bart et al. (2010) did not find any significant
changes with respect to the static balance item on the MABC.
With respect to fine motor skills, Brossard-Racine et al. (2012) found that the most important improvement was in
manual dexterity of the MABC-2. For a group of 12 children with ADHD and DCD, eleven improved their scores by at least one
point when on medication (Flapper, Houwen, & Schoemaker, 2006). Thus, the influence of medication on the quality of
handwriting is not clear. In one study, improvements were noted regarding better legibility, better letter formation, more
regular spacing and better alignment of the letters (Tucha & Lange, 2001). Conversely, Rosenblum, Epsztein, and Josman
350
Table 2
Studies on the effect of medication.
Studies Sample Age Gender IQ Diagnosis ADHD Outcome measure Analysis Design of study Effect of medication
Wade (1976) 12 ADHD 7.7–12 (NR) NR NR -MD diagnosis Rotated square ANOVA Single, fixed effects Improvement of time in
12 TD -Conners parents rating platform model balance and less
scale variability
Comorbidity NR
Tucha and 21 ADHD 10.7 (0.4) Only M NR -MD diagnosis on DSM-IV Kinematic analysis Non parametric Crossover study -Improvement of
Lange (2001) 21 TD 10.5 (0.4) criteria of handwriting of test 7 days interval legibility; spacing
-Conners parents and ‘ll’ Variability of the
teachers rating scale acceleration and of the
(CPTRS) velocity
Exclusion if spelling or -Slower handwriting

reading disorders
Rubia et al. 13 ADHD 8.1 (2) Only M IQ > 80 -MD diagnosis on DSM-IV -Free taping -Planned t-tests Double-blind; Improvement of
(2003) 11 TD 9.4 (2) criteria -Synchronised -Effect size placebo-controlled; synchronised tapping
-CBCL taping crossover trial
-Teacher Report form -Sensorimotor 1,2 and 4 weeks
Exclusion if neurological or anticipation task interval
Pedersen 16 ADHD-C 12.8 (NR) Only M VIQ > 80 -MD diagnosis on DSM- -Lower limb -Mixed ANOVA Randomised study Faster premotor time
et al. (2004) 19 TD 12.6 (NR) IV-TR criteria apparatus with -Effect size on and off Less variability in the
-Interview with parents Electromyography medication movement time
and teachers One day interval
Exclusion if neurological,
physical or learning
disorders
Klimkeit 7 ADHD 11.2 (2.2) Only M IQ > 80 -MD on DSM-IV criteria Selective reaching -ANOVA Pilot trial No difference between
et al. (2005) 7 TD 11 (2.1) Inclusion if learning and task -Partial effect groups on RT and on
behavioural disorders sizes movement time
Flapper 12 ADHD + DCD 9.8 (1.7) 11M; 1F IQ > 70 -MD diagnosis on DSM-IV -Manual dexterity -Mann Whitney Double-blind -6 children improved
et al. (2006) 12 TD 9.7 (1.2) criteria of MABC U-test placebo-controlled the handwriting but not
-Checklist questionnaire -BHK trial speed
Exclusion if neurological, -Kinematic analysis -Flower trail: more
psychiatric or learning of flower trail accurate but less fluent
disorders
-For diagnosis of DCD:
MABC < 15th p
Harvey 22 ADHD 9.7 20M; 2F IQ > 70 -MD on DSM-IV criteria TGMD-2 -ANOVA Baseline No effect of medication
et al. (2007) 22 TD 9.8 20M; 2F for both groups -MANOVA Randomised on TGMD-2 score
10 children -Conners’ parents and -Effect size medication and
with affective teachers Q placebo; one week
disorder Inclusion if psychiatric each
disorder
Leitner 16 ADHD 11.9 (1.8) NR NR -MD diagnosis -Walking -Mixed effect Double-blind Decrease of stride time
et al. (2007) 18 TD 12.5 (2.1) -CPTRS -Dual task: models for placebo-controlled variability
Comorbidity: refer to Walk and listen to a repeated trial
Table 1 story; count a measures
specific word
Lufi and 19 ADHD 9.51 (1.57) 12M; 7F NR MD on DSM-IV Handwriting in t-test Double-blind; No difference in the
Gai (2007) Comorbidity NR copy placebo-controlled; quality of handwriting
crossover trial
Rosenblum 12 ADHD 8–10 10M; 2F NR -MD on DSM-IV criteria -Kinematic analysis Wilcoxon test Baseline without any -No improvement of
et al. (2008) 12 TD 10M; 2F for both groups of a text medication speed;
-Conners’ Rating Scale – -Hebrew Post medication after -Improvement of
Parent Handwriting 1 month legibility and spatial
Exclusion if neurological, Evaluation arrangement
physical or psychiatric -Less time in the air
disorders
Jacobi-Polishook 24 ADHD 12 ADHD 11M; 1 F IQ > 70 MD diagnosis Force platform: -Mixed effect Blind randomised -No effect of medication
et al. (2009) in EGa: 11M; 1F Conners’ parent and -Viewing an ‘‘X’’ models for clinical trial: 12 with on postural sway
10.6 (2.5) teacher Q and listening to repeated medication; 12 with parameters during the
12 ADHD Exclusion if neurological, music measures placebo single task condition
in CGb: physical or psychiatric -Dual task: listening -Effect size -Medication improves
10.9 (3.25) disorders to songs and postural stability in dual
remembering task condition

