Motor abilities of children and adolescents with a psychiatric condition: A systematic literature review

Table 1 Characteristics and brief summary of each article reviewed

Ref.	Research population(s)	Comparison/control group(s)	Motor assessment instrument(s)	Main findings
Berkeley et al[40] (2001)	HFA (n = 15) Age: 6-8 yr Gender: Male and female IQ: Not specified	Norm population	TGMD	73% cored in the poor to very poor category, illustrating an overall fundamental motor delay. 80% scored ≤ -1.5 SD on the locomotor subscale and 53% scored in the poor/very poor category on the object control subscale
Beyer[78] (1999)	ADHD (n = 56) Age: 7-12 yr Gender: Male IQ > 70	Learning disabilities (n = 56)	BOTMP (Without subscale running speed)	Children with ADHD performed worse on bilateral coordination, strength, visual-motor integration, upper-limb speed and dexterity. Both groups performed equally poorly on the subscales balance, upper limb coordination and response speed
Brossard-Racine et al[79] (2011)	ADHD (n = 40) Age: 6-11 yr Gender: Male and female IQ > 80	Norm population	Movement ABC VMI-V	50% of the children obtained a score below pc 5 on the Movement ABC, another 20% scored below pc 15 An important subset of the population (85%) exhibited manual dexterity problems 55% of the children obtained a score < -1.5 SD on the VMI
Brossard-Racine et al[80] (2012)	ADHD (n = 49) Age: 6-11 yr Gender: Male and female IQ > 80	Norm population	Movement ABC VMI-V	Motor difficulties were highly present at baseline (73%) but resolved in 18% of the cases after treatment with stimulant medication. Motor impairment persisted in 55% of the population. The severity of the behavioral symptoms was associated with balance skills. No significant differences emerged between the ADHD subtypes
				After controlling for IQ, the ASD group scored significantly lower than the other 4 groups. Children with DCD and ADHD + DCD also obtained significantly lower scores than the children from the TD group and the ADHD only group
Dewey et al[51] (2007)	ASD (n = 49) DCD (n = 46) ADHD (n = 27) ADHD + DCD (n = 38) Age: 5-18 yr Gender: Male and female IQ: Full range	TD (n = 78)	BOTMP-SF
Doyle et al[81] (1995)	ADHD-C (n = 38) Age: 7-12 yr Gender: Male and female IQ: Full range	Norm population	BOTMP-SF	82% of the children with ADHD exhibited gross motor skills above the norms of the BOTMP-SF Less than 10% of the children had significant motor skill difficulties. Fine motor skills were considered a relative deficit in comparison to gross motor skills
Emck et al[2] (2011)	PDD (n = 39) Emotional disorders (n = 17) Behavioral disorders (n = 44) Age: 6-12 yr Gender: Male and female IQ: Not mentioned	Norm population	TGMD-2	All clinical groups differed significantly from the norm population. Children from the emotional disorders group obtained a higher total score, in comparison to children from the PDD and behavioral disorders groups. Similarly, these groups differed on the locomotion subscale, but no differences emerged for the object control scale
Fliers et al[64] (2008)	ADHD (n = 486) Age: 5-19 yr Gender: Male and female IQ > 70	Controls (n = 269)	DCD-Q Groningen motor Observation scale	Motor coordination problems were demonstrated in one third of children with ADHD (33%-34% boys and 29% girls) Fine and gross motor skills, coordination skills and motor control were related to the inattentive rather than to the hyperactive/impulsive symptoms
Fliers et al[65] (2010)	ADHD (n = 32) Age: 6-17 yr Gender: Male and female IQ > 70	Unaffected siblings (n = 18) Controls (n = 50)	Movement ABC	In total, 63% of the children with ADHD demonstrated motor impairment (29% < pc 15 and 34% < pc5). Children with ADHD performed worse than the unaffected siblings and controls, especially on manual dexterity
Ghaziuddin et al[41] (1998)	Autism (n = 12), AS (n = 12), PDD-NOS (n = 12) Age: 8-15 yr Gender: Male and female IQ ≥ 60	Norm population	BOTMP	Motor problems were present in all groups Differences between the subgroups emerged (Asperger > PDD-NOS > Autism), but after controlling for IQ, the relationship between motor scores and diagnosis was no longer significant
Goulardins et al[66] (2013)	ADHD-C (n = 34) Age: 7-11 yr Gender: Male IQ > 70	Age- and gender matched TD (n = 32)	Motor Development scale	The motor quotients in all areas were lower in the ADHD group in comparison to the TD group However, 88% of the ADHD group scored within the normal range
