'Putting your foot in it'! A window into clumsy behaviour

Behavioral and Neuroimaging Research on Developmental Coordination Disorder (DCD): A Combined Systematic Review and Meta-Analysis of Recent Findings

AIM

The neurocognitive basis of Developmental Coordination Disorder (DCD; or motor clumsiness) remains an issue of continued debate. This combined systematic review and meta-analysis provides a synthesis of recent experimental studies on the motor control, cognitive, and neural underpinnings of DCD.

METHODS

The review included all published work conducted since September 2016 and up to April 2021. One-hundred papers with a DCD-Control comparison were included, with 1,374 effect sizes entered into a multi-level meta-analysis.

RESULTS

The most profound deficits were shown in: voluntary gaze control during movement; cognitive-motor integration; practice-/context-dependent motor learning; internal modeling; more variable movement kinematics/kinetics; larger safety margins when locomoting, and atypical neural structure and function across sensori-motor and prefrontal regions.

INTERPRETATION

Taken together, these results on DCD suggest fundamental deficits in visual-motor mapping and cognitive-motor integration, and abnormal maturation of motor networks, but also areas of pragmatic compensation for motor control deficits. Implications for current theory, future research, and evidence-based practice are discussed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, identifier: CRD42020185444.

Children with Auditory Brainstem Implant: How Do They Perform in Motor and Language Skills?

BACKGROUND

Young children are able to explore new objects and practice language through the acquisition of motor skills that lead to their overall development. Congenital hearing loss and total vestibular loss may contribute to the delay in speech and motor skill development.

OBJECTIVES

To investigate the relationship between motor development performance, speech perception, and language performance in children with auditory brainstem implant (ABI).

METHOD

Ten children, aged 4-17 years (mean age 9.76 ± 4.03), fitted with unilateral ABI for at least 2 years due to the presence of labyrinthine aplasia and rudimentary otocyst at least 1 side were included in the study. Several standardized tests, such as Bruininks-Oseretsky Motor Proficiency Test-2 (BOT-2), Children's Auditory Perception Test Battery, Meaningful Auditory Integration Scale (MAIS), and Test of Early Language Development-3, were performed to evaluate their skills of fine motor control, balance, manual dexterity, language, and auditory perception.

RESULTS

A significant correlation was established between the BOT-2 manual dexterity and MAIS scores (r = 0.827, p < 0.05) and between the manual dexterity and language skills (for expressive language, r = 0.762, p < 0.05; for receptive language, r = 0.650, p < 0.05). Some of the BOT-2 balance tasks, such as standing on 1 leg on a line with eyes closed, standing on 1 leg on a balance beam with eyes open, standing heel-to-toe on a balance beam, and walking forward heel-to-toe on a line, showed a strong correlation with their receptive and expressive language performance (p < 0.05).

CONCLUSION

The current study has indicated that significantly poor manual and balance performances are associated with poor speech perception and language skills in children with ABI. The authors recommend performing a vestibular assessment before and after ABI surgery and the use of a holistic rehabilitation approach, including auditory and vestibular rehabilitation, to support development of the children with ABI.

Gender differences in the rat corpus callosum: An ultrastructure study

Sexual dimorphism exists at all levels of the nervous system, from genetic, anatomical and system levels. The sexual dimorphism in the axonal content of the corpus callosum (CC) has always been controversial; hence, the aim of this study was to analyse the differences in total, myelinated and unmyelinated axons density of various regions of the CC between male and female rats. To assess that, six pairs of adult male and female rats were perfused and the CC was removed and sectioned. Four sections from different subregions of the corpus callosum that represent the genu, anterior body, posterior body, and splenium, were stained, and electron microscopic images were captured using stereological guidelines. Later, the axons density for each subregion was calculated and compared between males and females. The findings of the present study indicated region-specific differences in the myelinated, unmyelinated or the ratio of myelinated/total axons in the CC between male and female rats.

Lack of Motor Inhibition as a Marker of Learning Difficulties of Bimanual Coordination in Teenagers With Developmental Coordination Disorder

This study tested the learning of a new bimanual coordination in teenagers with and without Developmental Coordination Disorder (DCD). Both groups improved accuracy of the new coordination. No difference was found on stability. But DCD teenagers exhibited an overall higher number of additional taps, suggesting a persistent lack of motor inhibition during learning. Moreover, teenagers with the lowest scores of motor abilities present the highest number of additional taps. All these results suggest that this number of additional taps (rather than traditional measures of accuracy and stability) could be a good marker of perceptual-motor learning deficit in DCD.

