Effects of Comorbid Developmental Coordination Disorder and Symptoms of Attention Deficit Hyperactivity Disorder on Physical Activity in Children Aged 4–5 Years


Developmental coordination disorder (DCD) is often comorbid with attention-deficit/hyperactivity disorder (ADHD). While children with DCD engage in less moderate-to-vigorous physical activity (MVPA) compared to typically developing (TD) children, research pertaining to how ADHD affects this relationship is limited. We investigated the effect of ADHD on MVPA among children at risk for DCD (DCDr). 507 children aged 4–5 years (DCDr = 233, TD = 274) participated. Motor skills were assessed using the Movement Assessment Battery for Children-2nd edition (DCDr; ≤ 16th percentile), ADHD symptoms were assessed using the Child Behaviour Checklist, and Actigraph accelerometers measured MVPA over seven days. DCD did not negatively affect MVPA, however, after adjusting for ADHD symptoms, the effect of DCD became significant and was driven by symptoms of inattention. Symptoms of ADHD may be suppressing the negative effects of DCD on MVPA, highlighting the importance of assessing and controlling for ADHD symptoms in this population.

This is a preview of subscription content, access via your institution.


  1. 1.

    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington, VA

    Google Scholar 

  2. 2.

    Kadesjö B, Gillberg C (1999) Developmental coordination disorder in Swedish 7-year-old children. J Am Acad Child Adolesc Psychiatry 38:820–828. https://doi.org/10.1097/00004583-199907000-00011

    Article  PubMed  Google Scholar 

  3. 3.

    Lingam R, Hunt L, Golding J et al (2009) Prevalence of developmental coordination disorder using the DSM-IV at 7 years of age: A UK population–based study. Pediatrics 123:693–700

    Article  Google Scholar 

  4. 4.

    Gomez A, Sirigu A (2015) Developmental coordination disorder: core sensori-motor deficits, neurobiology and etiology. Neuropsychologia 79:272–287. https://doi.org/10.1016/j.neuropsychologia.2015.09.032

    Article  PubMed  Google Scholar 

  5. 5.

    Gibbs J, Appleton J, Appleton R (2007) Dyspraxia or developmental coordination disorder? Unravelling the enigma. Arch Dis Child 92:534–539

    Article  Google Scholar 

  6. 6.

    Missiuna C, Gaines R, Soucie H, McLean J (2006) Parental questions about developmental coordination disorder: a synopsis of current evidence. Paediatr Child Health 11:507–512. https://doi.org/10.1093/pch/11.8.507

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Rodriguez MC, Wade TJ, Veldhuizen S et al (2019) Emotional and behavioral problems in 4- and 5-year old children with and without motor delays. Front Pediatr. https://doi.org/10.3389/fped.2019.00474

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Rivilis I, Hay J, Cairney J et al (2011) Physical activity and fitness in children with developmental coordination disorder: a systematic review. Res Dev Disabil 32:894–910. https://doi.org/10.1016/j.ridd.2011.01.017

    Article  PubMed  Google Scholar 

  9. 9.

    Pate RR, Hillman CH, Janz KF et al (2019) Physical activity and health in children younger than 6 years: a systematic review. Med Sci Sports Exerc 51:1282–1291. https://doi.org/10.1249/MSS.0000000000001940

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Zeng N, Ayyub M, Sun H et al (2017) Effects of physical activity on motor skills and cognitive development in early childhood: a systematic review. Biomed Res Int. https://doi.org/10.1155/2017/2760716

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Cairney J, Hay JA, Veldhuizen S et al (2010) Developmental coordination disorder, sex, and activity deficit over time: a longitudinal analysis of participation trajectories in children with and without coordination difficulties. Dev Med Child Neurol 52:e67–e72. https://doi.org/10.1111/j.1469-8749.2009.03520.x

    Article  PubMed  Google Scholar 

  12. 12.

    Hay J, Missiuna C (1998) Motor proficiency in children reporting low levels of participation in physical activity. Can J Occup Ther 65:64–71. https://doi.org/10.1177/000841749806500203

    Article  Google Scholar 

  13. 13.

    Batey CA, Missiuna CA, Timmons BW et al (2014) Self-efficacy toward physical activity and the physical activity behavior of children with and without Developmental Coordination Disorder. Hum Mov Sci 36:258–271. https://doi.org/10.1016/j.humov.2013.10.003

    Article  PubMed  Google Scholar 

  14. 14.

    Green D, Lingam R, Mattocks C et al (2011) The risk of reduced physical activity in children with probable developmental coordination disorder: a prospective longitudinal study. Res Dev Disabil 32:1332–1342

    Article  Google Scholar 

  15. 15.