Green et al[47] (2002)	AS (n = 11) Age: 6-10 yr Gender: Male VIQ > 80, TIQ > 70	SDD-MF (n = 9)	Movement ABC	Children with Asperger syndrome performed worse on all subscales in comparison to SDD-MF, but only the subscale ball skills yielded a significant difference. All the children with Asperger syndrome scored below pc 15, of which 82% had a score beneath pc 5
Green et al[4] (2009)	ASD/autism (n = 101) Age: 9-10 yr Gender: Male and female IQ: Full range	Norm population	Movement ABC DCD-Q	In the ASD group, 79% scored below pc 5 and 10% scored below pc 15. Only 11% scored in the average range (> pc 15). 97% of the children with a low IQ scored beneath pc 5 in comparison to 70% of the children with a higher IQ. The DCD-Q performed moderately well as a screening instrument for motor problems
Harvey et al[82] (1997)	ADHD (n = 19) Age: 7-12 yr Gender: Male and female IQ: 80-100	Norm population	TGMD	Fundamental gross motor performance of children with ADHD is substantially below average, as 61.6% of the children obtained a score ≤ pc 25
Harvey et al[67] (2007)	ADHD (n = 22) Age: 6-12 yr Gender: Male and female IQ > 70	Age- and gender matched TD (n = 22)	TGMD-2	Significant differences on the locomotor and object control subscales were revealed between children with and without ADHD. The performance of children with ADHD was classified in the “poor” and “very poor” category, in contrast to the TD children, whose performance was categorized as “average”. Older children obtained higher scores than younger children. No significant effect of stimulant medication was found
Hilton et al[52] (2007)	AS (n = 51) Age: 6-12 yr Gender: Male and female IQ ≥ 70	TD (n = 56)	Movement ABC	Significant differences between children with Asperger syndrome (65% < pc5, 25% < pc 15, 10% no impairment) and control group (100% no impairment) were established. Individuals with Asperger syndrome were most impaired on manual dexterity. A strong relationship exists between motor impairment and severity of the autistic symptoms
Hilton et al[5] (2012)	ASD: Concordant pairs (n = 29), Discordant pairs (n = 48) Age: 4-17 yr Gender: Males and females IQ: Not specified	Norm population	BOT-2 DCD-Q	Motor skills of the ASD-affected children were substantially impaired, in contrast to the motor skills of the unaffected siblings, which were essentially normal. 40% of the individuals with ASD scored < -1SD and 43% scored < -2SD from the population mean. Motor skills highly correlated with IQ and autistic severity
Jasmin et al[42] (2009)	ASD (n = 35) Age: 3-4 yr Gender: Male IQ: full range	Norm population	PDMS-II	In the ASD group, 63% showed a gross motor delay, 53% a fine motor delay and 57% an overall motor delay. In comparison to the population norms, the mean gross motor and total motor score were situated in the very poor range (-2SD). The mean fine motor score was categorized as poor (-1.5SD)
Kooistra et al[85] 2005	ADHD (n = 29), RD (n = 63), ADHD + RD (n = 47), ADHD + ODD (n = 19), ADHD + RD + ODD (n = 21) Age: 8-16 yr Gender: Male and female IQ > 75	TD (n = 112)	BOTMP VMI-III	All groups performed significantly worse on the BOTMP (total and subscales) in comparison to the control group, except for the children in the ADHD-only group, whose performance did not differ from the control group (apart from their visual-motor skills). Motor impairment in children with ADHD increased as a function of co-occurring disorders
Kooistra et al[68] (2009)	ADHD (n = 47) Age: 7-10 yr Gender: Male and female IQ > 80	FASD (n = 30) Controls (n = 39)	Movement ABC Clinical observations of motor and postural control	Significant differences between the groups were revealed on all scales, with the exception of the subscale Ball Skills. On the Movement ABC both children with ADHD and FASD exhibited more motor problems than controls. 38% of the ADHD group obtained a score below pc5 and 26% obtained a score < pc15 on the Movement ABC
Kopp et al[53] (2010)	ASD and/or ADHD (n = 100) Age: 3-18 yr Gender: Female IQ: Full range	Age- and IQ matched controls (n = 57)	Movement ABC EB-test	Children with ASD and/or ADHD showed more motor coordination problems than controls. 25% of the ASD group and 32% of the ADHD group met the diagnostic criteria for DCD
Liu et al[54] (2013)	ASD (n = 30) Age: 3-16 yr Gender: Male and female IQ: 70-100	Age-matched TD (n = 30)	Movement ABC-2	Children with ASD scored significantly lower than TD on all subscales and total motor score. All TD children scored within the normal range. In contrast to the TD group, 80% of the ASD group scored in the below average range, of which 77% obtained a score below pc5
