Abstracts
Objective
To determine frequency of motor alterations in children with attention deficit hyperactivity disorder (ADHD).
Method
We evaluated 19 children aged 7-12 years with ADHD classified in three sub-types: Combined (ADHD-C), with Inattention (ADHD-I), and with Hyperactivity (ADHD-H). Controls were age- and gender matched healthy children. We utilized Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) for measuring motor skills.
Results
We observed differences between children with ADHD and controls in BOTMP general score and in static coordination, dynamic general- and hand- coordination, and in synkinetic movements. We also found differences in dynamic hand coordination between controls and children with ADHD-C; in dynamic general coordination between controls and children with ADHD-H; and in frequency of synkinetic movements between controls and children with ADHD-H.
Conclusion
Children with ADHD with a major degree of hyperactivity showed greater frequency of motor alterations.
attention deficit disorder; motor development; inattention; hyperactivity; bruininks-oseretsky test
Objetivo
Determinar la frecuencia de alteraciones motoras en niños con trastorno por déficit de atención-hiperactividad (TDAH).
Método
Evaluamos 19 niños de 7-12 años de edad con TDAH clasificados en tres subtipos: Combinado (TDAH-C), con Inatención (TDAH-I) y con Hiperactividad (TDAH-H). Los controles fueron niños sanos pareados por edad y género. Utilizamos la Prueba de eficiencia motora de Bruininks-Oseretsky (PEMBO).
Resultados
Observamos diferencias entre los grupos de niños con TDAH en la calificación general de la PEMBO y en: coordinación estática, coordinación dinámica general, coordinación manual y en movimientos sincinéticos. También encontramos diferencias en la coordinación manual entre los controles y los niños con TDAH-C; en la coordinación dinámica general entre los controles y los niños con TDAH-H; y en la frecuencia de movimientos sincinéticos entre los controles y los niños con TDAH-H.
Conclusión
Los niños con TDAH con una mayor grado de hiperactividad muestran una mayor frecuencia de alteraciones motoras y movimientos sincinéticos.
trastorno por déficit de atención; desarrollo motor; inatención; hiperactividad; prueba de bruininks-oseretsky
Attention deficit-hyperactivity disorder (ADHD) is an alteration that begins early in
infancy and whose cardinal symptoms are inattention, hyperactivity, and impulsivity11 . Dupaul GJ, Mc Goey KE, Eckert TL, Brankle J. Preschool children
with attention-deficit/hyperactivity disorder: impairments in behavioral,
social, and school functioning. J Am Acad Child Adolesc Psychiatry.
2001;40(5):508-15. http://dx.doi.org/10.1097/00004583-200105000-00009
https://doi.org/10.1097/00004583-2001050...
,22 . Poblano A, Romero E. ECI-4 screening of attention
deficit-hyperactivity disorder and co-morbidity in Mexican preschool children.
Preliminary results. Arq Neuropsiquiatr. 2006;64(4):932-6.
http://dx.doi.org/10.1590/s0004-282x2006000600008
https://doi.org/10.1590/s0004-282x200600...
. One of the main symptoms of ADHD in children is motor
alterations manifested as restlessness and in other motor behaviors. For example, in one
research, authors found differential distribution of motor alterations in children with
ADHD with co-morbid developmental coordination disorder (DCD); children with ADHD
predominantly inattentive, had significantly poorer fine motor skills while children
with ADHD-combined type were found to experience significantly greater difficulty with
gross motor skills33 . Piek JP, Pitcher TM, Hay DA. Motor coordination and kinaesthesis
in boys with attention deficit-hyperactivity disorder. Dev Med Child Neurol.
1999;41(3):159-65. http://dx.doi.org/10.1017/s0012162299000341
https://doi.org/10.1017/s001216229900034...
