Paediatric motor difficulties and internalising problems: an integrative review on the environmental stress hypothesis

The current study aims to provide an in-depth analysis and extension of the Environmental Stress Hypothesis (ESH) framework, focusing on the complex interplay between poor motor skills and internalising problems like anxiety and depression. Using an integrative research review methodology, this study synthesises findings from 38 articles, both empirical and theoretical, building upon previous foundational works. The hypothesis posits that poor motor skills serve as a primary stressor, leading to internalising problems through various secondary stressors. A rigorous comparison of data was conducted, considering study design, findings, and methodologies-while exploring variables such as age, sex, and comorbidities. The study also enhances the ESH framework by including intrapersonal stressors and introducing resource buffers, including optimism and familial support as additional influencing factors. This multi-level approach yields a more nuanced and comprehensive ESH framework, highlighting the need for future studies to consider variables that intersect across multiple domains and how the relationship between poor motor skills and internalising problems may vary across different life stages.

Which outcomes are key to the pre-intervention assessment profile of a child with developmental coordination disorder? A systematic review and meta-analysis

BACKGROUND

Purpose of this study was to determine what key aspects of function should be incorporated to make up a pre-intervention assessment profile of a child with Developmental Coordination Disorder (DCD); more specifically, what aspects of functioning are implicated in DCD and what is their relative impact?

METHODS

A systematic review and meta-analysis were conducted, for which Pubmed, Web of Science, Scopus and Proquest were searched (last update: April 2023, PROSPERO: CRD42023461619). Case-control studies were included to determine point estimates for performances on field-based tests in different domains of functioning. Risk of bias was assessed, and level of evidence estimated. Random-effect meta-analyses were performed to calculate the pooled standardized mean differences for domains of functioning and subgrouping was done for clinically relevant subdomains. Heterogeneity was determined with I2.

RESULTS

121 papers were included for analyses. Data of 5 923 children with DCD were included (59.8% boys) and 23 619 Typically Developing (TD) children (45.8% boys). The mean (SD) age of the DCD group was 10.3y (1.2) and 9.3y (1.3) for the TD children. Moderate evidence was found for motor performance, executive functions, sensory processing and perceptions, cognitive functions and sports and leisure activities to be affected in children with DCD.

CONCLUSION

Differences between the two groups varied per domain of functioning. This emphasizes the diversity present within children with DCD and provides a rationale for explaining the heterogeneity in this patient group. Yet, results highlight the potential involvement of all these domains and call for clinicians to be alert not only to examine motor skill difficulties but also other aspects of function. Results indicate the need to develop an individualized pre-intervention multi-dimensional assessment profile for each child with DCD. It also supports the important role that clinicians play in an interdisciplinary team to tackle the difficulties encountered by children with DCD.

Move Well, Feel Good: Feasibility and acceptability of a school-based motor competence intervention to promote positive mental health

BACKGROUND

In response to the adverse impacts of the COVID-19 lockdown measures Move Well, Feel Good (MWFG) was developed as a school intervention using improvement of motor competence as a mechanism for promoting positive mental health. Study objectives were to evaluate the feasibility and acceptability of MWFG and to describe changes in child-level outcomes.

METHODS

Five northwest England primary schools were recruited. MWFG was delivered over 10-weeks through physical education (PE) lessons, which were supplemented by optional class-time, break-time, and home activities. The intervention focused on development of 9-10 year-old children's motor competence in locomotor, object control, and stability skills, and psychosocial skills. Feasibility was evaluated against nine pre-defined criteria using surveys, interviews (teachers), and focus groups (children). Pre- and post-intervention assessments of motor competence, mental health, prosocial behaviour, wellbeing, and 24-hour movement behaviours were also completed.

RESULTS

The five recruited schools represented 83% of the target number, 108 children consented (54% of target) with teachers recruited in all schools (100% of target). Intervention dose was reflected by 76% of the 45 scheduled PE lessons being delivered, and adherence was strong (>85% of children attending ≥75% of lessons). Positive indicators of acceptability were provided by 86% of children, 83% of PE teachers, and 90% of class teachers. Data collection methods were deemed acceptable by 91% of children and 80% of class teachers, and children spoke positively about participating in the data collection. Child-level outcome data collection was completed by 65%-97% of children, with a 3%-35% attrition rate at post-intervention, depending on measure. Favourable changes in motor competence (+13.7%), mental health difficulties (-8.8%), and prosocial behaviour (+7.6%) were observed.

CONCLUSIONS

MWFG is an acceptable and feasible motor competence intervention to promote positive mental health. Content and delivery modifications could inform progression to a pilot trial with a more robust design.

The Effect of Neurodevelopmental Disorders Characteristics on Aspects of Social Functioning

AIM

The purpose of this study was to estimate the extent to which neurodevelopmental disorders (NDD's) symptoms (motor, sensory, attention and executive function) are associated with aspects of social function among school aged children.

METHODS

This cross-sectional study included 39 children aged 6-9 years old (71.8% boys) who were referred to child development centers due to motor, sensory, and/or cognitive difficulties. The parents completed NDD's symptoms questionnaires: Developmental Coordination Disorder Questionnaire; Child Sensory Profile-2; Attention Deficit Hyperactive Disorder (ADHD) Rating Scale and the Behavior Rating Inventory of Executive Function. They also completed the Social Skills Improvement System and a social participation measure.

RESULTS

Analysis demonstrated low to moderate correlations between social functioning aspects and the majority of NDD's symptoms. Executive functioning was the only predictor of social skills and social participation and accounted for most of the variability of behavioral problems, alongside a small contribution of ADHD symptoms.

CONCLUSION

The findings contribute to the accumulating body of knowledge regarding social abilities of children with NDD's and suggest new information as to the effect of executive functions in this domain. Along with conducting a routine evaluation of social skills among children suspected to have NDD's, executive functions should also be comprehensively evaluated.