Liu et al[55] (2014)	ASD (n = 21) Age: 5-10 yr Gender: Male and female IQ: Not mentioned	Age–matched TD (n = 21) Norm population	TGMD-2	Significant differences between the ASD and TD group were established for all measures. Whereas 96% of the TD group scored within the normal range, 81% of the ASD group scored in the below average range. On the locomotor subscale, 27% of the ASD group was categorized as poor and 40% as very poor. On the object control scale, 27% were categorized as poor and 33% as very poor
Lopata et al[43] 2007	AS (n = 17) Age: 6-13 yr Gender: Male IQ: Within normal range	Norm population	BOTMP VMI-V	The children with AS performed significantly poor, in comparison to the norm populations. On the BOTMP, the mean composite scores for gross and fine motor skills were approximately -2SD below the population mean. The mean score on the VMI was -1SD below the population mean. No significant differences were found between fine and gross motor skills
Manjiviona et al[44] 1995	AS (n = 12) HFA (n = 9) Age: 7-17 yr Gender: Male and female IQ: Normal range	Norm population	Test of motor impairment-henderson revision	Approximately 67% of the children with HFA and 50% of the children with AS showed clinically significant deficits in motor skills. No differences between the HFA and AS groups emerged
Meyer et al[69] (2006)	ADHD (n = 264): ADHD-HI = 74, ADHD-PI = 94, ADHD-C = 96 Age: 6-13 yr Gender: Male and female IQ > 80	Controls (n = 264)	Grooved Pegboard Test Maze Coordination Test Finger Tapping Test	Children with ADHD performed poorer on the Grooved Pegboard Test and the Maze Coordination Test, but not on the Finger Tapping Test. Children with the ADHD-C subtype were the most impaired. The deficiencies in motor control were mainly confined to a younger age group (6-9 yr)
Miller et al[45] (2000)	Autism (n = 14) HFA (n = 26) Age: 6-12 yr Gender: Male and female IQ > 70	Norm population	Movement ABC	No significant differences appeared between the autism and HFA group. After controlling for IQ, a trend towards more motor impairment in the autism group emerged. Mean total motor scores were situated -1.33 SD below the population means. After controlling for IQ, the HFA group obtained a mean score -1SD and the autism group -1.66SD from the population mean
Miyahara et al[48] (1997)	AS (n = 26) Age: 6-15 yr Gender: Male and female IQ > 70	Learning disability (n = 16)	Movement ABC	85% of the children with Asperger and 88% of the children with learning disabilities obtained a score below -2SD from the population mean. No group differences were established, except for the subscale manual dexterity. No relationship was found between intellectual and motor functioning
Noterdaeme et al[46] (2010)	AS (n = 57) HFA (n = 55) Age: 6-19 yr Gender: Male and female IQ > 80	Norm population	Standard neurological examination	Motor problems were identified in 53% of children with AS and 47% of children with HFA
Pan et al[56] (2009)	ASD (n = 28) ADHD (n = 29) Age: 6-10 yr Gender: Male and female IQ: Average	Controls (n = 34)	TGMD-2	Both the ASD and ADHD group scored significantly lower than the control group on overall gross motor development as well as on the subscales. The ASD group performed worse than the ADHD group on both subscales. Only 16% of the children with ASD/ADHD showed clinical levels of impairment
Pan[31] (2014)	ASD (n = 31): AS = 7, HFA = 24 Age: 10-17 yr Gender: Male IQ: Within normal range	Controls (n = 31)	BOT-2	The ASD group scored significantly lower than the control group on all subscales, composites and total motor score. The mean manual coordination composite was the lowest, followed by the strength and agility composite
Papadopoulos et al[57] (2012)	HFA (n = 23), LFA (n = 8), AS (n = 22) Age: 6-13 yr Gender: Male and female IQ: Full range	TD (n = 20)	Movement ABC	Based on the population norms, 63% of the HFA group, 100% of the LFA group and 28% of the AS group scored below pc 5. Another 18% of the HFA group and 5% of the AS group scored in the borderline range (< pc15). All the TD children obtained a score within the normal range (> pc15). Comparisons between the groups revealed that the HFA group performed worse than the AS group, whereas no difference emerged between the AS en TD group