. These changes may
be seasonal, the shortening photoperiods contribute to increasing diurnal and nocturnal
agitation of children with ADHD44 . Langevin R, Ramdé J. Attention deficit hyperactivity disorder
(ADHD) in children, seasonal photoperiods, nocturnal movements and diurnal
agitation. J Can Acad Child Adolsc Psychiatry. 2012;21(1):53-8..
However, there are yet few studies on the topic of motor disorders in subjects with
ADHD55 . Lis S, Baer N, Stein-en-Nosse C, Gallhofer B, Sammer G, Kirsch P.
Objective measurement of motor activity during cognitive performance in adults
with attention-deficit/hyperactivity disorder. Acta Psychiatr Scand.
2010;122(4):285-94.
http://dx.doi.org/10.1111/j.1600-0447.2010.01549.x
https://doi.org/10.1111/j.1600-0447.2010...
.
Some authors have proposed that ADHD comprises a broad group of mixed clinical
categories, mainly groups with attention deficits only and those with a predominance of
hyperactivity66 . Coghill D, Seth S. Do the diagnostic criteria for ADHD need to
change? Comments on the preliminary proposals of the DSM-5 ADHD and Disruptive
Behavior Disorders Committee. Eur Child Adolesc Psychiatry. 2011;20(2):75-81.
http://dx.doi.org/10.1007/s00787-010-0142-4
https://doi.org/10.1007/s00787-010-0142-...
,77 . Solanto MV, Gilbert SN, Raj A, Zhu J, Pope-Boyd S, Stepak B et al.
Neurocognitive functioning in AD/HD, predominantly inattentive and combined
subtypes. J Abnorm Child Psychol. 2007;35(5):729-44.
http://dx.doi.org/10.1007/s10802-007-9123-6
https://doi.org/10.1007/s10802-007-9123-...
. From this point of view, each subtype
could have different neuropsychologic features. Thus, the objective of this research was
to determine the frequency of motor alterations in a group of children with ADHD, with
the working hypothesis that the percentage of motor alterations in children with ADHD
with a major degree of hyperactivity, would be more than those without hyperactivity. On
the other hand, as a secondary objective we sought to ascertain whether motor
alterations correlate with other examinations, such as the scale for Evaluation of
Deficit of Attention and Hyperactivity (EDAH).
METHOD
Subjects
We evaluated children aged 7-12 years who were students at a private or from
public elementary schools who were referred as being suspected of ADHD by their
school teachers. The children were examined by means of neurological,
neuropsychiatric, neuropsychological, and electrophysiological tests. In case of
acceptance, they were included in the Prospective Study of Children with ADHD of
Mexico City (PSC-AD-HD-Mex). The diagnosis of ADHD was performed in agreement
with recommendations of American Psychiatry Society guidelines88 . American Psychiatric Association. Diagnostic and statistical
manual of mental disorders (DSM-IV). 4thedition . Washington: American
Psychiatric Association; 1994., in a three-step levels
evaluation as follows; the first step was identification-at-school of children
with a suspicion of ADHD by qualitative evaluation of teachers for their
inattention and hyperactivity among the school population; the second was a
screening conducted by means of the Diagnostic and Statistical Manual of Mental
Disorders-IV-Text Revision (DSM-IV-R), and the scale of Evaluation Deficit of
Attention and Hyperactivity (EDAH), searching for those children fulfilling
criteria for inattentive and hyperactivity according to normative data; at last,
the third step, comprised the semi-structured multidisciplinary interview by
means of the Diagnostic Interview for Children and Adolescents (Chronbach's
alpha score among interviewers of 0.65-1.00, and test-retest confidence values
of 0.78-0.86)99 . Angold A, Erkanli A, Copeland W, Goodman R, Fisher PW, Costello
EJ. Psychiatric diagnostic interviews for children and adolescents: a
comparative study. J Am Acad Child Adolesc Psychiatry. 2012;51(5):506-17.
http://dx.doi.org/10.1016/j.jaac.2012.02.020
https://doi.org/10.1016/j.jaac.2012.02.0...