Socialization and Behavioral Problems of Elementary School Pupils with Developmental Coordination Disorder

The present study examined the role of the developmental coordination disorder in 154 children's socialization and the expression of deviant behaviors in the context of Greek primary education. For assessment of their motor coordination, the Movement Assessment Battery for Children of Henderson and Sugden was used. The peer nomination method (sociogram) was used for the estimation of children's social status, and the expression of deviant behaviors was assessed via Conners' Teacher Questionnaire. Analyses showed that developmental coordination disorder was associated with poor socialization and the expression of deviant behaviors. These findings support the development of educational programs to include children with poor motor coordination.

Developmental changes in lateralized inhibition of symmetric movements in children with and without Developmental Coordination Disorder

The present study investigates developmental changes in selective inhibition of symmetric movements with a lateralized switching task from bimanual to unimanual tapping in typically developing (TD) children and with Developmental Coordination Disorder (DCD) from 7 to 10 years old. Twelve right-handed TD children and twelve gender-matched children with DCD and probable DCD produce a motor switching task in which they have (1) to synchronize with the beat of an auditory metronome to produce bimanual symmetrical tapping and (2) to selectively inhibit their left finger's tapping while continuing their right finger's tapping and conversely. We assess (1) the development of the capacity to inhibit the stopping finger (number of supplementary taps after the stopping instruction) and (2) the development of the capacity to maintain the continuing finger (changes in the mean tempo and its variability for the continuing finger's tapping) and (3) the evolution of performance through trials. Results indicate that (1) TD children present an age-related increase in the capacity to inhibit and to maintain the left finger's tapping, (2) DCD exhibits persistent difficulties to inhibit the left finger's tapping, and (3) both groups improve their capacity to inhibit the left finger's movements through trials. In conclusion, the lateralized switching task provides a simple and fine tool to reveal differences in selective inhibition of symmetric movements in TD children and children with DCD. More theoretically, the specific improvement in selective inhibition of the left finger suggests a progressive development of inter-hemispheric communication during typical development that is absent or delayed in children with DCD.

Online motor control in children with developmental coordination disorder: chronometric analysis of double-step reaching performance

BACKGROUND

Although there are a number of plausible accounts to explain movement clumsiness in children [or developmental coordination disorder (DCD)], the cause(s) of the disorder remain(s) an issue of debate. One aspect of motor control that is particularly important to the fluid expression of skill is rapid online control (ROC). Data on DCD have been conflicting. While some recent work using double-step reaching suggests no difficulty in online control, others suggest deficits (e.g. based on sequential pointing). To help resolve this debate, we suggest two things: use of recent neuro-computational models as a framework for investigating motor control in DCD, and more rigorous investigation of double-step reaching. Our working assumption here is that ROC is only viable through the seamless integration of predictive (or forward) models of movement and feedback-based mechanisms.

AIM

The aim of this chronometric study was to explore ROC in children with DCD using a double-step reaching paradigm. We predicted slower online adjustments in DCD based on the argument that these children manifest a core difficulty in predictive control.

METHODS

Participants were a group of 17 children with DCD and 27 typically developing children aged between 7 and 12 years. Visual targets were presented on a 17-inch LCD touch screen, inclined to an angle of 15° from horizontal. The children were instructed to press each target as it appeared as quickly and accurately as possible. For 80% of the trials, the central target location remained unchanged for the duration of the movement (non-jump trials), while for the remaining 20% of trials, the target jumped at movement onset to one of the two peripheral locations (jump trials). Reaction time (RT), movement time (MT) and reaching errors were recorded.

RESULTS

For both groups, RT did not vary according to trial condition, while children with DCD were slower to initiate movement. Further, the MT of children with DCD was prolonged to a far greater extent on jump trials relative to controls, with a large effect size. As well, children with DCD committed significantly more errors, notably a reduced ability to inhibit central responses on jump trials.

CONCLUSION

Our findings help reconcile some disparate findings in the literature using similar tasks. The pattern of performance in children with DCD suggests impairment in the ability to make rapid online adjustments that are based on a predictive (or internal) model of the action. These results pave the way for future kinematic investigation.