Bart et al. (2010) 18 ADHD + DCD 8.3 (2.5) 13M; 5F NR -K-SADS-PLc MABC <15th t-test and Double-blind within- -5 children of 18 with a
-MABC Q percentile effect size subjects design; 4– score below the 15th
Exclusion if neurological, 14 days interval percentile improved to
physical or psychiatric normal range on the
disorders MABC
-Except for static
balance, improvement
of all subscores of the
MABC
Stray et al. (2010) 73 ADHD 10.9 (2.7) 62M; 11F NR -MD diagnosis Motor Function Mann–Whitney Double-blind The children with
-Conners’ parent and Neurological U-test placebo-controlled moderate or severe
teacher Q Assessment trial; 1 day interval results at the MNFU
Exclusion Tourette or (MNFU) showed a greater
Asperger syndrome improvement after
medication than
children with a good
results at MNFU
Brossard-Racine 49 ADHD 8.4 (1.3) 39M; 10F IQ > 80 -MD diagnosis based on MABC <15th -Wilcoxon Baseline without any -9 children of 36 who
et al. (2012) DSM-IV percentile signed rank test medication had a score below the
-Parents’ Conners’ Q VMI: copying forms -Spearman Post medication after 15th percentile
-Global Index correlations 3 months improved to normal
Interview with teachers -Simple linear range at the MABC
Comorbidity: refer to regression -Change at MABC except
Table 1 balance
-No significant change
for VMI copying forms
Bart et al. (2013) 30 ADHD + DCD 8.3 (2.5) 24M; 6F NR -MD diagnosis MABC-2 <15th -Paired t-test Double crossover 20 children of 30 who
-Conners’ parents rating percentile -Effect size design had a score below the
scales 3–14 days interval 15th percentile
-DCDQ Blind assessment improved to normal
Exclusion if neurological, range at the MABC
physical or psychiatric
disorders
NR, not reported; MD, medical diagnosis.
a
EG: experimental group.
b
CG: control group.
c
K-SADS-PL, schedule for affective disorders and schizophrenia for school-age children-kiddie-sads-present and lifetime version.
351
(2008) found no improvement with respect to legibility, a finding that is consistent with the results of Lufi and Gai (2007).
Flapper et al. (2006) found an intermediate result with an improvement in half of the children after medication.
While the influence of medication on dynamic balance and on fine motor skills is well demonstrated, more evidence is
needed to affirm that medication has a positive influence on handwriting. The reason why the results are divergent is
perhaps due to the type of handwriting assessment. Tucha and Lange (2001) used a sequence of double ‘‘ll’’, whereas the
others (Flapper et al., 2006; Lufi & Gai, 2007; Rosenblum et al., 2008) required the subjects to copy text.
3.5. Effect of medication on motor control aspects
The influence of medication on reaction time was analysed in several studies wherein the results of the same group of
subjects were compared with and without medication. Pedersen et al. (2004) found that among a group of 16 children with
ADHD using a lower extremity response time apparatus, children had a faster premotor time and had less variability in
movement time when they were on medication than when they were not.
In a gait analysis study, Leitner et al. (2007) found that stride time variability decreased with methylphenidate in simple
task conditions while gait speed increased in dual task conditions. Jacobi-Polishook, Shorer, and Melzer (2009) did not find
any differences in balance parameters on a force plate between the same children with and without medication, but they did
find an improvement in dual task conditions after medication.
With regard to a tapping task, the children improved their synchronisation (Rubia et al., 2003), and they were less variable
in their movement time (Pedersen et al., 2004). Conversely, on a selective reaching task, Klimkeit et al. (2005) did not find any
differences between groups with respect to RTs and movement times. As the sample was quite small (5 subjects), this result
should be taken with caution.
Considering the kinematics of handwriting, Tucha and Lange (2001) described that the ADHD group, due to medication, had
an increase in the number of inversions in velocity and in acceleration compared to the control group. Rosenblum et al. (2008)
found that children with ADHD on medication spent less time in the air with their pencil than they did when they were not on
medication. These fewer hesitations could indicate that they were more efficient in planning ahead in their writing.
There is a good evidence to indicate that medication decreases the variability in reaction time and movement time. The
influence of medication on reaction times and movement times, however, requires further investigation as the reaction
times was faster in one study (Pedersen et al., 2004) and showed no improvement in the study of Klimkeit et al.
(2005). Furthermore, an improvement in gait speed was found in the study of Leitner et al. (2007), while Tucha and Lange
(2001) reported slower handwriting.
4. Discussion
From this review, we draw the straightforward conclusion that a majority of children with ADHD have poorer motor skills
than their TD peers and that both fine motor skills and gross motor skills may be affected. We further conclude that the
children with ADHD-I as well as children with ADHD-C show more often an impairment of motor skills than children with
ADHD-H. During this period of school-age, the symptoms of ADHD are quite stable (Willcutt, 2012) and we also know that if
children have DCD, it will stay generally stable during the childhood as described by Cantell et al. (1994).
When children have a double diagnosis of ADHD and DCD, the disorders may share a common aetiology. In fact, McLeod,
Langevin, Goodyear and Dewey (2014) described, among children with DCD and/or ADHD, similarities in dysfunctional
brains regions such as in bilateral inferior frontal gyri, the right supramarginal gyrus, angular gyri, insular cortices, amygdala,
putamen and pallidum.
While children with ADHD do not show slower reaction time than their peers when performing simple reaction tasks, the
reaction times do increase when the child must make a decision, realise movements with many sequences or write a difficult
letter or word. The ADHD children required more time to plan their movements and they need more online control.
Moreover, variability in the movements as well as in the written products are characteristic among children with ADHD.
Though these children know how to draw letters, the parameters of the production of the letters are inconsistent, thus
resulting in variability with respect to the size of the letters and/or the spacing between letters and words. In other words,
ADHD children have difficulty parameterising movements in a consistent way.
The review shows that dynamic balance and fine motor skills improve when ADHD children are medicated. For example,
with medication the variability in walking decreases. The medication does not seem to influence static balance. The reason
may be that static balance is a much more automatic process than is dynamic balance (Bart et al., 2010). The mechanisms by
which the medication of ADHD improves motor skills and motor control is not yet clear. Further research is needed in order
to understand if the effects of medication on neurological dysfunction have a direct influence on the performance of motor
skills and motor control.
While some of the children demonstrated improvement when on the medication, others still presented moderate to
severe motor deficits. Accordingly, three levels of motor deficits are distinguished among ADHD children: (1) severe (5th
percentile on a motor skills test); (2) moderate (between the 5th and the 15th percentile on a motor skills test (Brossard-
Racine et al., 2012); (3) subnormal, demonstrating fine motor skill deficits. In fact, several studies excluded DCD among
children with ADHD and described difficulties in motor skills such as a lack of accuracy in graphic or handwriting tasks
(Langmaid et al., 2013; Schoemaker et al., 2005) and greater variability in peak force (Pitcher et al., 2002).
4.1. Hypothesis of explanation of impairment of motor skills among children with ADHD
Which are the explanations for motor problems associated with ADHD? When deficits in motor skills deficits persist,
three main hypotheses are retained. The first is that comorbidity can be the cause of the motor skills deficits among ADHD
children. The second hypothesis states that the deficits in motor skills are due to a lack of attention. The third postulates that
a lack of inhibition interferes with motor control.
4.1.1. Comorbidity
Could the motor problems associated with ADHD be due to a comorbid developmental disorder? Kadesjo and Gillberg
(2001) reported that 87% of a sample of ADHD had at least one comorbid disorder and 67% two comorbid disorders. One of
the most frequent comorbid disorders cited by these authors, was DCD. In that perspective, Gillberg (2003) has introduced
the diagnosis of Deficits in attention, motor control, and perception (DAMP) that regroups children with a diagnosis of ADHD
and DCD. Autistic disorder is also frequent among ADHD children (Taurines et al., 2010) and there is some evidence that this
disorder has an influence on motor skills. In fact, Papadopoulos et al. (2013) has shown that without autistic disorder, the
ADHD children did not differ from TD children on motor skills. Concurrently, Dewey et al. (2007) described that children with
autism spectrum disorders (ASD) scored lower on motor skills than the ADHD children or the DCD children. They showed
difficulties to imitate movements and to execute movements on command. Finally, the children with ADHD can have a co-
existing DCD that may be diagnosed on the basis of the DSM criteria as described by Brossard-Racine et al. (2012) or Fliers, de
Hoog, et al. (2010) and Fliers, Franke, et al. (2010).
From the review, it is evident that children with ADHD-DCD have more severe motor problems than children with only
ADHD. Apart from that, children with ADHD who do not meet the criteria for DCD may still have motor skill challenges, albeit
to a lesser degree (Langmaid et al., 2013; Schoemaker et al., 2005). The information above makes it clear that motor problems
in ADHD may be due to a comorbid disorder like DCD or one with associated motor problems like autism. Whether the
comorbid disorder is an independent disorder, or shares a common developmental ground with ADHD is presently
unknown. The fact that medication such as methylphenidate improves both symptoms of ADHD and motor performance
point at the direction of some common grounds.
4.1.2. The hypothesis of a deficit of attention