    Kwan MYW, King-Dowling S, Hay JA et al (2016) Longitudinal examination of objectively-measured physical activity and sedentary time among children with and without significant movement impairments. Hum Mov Sci 47:159–165. https://doi.org/10.1016/j.humov.2016.03.004

    Article  PubMed  Google Scholar 

  16. 16.

    De Meester A, Stodden D, Goodway J et al (2018) Identifying a motor proficiency barrier for meeting physical activity guidelines in children. J Sci Med Sport 21:58–62

    Article  Google Scholar 

  17. 17.

    Robinson LE, Stodden DF, Barnett LM et al (2015) Motor competence and its effect on positive developmental trajectories of health. Sport Med 45:1273–1284. https://doi.org/10.1007/s40279-015-0351-6

    Article  Google Scholar 

  18. 18.

    King-Dowling S, Kwan MYW, Rodriguez C et al (2019) Physical activity in young children at risk for developmental coordination disorder. Dev Med Child Neurol 61:1302–1308. https://doi.org/10.1111/dmcn.14237

    Article  PubMed  Google Scholar 

  19. 19.

    Zwicker JG, Missiuna C, Boyd LA (2009) Neural correlates of developmental coordination disorder: a review of hypotheses. J Child Neurol. https://doi.org/10.1177/0883073809333537

    Article  PubMed  Google Scholar 

  20. 20.

    Berquin PC, Giedd JN, Jacobsen LK et al (1998) Cerebellum in attention-deficit hyperactivity disorder: a morphometric MRI study. Neurology 50:1087–1093. https://doi.org/10.1212/WNL.50.4.1087

    Article  PubMed  Google Scholar 

  21. 21.

    Xavier Castellanos F, Lee PP, Sharp W et al (2002) Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. J Am Med Assoc 288:1740

    Article  Google Scholar 

  22. 22.

    Mostofsky SH, Reiss AL, Lockhart P, Denckla MB (1998) Evaluation of cerebellar size in attention-deficit hyperactivity disorder. J Child Neurol 13:434–439

    Article  Google Scholar 

  23. 23.

    Martin N, Piek J, Hay D (2006) DCD and ADHD: a genetic study of their shared aetiology. Hum Mov Sci 25:110–124

    Article  Google Scholar 

  24. 24.

    Pearsall-Jones JG, Piek JP, Rigoli D et al (2009) An investigation into etiological pathways of DCD and ADHD using a monozygotic twin design. Twin Res Hum Genet 12:381–391. https://doi.org/10.1375/twin.12.4.381

    Article  PubMed  Google Scholar 

  25. 25.

    Kaiser M-L, Schoemaker MM, Albaret J-M, Geuze RH (2015) What is the evidence of impaired motor skills and motor control among children with attention deficit hyperactivity disorder (ADHD)? Systematic review of the literature. Res Dev Disabil. https://doi.org/10.1016/j.ridd.2014.09.023

    Article  PubMed  Google Scholar 

  26. 26.

    Dane AV, Schachar RJ, Tannock R (2000) Does actigraphy differentiate ADHD subtypes in a clinical research setting? J Am Acad Child Adolesc Psychiatry 39:752–760. https://doi.org/10.1097/00004583-200006000-00014

    Article  PubMed  Google Scholar 

  27. 27.

    Halperin J, Newcorn J, Matier K et al (1993) Discriminant validity of attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 32:1038–1043

    Article  Google Scholar 

  28. 28.

    Jones DE, Greenberg M, Crowley M (2015) Early social-emotional functioning and public health: the relationship between kindergarten social competence and future wellness. Am J Public Health 105:2283

    Article  Google Scholar 

  29. 29.

    Lin CY, Yang AL, Su CT (2013) Objective measurement of weekly physical activity and sensory modulation problems in children with attention deficit hyperactivity disorder. Res Dev Disabil 34:3477–3486. https://doi.org/10.1016/j.ridd.2013.07.021

    Article  PubMed  Google Scholar 

  30. 30.

    Miyahara M, Healey DM, Halperin JM (2014) One-week temporal stability of hyperactivity in preschoolers with ADHD during psychometric assessment. Psychiatry Clin Neurosci 68:120–126. https://doi.org/10.1111/pcn.12096

    Article  PubMed  Google Scholar 

  31. 31.

    Porrino LJ, Rapoport JL, Behar D et al (1983) A naturalistic assessment of the motor activity of hyperactive boys. Arch Gen Psychiatry 40:681–687

    Article  Google Scholar 

  32. 32.