The effectiveness of exercise intervention on inhibitory control in children with developmental coordination disorder: using a visuospatial attention paradigm as a model

Children with developmental coordination disorder (DCD) have been demonstrated to show a deficit of inhibitory control in volitional shifts of attention. The aim of this study was to use ecological intervention to investigate the efficacy of table-tennis training on treating both problems with attentional networks and motor disorder in children with DCD. Forty-three children aged 9-10 years old were screened using the Movement Assessment Battery for Children and divided into DCD (n=27) and typically developing (TD, n=16) groups. Children with DCD were then quasi-randomly assigned to either a DCD-training group who underwent a ten-week table-tennis training program with a frequency of 3 times a week or a DCD non-training group. Before and after training, the capacity of inhibitory control was examined with the endogenous Posner paradigm task for DCD and TD groups. Table-tennis training resulted in significant improvement of cognitive and motor functions for the children with DCD. The study demonstrated that exercise intervention employed within the school setting can benefit the inhibitory control and motor performance in children with DCD. However, future research efforts should continue to clarify whether the performance gains could be maintained over time.

Rhythmic coordination of hand and foot in children with Developmental Coordination Disorder

BACKGROUND

Children with Developmental Coordination Disorder (DCD) have difficulties producing stable rhythmic bimanual coordination patterns in comparison with age-related peers. Rhythmic coordination of non-homologous limbs (e.g. hand and foot) is even more difficult to perform because of mechanical differences between the limbs. The aim of the present study is to investigate the stability of hand-foot coordination patterns of children with DCD.

METHODS

Ten children with DCD (mean age 7.0 years, SD 1.1 years) and 16 control children (mean age 7.4 years, SD 1.3 years) participated in the study. They were asked to perform in-phase or anti-phase tapping movements in three different interlimb coordination combinations: (1) hand-hand (homologous), (2) hand-foot same body side (ipsilateral), and (3) hand-foot different body side (contralateral). Coordination stability was measured by the variability of the relative phase between the limbs under a 'steady state' (preferred) frequency condition, and by the critical frequency (i.e. the point at which loss of pattern stability was observed) in a condition in which the movement frequency was 'scaled' up (only anti-phase tapping).

RESULTS

Coordination patterns of children in the DCD group were less stable in all three limb combinations compared with controls. Further, hand-foot coordination patterns were less stable than hand-hand coordination patterns. With regard to hand-foot coordination, ipsilateral patterns were equally stable compared with contralateral patterns in the in-phase task, but less stable in the anti-phase task. No differential effects were found between the DCD and control groups across the different limb combinations, except for steady-state anti-phase coordination in the ipsilateral limb condition. This effect was due to a relatively good performance of the control children in this condition in comparison with the other limb combination conditions.

CONCLUSIONS

Children with DCD have difficulties producing stable rhythmic hand-foot coordination patterns compared with control children.

Disorders of motor development (clumsy child syndrome)

This presentation will focus on motor competence, the clumsy child, perceptual deficits in clumsy children and possible neurological dysfunction in this group of children. Motor competence not only allows children to carry out everyday practical tasks, but it is also an important determinant of their level of self-esteem and of their popularity and status in their peer group. Research has shown that about 6-10% of children have motor competences well below the norm. It is unusual for motor problems to simply disappear over time. In the absence of intervention the syndrome is likely to manifest itself. In the clinical literature attempts have been made to establish causal links between surface manifestations of clumsiness and underlying perceptual deficits. In this respect the attention is primarily directed towards the concept of inter- and intra-modal matching, particularly with respect to vision and proprioception, an ability deemed to underlie many real-life motor skills. Neurobehavioural model of inter- and intra-modal matching and deficit model is presented. Findings from studies using this paradigm are discussed and it is argued that clumsiness must be seen as a neurological dysfunction (insufficiency).

Development of upper limb proprioceptive accuracy in children and adolescents

This study was designed to determine differences in the proprioceptively guided movements of children (8-10 years) and adolescents (16-18 years). Participants were blindfolded and asked to actively match passively determined target positions of the elbow joint under three matching conditions. Overall, children were less accurate than adolescents in all matching tasks and utilized different kinematic strategies for making the matching movements. Specifically, children made larger absolute errors and utilized matching movements which, compared to adolescents, were of shorter duration and less irregular in terms of their velocity profiles. An assessment of limb asymmetry was also performed revealing a non-dominant arm matching advantage but only for children and only in the task requiring interhemispheric transfer of a memory-based model of limb position. The proprioceptive differences observed in this study are likely the result of experience-driven refinement in the utilization of somatosensory feedback throughout childhood and into adolescence.