Papadopoulos et al[86] (2013)	ADHD-C without ASD (n = 16) Age: 7-14 yr Gender: Male IQ: Within normal range	TD (n = 16)	Movement ABC-2	Children with ADHD-C, without comorbidity with ASD, did not display motor difficulties. Higher levels of inattention, but not hyperactivity/impulsivity were associated with poorer total score and performance on the field of ball skills
Piek et al[70] (1999)	ADHD-C (n = 16) ADHD-PI (n = 16) Age: 8-11 yr Gender: Male VIQ > 80	Age matched controls (n = 16)	Movement ABC	Children with ADHD performed significantly poorer than the controls (ADHD-C = 31% < pc5 and 25% < pc15; ADHD-PI = 31% < pc5 and 37% < pc15). Children with ADHD-PI showed a poorer result on Manual Dexterity, whereas children with ADHD-C performed worse on balance
Pitcher et al[71] 2003	ADHD-PI (n = 50) ADHD-C (n = 38) ADHD-HI (n = 16) Age: 7-12 yr Gender: Male VIQ: Full range	Controls (n = 39)	Movement ABC Purdue Pegboard	In comparison to the control group, the ADHD-PI and ADHD-C groups performed significantly worse on the subscales Manual Dexterity and Ball Skills and total score of the Movement ABC. The ADHD-HI did not differ significantly from the control group. The ADHD-PI group performed worse on the Purdue Pegboard in comparison to the controls. No differences were established between any other groups
Provost et al[49] (2006)	ASD (n = 19) Age: 21-41 mo Gender: Male and female IQ: Full range	DD without motor problems (n = 18) DD with motor problems (n = 19)	PDMS-2 BSID-II (motor scale)	None of the children with ASD obtained a score within the normal range on the PDMS-2 (84% < -2SD, 16% < -1SD). Motor scores of children with ASD did not differ significantly from those of children with DD and motor problems
Schlooz et al[58] (2012)	ASD (n = 12) Age: 9-12 yr Gender: Male IQ: Within normal range	TD (n = 12) Tourette Syndrome (n = 12)	VMI-IV	The ASD group performed worse than the pooled control group on the VMI copy task. Their scores on the visual perception and motor coordination subscales did not differ from the controls
Schurink et al[59] 2012	PDD-NOS (n = 28) Age: 7-12 yr Gender: Male and female IQ > 70	Age- and gender matched TD (n = 28)	Movement ABC	Compared to the TD group, children with PDD-NOS obtained poor motor scores. In the PDD-NOS group 43% obtained a score below pc 5, 21% showed borderline motor problems and 36% showed no motor problems
Sharoun et al[72] (2013)	ADHD (n = 58) Age: 9-11 yr Gender: Male and female IQ: Not mentioned	Controls (n = 58)	7 motor skill assessments (fine and gross motor tasks)	Children with ADHD showed poorer fine motor skills in comparison to the control group. Results indicate that impairments were observed in tasks requiring more complex motor skills, whereas performance was similar in the less complex tasks
Siaperas et al[60] 2011	AS (n = 50) Age: 7-14 yr Gender: Male IQ > 70	Age matched controls (n = 50)	Movement ABC-2	Children with AS showed significant impairment in motor performance. Significant group differences were revealed for all three subscales and the total score
Skirbekk et al[73] 2011	ADHD (n = 39) Anxiety disorder (n = 41) ADHD + Anxiety disorder (n = 25) Age: 7-13 yr Gender: Male and female IQ > 70	Controls (n = 36)	Movement ABC	All clinical groups showed similar profiles of motor impairment and exhibited a higher total impairment score on the Movement ABC in comparison to the control group. 46% of the children with anxiety disorders, 26% of the ADHD group and 36% of the ADHD + anxiety disorder scored below pc5
Staples et al[61] (2010)	ASD (n = 25) Age: 9-12 yr Gender: Male and female IQ: Full range	Chronological age matched TD (n = 25) Movement skill matched TD (n = 22) Mental age matched TD (n = 19)	TGMD-2	The movement skills of children with ASD reflect deficits, in addition to delays. The group matched on chronological age performed significantly better on the TGMD-2. Children with ASD perform similarly to children approximately half their age. The motor skills of children with ASD are more impaired, than would be expected, given their cognitive level
Tseng et al[74] (2004)	ADHD-C (n = 42) Age: 6-11 yr Gender: Male and female IQ: (above) average	Age-, gender- and handedness matched controls (n = 42)	BOTMP	Significant differences in fine and gross motor skills were revealed between children with and without ADHD. Attention, impulse control and parent rating of activity level were the best predictors of gross motor skills in children with ADHD. Attention and impulse control were the best predictors for fine motor skills