Many arguments support the hypothesis that a lack of attention is the underlying mechanism for the motor skills deficit.
First, an attention deficit influences motor skills. Adi-Japha et al. (2007) studied handwriting and reported that errors such as
omissions, insertions and corrections of letters are related to inattention and are not the result of a deficit in motor skills.
Second, the fact that children with ADHD are more performant on balance in dual task conditions led Leitner et al. (2007) to
postulate that dual tasks raise the level of vigilance that influences the performance. It is possible that in single tasks, the
degree of vigilance among children with ADHD fluctuates, thus leading to greater variability in the level of production, while
on dual tasks the level of vigilance is more stable. Third, there is a strong argument that with medication motor skills as well
some aspects of motor control improved. Moreover, the quality of the handwriting of those children with ADHD who are
medicated also improved. This improvement in quality likely occurs because the medicated ADHD child is better able to
focus on the task.
Given this last argument, two explanations are advanced. The first is that methylphenidate improves attention, which,
in turn, improves motor skills. The second is that the medication improves attention and motor skills independent each
other. With respect to arguments that favour the first hypothesis, the study of Bart et al. (2013) found that, with medication,
the improvement in a continuous performance test that measures sustained attention is strongly related to an
improvement in motor coordination. Furthermore, the reduced variability in the handwriting product observed with
medication may also be interpreted as the result of improvement in attention. From the perspective of the model of Paine,
Grossberg, and Van Gemmert (2004) constant visual attention is required to anticipate the change of direction between
strokes. If visual attention fluctuates, these changes will occur too late, thus contributing of higher letters and a lack of
alignment of letters on the baseline. Third, the fact that a number of children improved their scores into the normal range on
the MABC when on medication might be explained by the effect of methylphenidate, which improved their ability to focus
and thus better meet the requirements of the MABC. Kaplan, Wilson, Dewey, and Crawford (1998) showed that children
with attention deficit scored more poorly on the MABC than did the TD children. In fact, the MABC was more sensitive to
attention deficit than was the BOTMP, a result likely due to feedback not being allowed during the MABC whereas it is
permitted during the BOTMP.
Alternatively, the possibility that medication improves motor skills independently of the improvement of attentional
skills must be considered. Stray et al. (2010), in a retrospective study, found that ADHD children who were good responders
to methylphenidate and exhibited a decrease of ADHD symptoms more often obtained weak scores on the Motor Function
Neurological Assessment (MNFU) before medication, whereas the ADHD children who were poor responders to the
medication obtained normal scores on the MNFU. Because they found improvement in motor skills among those who
responded well to the medication, they suggested that the medication had a direct influence on motor skills.
However, not all the children with ADHD improve their motor skills with medication to the normal range. Some children
still show motor problems, which implies that a lack of attention is not the only explanation for poor motor skills in children
with ADHD.
4.1.3. The hypothesis of lack of inhibition