Do 'clumsy' children have visual recognition problems?

OBJECTIVE

Visual recognition by 8-year-old children with hand-eye co-ordination problems (HECP), and by a control group of children without such problems was tested using a task of visual closure.

DESIGN

The task required the children to identify common objects from an incomplete visual presentation.

RESULT

As predicted, it was found that the HECP children, who were designated as such solely on the basis of their motor difficulties, identified significantly fewer correct objects than their control counterparts.

CONCLUSIONS

This finding raises the possibility that the visual processing problems of clumsy children contribute to, or even strongly determine, not only their movement problems but also their learning difficulties.

Goal-directed upper limb movements by children with and without DCD: a window into perceptuo-motor dysfunction?

BACKGROUND AND PURPOSE

Developmental co-ordination disorder (DCD) occurs in at least 6% of school-aged children. Researchers agree that motor co-ordination problems evident in DCD are, in part, the result of perceptual and cognitive processes, but the limited research available remains inconclusive. The present study investigated perceptual-motor abilities, with regard to vision, kinaesthesia and cross-modal judgement, in children with and without DCD.

METHOD

A cross-sectional study design was used. Nine children, aged six years (+/- six months) with DCD, and nine children without DCD, matched for age and gender, participated in the study. The children were required to point with the preferred hand to a target in three different positions under four sensory conditions, either with or without vision. Three-dimensional motion analysis was used to investigate trajectory lengths, endpoint error and movement time. The results were analysed using a generalized linear mixed model to examine the systematic effects of group, target position and task.

RESULTS

Compared with children without DCD, the children with DCD produced larger endpoint errors, greater movement times and longer trajectories. Children in both groups produced larger endpoint errors, greater movement times and longer trajectories in non-visually guided aiming versus visually guided aiming tasks.

CONCLUSIONS

Children with DCD moved more slowly, with longer movement trajectories and were less accurate than children without DCD when aiming to all target positions under all sensory conditions. The greatest error and trajectory length occurred for both groups when aiming movements were performed in the absence of vision. As children in the DCD group had difficulties with movement executed under kinaesthetic or visual control, the results indicate that the normal advantage of vision displayed by children without DCD is not apparent, and visual and kinaesthetic problems may be present in children with DCD.

Consequences of comorbidity of developmental coordination disorders and learning disabilities for severity and pattern of perceptual-motor dysfunction

Children with developmental coordination disorder (DCD) have difficulty learning and performing age-appropriate perceptual-motor skills in the absence of diagnosable neurological disorders. Descriptive studies have shown that comorbidity of DCD exists with attention-deficit/hyperactivity disorder (ADHD) and learning disabilities (LD). This study examined the consequences of the comorbidity of DCD and LD for the severity and pattern of perceptual-motor dysfunction. Compared to children with DCD without LD, children with comorbid DCD and LD performed lower on a standardized assessment of perceptual-motor ability. Furthermore, it appeared that children with combined DCD and LD have particular difficulty performing manual dexterity and balance tasks but not ball-skill tasks. Implications for understanding the relationship between LD and perceptual-motor problems are discussed. We conclude that the comorbidity of DCD and LD not only affects the severity of perceptual-motor dysfunction but also is associated with a distinctive pattern of perceptual-motor dysfunction.

Static balance in children with hand-eye co-ordination problems

OBJECTIVE

The aim of the present study was to examine static balance on one leg in 10-year-old children with and without hand-eye co-ordination problems (HECP) in an attempt to come closer to an understanding of developmental co-ordination disorder in children.

METHOD

The children were compared on three different balance tasks with the right and/or left leg together with a systematic manipulation of vision.

RESULTS

The results showed that when the scores for both legs were combined, the control group, in general, had superior performance in all conditions. Separate preferred and non-preferred leg analyses demonstrated that the differences between the HECP group and control group could be accounted for by lowered performances when the non-preferred leg was used in only one static balance task, stork stand with vision. In the two other balance tasks, balance on beam and one-board balance, the HECP group displayed significantly worse performance than the control group irrespective of the use of the preferred or non-preferred leg.