, taking into
account persistence of the disorder for a period >6 months of ADHD
symptoms in at least two environments, such as school and home. The interview
was performed by neurologist, psychiatrist, psychologist, and teachers-parents
opinions22 . Poblano A, Romero E. ECI-4 screening of attention
deficit-hyperactivity disorder and co-morbidity in Mexican preschool children.
Preliminary results. Arq Neuropsiquiatr. 2006;64(4):932-6.
http://dx.doi.org/10.1590/s0004-282x2006000600008
https://doi.org/10.1590/s0004-282x200600...
,1010 . Zambrano-Sánchez E, Martínez-Cortés JA, del
Río-Carlos Y, Martínez-Wbaldo MC, Poblano A. Executive dysfunction
screening and intellectual coefficient measurement in children with attention
deficit-hyperactivity disorder. Arq Neuropsiquiatr. 2010;68(4):545-9.
http://dx.doi.org/10.1590/s0004-282x2010000400013
https://doi.org/10.1590/s0004-282x201000...
,1111 . Zambrano-Sánchez E, Martínez-Cortés JA,
Río-Carlos Y, Martínez-Wbaldo MC, Poblano A. Identification of
attention deficit hyperactivity disorder and conduct disorder in Mexican
children by the scale of evaluation of deficit of attention and hyperactivity.
Psychiatry Res. 2011;187(3):437-40. http://dx.doi.org/
10.1016/j.psychres.2010.09.004
https://doi.org/10.1016/j.psychres.2010....
. We studied only children
with intelligence quotients >90 (Wechsler intelligence scale for
children). Children with ADHD were classified into the three recognized DSM-IV-R
sub-types as follows: ADHD Combined (ADHD-C), mainly with Inattention symptoms
(ADHD-I), and mainly with Hyperactivity-impulsivity (ADHD-H). All patients were
medication-free until the conclusion of the initial assessment. Exclusion
criteria were the following: co-morbidity of oppositional defiant disorder or
conduct disorder; mental retardation; epilepsy; cerebral palsy; autism;
blindness; deafness, and other neurological diseases. Anxiety, bipolar and
coordination disorders were only searched in the case that child presented the
symptoms that suggests the alteration. We rejected also children who were
previously tested within the last 6 months with the same neuropsychological
tests that we employed in this research. We constructed a control group of age-
and gender matched healthy asymptomatic children from the same schools. Control
children were similar in academic grade and had a similar socio-economic
background without ADHD. Comparison of intelligence quotients showed not
differences with children with ADHD. Children with ADHD and control subjects
were studied in a blind fashion to avoid any bias. Sample size was calculated by
standard deviation obtained after Piek et al., in the Motor assessment battery
for children in 9 children per group (ADHD and controls) with a beta power of
80%1212 . García-García JA, Reding-Bernal A, López-Alvarenga
JC. Sample size calculation in medical education research [Spanish].
Inv Ed Med. 2013;2(8):217-24.. Parents and
children were widely informed about the study and the importance of their
participation in it. This investigation was approved by the Research and Ethics
Committee of the National Institute of Rehabilitation (Mexico City), and
informed consent was signed by the parents of participating children.
Bruininks-Oseretsky Test of Motor Proficiency
We utilized the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) as the
instrument for measuring motor skills1313 . Wilson BN, Polatajko HJ, Kaplan BJ, Faris P. Use of
Bruininks-Oseretsky test of motor proficiency in occupational therapy. Am J
Occup Ther 1995;49(1):8-17.
http://dx.doi.org/10.5014/ajot.49.1.8
https://doi.org/10.5014/ajot.49.1.8...
. The BOTMP is a standardized assessment of motor
skills achievement commonly utilized in the assessment of motor abilities in
children. The BOTMP has been validated in Spanish1414 . Lozoff B, Jiménez E, Wolf AW. Long-term developmental outcome
of infants with iron deficiency. New Engl J Med 1991;325(10):687-94.
http://dx.doi.org/10.1056/NEJM199109053251004
https://doi.org/10.1056/NEJM199109053251...
and consists of several items in five sub-tests.
