How effective is fine motor training in children with ADHD? A scoping review

The Role of Visual Information Quantity in Fine Motor Performance

BACKGROUND/OBJECTIVES

Fine motor movements are essential for daily activities, such as handwriting, and rely heavily on visual information to enhance motor complexity and minimize errors. Tracing tasks provide an ecological method for studying these movements and investigating sensorimotor processes. To date, our understanding of the influence of different quantities of visual information on fine motor control remains incomplete. Our study examined how variations in the amount of visual feedback affect motor performance during handwriting tasks using a graphic pen tablet projecting on a monitor.

METHODS

Thirty-seven right-handed young adults (20 to 35 years) performed dot-to-dot triangle tracing tasks under nine experimental conditions with varying quantities of visual cues. The conditions and triangle shape rotations were randomized to avoid motor training or learning effects. Motor performance metrics, including absolute error, time of execution, speed, smoothness, and pressure, were analyzed.

RESULTS

As visual information increased, absolute error (from 6.64 mm to 2.82 mm), speed (from 99.28 mm/s to 57.19 mm/s), and smoothness (from 4.17 mm2/s6 to 0.80 mm2/s6) decreased, while time of execution increased (from 12.68 s to 20.85 s), reflecting a trade-off between accuracy and speed. Pressure remained constant across conditions (from 70.35 a.u. to 74.39). Spearman correlation analysis demonstrated a moderate to strong correlation between absolute error and time of execution across conditions. The Friedman test showed significant effects of experimental conditions on all motor performance metrics except for pressure, with Kendall's W values indicating a moderate to strong effect size.

CONCLUSION

These findings deepen our understanding of sensorimotor integration processes and could potentially have implications for optimizing motor skills acquisition and training and developing effective rehabilitation strategies.

Association between reported ADHD symptom and motor development delay in preschool children

Objective

To explore whether the motor developmental level is associated with the attention deficit/hyperactivity disorder (ADHD) symptoms severity reported by parents in preschool children.

Methods

Preschool children aged 4-6 years old with the chief complaint of reported inattention or hyperactivity by kindergarten teachers or parents were recruited in this study. All participants were consulted by at least one experienced developmental behavior pediatrician, according to DSM-V diagnostic criteria of ADHD. Their neuromotor developments were assessed by the Children's Neuropsychological and Behavior Scale and recorded as developmental quotient (DQ) score in gross motor, fine motor, and other domains. Regarding the evaluation of ADHD symptoms, parents of the 4-year-old group completed the Conners' Parent Symptom Questionnaire, while parents of the 5-year-old group completed The Vanderbilt ADHD Diagnostic Parent Rating Scale.

Results

A total of 137 preschool children aged 4-4.9 years (4-year-old group) and 252 were aged 5.0-5.9 years (5-year-old group) were included in the study. Children exhibiting ADHD symptoms were at a much higher risk of fine motor delays compared to gross motor delays, particularly among the younger age group. Correlation analysis and hierarchical regression showed that in the 4-year-old ADHD group, better gross motor development was associated with increased severity of parent-reported ADHD symptoms. In the 5-year-old ADHD group, poorer fine motor development was linked to higher ADHD symptom severity. For children who do not meet ADHD diagnostic criteria, no significant correlations were found between gross or fine motor developmental quotients (DQ) and the severity of ADHD symptoms.

Conclusions

Preschool children exhibiting ADHD symptoms are at a notable high risk of fine motor delays. Motor development in preschool children who meet ADHD diagnostic criteria is related to the severity of their symptoms. It is important to monitor both fine and gross motor development in preschool children with ADHD.

Benefits of Table Tennis for Children and Adolescents: A Narrative Review

This study aims to review the scientific evidence regarding the effects of table tennis practice on children and adolescents. Studies were searched in three electronic databases (PubMed, Scopus, and SportDiscus) from their inception up to May 2024. The methodological quality of the included studies was assessed using the 10-point Physiotherapy Evidence Database (PEDro) and Methodological Index for Non-Randomized Studies (MINORS). A total of twelve studies were examined, with interventions involving children with intellectual disabilities, ADHD, DCD, ASD, and typically developing children. A variety of training programs were assessed over durations ranging from 6 weeks to 1 year in the studies included. Table tennis was shown to positively impact various domains, including executive function, motor skills, visual perception, graphomotor function, gross motor skills, coordination capacity, behavioral inhibition, and social behavior. Nonetheless, it is imperative to expand the number of studies on children and adolescents with diverse conditions to more comprehensively evaluate the benefits of table tennis for each specific condition.

Effects of methylphenidate and physiotherapeutic treatment on graphomotor movements in children with ADHD

In addition to the core symptoms defining ADHD, affected children often experience motor problems; in particular, graphomotor movements including handwriting are affected. However, in clinical settings, there is little emphasis on standardized and objective diagnosing and treatment of those difficulties. The present study investigated for the first time the effects of methylphenidate as well as physiotherapeutic treatment on objectively assessed graphomotor movements compared to a control condition, i.e. parental psychoeducation, in 58 children (mean age: 9.52 ± 1.91 years) newly diagnosed with ADHD in an outpatient clinic for child and adolescent psychiatry. Families were invited to join one of the treatment groups. Before and after 8 weeks of treatment, children performed six different tasks on a digitizing tablet which allowed the objective analysis of three important kinematic parameters of graphomotor movements (fluency, velocity, and pen pressure) in different levels of visual control and automation. Graphomotor movement fluency and velocity improves over time across the groups, especially in tasks with eyes closed. We did not find clear evidence for beneficial effects of methylphenidate or physiotherapeutic treatment on children's overall graphomotor movements suggesting that treatments need to be better tailored towards specific and individual deficits in graphomotor movements.