Co-Creation of a School-Based Motor Competence and Mental Health Intervention: Move Well, Feel Good

Low motor competence (MC) and inhibited psychosocial development are associated with mental health difficulties. Improving children's MC through school-based physical activity interventions emphasising psychosocial development may therefore be a mechanism for promoting positive mental health. This study describes and provides reflective insights into the co-creation of 'Move Well Feel Good', a primary school physical activity intervention to improve children's MC and mental health. Class teachers, school leaders, physical activity specialists, and children (aged 8-9 years) participated in a series of co-creation workshops. Stakeholders' knowledge and experiences were integrated with existing research evidence using creative methods (e.g., post-it note tasks, worksheets, and drawings) to facilitate discussion. The co-creation process culminated in stakeholder consensus voting for one of three proposed intervention ideas. Children cited physical and mental health benefits, enjoyment with friends, and high perceived competence as motives for being physically active. Opportunities to develop MC across the different segments of the school day were identified by adult stakeholders, who perceived children's lack of resilience, an overloaded curriculum, and poor parental support for physical activity as barriers to intervention implementation. The chosen intervention idea received six out of a possible twelve votes. Co-creation projects are specific to the contexts in which they are implemented. This study reinforces the complex nature of school-based intervention development and highlights the value of engaging with stakeholders in co-creation processes.

Self-esteem, self-efficacy, and social support mediate the relationship between motor proficiency and internalizing problems in adults: Exploring the environmental stress hypothesis in adulthood

The Environmental Stress Hypothesis (ESH) is a theoretical model used to understand the factors mediating the relationship between motor proficiency and internalizing problems. The aim of this study is to explore a potential extension of the ESH by examining whether BMI, physical activity levels, self-esteem, self-efficacy and social support are potential mediators between motor proficiency and internalizing problems in young adults. 290 adults aged between 18 and 30 years old (150 women, 140 men) were evaluated with the following instruments: Adult Developmental Coordination Disorders Checklist (ADC), Depression, Anxiety and Stress Scale (DASS 21), Social Support Satisfaction Scale (SSSS), Perceived General Self-Efficacy Scale (GSE), Rosenberg Self-Esteem Scale (RSES), International Physical Activity Questionnaire (IPAQ), and self-reported body mass index (BMI). The results indicated that self-esteem, self-efficacy, and social support mediate the relationship between motor proficiency and internalizing problems in this sample. Thus, the findings reinforce the notion that early intervention and preventive psychological care can serve as protective aspects of mental health in adults at risk for low motor proficiency.

Trajectories of emotional and behavioral problems in school-age children with coordination difficulties and their relationships to ASD/ADHD traits

BACKGROUND

Although research has demonstrated associations between motor coordination difficulties and psychological problems in school-age children, including emotional and behavioral problems, longitudinal changes in these problems in children with motor coordination difficulties are not fully understood.

AIMS

The current study aimed to identify patterns in the trajectory of emotional and behavioral problems in school-age children with motor coordination difficulties, and to elucidate the effect of co-existing neurodevelopmental traits on the occurrence and course of these problems.

METHODS AND PROCEDURES

Using the Developmental Coordination Disorder Questionnaire, 773 children were defined as cases with motor coordination difficulties and followed for 4 years, from 6 to 10 years of age. Emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire completed by children's parents or guardians.

OUTCOMES AND RESULTS

We identified four trajectory patterns of emotional and behavioral problems. Children with higher autism spectrum disorder and attention deficit hyperactivity disorder traits were more likely to be assigned to poor prognostic trajectory patterns.

CONCLUSIONS AND IMPLICATIONS

Our findings emphasize the importance of assessing emotional and behavioral problems and co-existing neurodevelopmental traits in children with motor coordination difficulties in early elementary school.

Social skills of kindergarten children with Global Developmental Delay (GDD), with and without Developmental Coordination Disorder (DCD)

AIM

A high prevalence of co-occurring Developmental Coordination Disorder (DCD) has been noted in the population of children with global developmental delays (GDD). The presence of developmental disabilities in general, and DCD in particular, constitute a risk factor for difficulties in social skills. However, to the best of our knowledge, no studies, have examined the unique contribution of DCD to social skills, over and above the effect of other general developmental impairments. The aim of this study was to compare the social skills of kindergarten children with Global Developmental Delay, with and without DCD.

METHODS

Participants included 26 kindergarten children with Global Developmental Delay and DCD (Mage = 4.92, 61 % boys), and 26 children with Global Developmental Delay without DCD (Mage = 5.09, 69.25 % boys). All participants' parents and kindergarten teachers completed the Social Skills Improvement System Questionnaire (SSIS).

RESULTS

Children with GDD only performed significantly better on social skills compared to children with GDD and DCD. Parents in general reported better social skills and less behavioral problems compared to kindergarten teachers.

CONCLUSIONS

The findings contribute to the accumulating body of knowledge regarding social abilities of children with developmental disabilities and present new information as to the unique effect of DCD in this domain. Routine evaluation of social skills should be conducted among children with GDD and DCD, taking into account the negative influence that motor dysfunction has in this domain. Furthermore, children's social performance in different environments needs to be considered by relating to both parents and kindergarten teachers' perspective. Subsequent intervention programs should then address the unique profile of this population.

Fine and gross motor skills predict later psychosocial maladaptation and academic achievement

BACKGROUND

Difficulties in fine and gross motor skills are often overlooked as developmental problems, although approximately 6-13% of all school-age children have poor motor coordination. Understanding motor coordination is important from the perspective of school adaptation. This longitudinal cohort study aimed to determine whether fine and gross motor skills in preschool children predict later academic achievement and psychosocial maladaptation.

METHODS & PROCEDURES

Participants were 2,501 children from nursery and elementary schools (5-13 years old). The motor skills of preschool children were assessed by their nursery teacher immediately before entering elementary school. The Strengths and Difficulties Questionnaire and a standardized Japanese test were administered annually throughout elementary school.