These sub-tests including the following: static coordination; dynamic hand
coordination; dynamic general coordination; speed of movements; simultaneous
movements, and presence of synkinetic movements. BOTMP possesses a whole general
score and others scores for each sub-test measurements that were adjusted for
child's age and gender. Score was employed to interpret test
performance.
EDAH
We administered the scale for Evaluation for Deficit in Attention and
Hyperactivity (EDAH) in teachers and parents of the population of children in
our sample1111 . Zambrano-Sánchez E, Martínez-Cortés JA,
Río-Carlos Y, Martínez-Wbaldo MC, Poblano A. Identification of
attention deficit hyperactivity disorder and conduct disorder in Mexican
children by the scale of evaluation of deficit of attention and hyperactivity.
Psychiatry Res. 2011;187(3):437-40. http://dx.doi.org/
10.1016/j.psychres.2010.09.004
https://doi.org/10.1016/j.psychres.2010....
,1515 . Farre-Riba A, Narbona-García J. EDAH. Scales for evaluation
of deficit of attention and hyperactivity [Spanish]. Madrid:
Publicaciones de Psicología Aplicada; 2001.. The questionnaire
affords a structured observation of 20 items that are divided into the following
two 10-item sub-scales: (1) sub-scale for attention deficit-hyperactivity
disorder, and (2) sub-scale for conduct disorder (CD). When a certain child
complies with the criteria, he/she can be categorized as being suspected of
having ADHD. Questions can be answered in four ways with the following numerical
equivalences: “never” = 0; “sometimes” = 1;
“often” = 2, and “very often” = 3.
Statistical analysis
We measured the mean and SD of continuous variables and percentages in binomial variables. We utilized the Student t-test to compare means between groups. We used a one-way Analysis of Variance (ANOVA) to compare the means of each ADHD type with control children. The Tukey Honestly significant differences (HSD) test was utilized to find differences between groups. We employed the calculation of the correlation between BOTMP and EDAH scores by means of the Spearman method. The a-priori alpha value accepted was p≤0.05. We utilized SPPS software version 17.0.
RESULTS
The sample was of 19 children with ADHD, and 19 control children. Both groups had a median age of 10 years. In both groups 16 children were masculine (84%) and three, feminine (16%). In the group of children with ADHD, five children were in the ADHD-I (26%) group, five were in the ADHD-H (26%) group, and nine were in the ADHD-C (47%) group.
In overall, children diagnosed with ADHD achieved lower scores than those of control children in all BOTMP sub-tests. The general score of the BOTMP test in control children was 328.94±71.72, while that of children with ADHD was 215.89±69.94 (t=4.87; p<0.001). The results of each sub-test can be seen in Table. This table depicts significant differences in static coordination, dynamic hand coordination, dynamic general coordination, and frequency of synkinetic movements.
One-way ANOVA analysis detected differences in BOTMP between control children and children with ADHD in each type as follows: BOTMP general score (F=7.47; df=3,33; p=0.001), Tukey HSD found that there were differences between control children and children with AD-HD of the three groups; dynamic hand coordination (F=6.06; df=3,34; p=0.002), Tukey HSD exhibited differences between control children and children with ADHD-C; dynamic general coordination (F=3.64; df=3,34; p=0.02), Tukey HSD found differences between control children and children with ADHD-H; frequency of synkinetic movements (F=3.20; df=3,34; p=0.03), Tukey HSD also found differences between control children and children with ADHD-H.
We disclosed a positive correlation only between the frequency of the synkinetic movements score in BOTMP and EDAH teachers score (r=0.76; p=0.004).