Barkley (1997) was among the first to describe the relationship between the lack of inhibition and motor skills. However,
prior to discussing his hypothesis, it is important to note that he made a clear distinction between children with ADHD-C and
the inattentive subtype. According to Barkley, the children with ADHD-I do not have the same type of impairment as the
children with ADHD-C. He contends that ADHD-I children tend to daydream and they demonstrate a deficit with respect to
the speed of processing information in both focused and selective attention but not in behavioural inhibition. On the other
hand, children with ADHD-C suffer from a lack of inhibition that includes the capacities to inhibit the preparation of a
response, to stop an ongoing response and to control interference. These capacities influence the executive functions such as
working memory, self-regulation of affect, motivation, arousal, internalisation of speech and reconstitution. The
perturbation of these executive functions then interferes with motor control. From this perspective, studies have shown
that a lack of inhibition is a main characteristic of ADHD children (Alderson, Rapport, & Kofler, 2007; de Zeeuw et al., 2008).
One study reported that the medication tends to improve the response inhibition and thus improve motor control as a result
(Klimkeit et al., 2005). Nevertheless, Klimkeit et al. (2005) also found that non-medicated ADHD children as well as
medicated ADHD children performed better than the TD children did when a distractor was present, demonstrating equal
reaction time and fewer errors due to inattention. Accordingly, neither of the ADHD groups (medicated and non-medicated)
had difficulty controlling and inhibiting responses due to interference, as would be predicted by Barkley’s theory.
Furthermore, the fact that often the motor deficits are found in the ADHD-I group is an argument against the lack of
inhibition as an explanation, as ADHD-I do not have problem of inhibition according to Barkley.
Even if more research is needed to prove the relationship between the lack of inhibition and motor control, it is obvious
that lack of inhibition can influence certain motor skills. In fact, the child with ADHD who realises a goal directed movement
without preliminary reflexion or anticipation of the effect of the movements would fail this task. Further studies on motor
skills among ADHD children should consider the types of movements or tasks such as goal/not goal directed, closed/open
looped, and discrete/serial/continuous tasks to better understand the types of tasks that are likely to be impaired. This is
directly relevant for participation in daily life.
5. Limitations
This review includes comparative studies that have been conducted with limited samples of participants. As we did not
realise a meta-analysis, conclusions reached in this review should be interpreted with some caution until substantiated by
further research. Gender differences have not been analysed due to the fact that 15 of the studies included had samples of
boys only, the remaining studies most often included only a minority of females. The influence of gender may be important,
however, as Hasson and Fine (2012) in their meta-analytic review of continuous performance tests, found a moderate effect
of gender with a larger difference between ADHD boys and TD boys than between ADHD girls and TD girls.
While few studies have realised a standardised evaluation of attention and motor skills, more research is needed to gain
an understanding of the relationship between motor skills deficits and attention and inhibition behaviours.
6. Conclusion
This review indicates that a majority of children with ADHD has motor skills deficits. When on medication, the ADHD
children with a mild motor deficit before medication tend to improve their motor skills to the normal range, whereas the
ADHD children with a severe motor deficit before medication tend to show persistent motor skill impairment which might
meet the diagnostic criteria of DCD as a comorbid disorder. Moreover, the profiles of ADHD children can differ so
dramatically that the three hypotheses presented in this article may explain the results of the varied profiles of children.
Accordingly, more research among large samples that controls for comorbidity is needed to describe subgroups and to obtain
a better perspective of these disorders.
This review confirms the need to assess motor skills among children with ADHD because, as Davis, Pass, Finch, Dean, and
Woodcock (2009) have described, there is an important relationship between sensory-motor skills and academic
achievement.
References
Adi-Japha, E., Landau, Y. E., Frenkel, L., Teicher, M., Gross-Tsur, V., & Shalev, R. S. (2007). ADHD and dysgraphia: Underlying mechanisms. Cortex, 43(6), 700–709.
http://dx.doi.org/10.1016/s0010-9452(08)70499-4
Alderson, R. M., Rapport, M. D., & Kofler, M. J. (2007). Attention-deficit/hyperactivity disorder and behavioral inhibition: A meta-analytic review of the stop-signal
paradigm. Journal of Abnormal Child Psychology, 35(5), 745–758. http://dx.doi.org/10.1007/s10802-007-9131-6
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Press.
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1),
65–94. http://dx.doi.org/10.1037/0033-2909.121.1.65
Bart, O., Daniel, L., Dan, O., & Bar-Haim, Y. (2013). Influence of methylphenidate on motor performance and attention in children with developmental coordination
disorder and attention deficit hyperactive disorder. Research in Developmental Disabilities, 34(6), 1922–1927. http://dx.doi.org/10.1016/j.ridd.2013.03.015
Bart, O., Podoly, T., & Bar-Haim, Y. (2010). A preliminary study on the effect of methylphenidate on motor performance in children with comorbid DCD and ADHD.
Research in Developmental Disabilities, 31(6), 1443–1447. http://dx.doi.org/10.1016/j.ridd.2010.06.014
Beery, K. E. (1997). The Beery–Buktenica developmental test of visual motor integration: VMI with supplemental tests of visual perception and motor coordination:
Administration, scoring and teaching manual. Parsippany, NJ: Modern Curriculum Press.
Blank, R. (2012). European Academy of Childhood Disability (EACD): Recommendations on the definition, diagnosis and intervention of developmental
coordination disorder (pocket version). German–Swiss interdisciplinary clinical practice guideline S3-standard according to the Association of the Scientific
Medical Societies in Germany. Pocket version. Definition, diagnosis, assessment, and intervention of developmental coordination disorder (DCD).
Developmental Medicine and Child Neurology, 54(11), e1–e7. http://dx.doi.org/10.1111/j.1469-8749.2011.04175.x
Borella, E., Chicherio, C., Re, A. M., Sensini, V., & Cornoldi, C. (2011). Increased intraindividual variability is a marker of ADHD but also of dyslexia: A study on