RESULTS

Early motor difficulties in preschool children had significant effects on their academic achievement and psychosocial maladaptation up until the sixth grade. Gross motor difficulties in preschool were associated with the later peer problems and worsened emotional symptoms.

CONCLUSIONS

Motor skills in preschool children are useful as a predictor of later psychosocial maladaptation and academic achievement.

Does physical activity and BMI mediate the association between DCD and internalizing problems in early childhood? A partial test of the Environmental Stress Hypothesis

BACKGROUND AND PURPOSE

Young children with Developmental Coordination Disorder (DCD) are more likely to experience internalizing problems, such as depression and anxiety, than typically developing (TD) children. Currently, the underlying mechanisms resulting in increased internalizing problems in DCD remains unknown; however, a previous study based on the Environmental Stress Hypothesis (ESH) indicated that physical inactivity and obesity may mediate the relationship between DCD and internalizing problems. The purpose of this study is to investigate the relationships among DCD, internalizing problems, physical activity, and BMI, and the role of sex in these relationships in preschool children, a population for which we currently have very limited data.

METHODS

Young children between the ages of 4 and 5 years enrolled in the Coordination and Activity Tracking in CHildren (CATCH) study comprised the sample (n = 589). Of these, 288 (193 boys, 67.0%) were classified as at risk for DCD (rDCD), based on scoring at or below 16th percentile on the Movement Assessment Battery for Children - Second Edition. Physical activity was measured using accelerometers and height and weight were measured by trained research assistants, while parents completed the Child Behavior Checklist to rate internalizing problems. The mediating effects of physical activity and BMI were tested on the relationship between rDCD and internalizing problems.

RESULTS

Children with rDCD reported more internalizing problems than TD children. While there was a direct effect of rDCD on internalizing problems, neither physical activity nor BMI were found to mediate this relationship.

CONCLUSION

The findings from this study support co-occurring internalizing problems in preschool children with DCD, and extend these findings to demonstrate that this relationship is not explained by physical activity or BMI in early childhood. Further research should be directed toward other psychosocial factors identified in the ESH to better understand the underlying mechanisms between DCD and co-occurring internalizing problems.

Does level of motor competence affect the associations between identity health and self-perceptions in adolescents?

BACKGROUND

Adolescence is a particularly important time for the development of self-perceptions and identity as many environmental and personal factors are influential. One relatively unexplored factor is level of motor competence.

AIM

To examine the relationship between identity health and self-perceptions in male and female adolescents with low motor competence (LMC) compared to typically developing (TD) adolescents.

METHOD

Adolescents (N = 160, 64.4% males, M_age = 14.45 yrs., SD = 0.75) completed the Adolescent Motor Competence Questionnaire (AMCQ), Assessment of Identity Development in Adolescence (AIDA), and Harter's Self-Perception Profile for Adolescents (SPPA). Based on the AMCQ score, the sample was grouped into LMC and TD. Pearson's product moment correlations between the AIDA and SPPA subscales were derived for gender, competence groups, and gender x competence sub-groups.

RESULTS

Overall, males had lower AIDA scores (healthier identity) than the females and significant associations with all self-perception domains. For females, only scholastic and social competence, physical appearance, behavioural conduct, close friendship and Global Self-worth (GSW) domains were significantly related to their AIDA score. The adolescents in the LMC group had higher AIDA scores (less-healthier identity) and fewer self-perception domains [scholastic competence, physical appearance, behavioural conduct, close friendships and GSW] were associated to their AIDA scores. For the TD group, all self-perception domains were significantly correlated with their AIDA scores. When grouped by gender and motor competence, the TD males had the healthiest identity scores which were strongly associated with all self-perception subdomains. For males with LMC, only scholastic competence, behavioural conduct and GSW domains were significantly related with their identity score. Females from both competence groups reported significant associations between physical appearance, close friendships, behavioural conduct, and social competence domains with their identity scores. Scholastic competence was also significantly associated with identity only for females with LMC.

CONCLUSION

Positive self-perceptions across a range of domains are associated with a healthier identity, but differ according to level of motor competence and gender. For those with LMC, the self-perception subdomains unrelated to physical activity and sport, such as school-based aspects were associated with a healthier identity. These findings should guide school based interventions to provide support in these domains in order to strengthen self-worth and identity health.

The Acceptability and Feasibility of a Preschool Intervention Targeting Motor, Social, and Emotional Development

Background: Children and youth are facing three major challenges: (1) poor mental health, (2) physical inactivity, and (3) lack of school readiness. Fundamental movement skills (FMS) and social-emotional learning (SEL) are two developmental domains that are associated with each of these challenges. Currently, there is little focus on interventions that target both FMS and SEL. Thus, the purposes of this study were to: (1) examine the acceptability and feasibility of an FMS and SEL program (Move 2 Smile) and (2) assess the impact of Move 2 Smile on FMS and SEL in children. Methods: An exploratory, pilot study using a within-subjects design was conducted. Descriptive statistics were computed to assess the acceptability and feasibility of the Move 2 Smile program. Changes in FMS and SEL were analyzed using a paired sample t-test. A focus group was conducted with parents to gain feedback after the program ended. Results: Eleven children (four girls; M age = 50.56 months, SD = 8.63) participated, with families attending 80% of the sessions. The children and parents rated the enjoyment of the program 4.1/5 and 4.7/5, respectively. The instructor rated the children's perceived enjoyment 4.6/5 and feasibility of the sessions 4.7/5. Parents engaged in the FMS take-home activities once per week and the SEL activities three times per week. The intervention had a non-significant small to medium effect on FMS (d z = 0.42, p = 0.19), a significant large effect on social skills (d z = 1.38, p = 0.001) and emotion expressiveness (d z = 0.79, p = 0.03), and a non-significant small to medium effect on emotion knowledge (d z = 0.58, p = 0.10) and emotion regulation (d z = 0.44, p = 0.17). The results from the focus group suggest that parents and children enjoyed the program and that the program was useful and effective at impacting FMS and SEL. Conclusions: This intervention is one of the first to intentionally target both FMS and SEL. Children, parents, and instructors deemed this program as acceptable and feasible. These preliminary findings warrant future evaluations of Move 2 Smile, including a randomized controlled trial.