CONCLUSIONS

Explanation related to the development of the hemispheres controlling the preferred and non-preferred leg is invoked to account for the poor performance in the HECP group.

Gender- and age-related differences in the morphology of the corpus callosum

The size and shape of the adult corpus callosum may vary with gender and age. There is, however, little data on the morphology of the corpus callosum in the Indian population. The purpose of this study was to measure the size of the corpus callosum in normal adult Indian males and females, and to identify gender- and age-related differences. The size of the corpus callosum on midsagittal section was measured in 100 (50 males, 50 females) normal adult Indians using magnetic resonance imaging. The length of the corpus callosum, the width of the genu, trunk, and splenium, the area of the splenium, and the total area of the corpus callosum were measured. The length of the brain also was measured. Means were compared for significant difference by gender using the Student's unpaired t-test and by age using ANOVA followed by Duncan's multiple range test. Gender was estimated by discriminant function analysis and age was estimated by regression analysis from significant parameters. The corpus callosum was longer in males and the discriminant score to differentiate gender was determined with an accuracy of 66%. The length of the corpus callosum increased with age and regression equations for predicting age was derived from the length of the corpus callosum. The width of the trunk and genu decreased with age in males but not in females.

Do 'clumsy' children have visual deficits

Visual processing by 10-year-old children diagnosed on the basis of standardised tests as having developmental 'clumsiness' syndrome, and by a control group of children without motor difficulties, was tested using three different psychophysical tasks. The tasks comprised a measure of global motion processing using a dynamic random dot kinematogram, a measure of static global pattern processing where the position of the target was randomised, and a measure of static global pattern processing in which the target position was fixed. The most striking finding was that the group of clumsy children, who were diagnosed solely on the basis of their motor difficulties, were significantly less sensitive than the control group on all three tasks of visual sensitivity. Clumsy children may have impaired visual sensitivity in both the dorsal and ventral streams in addition to their obvious problems with motor control. These results support the existence of generalised visual anomalies associated with impairments of cerebellar function.

Hand preference in children with developmental coordination disorders: cause and effect?

Inter- and intra-modal matching by eight-year-old children diagnosed as having hand-eye coordination problems (HECP) and categorized as left-handed, together with a left-handed control group of children without such problems, were tested using a manual sensory matching task. The task required the children to locate target pins, visually (seen target), proprioceptively (felt target) or in combination (felt and seen target), while matching to the located target was always carried out without vision. Performance was superior when the target was located visually or visually/proprioceptively for both groups of children. These results question the conclusion that intra-modal will always be more accurate than inter-modal matching. When the combined scores for both hands were analyzed, the HECP children showed inferior performance to the control children in both inter- and intra-modal matching. Separate right and left hand analyses, demonstrated that the differences between the HECP group and control children could be accounted for by lowered performances when the right hand (nonpreferred) was used to match the located target position. Putative neurological disorders related to the development of the hemisphere controlling the nonpreferred hand (left hemisphere) are invoked to account for the poor performance with the nonpreferred hand of the HECP children.

Dynamics of hand preference in 4 year-old children

Hand preference in groups of 4 year-old children towards either end of the skill continuum (as determined by the Movement ABC test) was explored by means of a catching task in which the 'direction of approach of the ball' was used as a control parameter within a dynamical systems framework. In Condition 1, the ball direction was systematically scaled in degrees from the right side of the subject to the left and vice versa. In Condition 2, the spatial location of the ball direction was varied randomly, rather than systematically, over the same range as for Condition 1. In both conditions, the two groups of children were shown to switch between hands (from left to right and vice versa) at well-defined positions on the scale. The different scale values obtained when ball direction was scaled from left to right compared with right to left were used to define hysteresis areas. These areas were more extensive and located more to the left of the midline for the group towards the less skilled end of the continuum than for those towards the more skilled end. Additionally, the less-skilled children were shown to use the right hand more to catch the balls delivered to the left side than did the more skilled children. In Condition 3, objects were placed on the table of the ball-delivery apparatus in order to make the catching action more complicated. The less skilled group were shown to use the right hand more than the left hand in all catching positions whereas the more skilled group showed an equal usage of both catching regimes.

