Background
Motor deficiencies in ADHD
Fine motor deficiencies in children with ADHD
Handwriting and graphomotor skills in children with ADHD
Correlates of fine motor impairments in ADHD
Subtype
Gender
Age
Ethnicity and culture
Handedness
Underlying factors of fine motor deficiencies in ADHD
How the intervention might work
Why it is important to do this review
The need for ADHD-specific, non-pharmacological interventions
Implications of fine motor impairments
Objectives
Methods
Study design and protocol
Eligibility criteria
Population
Intervention
Comparator
Outcome
Study design
Other
Information sources
Electronic searches
Searching other resources
Search strategy
Selection of sources of evidence
Data charting process and data items
Source | Study design | Population | Intervention | Outcomes (incl. outcome measures) |
---|---|---|---|---|
Bartscherer & Dole (2005) [78] | Case report | Boy with attention and motor coordination difficulties (n = 1; no formal ADHD diagnosis) Age: 9 Medication: no | Interactive Metronome training: Variety of upper and lower limb tasks performed with metronome beat Schedule: 7-week program Sessions 3x/week (60–90 min each) 4 pre-sessions, 15 sessions | Bruininks-Oseretsky Test of Motor Proficiency (BOTMP): Improvements in gross and fine motor skills: ∙ Largest improvements in balance, response speed, visual-motor control, upper limb speed, dexterity ∙ Smaller changes in bilateral coordination, strength ∙ No change in running speed, agility ∙ Decline in upper limb coordination Interactive Metronome long-form test (IM LFT): Improvements in timing accuracy Parent reports: Behavior changes More cooperative, less resistance & fighting, self-confidence (willingness to take risks), faster at solving math problems, improvements in handwriting |
Dahan et al. (2018) [20] | Review | ADHD subjects | Neurofeedback (NF) interventions: Theta/beta frequency training and SCP neurofeedback EMG-Biofeedback (EMG-BF) interventions: Feedback on motor activity Physical activity and motor interventions: Several weeks training program or single intervention (e.g. running on treadmill, ball handling and balance exercises, general exercise) | NF: Improvements in behavioral self-regulation; reduction of ADHD symptoms (mixed findings); increase in response speed; no differences between the different NF approaches EMG-BF: Improvements in motor coordination and regulation, visuo-motor precision, flexibility, fine motor control, muscle relaxation; reduction of ADHD symptoms Physical activity and motor interventions: Improvements in executive functioning, social behavior, response preparation, working memory, motor performance; reduction of ADHD symptoms; regardless of type of physical activity Follow-up: Evidence for persisting changes |
Duda et al. (2019) [79] | Case-control study | Children and adolescents with ADHD (n = 16) Control group: Children and adolescents without ADHD (n = 16) Age: 9–15 Medication: no | Graphomotor learning task: Practicing a novel grapheme on a digitizing tablet 30 x Schedule: One single session Note: Not a training for fine motor skills but to investigate graphomotor procedural learning | WACOM Cintiq 21UX digitizing tablet & MovAlyzeR software ADHD group: No improvements in graphomotor fluency and automaticity Control group: Improvement in graphomotor fluency and automaticity |
Gharebaghy et al. (2015) [80] | Single case experimental design (multiple baselines) | Children with ADHD (n = 6) Age: 7–12 Medication: yes | Cognitive Orientation to daily Occupational Performance (CO-OP): Use of cognitive strategies to reach self-selected goals regarding motor performance in daily living activities (e.g. handwriting, dressing) Schedule: 12-week program 12 sessions (45–60 min each) | Bruininks-Oseretsky Test of Motor Proficiency and Performance (BOTMP): Improvements in motor performance Canadian Occupational Performance Measure (COPM): Perceived improvements in chosen goals (satisfaction and performance) reported by all children and parents Goal Attainment Scaling: 17/18 goals attained or exceeded |