The Influence of Motor Competence on Adolescent Identity Health: A Mixed Method Study

Our identity develops with age, and many impacting factors will determine whether it is healthy or unhealthy. A particularly fragile phase of identity development occurs during adolescence when level of motor competence may be influential, yet is rarely considered. Purpose: The purpose of this study was to examine male and female adolescent's perceptions towards their motor competence and identity development. In-depth information was also collected to understand what factors are important towards identity development during adolescence. Method: An explanatory sequential mixed methods study was used to examine the extent motor competence influenced the health of an adolescent's identity. A sample of 160 adolescents (male n = 103, female n = 57, M_age = 14.45 SD = .75) completed the Adolescent Motor Competence Questionnaire (AMCQ) and the Assessment of Identity Development in Adolescence (AIDA). The AMCQ scores were used to group the participants into high (HMC = > 83) and low (LMC = < 83) motor competence. Results: More females had less-healthy identities than males and those with LMC had less-healthy identities than those with HMC. Subsamples of 17 participants were interviewed in order to explain these results. The most at risk group, females with LMC, identified negative peer comparisons, poor social support and higher stress levels to achieve academic performance as key challenges. Conclusions. Well-designed support services for those with LMC, especially for the females should incorporate activities to develop individual competency and close friendships.

Exploring the influence of self-perceptions on the relationship between motor competence and identity in adolescents

Background and aims

A relationship exists between an adolescent’s level of motor competence and the health of their identity. As those with low motor competence (LMC) form less healthy identities, the aim of this study was to investigate if self-perceptions mediated the negative impact of LMC on identity health.

Methods

Adolescents (N = 160) completed the Adolescent Motor Competence Questionnaire (AMCQ), Assessment of Identity Development in Adolescence (AIDA) and the Self Perception Profile for Adolescence (SPPA). The mediating effect of their self-perceptions on the relationship between motor competence and identity health was examined in several ways: for the total sample, between male and females, and level of motor competence. Two motor competence groups were formed by dichotomizing their AMCQ scores (< 83 = LMC).

Results

There was an indirect effect of self-perceptions of social competence, physical appearance, romantic appeal, behavioural conduct, close friendships and global self-worth on the relationship between motor competence and identity health for the total sample (N = 160, 64.4% males, M_age = 14.45 SD = .75, 12 to 16 years). No indirect effects were significant for females however close friendships and global self-worth were significant for the males. When the sample was grouped for motor competence, indirect effects of social competence, athletic competence, physical appearance, behavioural conduct, and global self-worth were significant for the high motor competence (HMC) group. The only self-perception significant for the LMC group was close friendships.

Conclusion

Self-perceptions in several domains mediated the relationship between motor competence and identity health, and these differed for level of motor competence but not gender. Those with LMC who had a higher self-perception in the close friendships domain had a healthier identity. Designing physical activity programs that focus on skill development and forming close friendships are important for adolescents with LMC.

Research Review: Internalising symptoms in developmental coordination disorder: a systematic review and meta-analysis

BACKGROUND

Developmental coordination disorder (DCD) affects 5%-6% of children. There is growing evidence that DCD is associated with greater levels of internalising symptoms (i.e. depression and anxiety). This is the first systematic review and meta-analysis to explore the magnitude of this effect, the quality of the evidence and potential moderators.

METHODS

A systematic search was conducted to identify studies reporting a comparison between individuals with DCD/probable DCD and typically developing (TD) individuals on measures of internalising symptoms. A pooled effect size (Hedges g) was calculated using random-effects meta-analysis. Study quality, publication bias and potential moderators of the effect were explored.

RESULTS

Twenty studies, including a total of 23 subsamples, met the inclusion criteria, of which 22 subsamples were included in the meta-analysis (DCD: n = 1123; TD: n = 7346). A significant, moderate effect of DCD on internalising symptoms was found (g = 0.61). This effect remained robust after accounting for publication bias and excluding lower quality studies. The effect was significantly larger in studies utilising a cross-sectional design (vs. longitudinal), convenience sampling (vs. population screening) and a majority male sample.

CONCLUSIONS

The findings demonstrate that individuals with DCD experience greater levels of internalising symptoms than their peers. This highlights the importance of routine screening for emotional difficulties in DCD, raising awareness of the condition in mental health services and developing psychosocial interventions that extend beyond a focus on motor impairments. However, there is a need for higher quality, longitudinal studies to better understand the causal relationship between DCD and internalising symptoms.

The Interdependence of Motor and Social Skill Development: Influence on Participation

Participation is a major outcome area for physical therapists serving young children with disabilities. Contemporary models of disability such as the International Classification of Function, developmental theories such as the system perspective, and evidence-based early childhood practices recognize the interdependence of developmental domains, and suggest that change in 1 area of development influences change in another. Physical therapy provided in naturally occurring activities and routines, considered the preferred service delivery method, promotes participation of young children with disabilities. Research indicates that: (1) children develop skills, become independent, and form relationships through participation; and (2) with developing skills, children can increasingly participate. The purpose of this Perspective article is to synthesize the literature examining the relationship between motor skill development and the social interaction dimension of participation in young children. Current research examining the influence of motor skill development on social interactions in children with autism spectrum disorder will be discussed, exemplifying the interdependence of developmental domains. Implications for physical therapist practice and recommendations for future research are provided.

