Motor Performance of Children With Attention Deficit Hyperactivity Disorder in Fourth to Sixth Grades: Differences Among Subtypes

BACKGROUND AND PURPOSE: Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent neurobehavioral disorders of childhood, characterized by three primary symptoms: hyperactivity, impulsivity, and inattention. Based on the primary symptoms, three clinical subtypes of ADHD have been proposed: predominantly inattentive (ADHD–PI), hyperactive–impulsive (ADHD–HI), and combined types (ADHD–C). In addition to the primary symptoms, studies have reported that more than 50% of school-age children with ADHD have associated motor performance impairment, including fine motor and gross motor skills. School-age children with motor deficits experience interference in school-related functions, such as participation and cognitive and physical functioning, that negatively influence their social and emotional adjustment. Although there is good evidence that children with ADHD have poorer motor performance than their peers, little is known about how the subtypes of ADHD may relate to motor deficits. Therefore, the purpose of the present study was to investigate the characteristics of motor performance, including fine motor skills and gross motor skills, with comprehensive standardized measurements in children with the three subtypes of ADHD.

DESIGN: This study has a cross-sectional design. Participants in this study were children who met the following inclusion criteria: diagnosis of ADHD for at least 1 yr and attendance at a mainstream elementary school in Taiwan in the fourth, fifth, or sixth grade. Children diagnosed with other neurological or psychiatric disorders were excluded from the study because these conditions might influence their motor performance. Participants were recruited from multiple sources, including clinics and hospitals as well as public elementary schools in Taiwan. A total of 61 Taiwanese children with ADHD (53 boys and eight girls) ages 9–12 yr participated in this study.

METHOD: The parent form of the Swanson, Nolan, and Pelham–IV scale, Chinese version (SNAP–IV–C) was used to identify the subtypes of ADHD for the participating children. Motor performance was measured by the Bruininks–Oseretsky Test of Motor Performance, second edition (BOT–2), including four subscales: (1) fine manual control (FMC) and (2) manual coordination (MC), which measure fine motor skills, and (3) body coordination (BC) and (4) strength/agility (SA), which measure gross motor skills. Data were analyzed using IBM SPSS Statistics Version 22.0.

First, participants were divided into three subtype groups (ADHD–C, ADHD–PI, and ADHD–HI) based on the results of the SNAP–IV–C. To examine the difference among children classified as the three subtypes of ADHD in motor performance, a series of multiple linear regression analyses was conducted. Standard scores obtained on the FMC, MC, BC, and SA subscales of the BOT–2 were the dependent variables, subtypes of ADHD were the independent variables, and gender, age, and medication were the covariates.

RESULTS: The results indicated that the children with ADHD scored below average on all subscales of BOT–2, including both fine motor and gross motor skills. After controlling for the effect of age, gender, and medication, children with ADHD–PI presented more impairment of both fine motor skill and gross motor skill than children with ADHD–C and ADHD–HI. Specifically, children with ADHD–PI demonstrated poorer body coordination (e.g., jumping jacks, balance) than children with ADHD–C, as well as poorer manual coordination (e.g., placing pegs in a pegboard, dribbling and catching a ball) and strength/agility (e.g., standing long jump, push-ups) than children with ADHD–HI.

CONCLUSION: Results of this study confirm that children with three subtypes of ADHD showed different levels of fine motor skills and gross motor skills, which has important practical implications. In current clinical practice, occupational therapy evaluations and interventions provided to children with ADHD are based on general clinical guidelines rather than on specific strategies tailored for different subtypes of ADHD. In light of these findings, the importance is emphasized of assessing motor skills among children with ADHD in practice according to the subtypes. Moreover, educators and clinicians should be aware of the need to identify specific deficits in motor performance in children with different subtypes of ADHD and to help select and provide more precise and effective interventional strategies for this population instead of providing a general intervention.

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