Halperin et al. (2013) [81] | Proof-of-concept study | Preschool children with ADHD (n = 29; all subtypes) Age: 4–5 Medication: no | TEAMS Intervention (Training Executive, Attention, and Motor Skills): Games designed to enhance inhibitory control, working memory, attention, visuo-spatial abilities, planning, and motor skills (e.g. games with balls, puzzles, jump rope) + additional aerobic exercises (e.g. jumping jacks) Schedule: Therapist sessions for children (90 min each) Parent sessions (20 min each): Psychoeducation & support Group A: 5 weeks, 1x/week Group B: 8 weeks, 1x/week Group C: 5 weeks, 2x/week A, B, C: Additional daily training sessions at home (30–45 min each) | ADHD-RS-IV (parent & teacher ratings): Improvement in ADHD symptoms; reductions in impairment No differences on outcomes among groups Parent Satisfaction Questionnaire (PSQ): Satisfaction with program and treatment compliance Follow-up (1 month & 3 months): Improvements in ADHD symptoms maintained |
Molsberger et al. (2014) [82] | Case report | Boy with ADHD (n = 1) Age: 9 Medication: yes | Complementary medical intervention: Applied kinesiology (AK), acupuncture, respiratory exercises Schedule: 10 months 18 sessions Week 1: 2 sessions Week 2 to end: sessions every 2–4+ weeks First 3 sessions: respiratory exercises (10–15 min each) + acupuncture (permanent needles for 2 days each time) Respiratory exercises at home (2 min/day) | Coachman’s test: Normalized muscle function Parent reports: Improvements in sleep behavior and handwriting; increased effectiveness of medication after acupuncture Follow-up (15 months): Improvements maintained |
Palsbo & Hood-Szivek (2012) [83] | Non-randomized uncontrolled pretest-posttest design | Children with learning impairments, neuromotor and/or handwriting deficits (n = 18): ASD (n = 5), ADD or ADHD (n = 2), Pervasive developmental delay (n = 1), Intellectual disability (n = 2), Auditory processing disorder or deafness (n = 2), no disability (n = 6) Age: 5–11 | Robotic-assisted three-dimensional repetitive motion training: Use of a haptic computer-user interface to improve handwriting through a program of active therapy (e.g. proprioception exercises, robot-assisted glyph formation) with multisensory feedback Schedule: 4–6/8 weeks 15–20 sessions 3-5x/week or daily sessions (25–30 min each) | Beery-Buktenica Developmental Test of Visual-Motor Integration (Motor Coordination Subtest): Improvements in fine motor skills & motor control (children with learning disabilities and ≥ 9 years) No improvements (children with CP or < 9 years) Test of Handwriting Skills-Revised (THS-R; random number and uppercase letter order subtests) & Print Tool (random lowercase letter order subtest): Improvements in consistency of glyph formation (10/14 children) and writing size (all children with ASD) Evaluation Tool of Children’s Handwriting (ETCH; copy subtest): Improvements in handwriting fluidity (writing speed) while maintaining legibility (all children with ASD or ADHD/ADD) |
Ruiz-Manrique et al. (2014) [84] | Case report | Boy with ADHD and comorbid video game addiction (n = 1) Age: 10 Medication: yes | “ADHD Trainer”: Mobile/tablet application designed to treat ADHD using a cognitive training method to enhance cognitive skills (attention, working memory, processing speed, calculation ability, reasoning, visuo-motor coordination) Schedule: 2 months (within study), 6 months (total training reported by parents) 1st month: 10 min-4 h/day (average: 1 h/day) 2nd month: min. 10 min/day | Conners’ Parent and Teacher Rating Scales & Barkley School Situations Questionnaire: ∙ Behavioral improvements ∙ Academic improvements ∙ Improvement of cognitive areas: visuo-spatial working memory, fine motor skills Parent report: Reduction of videogame abuse (playing time) |