DISCUSSION
Main findings
As expected from antecedents in literature, we disclosed that our children with ADHD showed a major frequency of motor alterations when they were compared with a group of control children. The main alterations were observed in the following BOTMP subtests: static coordination; dynamic hand coordination, dynamic general coordination, and in synkinetic movements. We must underline, that as predicted in our working hypothesis, children with ADHD subtypes with hyperactivity (ADHD-H and ADHD-C) demonstrated a significantly greater frequency of motor alterations than children with ADHD-I without hyperactivity. This result highlights our working hypothesis, that children with ADHD with hyperactivity exhibit different neuropsychological features than children with only inattentive symptoms. However it is difficult to make statements about coordination alteration and ADHD subtype yet. Finally, we discovered a positive correlation between synkinetic movement score in BOTMP with the EDAH teachers' score.
Our results underline the clinical relevance of motor alteration in children with ADHD. Thus, clinicians must ask for alterations in specific motor behaviors (static coordination; dynamic hand and general coordination, and presence of synkinetic movements) to teachers and parents of children with ADHD. Data reported here, and from other groups could be a guide to the questions for these movement disorders. On the other hand, our results confirm the clinical observation, that children with ADHD with hyperactivity have more motor alterations, than those children with ADHD with attention deficit only. This finding suggest, that hyperactivity disorder must engage different neural networks alteration that attention deficit only, as will be discussed below. Correlation among frequency of synkinetic movements and teachers' EDAH scores may means that teachers are more sensitive to detect abnormal movements than parents, because they have opportunity to compare motor behavior in more children. If gender has influence on motor impairment in children with ADHD, it is an interesting question, but we studied few female subjects to make inferences on this effect, this fact deserve more attention in future research.
Comparison with other studies
Pitcher et al. published three papers about motor alterations present in male
children with ADHD33 . Piek JP, Pitcher TM, Hay DA. Motor coordination and kinaesthesis
in boys with attention deficit-hyperactivity disorder. Dev Med Child Neurol.
1999;41(3):159-65. http://dx.doi.org/10.1017/s0012162299000341
https://doi.org/10.1017/s001216229900034...
,1616 . Pitcher TM, Piek JP, Barrett NC. Time and force control in boys
with attention deficit hyperactivity disorder: subtype differences and the
effect of co-morbid developmental coordination disorder. Hum Mov Sci.
2002;21(5-6):919-45.
http://dx.doi.org/10.1016/s0167-9457(02)00167-7
https://doi.org/10.1016/s0167-9457(02)00...
,1717 . Pitcher TM, Piek JP, Hay DA. Fine and gross motor ability in males
with ADHD. Dev Med Child Neurol. 2003;45(8):525-35.
http://dx.doi.org/10.1017/s0012162203000975
https://doi.org/10.1017/s001216220300097...
. Comparison with our results must be made with
caution due to differences in methodology and in type of subjects studied.
However, in overall, author's results are in line with our data. In the
first investigation, the authors found differential distribution of motor
alterations in children with ADHD with co-morbid developmental coordination
disorder (DCD). Children with ADHD-I had significantly poorer fine motor skills,
while children with ADHD-C were found to experience greater difficulty with
gross motor skills. The severity of the children's with inattentive
symptoms was found to be a significant predictor of motor coordination
difficulties33 . Piek JP, Pitcher TM, Hay DA. Motor coordination and kinaesthesis
in boys with attention deficit-hyperactivity disorder. Dev Med Child Neurol.
1999;41(3):159-65. http://dx.doi.org/10.1017/s0012162299000341
https://doi.org/10.1017/s001216229900034...
. In the
second research, investigators found that boys with subtypes that included
inattentive symptomatology had significant difficulties with timing and force
control; and showed greater variability in motor outcomes; boys with DCD had
particular difficulty with force control1616 . Pitcher TM, Piek JP, Barrett NC. Time and force control in boys
with attention deficit hyperactivity disorder: subtype differences and the
effect of co-morbid developmental coordination disorder. Hum Mov Sci.