Vasserman et al[83] (2014)	ADHD-C (n = 48) ADHD-PI (n = 53) Age: 5-18 yr Gender: Male and female IQ: Full range	Norm population	Any Pegboard task (Purdue Pegboard, Grooved Pegboard…)	In total, 51% of the children with ADHD showed fine motor deficits. Impairment in fine motor skills was more prevalent in the ADHD-PI group (60%) in comparison to the ADHD-C group (40%)
Verret et al[75] (2010)	ADHD with stimulant medication (n = 24) ADHD without stimulant medication (n = 19) Age: 7-12 yr Gender: Male and female IQ > 70	Controls (n = 27)	TGMD-2	Both groups of children with ADHD obtained lower scores on the locomotor subscale. 47% of the children with ADHD obtained a total score below pc 25, in comparison to 21% of the control group. No differences in performance between the children with or without stimulant medication were established
Volker et al[62] 2010	HFA (n = 60) Age: 6-14 yr Gender: Male and female IQ > 70	TD (n = 46) Matched ASD subsample (n = 27)	Bender Gestalt-II VMI-V	HFA performed worse on all scales in comparison to the TD group. After controlling for IQ, only differences in performance on scales with a pronounced motor component remained significant
Watemberg et al[84] (2007)	ADHD (n = 96): ADHD only = 43, ADHD + DCD = 53 Age: 6-12 yr Gender: Male and female IQ: Not mentioned	Norm population	Movement ABC	DCD was detected in 55% of the children with ADHD. DCD is most prevalent in children with ADHD-PI (63%) and ADHD-C (59%) in comparison to ADHD-HI (11%)
Wang et al[76] (2011)	ADHD (n = 25) Age: 4-8 yr Gender: Male and female IQ: 61-112	Age- and gender matched controls (n = 24)	Movement ABC	Compared to the control group, children in the ADHD group exhibited poorer motor ability on all three subscales. In the ADHD group, 36% had significant motor problems (< pc5) and 28% were borderline cases (< pc15)
Whyatt et al[63] (2012)	ASD (n = 18) Age: 7-10 yr Gender: Male and female IQ > 80	Age-matched receptive vocabulary control group (n = 19) Age-matched non verbal IQ control group (n = 22)	Movement ABC-2	The ASD group showed overall motor impairment relative to both control groups. Performance comparisons indicate significant impairment in the area of ball skills and manual control in the ASD group; comparable levels of balance control were found in the ASD en control groups
Wisdom et al[50] (2007)	ASD (n = 30) Age: 3-13 yr Gender: Male and female IQ: Full range	DCD (n = 22) Receptive-expressive language disorder (n = 30)	Mc Carron Assessment of Neuromuscular Development	Significant group differences emerged for fine and gross motor coordination. The language disorder group was the least impaired (-1SD). The DCD group obtained a mean score of -2SD. The ASD obtained the poorest results, with a mean score below -3SD. The DCD and ASD groups appear to differ more in severity than in kind
Yochman et al[77] (2006)	ADHD (n = 49) Age: 4-6 yr Gender: Male and female IQ: Within normal range	Age- and gender matched TD (n = 48)	Miller Assessment for Preschoolers VMI-IV	The scores of the ADHD group were significantly lower than those of the TD group. The group differences remained significant, after controlling for IQ. 47% of the children with ADHD showed fine motor and gross motor problems, 45% showed visual motor problems and 22% exhibited problems with visuomotor integration

ASD: Autism spectrum disorders; AS: Asperger syndrome; HFA: High functioning autism; LFA: Low functioning autism; PDD-NOS: Pervasive developmental disorder - not otherwise specified; ADHD: Attention deficit hyperactivity disorder; ADHD-C: Attention deficit hyperactivity disorder, combined type; ADHD-PI: Attention deficit hyperactivity disorder, predominantly inattentive type; ADHD-HI: Attention deficit hyperactivity disorder, predominantly hyperactive and impulsive type; DCD: Developmental coordination disorder; SDD-MF: Specific developmental disorder of motor function; FASD: Fetal alcohol spectrum disorder; RD: Reading disability; ODD: Oppositional defiant disorder; TD: Typically developing children; DD: Developmental delay; TGMD: Test of gross motor development; Movement ABC: Movement assessment battery for children; DCD-Q: Developmental Coordination disorder questionnaire; BOTMP: Bruininks-oseretsky test of motor proficiency; BOTMP-SF: Bruininks-oseretsky test of motor profiency, short form; BOT-2: Bruininks-oseretsky test of motor proficiency, second edition; BSID–II: Bailey scales of infant development, 2^nd edition; PDMS: Peabody developmental motor scales; VMI: Developmental test of visual-motor integration.