    Tsujii N, Okada A, Kaku R et al (2007) Association between activity level and situational factors in children with attention deficit/hyperactivity disorder in elementary school. Psychiatry Clin Neurosci 61:181–185. https://doi.org/10.1111/j.1440-1819.2007.01634.x

    Article  PubMed  Google Scholar 

  33. 33.

    Fenollar-Cortés J, Gallego-Martinez A, Fuentes L (2017) The role of inattention and hyperactivity/impulsivity in the fine motor coordination in children with ADHD. Res Dev Disabil 69:77–84

    Article  Google Scholar 

  34. 34.

    Piek JP, Pitcher TM, David AH (1999) Motor coordination and kinaesthesis in boys with attention deficit-hyperactivity disorder. Dev Med Child Neurol 41:159–165. https://doi.org/10.1017/S0012162299000341

    Article  PubMed  Google Scholar 

  35. 35.

    Pitcher TM, Piek JP, Hay DA (2003) Fine and gross motor ability in males with ADHD. Dev Med Child Neurol 45:525–535. https://doi.org/10.1111/j.1469-8749.2003.tb00952.x

    Article  PubMed  Google Scholar 

  36. 36.

    Baerg S, Cairney J, Hay J et al (2011) Evaluating physical activity using accelerometry in children at risk of developmental coordination disorder in the presence of attention deficit hyperactivity disorder. Canada Res Dev Disabil 32:1343–1350. https://doi.org/10.1016/j.ridd.2011.02.009

    Article  PubMed  Google Scholar 

  37. 37.

    Baquet G, Stratton G, Van PE, Berthoin S (2007) Improving physical activity assessment in prepubertal children with high-frequency accelerometry monitoring: a methodological issue. Prev Med (Baltim) 44:143–147. https://doi.org/10.1016/j.ypmed.2006.10.004

    Article  Google Scholar 

  38. 38.

    Tremblay MS, Carson V, Chaput J-P et al (2016) Canadian 24-hour movement guidelines for children and youth: an integration of physical activity, sedentary behaviour, and sleep 1. Appl Physiol Nutr Metab. https://doi.org/10.1139/apnm-2016-0151

    Article  PubMed  Google Scholar 

  39. 39.

    Bouffard M, Watkinson E, Thompson L et al (1996) A test of the activity deficit hypothesis with children with movement difficulties. Adapt Phys Act Q 13:61–73

    Google Scholar 

  40. 40.

    Larkin D, Hands B (2002) Physical fitness and developmental cordination disorder. In: Cermak SA, Larkin D (eds) Developmental coordination disorder. Singular Publishing Group, San Diego, pp 172–184

    Google Scholar 

  41. 41.

    Barkley R (2014) The assessment of executive functioning using the barkley deficits in executive functioning scales. In: Goldstein S, Naglieri JA (eds) Handbook of executive functioning. Springer, New York

    Google Scholar 

  42. 42.

    Cairney J, Missiuna C, Timmons BW et al (2015) The coordination and activity tracking in children (CATCH) study: rationale and design. BMC Public Health 15:1266. https://doi.org/10.1186/s12889-015-2582-8

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Cairney J, Veldhuizen S, Rodriguez MC et al (2019) Cohort profile: the Canadian coordination and activity tracking in children (CATCH) longitudinal cohort. BMJ Open 9:29784. https://doi.org/10.1136/bmjopen-2019-029784

    Article  Google Scholar 

  44. 44.

    King-Dowling S, Rodriguez C, Missiuna C et al (2018) Health-related fitness in preschool children with and without motor delays. Med Sci Sport Exerc 50:1442–1448. https://doi.org/10.1249/MSS.0000000000001590

    Article  Google Scholar 

  45. 45.

    Blank R, Smits-Engelsman B, Polatajko H, Wilson P (2012) European Academy for Childhood Disability (EACD): recommendations on the definition, diagnosis and intervention of developmental coordination disorder (long version)*. Dev Med Child Neurol 54:54–93. https://doi.org/10.1111/j.1469-8749.2011.04171.x

    Article  PubMed  Google Scholar 

  46. 46.

    Kaufman A, Kaufman N (2004) KBIT-2: Kaufman brief intelligence test, 2nd edn. Pearson Inc., Bloomington, MN

    Google Scholar 

  47. 47.

    Achenbach TM (2013) DSM-oriented guide for the achenbach system of empirically based assessment (ASEBA). Springer, Berlin

    Google Scholar 

  48. 48.

    Achenback T, Rescorla L (2000) Manual for the ASEBA preschool forms and profiles. University of Vermont, Research Center for Children, Youth, & Families, Burlington, VT

    Google Scholar 

  49. 49.