Motor coordination problems and psychological distress in young adults: A test of the Environmental Stress Hypothesis

BACKGROUND AND AIMS

The Environmental Stress Hypothesis (ESH) has been used to examine how the relationship between poor motor coordination and psychological distress is affected by physical health and psychosocial factors. However, work applying the ESH is still limited, and no studies have used this framework with adults. The current investigation aims to examine the association between motor coordination and psychological distress among emerging adults, and examine potential mediators to this relationship based on the ESH.

METHODS

225 young adults aged 17-23 years completed a survey of motor coordination, physical activity, secondary stressors (i.e., general stress and global relationships), perceived social support, self-concept, and psychological distress. Structural equation modeling was conducted to examine mediating pathways and overall model fit.

RESULTS

The final model of the ESH showed good model fit (x² = 83.24, p < .01; RMSEA=0.056; NNFI = 0.927; CFI = 0.954; GFI = 0.947), and indicated that the relationship between poor motor coordination and psychological distress was mediated by secondary stressors, perceived social support, and self-concept.

CONCLUSIONS

This study highlights the effect of poor motor coordination on psychological distress in young adults, and suggests that interventions should target psychosocial well-being, in addition to motor coordination, to prevent psychological distress.

Motor skills and internalizing problems throughout development: An integrative research review and update of the environmental stress hypothesis research

BACKGROUND

The Environmental Stress Hypothesis provides a conceptual framework detailing the complex relationship between poor motor skills and internalizing problems.

AIMS

This integrative research aimed to synthesize studies that have evaluated complex pathways posited in the framework.

METHOD

This study followed the four stages of an integrative research review: (i) problem formation and research aims, (ii) literature search and data collection, (iii) data evaluation and analysis, and (iv) results and discussion.

OUTCOMES AND RESULTS

Twelve peer-reviewed, English language studies published within 2010-2018 were identified. These used mostly cross-sectional, correlational methods and provided varying levels of support for relationships posited in the framework in samples spanning early childhood to adulthood. Compared to intrapersonal factors (e.g., self-esteem/ perceived competence), interpersonal factors (e.g., social support, peer problems) were found to more strongly and consistently mediate the relationship between motor skills and internalizing problems.

CONCLUSIONS AND IMPLICATIONS

There is growing empirical support for many of the Environmental Stress Hypothesis pathways. However, research to date is limited in the ability to establish causal relationships between variables, which is integral to the Environmental Stress Hypothesis. Intervention studies provide a useful type of experimental research that could establish causality between variables, while working to improve the physical and psychosocial functioning of people with poor motor skills.

Emotional and Behavioral Problems in 4- and 5-Year Old Children With and Without Motor Delays

Background: An increased prevalence of psychological and behavioral conditions has been observed in youth and adolescents with DCD. The majority of research examining the relationship between motor skill proficiency and psychological problems has focused on older children and adolescents. The aim of the present study was to examine the relationship between motor skill proficiency and emotional and behavioral problems among pre-school age children with DCD to help determine how young children are when more severe problems begin to emerge (i.e., symptoms meet clinical thresholds) and the prevalence of comorbidity. Methods: Children 4 to 5 years of age (n = 589) from the Coordination and Activity Tracking in CHildren (CATCH) study were divided into two groups: at risk for DCD (rDCD; n = 288) and typically developing (TD; n = 301). Inclusion in the rDCD group required a score ≤16th percentile on the Movement Assessment Battery for Children-2. Emotional and behavioral problems were assessed using the Child Behavior Checklist (CBCL) 1.5 to 5 year parent-report questionnaire. CBCL data were scored using the CBCL syndrome scales as well as the DSM V revised scale scoring. Results: Seven children had missing or incomplete data on the CBCL and were excluded from the present analysis, leaving 582 participants. The mean age was 5.0 (SD 0.6) years and 57% of children were male (TD: 48% male, rDCD group: 67% male). After adjusting for sex, rDCD children scored significantly higher on all CBCL syndrome scales, all DSM-V scales, and all three summative scales. They were also significantly more likely to score at or above the syndrome scale clinical threshold on anxiety, withdrawn, emotionally reactive, aggression, ADHD, internalizing, externalizing, and total problems; and above the DSM-V thresholds on depression and autism. In addition, rDCD status was associated with a higher probability of meeting criteria for one, two, or more disorders in an ordinal logistic regression model. Conclusion: Preschool-age children with rDCD have more parent-reported psychological problems, and are more likely to be above the clinical threshold for many psychological problems and meet criteria for multiple conditions.

Moderating Effects of Physical Activity and Global Self-Worth on Internalizing Problems in School-Aged Children With Developmental Coordination Disorder

School-aged children with developmental coordination disorder (DCD) are at greater risk for physical inactivity, lower global self-worth, and internalizing problems, such as depression and anxiety. Based on the environmental stress hypothesis (ESH), recent research has shown that physical inactivity and lower global self-worth sequentially mediate the relationship between DCD and internalizing problems, suggesting that DCD leads to lower levels of physical activity, which in turn leads to lower levels of global self-worth, and ultimately, a greater amount of internalizing problems. However, physical activity and global self-worth may also buffer (i.e., moderate) the adverse effect of DCD on internalizing problems. To date, this has yet to be tested. Participants were 1206 children aged 12–14 years [611 boys, 79 with probable DCD (pDCD)]. All children received assessments of motor coordination, physical activity, global self-worth, and internalizing problems. Children with pDCD were less physically active, had lower self-worth, and experienced more internalizing problems compared to typically developing (TD) children (p’s < 0.05). Furthermore, the moderated moderating effect (three-way interaction) of physical activity and global self-worth was also evident (p < 0.05), indicating that internalizing problems in both TD and pDCD groups decreased with concurrent increases in physical activity and global self-worth. Importantly, when compared to TD children, increases in physical activity and global self-worth were associated with a greater reduction in internalizing problems among children with pDCD. The findings support several pathways in the ESH and highlight that, in addition to improving motor skills, interventions should also target both physical activity and global self-worth to mitigate potential mental health issues for children with motor difficulties.