2002;21(5-6):919-45.
http://dx.doi.org/10.1016/s0167-9457(02)00167-7
https://doi.org/10.1016/s0167-9457(02)00...
. In partial agreement with our results, the
authors identified a need for increased recognition of relationship between ADHD
and motor dysfunction, and found that type and degree of movement difficulty
differed among ADHD subtypes. In the third research, authors found that males
with ADHD-I and ADHD-C had significantly poorer fine motor ability than control
children. Because children with ADHD only, and those of the control group did
not differ significantly in terms of fine motor ability but were significantly
better than children categorized with both ADHD and DCD, researchers suggested
that the poorer fine motor ability found in children with ADHD could not be
attributed to deficits in attention and concentration, but rather to factors
relating to their motor ability1717 . Pitcher TM, Piek JP, Hay DA. Fine and gross motor ability in males
with ADHD. Dev Med Child Neurol. 2003;45(8):525-35.
http://dx.doi.org/10.1017/s0012162203000975
https://doi.org/10.1017/s001216220300097...
. In overall, the main differences between these
investigations and our study comprise the presence of comorbid DCD, thus, we
think that the children in their studies had a more severe degree of alteration
in the motor domain; and that the different scale employed from ours to study
motor function development limits comparisons.
In other paper, motor development assessment of school children with ADHD was
studied in a sample of children aged 7-10 years. Investigators found that 48% of
children with ADHD were in the low range of motor performance according to a
Scale of Motor Development1818 . Poeta LS, Rosa-Neto F. Motor assessment in school aged children
with indicators of the attention deficit/hyperactivity disorder
[Spanish]. Rev Neurol. 2007;44(3):146-9.
http://dx.doi.org/10.1385/1-59259-891-9:143
https://doi.org/10.1385/1-59259-891-9:14...
.
In other research, motor development was reported again as normal, but in a
lower range, in children with ADHD in a sample of 846 children from 5-12 years
of age according to a Battery of Psychomotor Observation1919 . Vidarte JA, Ezquerro M, Girádez MA. Psychomotor profile of
children between 5 and 2 years of age, clinically diagnosed with attention
deficit hyperactivity disorder in Colombia [Spanish]. Rev Neurol.
2009;49(2):69-75.. Authors of these studies did not find a
clear disadvantage of children with ADHD vs. control children when these were
compared regarding motor behaviors. Comparison with our data is again difficult,
because of different objectives and study methods, but in general they are in
partial agreement with our data showing the low motor performance of children
with ADHD.
One study on the motor performance of subjects with ADHD was conducted in adults.
In this paper, an infrared motion-tracking system was employed to measure motor
activity in 20 free-of-medication adults with ADHD and 20 matched controls
during a one-back working memory task. Motor activity was higher in adults with
ADHD, and increased over the duration of testing and co-varied with cognitive
performance in ADHD only55 . Lis S, Baer N, Stein-en-Nosse C, Gallhofer B, Sammer G, Kirsch P.
Objective measurement of motor activity during cognitive performance in adults
with attention-deficit/hyperactivity disorder. Acta Psychiatr Scand.
2010;122(4):285-94.
http://dx.doi.org/10.1111/j.1600-0447.2010.01549.x
https://doi.org/10.1111/j.1600-0447.2010...
.
Although this work showed differences in motor behavior in adults with ADHD vs.
healthy controls, we are unable to formulated additional considerations due to
differences in age and methodologies between studies.
Barbosa-Goulardins et al.2020 . Goulardins JB, Bilhar JCF, Marques JC, Casella EB. Quality of life
and psychomotor profile of children with attention deficit hyperactivity
disorder (ADHD). Arq Neuropsiquiat. 2011;69(4):630-5.
http://dx.doi.org/10.1590/s0004-282x2011000500011
https://doi.org/10.1590/s0004-282x201100...