handwriting. Brain and Cognition, 77(1), 33–39. http://dx.doi.org/10.1016/j.bandc.2011.06.005
Brossard-Racine, M., Majnemer, A., Shevell, M., Snider, L., & Belanger, S. A. (2011). Handwriting capacity in children newly diagnosed with attention deficit
hyperactivity disorder. Research in Developmental Disabilities, 32(6), 2927–2934. http://dx.doi.org/10.1016/j.ridd.2011.05.010
Brossard-Racine, M., Shevell, M., Snider, L., Belanger, S. A., & Majnemer, A. (2012). Motor skills of children newly diagnosed with attention deficit hyperactivity
disorder prior to and following treatment with stimulant medication. Research in Developmental Disabilities, 33(6), 2080–2087. http://dx.doi.org/10.1016/
j.ridd.2012.06.003
Bruininks, R. H. (1978). Bruininks–Oseretsky test of motor proficiency. Circle Pines, MN: American Guidance Service.
Buderath, P., Gartner, K., Frings, M., Christiansen, H., Schoch, B., Konczak, J., et al. (2009). Postural and gait performance in children with attention deficit/
hyperactivity disorder. Gait & Posture, 29, 249–254.
Cantell, M. H., Smyth, M. M., & Ahonen, T. P. (1994). Clumsiness in adolescence: Educational, motor, and social outcomes of motor delay detected at 5 years.
Adapted Physical Activity Quarterly, 11(2), 115–129.
Carte, E. T., Nigg, J. T., & Hinshaw, S. P. (1996). Neuropsychological functioning, motor speed, and language processing in boys with and without ADHD. Journal of
Abnormal Child Psychology, 24(4), 481–498. http://dx.doi.org/10.1007/bf01441570
Chen, Y. Y., Liaw, L. J., Liang, J. M., Hung, W. T., Guo, L. Y., & Wu, W. L. (2013). Timing perception and motor coordination on rope jumping in children with attention
deficit hyperactivity disorder. Physical Therapy in Sport, 14(2), 105–109. http://dx.doi.org/10.1016/j.ptsp.2012.03.012
Conners, C. K. (2001). Conner’s rating scales-revised: Technical manual. North Tonawanda, NY: Multi-Health Systems.
Cortese, S. (2012). The neurobiology and genetics of attention-deficit/hyperactivity disorder (ADHD): What every clinician should know. European Journal of
Paediatric Neurology, 16(5), 422–433. http://dx.doi.org/10.1016/j.ejpn.2012.01.009
Coverdale, N. S., O’Leary, D. D., Faught, B. E., Chirico, D., Hay, J., & Cairney, J. (2012). Baroreflex sensitivity is reduced in adolescents with probable developmental
coordination disorder. Research in Developmental Disabilities, 33(1), 251–257.
Davis, A. S., Pass, L. A., Finch, W. H., Dean, R. S., & Woodcock, R. W. (2009). The canonical relationship between sensory-motor functioning and cognitive processing
in children with attention-deficit/hyperactivity disorder. Archives of Clinical Neuropsychology, 24(3), 273–286. http://dx.doi.org/10.1093/arclin/acp032
Denckla, M. B. (1974). Development of motor coordination in normal children. Developmental Medicine and Child Neurology, 16(6), 729–741.
Denckla, M. B. (1985). Revised neurological examination for subtle signs (1985). Psychopharmacology Bulletin, 21(4), 773–779.
Depue, B. E., Burgess, G. C., Bidwell, L. C., Willcutt, E. G., & Banich, M. T. (2010). Behavioral performance predicts grey matter reductions in the right inferior frontal
gyrus in young adults with combined type ADHD. Psychiatry Research – Neuroimaging, 182(3), 231–237. http://dx.doi.org/10.1016/j.pscychresns.2010.01.012
Dewey, D., Cantell, M., & Crawford, S. G. (2007). Motor and gestural performance in children with autism spectrum disorders, developmental coordination
disorder, and/or attention deficit hyperactivity disorder. Journal of the International Neuropsychological Society, 13(2), 246–256. http://dx.doi.org/10.1017/
s1355617707070270
de Zeeuw, P., Aarnoudse-Moens, C., Bijlhout, J., Konig, C., Uiterweer, A. P., Papanikolau, A., et al. (2008). Inhibitory performance, response speed, intraindividual
variability, and response accuracy in ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 47(7), 808–816. http://dx.doi.org/10.1097/
CHI.0b013e318172eee9
Egeland, J., Ueland, T., & Johansen, S. (2012). Central processing energetic factors mediate impaired motor control in ADHD combined subtype but not in ADHD
inattentive subtype. Journal of Learning Disabilities, 45(4), 361–370. http://dx.doi.org/10.1177/0022219411407922
Eliasson, A. C., Rosblad, B., & Forssberg, H. (2004). Disturbances in programming goal-directed arm movements in children with ADHD. Developmental Medicine
and Child Neurology, 46(1), 19–27. http://dx.doi.org/10.1017/s0012162204000040
Finch, H., Davis, A., & Dean, R. S. (2010). Factor invariance assessment of the Dean–Woodcock sensory-motor battery for patients with ADHD versus nonclinical
subjects. Educational and Psychological Measurement, 70(1), 161–173. http://dx.doi.org/10.1177/0013164409344528
Flapper, B. C. T., Houwen, S., & Schoemaker, M. M. (2006). Fine motor skills and effects of methylphenidate in children with attention-deficit-hyperactivity
disorder and developmental coordination disorder. Developmental Medicine and Child Neurology, 48(3), 165–169. http://dx.doi.org/10.1017/
S0012162206000375
Fliers, E. A., de Hoog, M. L. A., Franke, B., Faraone, S. V., Rommelse, N. N. J., Buitelaar, J. K., et al. (2010). Actual motor performance and self-perceived motor
competence in children with attention-deficit hyperactivity disorder compared with healthy siblings and peers. Journal of Developmental and Behavioral
Pediatrics, 31(1), 35–40.
Fliers, E. A., Franke, B., Lambregts-Rommelse, N. N. J., Altink, M. E., Buschgens, C. J. M., Nijhuis-van der Sanden, M. W. G., et al. (2010). Undertreatment of motor
problems in children with ADHD. Child and Adolescent Mental Health, 15(2), 85–90. http://dx.doi.org/10.1111/j.1475-3588.2009.00538.x
Fliers, E., Rommelse, N., Vermeulen, S., Altink, M., Buschgens, C. J. M., Faraone, S. V., et al. (2008). Motor coordination problems in children and adolescents with
ADHD rated by parents and teachers: Effects of age and gender. Journal of Neural Transmission, 115(2), 211–220. http://dx.doi.org/10.1007/s00702-007-0827-
0
Germano, E., Gagliano, A., & Curatolo, P. (2010). Comorbidity of ADHD and dyslexia. Developmental Neuropsychology, 35(5), 475–493. http://dx.doi.org/10.1080/
875656412010494748
Geuze, R. H., Jongmans, M. J., Schoemaker, M. M., & Smits-Engelsman, B. C. M. (2001). Clinical and research diagnostic criteria for developmental coordination
disorder: A review and discussion. Human Movement Science, 20(1–2), 7–47. http://dx.doi.org/10.1016/s0167-9457(01)00027-6
Gillberg, C. (2003). Deficits in attention, motor control, and perception: A brief review. Archives of Disease in Childhood, 88(10), 904–910. http://dx.doi.org/10.1136/
adc.88.10.904
Goulardins, J. B., Marques, J. C. B., Casella, E. B., Nascimento, R. O., & Oliveira, J. A. (2013). Motor profile of children with attention deficit hyperactivity disorder,