Physical Functioning, Emotional, and Behavioral Problems in Children With ADHD and Comorbid ASD: A Cross-Sectional Study

OBJECTIVE

To examine (a) physical and daily functioning in children with ADHD and autism spectrum disorder (ASD) compared with ADHD alone and (b) whether decreased physical quality of life (QoL) is associated with increased emotional and behavioral problems in children with ADHD-ASD.

METHOD

Cross-sectional study comprising 392 children with confirmed ADHD (ADHD-ASD, n = 93; ADHD alone, n = 299) recruited from 21 pediatric practices in Victoria, Australia. Data were collected via parent and teacher surveys. Key measures included the Strengths and Difficulties Questionnaire (SDQ) and Pediatric Quality of Life Inventory (PedsQL).

RESULTS

Children with ADHD-ASD had poorer QoL across both psychosocial and physical health domains, and also had greater parent-reported behavioral, emotional, and peer problems, compared with children with ADHD alone. Poorer physical QoL partially mediated the relationship between comorbid ASD status and poorer emotional and behavioral functioning.

CONCLUSION

The comorbid overlay of ASD in ADHD appears to influence not only problems in physical functioning but also the severity of problems relating to areas of emotional and behavioral functioning.

The Relationship Between Motor Skills, Social Problems, and ADHD Symptomatology: Does It Vary According to Parent and Teacher Report?

OBJECTIVE

This study investigated the relationship between motor performance; attentional, hyperactive, and impulsive symptoms; and social problems. Correlations between parents' versus teachers' ratings of social problems and ADHD symptomatology were also examined.

METHOD

A total of 129 children aged 9 to 12 years were included. ADHD symptoms and social problems were identified based on Conners' Rating Scales-Revised: L, and the McCarron Assessment of Neuromuscular Development was used to assess motor skills.

RESULTS

After controlling for ADHD symptomatology, motor skills remained a significant predictor of social problems in the teacher model but not in the parent model. After controlling for motor skills, inattentive (not hyperactive-impulsive) symptoms were a significant predictor of social problems in the parent model, whereas hyperactive-impulsive (not inattentive) symptoms were a significant predictor of social problems in the teacher model.

CONCLUSION

The findings suggested that intervention strategies should consider the interaction between symptoms and environmental contexts.

Coordination difficulties in preschool-aged children are associated with maternal parenting stress: A community-based cross-sectional study

BACKGROUND

Although coordination difficulties are sometimes observed even in children in the general population, no empirical studies have examined the impact of these difficulties on parenting stress.

AIMS

The aim of this study was to elucidate the relationship between coordination difficulties and parenting stress in a community-based sample of preschool-aged children and their mothers.

METHODS

The study included 1691 families. Mothers with 4- or 5-year-old children completed questionnaires about parenting stress and children's coordination difficulties, as well as traits associated with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

RESULTS

The results of hierarchical multiple regression analyses showed that coordination difficulties, and ADHD and ASD traits were each independent predictors of parenting stress. Among the significant predictive factors, impaired general coordination, as well as hyperactivity-impulsivity, showed a strong impact on parenting stress. In addition, a gender difference was observed in the manner in which coordination difficulties influenced parenting stress.

CONCLUSIONS

Coordination difficulties in preschool-aged children in the general population increased maternal parenting stress (as did ADHD and ASD traits). This highlights the need to provide support for mothers who have children with coordination difficulties, even when there is no clinical diagnosis.

The relationship between motor skills and psychosocial factors in young children: A test of the elaborated environmental stress hypothesis

BACKGROUND

The elaborated environmental stress hypothesis (EESH) provides a framework that describes how motor skills may indirectly cause internalizing problems through various mediating psychosocial factors. While there is evidence to support this framework, little is known about how the proposed relationships may vary across different stages of development.

AIMS

This study aimed to investigate whether peer problems and perceived self-competence mediated the relationship between motor skills and internalizing problems in pre-primary children, and at 18-month follow up.

SAMPLE

A community sample of 197 pre-primary school children (M = 5.40 years, SD = 0.30 years; 102 males, 95 females) participated at Time 1, with 107 completing the Time 2 follow-up.

METHODS

Standardized instruments were used to measure motor skills and verbal IQ. Perceived self-competence was measured using a self-report measure. Participant peer problems and internalizing problems were measured using teacher report. Age, gender, and verbal IQ were included as covariates.

RESULTS

Mediation analysis using PROCESS showed that the relationship between motor skills and internalizing problems was mediated by peer problems at Time 1. At Time 2, the relationship was mediated by peer problems and perceived physical competence.

CONCLUSIONS

The current results indicate the EESH may function differently across different periods of development. The transition from pre-primary to Grade 1 represents a time of important cognitive and psychosocial development, which has implications for how the relationship between motor skills and internalizing problems can be understood. These findings highlight potential age-appropriate targets for psychomotor interventions aiming to improve the emotional well-being of young children.

Mental health outcomes of developmental coordination disorder in late adolescence

AIM

To assess the relationship between developmental coordination disorder (DCD) and mental health outcomes in late adolescence.

METHOD

Data were analyzed from the Avon Longitudinal Study of Parents and Children. Moderate-to-severe DCD was defined at 7 to 8 years according to the DSM-IV-TR criteria. Mental health was assessed at 16 to 18 years using self-reported questionnaires: Strengths and Difficulties Questionnaire, Short Moods and Feelings Questionnaire, and the Warwick-Edinburgh Mental Well-being Scale. Logistic and linear regressions assessed the associations between DCD and mental health, using multiple imputation to account for missing data. Adjustments were made for socio-economic status, IQ, and social communication difficulties.

RESULTS

Adolescents with DCD (n=168) had an increased risk of mental health difficulties (total Strengths and Difficulties Questionnaire score) than their peers (n=3750) (odds ratio 1.78, 95% confidence interval 1.12-2.83, adjusted for socio-economic status and IQ). This was, in part, mediated through poor social communication skills. Adolescent females with DCD (n=59) were more prone to mental health difficulties than males. Greater mental well-being was associated with better self-esteem (β 0.82, p<0.001).