,
studied the relationship between motor alterations and quality of life (QoL) in
children with ADHD. These authors demonstrated the adverse effects of ADHD in
QoL and in motor skills. Nine of their participants (64.2%) were classified in
motor development as: "normal medium", followed by the classification of "normal
low" in four (28.5%), and "low" in one subject (7.1%). These authors observed a
positive correlation between QoL and the psychomotor development of children
with ADHD in the following areas: fine motor and spatial organization with
social and psychosocial aspects; gross motor control with emotional aspects, and
temporal organization with the emotional, psychosocial, and in overall, with
QoL. Their results are in line with our data reported here and with those we
found in other observation that disclosed a low QoL in children with ADHD is
related with anxiety levels2121 . Zambrano Sánchez E, Martínez Cortés JA, Río
Carlos Y, Dehesa Moreno M, Poblano A. Low quality of life scores in school
children with attention deficit-hyperactivity disorder are anxiety-related. Arq
Neuropsiquiatr. 2012;70(3):180-4.
http://dx.doi.org/10.1590/S0004-282X2012000300005
https://doi.org/10.1590/S0004-282X201200...
.
Comparison are limited by the test used to study motor behavior. We used BOTMP
because the test is of wide use in our country and was standardized for use in
latino-communities.
We observed a significant correlation between synkinetic movements score in BOTMP
and the EDAH score of the teachers' scale. These results are in line with
other researchers found a correlation between EDAH scores and other ADHD tests,
such as Urzua et al.2222 . Urzúa A, Domic M, Ramos M, Cerda A, Quiroz J. Psychometric
properties of three rating scales for attention deficit hyperactivity disorder
in Chilean students [Spanish]. Rev Panam Salud Publica.
2010;27(3):157-67.
http://dx.doi.org/10.1590/S1020-49892010000300002
https://doi.org/10.1590/S1020-4989201000...
, and
Zambrano-Sánchez et al.1111 . Zambrano-Sánchez E, Martínez-Cortés JA,
Río-Carlos Y, Martínez-Wbaldo MC, Poblano A. Identification of
attention deficit hyperactivity disorder and conduct disorder in Mexican
children by the scale of evaluation of deficit of attention and hyperactivity.
Psychiatry Res. 2011;187(3):437-40. http://dx.doi.org/
10.1016/j.psychres.2010.09.004
https://doi.org/10.1016/j.psychres.2010....
. However, to our knowledge, few studies have been
performed before to correlate EDAH with another psychometric test, as we
did.
Alterations in dopaminergic activity has been related to abnormal motor behavior
in children with ADHD. Other condition in which abnormal dopaminergic activity
is the periodic limb movements in sleep (PLMS). The symptoms of PLMS in motor
sleep behavior in children are similar to those of motor restless in awake
children with ADHD. Both disorders are related with dopamine production and
metabolism, and both respond to dopaminergic therapy2323 . Pockett C, Kirk V. Periodic limb movements in sleep and attention
deficit hyperactivity disorder: are they related? Paediatr Child Health.
2006;11(6):355-8.. The co-existence of ADHD and PLMS is
reported to occur with a certain frequency2424 . Zambrano Sánchez E, Martínez Cortés JA, Dehesa
Moreno M, Río Carlos Y, Poblano A. Correlation between sleep disorders
screening and executive dysfunction in children with attention
deficit-hyperactivity disorder. Arq Neuropsiquiatr. 2013;71(11):896-901.
http://dx.doi.org/10.1590/0004-282x20130174
https://doi.org/10.1590/0004-282x2013017...
.
Symptoms in children with ADHD include hyperactivity, distractibility during task
performance, disorganization, inability to follow through on a plan, inability
to shift set and reprogram activities when needed, and deficient rule-governing
behavior. These symptoms have been associated with abnormalities of the frontal
lobe systems, particularly: executive systems1010 . Zambrano-Sánchez E, Martínez-Cortés JA, del
Río-Carlos Y, Martínez-Wbaldo MC, Poblano A. Executive dysfunction
screening and intellectual coefficient measurement in children with attention
deficit-hyperactivity disorder. Arq Neuropsiquiatr. 2010;68(4):545-9.
http://dx.doi.org/10.1590/s0004-282x2010000400013
https://doi.org/10.1590/s0004-282x201000...