Is There a Deficit in Product and Process of Handwriting in Children with Attention Deficit Hyperactivity Disorder? A Systematic Review and Recommendations for Future Research

Handwriting abnormalities in children with attention deficit hyperactivity disorder (ADHD) have sometimes been reported both (i) at the product level (i.e., quality/legibility of the written trace and speed of writing) and (ii) at the process level (i.e., dynamic and kinematic features, such as on-paper and in-air durations, pen pressure and velocity peaks, etc.). Conversely, other works have failed to reveal any differences between ADHD and typically developing children. The question of the presence and nature of handwriting deficits in ADHD remains open and merits an in-depth examination. The aim of this systematic review was, therefore, to identify studies that have investigated the product and/or process of handwriting in children with ADHD compared to typically developing individuals. This review was conducted and reported in accordance with the PRISMA statement. A literature search was carried out using three electronic databases. The methodological quality of the studies was systematically assessed using the Critical Appraisal Skills Program (CASP) criteria. Twenty-one articles were identified. Of these, 17 described handwriting quality/legibility, 12 focused on speed and 14 analyzed the handwriting process. All the studies (100%) with satisfactory methodology procedures reported an impaired product and process in children with ADHD, while 25% evidenced a difference in the speed of production. Most importantly, the studies differed widely in their methodological approaches. Substantial gaps remain, particularly with regard to ascertaining comorbidities, ADHD subtypes and the medical status of the included children. The lack of overall homogeneity in the samples calls for higher quality studies. We conclude with recommendations for further studies.

Effects of the Specific Eye Fixation Training on Fine Visuomotor Coordination in Children with Attention Deficit Hyperactivity Disorder

This study investigated the effects of quiet eye training (QET) on the neuropsychological functioning and fine motor performance of children with attention deficits. The participant cohort consisted of 106 children with attention deficit hyperactivity disorder (ADHD) between the ages of 8 and 12 years. The children were assigned to either the QET group (n = 54) or the control group (n = 52). The QET group went through a 5-week intervention in which the performance of blocks of targeting tasks was preceded by watching split-screen video footage featuring the gaze and body movements of a skilled model performing a throwing motion. Both groups underwent pre-test and post-test assessments, which included the reaction test of alertness, go/no-go inhibition test, and motor performance series test. The QET group demonstrated significant improvements in attentional engagement, inhibitory control, and fine motor skills, which require precise and fast visuomotor coordination. These results highlight the potential benefits of QET intervention in ameliorating attention deficits and enhancing fine aiming motor skills in children with ADHD. However, task specificity was evident, indicating that the intervention effects were most pronounced for the hand fine motor aiming tasks requiring both precision and speed.

How does therapist guided game-based intervention program effect motor skills in children with Attention Deficit Hyperactivity Disorder?: Single blind randomised study design

BACKGROUND

Virtual reality and game-based approaches to the rehabilitation process also brought an opportunity to design more accessible intervention programs.It was seen that many studies utilized trademarked and commercially available games, which were not originally designed as rehabilitation tools but were administrated by a rehabilitation professional to achieve the maximum therapeutic value.

AIMS

Study aims to investigate the effects of a Self-oriented game based program(SGBP)and Therapist Guided Game-based Intervention Program(TGGIP) on the motor skills of children with Attention Deficit Hyperactivity Disorder(ADHD).

METHODS AND PROCEDURES

This study was designed as a single-blind, randomized, controlled trial. A total of 176 children with ADHD participated in the study and were randomly divided into two groups (TGGIP and SGBP). Intervention in both groups was done with a telerehabilitation methodology.

OUTCOMES AND RESULTS

According to the within-group comparisons of pre- and post-intervention BOT2-BF scores, there were significant increases in all sub-scores and the total score(p < 0.05). The comparison of the BOT2-BF all sub-scores and the total score changes between the groups showed significantly higher in TGGIP.

CONCLUSION AND IMPLICATIONS

TGGIP was found to be more effective compared to SGBP in improving motor skills of children with ADHD.TGGIP that we designed acts as a facilitator for therapists in using trademarked and easily accessible games for structured and supervised virtual reality and game-based rehabilitation.

A Cross-Sectional Study to Measure Physical Activity with Accelerometry in ADHD Children according to Presentations

(1) Background: Attention deficit hyperactivity disorder (ADHD) is a common mental disorder affecting 5-7% of school-aged children. Previous studies have looked at the effects of physical activity interventions on the symptoms of ADHD, although few have compared the motor behavior of children with ADHD versus those without. This exploratory study provides detailed information on the patterns and intensity of physical activity and sedentary behavior in children with ADHD as measured by Actigraph GT3X accelerometry, as well as the differences in physical activity in the different presentations of ADHD; (2) Methods: A cross-sectional design was used with a sample of 75 children, aged 6 to 12 years, with and without ADHD. The ADHD group had a previous diagnosis, determined by clinical assessment based on DSM-5 criteria; (3) Results: Physical activity levels were higher in children with ADHD compared to children without ADHD, but there was no difference in sedentary time between groups during weekdays or weekends. Physical activity decreased with age, with significant differences in the ADHD group, who exhibited more minutes of moderate Physical activity in 6-7 year-olds than 10-11 year-olds during weekdays and weekends; (4) Conclusions: Sedentary time increased by age in children without ADHD, and there was a decrease in moderate-intensity physical activity time in children with ADHD by age.