INTERPRETATION

Individuals with DCD, particularly females, had increased risk of mental health difficulties in late adolescence. Interventions that aim to promote resilience in DCD should involve improving social communication skills and self-esteem.

Elaboration of the Environmental Stress Hypothesis-Results from a Population-Based 6-Year Follow-Up

The aim of this paper was to contribute to the elaboration of the Environmental Stress Hypothesis framework by testing eight hypotheses addressing the direct impact of gross motor coordination problems in elementary-school on selected physical, behavioral and psychosocial outcomes in adolescence. Results are based on a longitudinal sample of 940 participants who were (i) recruited as part of a population-based representative survey on health, physical fitness and physical activity in childhood and adolescence, (ii) assessed twice within 6 years, between the ages of 6 and 10 years old as well as between the ages of 12 and 16 years old (Response Rate: 55.9%) and (iii) classified as having gross motor coordination problems (N = 115) or having no gross motor coordination problems (N = 825) at baseline. Motor tests from the Körperkoordinationstest, measures of weight and height, a validated physical activity questionnaire as well as the Strength and Difficulties Questionnaire were conducted. Data were analyzed by use of binary logistic regressions. Results indicated that elementary-school children with gross motor coordination problems show a higher risk of persistent gross motor coordination problems (OR = 7.99, p < 0.001), avoiding organized physical activities (OR = 1.53, p < 0.05), an elevated body mass (OR = 1.78, p < 0.05), bonding with sedentary peers (OR = 1.84, p < 0.01) as well as emotional (OR = 1.73, p < 0.05) and conduct (OR = 1.79, p < 0.05) problems in adolescence in comparison to elementary-school children without gross motor coordination problems. However, elementary-school children with gross motor coordination problems did not show a significantly higher risk of peer problems (OR = 1.35, p = 0.164) or diminished prosocial behavior (OR = 1.90, p = 0.168) in adolescence, respectively in comparison to elementary-school children without gross motor coordination problems. This study is the first to provide population-based longitudinal data ranging from childhood to adolescence in the context of the Environmental Stress Hypothesis which can be considered a substantial methodological progress. In summary, gross motor coordination problems represent a serious issue for a healthy transition from childhood to adolescence which substantiates respective early movement interventions.

The relationship between motor proficiency and mental health outcomes in young adults: A test of the Environmental Stress Hypothesis

Growing evidence has highlighted the importance of motor proficiency in relation to psychosocial outcomes including self-perceived competence in various domains, perceived social support, and emotional areas such as anxiety and depression. The Environmental Stress Hypothesis-elaborated (Cairney, Rigoli, & Piek, 2013) is a proposed theoretical framework for understanding these relationships and recent studies have begun examining parts of this model using child and adolescent populations. However, the extent to which the relationships between these areas exist, persist or change during early adulthood is currently unclear. The current study aimed to investigate the Environmental Stress Hypothesis in a sample of 95 young adults aged 18-30years and examined the mediating role of physical self-worth and perceived social support in the relationship between motor proficiency and internalising symptoms. The McCarron Assessment of Neuromuscular Development (McCarron, 1997) was used to assess motor proficiency, the Depression Anxiety Stress Scale (Lovibond & Lovibond, 1995) provided a measure of internalising symptoms, and the Physical Self Perceptions Profile (Fox & Corbin, 1989) and the Multidimensional Scale of Perceived Social Support (Zimet, Dahlem, Zimet, & Farley, 1988) were used to investigate the possible mediating role of physical self-worth and perceived social support respectively. Potential confounding variables such as age, gender and BMI were also considered in the analysis. Structural Equation Modelling revealed that perceived social support mediated the relationship between motor proficiency and internalising symptoms, whereas, the mediating role of physical self-worth was non-significant. The current results provide support for part of the model pathways as described in the Environmental Stress Hypothesis and suggest an important relationship between motor proficiency and psychosocial outcomes in young adults. Specifically, the results support previous literature regarding the significant role of perceived social support for mental well-being and suggest that an intervention that considers social support may also indirectly influence mental health outcomes in young adults who experience movement difficulties.

The Relationship between Motor Skills, Perceived Social Support, and Internalizing Problems in a Community Adolescent Sample

OBJECTIVES

Poor motor skills are associated with a range of psychosocial consequences, including internalizing (anxious and depressive) symptoms. The Elaborated Environmental Stress Hypothesis provides a causal framework to explain this association. The framework posits that motor skills impact internalizing problems through an indirect effect via perceived social support. However, empirical evaluation is required. We examined whether motor skills had an indirect effect on anxious and depressive symptoms via perceived family support domains.

METHODS

This study used a community sample of 93 adolescents (12-16 years). Participants completed measures of motor skills, perceived social support across three dimensions (family, friend, and significant other), depressive symptoms, and anxious symptoms. Age, gender, verbal IQ, and ADHD symptoms were included as control variables.

RESULTS

Regression analysis using PROCESS revealed that motor skills had an indirect effect on depressive symptoms via perceived family support, but not by perceived friend support or significant other support. The negative association between motor skills and anxious symptoms was not mediated by any perceived social support domain.

CONCLUSIONS

Findings are consistent with previous literature indicating an association between motor skills and internalizing problems. However, we identified a different pattern of relationships across anxious and depressive symptoms. While anxiety and depressive symptoms were highly correlated, motor skills had an indirect effect on depressive symptoms via perceived family support only. Our findings highlight the importance of family support as a potential protective factor in the onset of depressive symptoms. This study provides partial support for the Elaborated Environmental Stress Hypothesis, however further research is required.