. The frontal systems are part of a broad network
with connections to nearly all parts of the central nervous system (CNS).
Therefore, possibly all cognitive systems are sensitive to frontal lobe
pathology, i.e., ADHD2525 . Lazar JW, Frank Y. Frontal systems dysfunction in children with
attention-deficit/hyperactivity disorder and learning disabilities. J
Neuropsychiatr Clinical Neurosci 1998;10(2):160-7.. The
involvement of executive control includes, for instance, the ability to command
motor exploration, to monitor and shift the direction of attention, to initiate
and direct language, to organize methods of memorization, to temporally
discriminate items in memory, and to inhibit interference during recall2626 . Mulligan RC, Knopik VS, Sweet LH, Fischer M, Seidenberg M, Rao SM.
Neural correlates of inhibitory control in adult attention deficit/hyperactivity
disorder: evidence from the Milwaukee longitudinal sample. Psychiatry Res.
2011;194(2):119-29.
http://dx.doi.org/10.1016/j.pscychresns.2011.02.003
https://doi.org/10.1016/j.pscychresns.20...
.
Recently, Langevin et al.44 . Langevin R, Ramdé J. Attention deficit hyperactivity disorder
(ADHD) in children, seasonal photoperiods, nocturnal movements and diurnal
agitation. J Can Acad Child Adolsc Psychiatry. 2012;21(1):53-8. found
by means of MRI by diffusion tension images that some alterations in the Corpus
callosum may underlie the difficulties in motor and attention functioning in
children with ADHD and developmental motor disorder. In a second paper, Langevin
and Ramdé showed that these changes may be seasonal, and shortening
photoperiods contribute to increase the diurnal and nocturnal agitation of
children with ADHD, and that lengthening diminish it2727 . Langevin LM, MacMaster FP, Crawford S, Lebel C, Dewey D. Common
white matter microstructure alterations in pediatric motor and attention
disorders. J Pediatr. 2014;164(5):1157-64.
http://dx.doi.org/10.1016/j.jpeds.2014.01.018
https://doi.org/10.1016/j.jpeds.2014.01....
. Results from the above quoted research,
support our data showing the possible pathophysiological basis of the motor
alterations. Thus, we suggest that the motor alterations must be systematically
examined in children with ADHD in future studies.
Study limitations
Our study has some limitations. In first place, the number of children studied is
small, therefore, our results must be considered as tendencies and not as strong
conclusions. The study design was a cross-sectional observation; in the future,
we must design a prospective long-term follow-up observations including other
co-variables that may influence motor development. Finally, our study lacks
dynamic neuroimaging correlation2828 . Shaw P, Rabin C. New insights into attention-deficit/hyperactivity
disorder using structural neuroimaging. Curr Psychiatry Rep. 2009;11(5):393-8.
http://dx.doi.org/10.1007/s11920-009-0059-0
https://doi.org/10.1007/s11920-009-0059-...
. Thus, in the subsequent research, we must include
functional magnetic resonance imaging studies to support our observations.
CONCLUSION
We must highlight that children with ADHD exhibited a greater frequency of motor alterations than control children. The main alterations were observed in: static coordination, dynamic hand coordination, dynamic general coordination, and in synkinetic movements. Finally, the synkinetic movements score in BOTMP correlates well with the EDAH teachers' scale score. We propose than in the future these alterations should be related to functional neuroimaging studies.
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Publication Dates
-
Publication in this collection
Nov 2014
History
-
Received
24 Jan 2014 -
Reviewed
19 July 2014 -
Accepted
07 Aug 2014