combined type. Research in Developmental Disabilities, 34(1), 40–45. http://dx.doi.org/10.1016/j.ridd.2012.07.014
Harpin, V. A. (2005). The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Archive of Disease Childhood, 90(Suppl.
1), i2–i7. http://dx.doi.org/10.1136/adc.2004.059006
Harvey, W. J., & Reid, G. (1997). Motor performance of children with attention-deficit hyperactivity disorder: A preliminary investigation. Adapted Physical Activity
Quarterly, 14(3), 189–202.
Harvey, W. J., & Reid, G. (2003). Attention-deficit/hyperactivity disorder: A review of research on movement skill performance and physical fitness. Adapted
Physical Activity Quarterly, 20(1), 1–25.
Harvey, W. J., Reid, G., Grizenko, N., Mbekou, V., Ter-Stepanian, M., & Joober, R. (2007). Fundamental movement skills and children with attention-deficit
hyperactivity disorder: Peer comparisons and stimulant effects. Journal of Abnormal Child Psychology, 35(5), 871–882. http://dx.doi.org/10.1007/s10802-007-
9140-5
Harvey, W. J., Reid, G., Bloom, G. A., Staples, K., Grizenko, N., Mbekou, V., et al. (2009). Physical Activity Experiences of Boys With and Without ADHD. Adapted
Hasson, R., & Fine, J. G. (2012). Gender differences among children with ADHD on continuous performance tests: A meta-analytic review. Journal of Attention
Disorders, 16(3), 190–198. http://dx.doi.org/10.1177/1087054711427398
Henderson, S. E., & Sugden, D. A. (2000). Movement assessment battery for children. New York: Psychological Corporation/Harcourt.
Jacobi-Polishook, T., Shorer, Z., & Melzer, I. (2009). The effect of methylphenidate on postural stability under single and dual task conditions in children with
attention deficit hyperactivity disorder – A double blind randomized control trial. Journal of the Neurological Sciences, 280(1–2), 15–21. http://dx.doi.org/
10.1016/j.jns.2009.01.007
Kadesjo, B., & Gillberg, C. (1998). Attention deficits and clumsiness in Swedish 7-year-old children. Developmental Medicine and Child Neurology, 40(12), 796–804.
Kadesjo, B., & Gillberg, C. (2001). The comorbidity of ADHD in the general population of Swedish school-age children. Journal of Child Psychology and Psychiatry and
Allied Disciplines, 42(4), 487–492.
Kaplan, B. J., Wilson, B. N., Dewey, D., & Crawford, S. G. (1998). DCD may not be a discrete disorder. Human Movement Science, 17(4–5), 471–490. http://dx.doi.org/
10.1016/S0167-9457(98)00010-4
Karatekin, C., Markiewicz, S. W., & Siegel, M. A. (2003). A preliminary study of motor problems in children with attention-deficit/hyperactivity disorder. Perceptual
and Motor Skills, 97(3), 1267–1280.
Klimkeit, E. I., Mattingley, J. B., Sheppard, D. M., Lee, P., & Bradshaw, J. L. (2005). Motor preparation, motor execution, attention, and executive functions in
attention deficit/hyperactivity disorder (ADHD). Child Neuropsychology, 11(2), 153–173. http://dx.doi.org/10.1080/092970490911298
Klotz, J. M., Johnson, M. D., Wu, S. W., Isaacs, K. M., & Gilbert, D. L. (2012). Relationship between reaction time variability and motor skill development in ADHD.
Child Neuropsychology, 18(6), 576–585. http://dx.doi.org/10.1080/09297049.2011.625356
Konicarova, J., Bob, P., & Raboch, J. (2014). Balance deficits and ADHD symptoms in medication-naive school-aged boys. Neuropsychiatric Disease and Treatment, 10,
85–88.
Langmaid, R. A., Papadopoulous, N., Johnson, B. P., Phillips, J., & Rinehart, N. J. (2013). Movement scaling in children with ADHD-combined type. Journal of Attention
Disorders. http://dx.doi.org/10.1177/1087054713493317
Largo, R. H., Fischer, J. E., & Caflisch, J. A. (2002). Zurich neuromotor assessment. Zurich: AWE Verlag.
Lavasani, N. M., & Stagnitti, K. (2011). A study on fine motor skills of Iranian children with attention deficit/hyper activity disorder aged from 6 to 11 years.
Occupational Therapy International, 18(2), 106–114. http://dx.doi.org/10.1002/oti.306
Leitner, Y., Barak, R., Giladi, N., Peretz, C., Eshel, R., Gruendlinger, L., et al. (2007). Gait in attention deficit hyperactivity disorder – Effects of methylphenidate and
dual tasking. Journal of Neurology, 254(10), 1330–1338. http://dx.doi.org/10.1007/s00415-006-0522-3
Leung, P. W. L., & Connolly, K. J. (1998). Do hyperactive children have motor organization and/or execution deficits? Developmental Medicine and Child Neurology,
40(9), 600–607.
Licari, M., & Larkin, D. (2008). Increased associated movements: Influence of attention deficits and movement difficulties. Human Movement Science, 27(2), 310–
324. http://dx.doi.org/10.1016/j.humov.2008.02.013
Lingam, R., Golding, J., Jongmans, M. J., Hunt, L. P., Ellis, M., & Emond, A. (2010). the association between developmental coordination disorder and other
developmental traits. Pediatrics, 126(5), E1109–E1118. http://dx.doi.org/10.1542/peds.2009-2789
Lufi, D., & Gai, E. (2007). The effect of methylphenidate and placebo on eye-hand coordination functioning and handwriting of children with attention deficit
hyperactivity disorder. Neurocase, 13(5), 334–341. http://dx.doi.org/10.1080/13554790701851486
McCarron, L. T. (1982). McCarron assessment of neuromuscular development: Fine and gross motor abilities. Dallas, TX: Common Market Press.
McLeod, K. R., Langevin, L. M., Goodyear, B. G., & Dewey, D. (2014). Functional connectivity of neural motor networks is disrupted in children with developmental
coordination disorder and attention-deficit/hyperactivity disorder. NeuroImage: Clinical, 4, 566–575. http://dx.doi.org/10.1016/j.nicl.2014.03.010
Meyer, A., & Terje, S. (2006). Fine motor skills in South African children with symptoms of ADHD: Influence of subtype, gender, age, and hand dominance. Brain and
Behavioral Functions, 2(33), 1–13.
Miyahara, M., Piek, J., & Barrett, N. (2006). Accuracy of drawing in a dual-task and resistance-to-distraction study: Motor or attention deficit? Human Movement
Science, 25(1), 100–109. http://dx.doi.org/10.1016/j.humov.2005.11.004
Paine, R. W., Grossberg, S., & Van Gemmert, A. W. (2004). A quantitative evaluation of the AVITEWRITE model of handwriting learning. Human Movement Science,
23(6), 837–860. http://dx.doi.org/10.1016/j.humov.2004.08.024
Papadopoulos, N., Rinehart, N., Bradshaw, J. L., & McGinley, J. L. (2013). Brief report: Children with ADHD without co-morbid autism do not have impaired motor
proficiency on the movement assessment battery for children. Journal of Autism and Developmental Disorders, 43(6), 1477–1482. http://dx.doi.org/10.1007/
s10803-012-1687-5
Pedersen, S. J., Surburg, P. R., Heath, M., & Koceja, D. M. (2004). Fractionated lower extremity response time performance in boys with and without ADHD. Adapted
Piek, J. P., Pitcher, T. M., & Hay, D. A. (1999). Motor coordination and kinaesthesis in boys with attention deficit-hyperactivity disorder. Developmental Medicine and
Child Neurology, 41(3), 159–165. http://dx.doi.org/10.1017/s0012162299000341