The Elaborated Environmental Stress Hypothesis as a Framework for Understanding the Association Between Motor Skills and Internalizing Problems: A Mini-Review

Poor motor skills have been shown to be associated with a range of psychosocial issues, including internalizing problems (anxiety and depression). While well-documented empirically, our understanding of why this relationship occurs remains theoretically underdeveloped. The Elaborated Environmental Stress Hypothesis by Cairney et al. (2013) provides a promising framework that seeks to explain the association between motor skills and internalizing problems, specifically in children with developmental coordination disorder (DCD). The framework posits that poor motor skills predispose the development of internalizing problems via interactions with intermediary environmental stressors. At the time the model was proposed, limited direct evidence was available to support or refute the framework. Several studies and developments related to the framework have since been published. This mini-review seeks to provide an up-to-date overview of recent developments related to the Elaborated Environmental Stress Hypothesis. We briefly discuss the past research that led to its development, before moving to studies that have investigated the framework since it was proposed. While originally developed within the context of DCD in childhood, recent developments have found support for the model in community samples. Through the reviewed literature, this article provides support for the Elaborated Environmental Stress Hypothesis as a promising theoretical framework that explains the psychosocial correlates across the broader spectrum of motor ability. However, given its recent conceptualization, ongoing evaluation of the Elaborated Environmental Stress Hypothesis is recommended.

Optimizing cross-sectional prediction of social functioning in youth referred for neuropsychological testing

The current study aimed to establish a fine-grained, efficient characterization of the concurrent neuropsychological contributions to social functioning in neuropsychologically-referred youth. A secondary aim was to demonstrate a useful statistic approach for such investigations (Partial Least Squares Regression; PLSR), which is underutilized in this field. Forty-five participants (70 - 164 months; Mage = 110.89; 34 male) were recruited from a large neuropsychological assessment clinic. Participants completed subtests from the NEPSY-II focusing on neuropsychological constructs that have been linked to social functioning (affect decoding, social memory, motor skills, visuomotor skills, response inhibition, attention and set-shifting, and verbal comprehension). Mothers completed the BASC-2, from which Atypicality and Social Skills scales were analyzed. PLSR revealed that difficulty with social memory, sensorimotor integration, and the ability to attend to and accurately discriminate auditory stimuli combine to best predict atypical or "odd" behavior. In terms of social skills, two factors emerged. The first factor indicated that, counterintuitively, greater emotional perception, visuospatial perception, ability to attend to and accurately discriminate auditory stimuli, and understand instructions was related to poorer social skills. The second factor indicated that a pattern of better facial memory, and sensorimotor ability (execution & integration) characterized a distinct profile of greater social ability. PLSR results were compared to traditional OLS and Backwards Stepwise regression approaches to demonstrate utility. Results also suggested that these findings were consistent across age, gender, and diagnostic group, indicating common neuropsychological substrates of social functioning in this sample of referred youth. Overall, this study provides the first characterization of optimized combinations of neuropsychological variables in predicting social functioning in assessment clinic-referred youth, and introduces to this literature a valuable statistical approach for obtaining such characterizations.

Psychological distress in children with developmental coordination disorder and attention-deficit hyperactivity disorder

This study explored whether or not a population-based sample of children with developmental coordination disorder (DCD), with and without comorbid attention deficit/hyperactivity disorder (ADHD), experienced higher levels of psychological distress than their peers. A two-stage procedure was used to identify 244 children: 68 with DCD only, 54 with ADHD only, 31 with comorbid DCD and ADHD, and 91 randomly selected typically developing (TD) children. Symptoms of depression and anxiety were measured by child and parent report. Child sex and caregiver ethnicity differed across groups, with a higher ratio of boys to girls in the ADHD only group and a slightly higher proportion of non-Caucasian caregivers in the TD group. After controlling for age, sex, and caregiver ethnicity, there was significant variation across groups in both anxiety (by parent report, F(3,235)=8.9, p<0.001; by child report, F(3,236)=5.6, p=0.001) and depression (parent report, F(3,236)=23.7, p<0.001; child report, F(3,238)=9.9, p<0.001). In general, children in all three disorder groups had significantly higher levels of symptoms than TD children, but most pairwise differences among those three groups were not significant. The one exception was the higher level of depressive symptoms noted by parent report in the ADHD/DCD group. In conclusion, children identified on the basis of motor coordination problems through a population-based screen showed significantly more symptoms of depression and anxiety than typically developing children. Children who have both DCD and ADHD are particularly at heightened risk of psychological distress.

Validation study of the Chinese Early Development Instrument (CEDI)

Background

The Early Development Instrument (EDI) is a comprehensive instrument used to assess school readiness in preschool children. This study was carried out to evaluate the psychometric properties of the Chinese version of the EDI (CEDI) in Hong Kong.

Methods

One hundred and sixty-seven children were purposefully sampled from kindergartens in two districts with very different socioeconomic statuses. The CEDI was assessed for concurrent validity, internal consistency and test-retest reliability. The developmental vulnerability identified using the CEDI scores was further examined in relation to the socioeconomic status of the district and family.

Results

The CEDI displayed adequate internal consistency, with Cronbach’s alphas ranging from 0.70 to 0.95 on its five domains. Concurrent validity was supported by moderate and significant correlations (0.25 to 0.49) on the relevant domains between the CEDI and a comparable measure. The level of test-retest reliability was good, with a kappa statistic of 0.89. In general, girls outperformed boys, particularly in the social, emotional and communication/general knowledge domains. After controlling for the uneven distribution of sex, children from socioeconomically disadvantaged districts and families were found to be at greater risk of developmental vulnerability than their more advantaged counterparts.

Conclusion

The evidence gathered in this study supports the CEDI’s use as a valid and reliable instrument in assessing school readiness and identifying developmentally vulnerable children in Chinese populations. Its preliminary findings on the socioeconomic gradients of child development suggest that the CEDI is a promising tool for leveraging evidence-based, context-sensitive policies and practices to foster the development of all children.