    Szatmari P, Offord DR, Boyle MH (1989) Ontario child health study: prevalence of attention deficit disorder with hyperactivity. J Child Psychol Psychiatry 30:219–223. https://doi.org/10.1111/j.1469-7610.1989.tb00236.x

    Article  PubMed  Google Scholar 

  50. 50.

    Evenson KR, Catellier DJ, Gill K et al (2008) Calibration of two objective measures of physical activity for children. J Sports Sci 26:1557–1565. https://doi.org/10.1080/02640410802334196

    Article  PubMed  Google Scholar 

  51. 51.

    Wall AET (2004) The developmental skill-learning gap hypothesis: implications for children with movement difficulties. Adapted Phys Activity Q 21:197–218

    Article  Google Scholar 

  52. 52.

    Peyre H, Albaret JM, Bernard JY et al (2019) Developmental trajectories of motor skills during the preschool period. Eur Child Adolesc Psychiatry 28:1461–1474. https://doi.org/10.1007/s00787-019-01311-x

    Article  PubMed  Google Scholar 

  53. 53.

    Boissy P, Bourbonnais D, Kaegi C et al (1997) Characterization of global synkineses during hand grip in hemiparetic patients. Arch Phys Med Rehabil 78:1117–1124

    Article  Google Scholar 

  54. 54.

    D’Agati E, Casarelli L, Pitzianti MB, Pasini A (2010) Overflow movements and white matter abnormalities in ADHD. Prog Neuro-Psychopharmacol Biol Psychiatry 34:441–445. https://doi.org/10.1016/j.pnpbp.2010.01.013

    Article  Google Scholar 

  55. 55.

    Gaddis A, Rosch KS, Dirlikov B et al (2015) Motor overflow in children with attention-deficit/hyperactivity disorder is associated with decreased extent of neural activation in the motor cortex. Psychiatry Res Neuroimaging 233:488–495. https://doi.org/10.1016/j.pscychresns.2015.08.001

    Article  Google Scholar 

  56. 56.

    Licari MK, Billington J, Reid SL et al (2015) Cortical functioning in children with developmental coordination disorder: a motor overflow study. Exp Brain Res 233:1703–1710. https://doi.org/10.1007/s00221-015-4243-7

    Article  PubMed  Google Scholar 

  57. 57.

    Sweeney KL, Ryan M, Schneider H et al (2018) Developmental trajectory of motor deficits in preschool children with ADHD. Dev Neuropsychol 43:419–429. https://doi.org/10.1080/87565641.2018.1466888

    Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Alhassan S, Nwaokelemeh O, Ghazarian M et al (2012) Effects of locomotor skill program on minority preschoolers’ physical activity levels. Pediatr Exerc Sci 24:435–449. https://doi.org/10.1123/pes.24.3.435

    Article  PubMed  Google Scholar 

  59. 59.

    Robinson LE, Rudisill ME, Goodway JD (2009) Instructional climates in preschool children who are at-risk. Part II: perceived physical competence. Res Q Exerc Sport 80:543–551. https://doi.org/10.1080/02701367.2009.10599592

    Article  PubMed  Google Scholar 

  60. 60.

    Burdette HL, Whitaker RC (2005) Resurrecting free play in young children: looking beyond fitness and fatness to attention, affiliation, and affect. Arch Pediatr Adolesc Med 159:46–50

    Article  Google Scholar 

  61. 61.

    Ginsburg KR, Shifrin DL, Broughton DD et al (2007) The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics 119:182–191. https://doi.org/10.1542/peds.2006-2697

    Article  PubMed  Google Scholar 

  62. 62.

    Johnson R, Rosen L (2000) Sports behaviour of ADHD children. Hournal Atten Disord 4:150–160

    Article  Google Scholar 

  63. 63.

    Missiuna C, Campbell WN (2014) Psychological aspects of developmental coordination disorder: can we establish causality? Curr Dev Disord Reports 1:125–131. https://doi.org/10.1007/s40474-014-0012-8

    Article  Google Scholar 

Download references


The authors would like to thank all of the CATCH study participants and their families as well as acknowledge the trainees and research staff who assisted with recruitment, scheduling, and data collection. The CATCH study is funded by the Canadian Institutes of Health Research (MOP 126015).

Author information



Corresponding author

Correspondence to John Cairney.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare. The results of the present study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

James, M.E., King-Dowling, S., Graham, J.D. et al. Effects of Comorbid Developmental Coordination Disorder and Symptoms of Attention Deficit Hyperactivity Disorder on Physical Activity in Children Aged 4–5 Years. Child Psychiatry Hum Dev (2021). https://doi.org/10.1007/s10578-021-01155-0

Download citation


  • Motor coordination
  • Motor control
  • Motor behaviour
  • Attention‐deficit hyperactivity disorder
  • Physical activity