Pitcher, T. M., Piek, J. P., & Barrett, N. C. (2002). Timing and force control in boys with attention deficit hyperactivity disorder: Subtype differences and the effect of
comorbid developmental coordination disorder. Human Movement Science, 21(5–6), 919–945. http://dx.doi.org/10.1016/s0167-9457(02)00167-7
Pitcher, T. M., Piek, J. P., & Hay, D. A. (2003). Fine and gross motor ability in males with ADHD. Developmental Medicine and Child Neurology, 45(8), 525–535.
Polderman, T. J. C., van Dongen, J., & Boomsma, D. I. (2011). The relation between ADHD symptoms and fine motor control: A genetic study. Child Neuropsychology,
17(2), 138–150.
Rommelse, N. N. J., Altink, M. E., Oosterlaan, J., Buschgens, C. J. M., Buitelaar, J., De Sonneville, L. M. J., et al. (2007). Motor control in children with ADHD and non-
affected siblings: Deficits most pronounced using the left hand. Journal of Child Psychology and Psychiatry, 48(11), 1071–1079. http://dx.doi.org/10.1111/
j.1469-7610.2007.01781.x
Rosch, K. S., Dirlikov, B., & Mostofsky, S. H. (2013). Increased intrasubject variability in boys with ADHD across tests of motor and cognitive control. Journal of
Abnormal Child Psychology, 41(3), 485–495. http://dx.doi.org/10.1007/s10802-012-9690-z
Rosenblum, S., Epsztein, L., & Josman, N. (2008). Handwriting performance of children with attention deficit hyperactive disorders: A pilot study. Physical &
Occupational Therapy in Pediatrics, 28(3), 219–234. http://dx.doi.org/10.1080/01942630802224934
Rubia, K., Noorloos, J., Smith, A., Gunning, B., & Sergeant, J. (2003). Motor timing deficits in community and clinical boys with hyperactive behavior: The effect of
methylphenidate on motor timing. Journal of Abnormal Child Psychology, 31(3), 301–313. http://dx.doi.org/10.1023/a:1023233630774
Scharoun, S. M., Bryden, P. J., Otipkova, Z., Musalek, M., & Lejcarova, A. (2013). Motor skills in Czech children with attention-deficit/hyperactivity disorder and their
neurotypical counterparts. Research in Developmental Disabilities, 34(11), 4142–4153. http://dx.doi.org/10.1016/j.ridd.2013.08.011
Schoemaker, M. M., Ketelaars, C. E. J., van Zonneveld, M., Minderaa, R. B., & Mulder, T. (2005). Deficits in motor control processes involved in production of graphic
movements of children with attention-deficit-hyperactivity disorder. Developmental Medicine and Child Neurology, 47(6), 390–395. http://dx.doi.org/10.1017/
s0012162205000769
Schoemaker, M. M., Lingam, R., Jongmans, M. J., van Heuvelen, M. J. G., & Emond, A. (2013). Is severity of motor coordination difficulties related to co-morbidity in
children at risk for developmental coordination disorder? Research in Developmental Disabilities, 34(10), 3084–3091.
Sergeant, J. A., Piek, J. P., & Oosterlaan, J. (2006). ADHD and DCD: A relationship in need of research. Human Movement Science, 25(1), 76–89. http://dx.doi.org/
10.1016/j.humov.2005.10.007
Sharma, A., & Couture, J. (2014). A review of the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD). Annals of
Pharmacotherapy, 48(2), 209–225. http://dx.doi.org/10.1177/1060028013510699
Shen, I. H., Lee, T. Y., & Chen, C. L. (2012). Handwriting performance and underlying factors in children with attention deficit hyperactivity disorder. Research in
Developmental Disabilities, 33(4), 1301–1309. http://dx.doi.org/10.1016/j.ridd.2012.02.010
Shorer, Z., Becker, B., Jacobi-Polishook, T., Oddsson, L., & Melzer, I. (2012). Postural control among children with and without attention deficit hyperactivity
disorder in single and dual conditions. European Journal of Pediatrics, 171(7), 1087–1094. http://dx.doi.org/10.1007/s00431-012-1695-7
Slaats-Willemse, D., de Sonneville, L., Swaab-Barneveld, H., & Buitelaar, J. (2005). Motor flexibility problems as a marker for genetic susceptibility to attention-
deficit/hyperactivity disorder. Biological Psychiatry, 58(3), 233–238. http://dx.doi.org/10.1016/j.biopsych.2005.03.046
Steger, J., Imhof, G., Coutts, E., Gundelfinger, R., Steinhausen, E. C., & Brandeis, D. (2001). Attentional and neuromotor deficits in ADHD. Developmental Medicine and
Child Neurology, 43(3), 172–179. http://dx.doi.org/10.1017/s0012162201000330
Stray, L. L., Ellertsen, B., & Stray, T. (2010). Motor function and methylphenidate effect in children with attention deficit hyperactivity disorder. Acta Paediatrica,
99(8), 1199–1204. http://dx.doi.org/10.1111/j.1651-2227.2010.01760.x
Taurines, R., Schmitt, J., Renner, T., Conner, A. C., Warnke, A., & Romanos, M. (2010). Developmental comorbidity in attention-deficit/hyperactivity disorder.
Attention Deficit Hyperactivity Disorder, 2(4), 267–289. http://dx.doi.org/10.1007/s12402-010-0040-0
Tervo, R. C., Azuma, S., Fogas, B., Falls, S., & Fiechtner, H. (2002). Children with ADHD and motor dysfunction compared with children with ADHD only.
Developmental Medicine and Child Neurology, 44(6), 383–390.
Tseng, M. H., Henderson, A., Chow, S. M. K., & Yao, G. (2004). Relationship between motor proficiency, attention, impulse, and activity in children with ADHD.
Developmental Medicine and Child Neurology, 46(6), 381–388. http://dx.doi.org/10.1017/s0012162204000623
Tucha, O., & Lange, K. W. (2001). Effects of methylphenidate on kinematic aspects of handwriting in hyperactive boys. Journal of Abnormal Child Psychology, 29(4),
351–356. http://dx.doi.org/10.1023/a:1010366014095
Ulrich, D. A. (2000). Test of gross motor development (2nd ed.). Texas: PRO-ED.
Wade, M. G. (1976). Effects of methylphenidate on motor skill acquisition of hyperactive children. Journal of Learning Disabilities, 9, 443–447.
Wang, H.-Y., Huang, T.-H., & Lo, S.-K. (2011). Motor ability and adaptive function in children with attention deficit hyperactivity disorder. Kaohsiung Journal of
Medical Sciences, 27(10), 446–452. http://dx.doi.org/10.1016/j.kjms.2011.06.004
Watemberg, N., Waiserberg, N., Zuk, L., & Lerman-Sagie, T. (2007). Developmental coordination disorder in children with attention-deficit-hyperactivity disorder
and physical therapy intervention. Developmental Medicine Child Neurology, 49(12), 920–925. http://dx.doi.org/10.1111/j.1469-8749.2007.00920.x
Whitmont, S., & Clark, C. (1996). Kinaesthetic acuity and fine motor skills in children with attention deficit hyperactivity disorder: A preliminary report.
Developmental Medicine and Child Neurology, 38(12), 1091–1098.
Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics, 9(3), 490–499.
Williams, J., Omizzolo, C., Galea, M. P., & Vance, A. (2013). Motor imagery skills of children with attention deficit hyperactivity disorder and developmental
coordination disorder. Human Movement Science, 32(1), 121–135.
Yan, J. H., & Thomas, J. R. (2002). Arm movement control: Differences between children with and without attention deficit hyperactivity disorder. Research
Quarterly for Exercise and Sport, 73(1), 10–18.