Shaffer et al. (2001) [85] | Randomized controlled pretest-posttest design (blinded) | Boys with ADHD (n = 56) Age: 6–12 | Interactive Metronome training: Variety of upper and lower limb tasks performed with metronome beat Schedule: Treatment group: 3–5 weeks Interactive Metronome training 15 sessions (60 min each) Control group A: No intervention Control group B: 3–5 weeks video game training (incl. eye-hand coordination, advanced mental planning, multiple task sequencing) 15 sessions (60 min each) | Treatment group: Improvements in attention: ∙ Tests of Variables of Attention (TOVA): Reduction of errors and distractibility, consistency of reaction time, improved overall attention ∙ Conners’ Rating Scales-Revised (CRS-R) Teacher & Parent versions: Improvements in aggression control ∙ Wechsler Intelligence Test for Children-Third Edition ∙ Achenbach Child Behavior Checklist Improvements in motor control: ∙ Conners’ Rating Scales-Revised (CRS-R) Teacher & Parent versions ∙ Achenbach Child Behavior Checklist ∙ The Sensory Profile ∙ Bruininks-Oseretsky Test for Motor Proficiency (selected subtests) Improvements in academic achievements: ∙ Wide Range Achievement Test (WRAT 3; reading & writing): Improvements in reading ∙ Language Processing Test: Improvements in language processing Differences between groups: Improved performance in treatment group; decreased performance in control group and video game group |
Tucha & Lange (2005) [86] | Study 1: Experimental design (randomized) Study 2: Experimental design (randomized) Study 3: Case report | Study1: Neurotypical students (n = 26) Age: 20–35 Study 2: Children with ADHD/combined type (n = 12; no fine motor problems) Age: 9–12 Medication: Depending on experimental condition Study 3: Boy with ADHD/combined type (n = 1) Age: 10 Medication: yes | Study 1: Examination of handwriting movements of neurotypical students under different conditions (normal/neat/blind writing, visually/mentally tracking the pen) Schedule: 1 single session Note: Not included in review (not ADHD) Study 2: Examination of handwriting movements of children with ADHD under medication vs. placebo condition Medication condition: different instructions (repetitive hand movements, fluent circle drawing, blind/fast writing) Schedule: 2 sessions in 5–7 days Note: Not included in review (no training) Study 3: Training of automated handwriting movements (copying short texts) aided by simple instructions to direct attention away from accuracy and legibility of handwriting Schedule: ~ 3 weeks 6 sessions | WACOM IV Digitizing Tablet & specific pen: Study 1 (Tablet): Automated handwriting movements under different conditions Study 2 (Tablet): Reduced handwriting fluency on medication; automated handwriting movements on medication through instructions Study 3: ∙ Tablet: Automated and perfectly smooth handwriting movements (on tablet and homework) through instructions and feedback; reduced number of false starts ∙ Parent and teacher reports: Increased writing speed; legible handwriting but irregular alignment; better grades; higher motivation Follow-up (4 weeks): Improvements of handwriting movements maintained |
Weerdmeester et al. (2016) [87] | Feasibility study (randomized controlled pretest-posttest design) | Children with ADHD (n = 47) or elevated ADHD symptoms (n = 26) Age: 6–13 | “Dragon”: Full-body videogame intervention with ADHD-focused training components Intervention condition: “Dragon” Control condition: “Angry Birds Trilogy” (comparable full-body videogame not targeting ADHD symptoms) Schedule: 6 sessions (15 min each) | ADHD VragenLijst (AVL; teacher-ratings): Greater improvement of ADHD symptoms in intervention vs. control group Go/no-go task: Reduction in number of hits (sustained attention) in both groups; greater increase in false alarms (impulsivity) in intervention vs. control group Movement Assessment Battery for Children (MABC-2-NL): Improvements in fine motor skills (both groups); no improvement in gross motor skills Evaluative questions about “Dragon”: Satisfaction with game |
Yazd et al. (2015) [88] | Experimental design (randomized) | Children with ADHD (n = 36) Age: 6–12 Medication: Depending on experimental condition | Group A: Perceptual-motor training (incl. spatial/temporal/directional/body awareness, balance, coordination) Group B: Combination of perceptual-motor training and drug therapy Group C: Drug therapy (Methylphenidate, Risperidone) Schedule: 6-week treatment/training Group B & C: 18 training sessions | Bruininks-Oseretsky Test of Motor Proficiency: ∙ Group A: Improvements in gross and fine motor skills ∙ Group B: Improvement in gross and fine motor skills ∙ Group C: No improvement in motor performance |