Perceptual skills of children with developmental coordination disorder

The aim of this study was to investigate whether children with a Developmental Coordination Disorder (DCD) experience problems in the processing of visual, proprioceptive or tactile information. Different aspects of visual perception were tested with the Developmental Test of Visual Perception (DTVP-2), tactile perception was assessed with the Tactual Performance Test (TPT), and a manual pointing task was employed to measure the ability to use visual and proprioceptive information in goal-directed movements. Nineteen children with DCD and nineteen age and sex-matched controls participated in this study. Differences between groups were most pronounced in the subtests measuring visual-motor integration of the DTVP-2, and in two subtests measuring visual perception (visual closure and position in space). On average the children with DCD performed slightly below the norm for tactile perception, with only three children failing the norm. On the manual pointing task, children with DCD made inconsistent responses towards the targets in all three conditions (visual, visual-proprioceptive and proprioceptive condition). No significant differences between groups were found for absolute error. Inspection of the individual data revealed that only two children failed on the majority of perceptual tasks in the three modalities. Across tasks, no consistent pattern of deficits appeared, illustrating the heterogeneity of the problems of children with DCD.

Clinical and research diagnostic criteria for developmental coordination disorder: a review and discussion

The aim of this review was to investigate the selection criteria used in the past in studies of children with developmental motor problems (excluding those suffering from neurological dysfunctions such as cerebral palsy, muscular dystrophy, etc.). We therefore conducted an extensive analysis of 176 publications. First, an overview of the main characteristics of these studies (terminology, population, type and purpose) and the selection criteria that are reported in these publications are presented. Following this, the DSM-IV selection criteria for developmental coordination disorder (DCD) are contrasted with the selection criteria reported in 41 publications that have used this terminology to classify the children. The results of this comparison show that the inclusion criteria are largely followed, albeit with little consistency concerning selection instruments and quantitative cut-offs, while adherence to the exclusion criteria is not common practice. Strengths and weaknesses of the DSM-IV criteria, complementary to the previous discussion by Henderson and Barnett in the HMS special issue on DCD in 1998 on this same topic, are discussed. The results of the review also show that many studies have used additional selection criteria related to the specific research questions of the study concerned. In the broader context of clinical practice as well as basic research, the latter result suggests the usefulness of a distinction between Clinical Diagnostic Criteria and Research Diagnostic Criteria. This distinction helps to develop a unifying view on the use of diagnostic criteria for research and clinical practice. We conclude with a number of recommendations concerning the selection criteria for children with DCD.

Differential contributions of the two hemispheres in intra-modal proprioceptive sensory matching in 7-10-year-old boys

This study explores putative differential contributions of the two hemispheres when 7-10-year-old right-hand and left-hand preferent boys are required to carry out a 'foot-hand' target location and matching task. The task required subjects to locate a target pin with the big-toe (felt target), and match the located target position with the hand, without vision. Right-handed (n=25) and left-handed (n=22) boys were tested in a four-condition design. Two intra-hemispheric conditions (right foot locating-right hand matching, left foot locating-left hand matching), and two inter-hemispheric conditions (right foot locating-left hand matching, left foot locating-right hand matching) were used. When the criterion for handedness was writing hand only the results were found to be confounded by the large number of subjects with indeterminate handedness (isolated by use of the Edinburgh Handedness Inventory) originally assigned to the left-handed group. Reclassification of the handedness groups, on the basis of this inventory, showed the pure-left handers to be as good on those conditions mediated by the right hemisphere as pure right handers were with those conditions mediated by the left. These findings are discussed with respect to the contention that left handers are not just 'reversed' right handers.

Proximal versus distal control in proprioceptively guided movements of motor-impaired children

Two groups of 7-year-old children diagnosed as motor-impaired (N = 6) or as controls (N = 6) were required to perform a task that involved locating targets under a table-top with one hand while attempting to match the position of the target with the other, on the table-top (intra-modal matching), always without visual control. The experimental design involved three different conditions: proximal control (P), distal control (D) or both (PD). Target distance errors were analysed in terms of absolute (AE) and variable error. When the scores for each hand were combined, the motor-impaired group showed inferior mean performance (AE scores) on all three conditions as compared with the control children and were also more variable in their behaviour. Analyses of scores achieved with the right and the left hand separately, however, demonstrated that the difference could largely be attributed to the scores obtained when matching with the right hand in conditions P and PD, and matching with the left hand in condition D. Possible explanations of these findings are discussed in the context of 'delay' (developmental lag) and/or 'deviancy' (neurological lesion/disconnection).