Research in Developmental Disabilities: Review Article

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Research in Developmental Disabilities: Review Article

Uploaded by

Copyright:

Available Formats

Research in Developmental Disabilities 36 (2015) 338–357

Contents lists available at ScienceDirect

Research in Developmental Disabilities

What is the evidence of impaired motor skills and motor

3.1. Description of studies

41 articles on motor 15 articles on the

11 articles on motor 30 articles on motor 15 articles on the

Fig. 1. Process of selection of the review.

3.2. Motor skills of ADHD children without medication

M.-L. Kaiser et al. / Research in Developmental Disabilities 36 (2015) 338–357

M.-L. Kaiser et al. / Research in Developmental Disabilities 36 (2015) 338–357

M.-L. Kaiser et al. / Research in Developmental Disabilities 36 (2015) 338–357

M.-L. Kaiser et al. / Research in Developmental Disabilities 36 (2015) 338–357

M.-L. Kaiser et al. / Research in Developmental Disabilities 36 (2015) 338–357

3.3. Motor control aspects of non-medicated ADHD children

3.4. Effect of medication on motor skills of children with ADHD

M.-L. Kaiser et al. / Research in Developmental Disabilities 36 (2015) 338–357

M.-L. Kaiser et al. / Research in Developmental Disabilities 36 (2015) 338–357

3.5. Effect of medication on motor control aspects

4.1.2. The hypothesis of a deﬁcit of attention

4.1.3. The hypothesis of lack of inhibition

You might also like