A longitudinal examination of fine motor, executive functioning, and attention deficit hyperactivity disorder in school-age children with Down syndrome (DS)

Moshe Maiman, PhD

Boston Children’s Hospital – Fellow
Maiman_Moshe poster

Scientific Abstract

Background: Children with Down syndrome (DS) experience high rates of executive function difficulties and ADHD. Understanding factors that may predict their high occurrence in this group is important, as it could help identify those children at greatest risk for poor outcomes. One potential marker is fine motor (FM) skills, as concurrent relations between these domains have been documented in children with DS. These relations have yet to be explored longitudinally in this group, which is the goal of this study.

Methods: This longitudinal study followed 31 children with DS (male = 42%; Mage= 11.54 years), who participated in an earlier study, 1.5 years earlier. At Time 1 [T1], participants completed a performance-based measure of FM (Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition). Parents also completed a FM questionnaire (Developmental Coordination Disorder Questionnaire). At Time 2 [T2], participants completed performance-based measures of EF(Missing Scan Task, NIH Dimensional Change Card Sorting Task, NIH Flanker Task). Their parents completed questionnaires of EF (Behavior Rating Inventory of Executive Function, Second Edition [BRIEF-2]) and ADHD (ADHD Rating Scale-IV).

Results: Parent-reported FM skills at T1 significantly predicted BRIEF-2 Global Executive Composite [GEC],F(1,18)=19.99; p<0.01, ADHD-RS-IV Inattention [IA], F(1,17)= 8.72; p<0.01, and ADHD-RS-IV Hyperactivity/Impulsivity [HI], F(1,17)= 7.44; p=0.01, at T2 in our DS sample. Performance-based FM skills at T1 also significantly predicted BRIEF-2 GEC, F(1,15)= 23.00; p<0.01, ADHD-RS-IV IA, F(1,14)= 12.25; p<0.01, and ADHD-RS-IV HI, F(1,14)= 22.73; p=0.01, at T2 in this group. Conversely, performance-based FM abilities at T1 did not significantly predict performance-based EF abilities at T2 in our DS sample.

Conclusion: This study provides support that earlier performance-based and parent-reported FM abilities can predict parent-reported EF skills and ADHD symptomology 1.5 years later in children with DS. Future studies should examine these relations in younger children with DS to evaluate the predictive validity of initial FM skills for later EF difficulties and ADHD symptomatology.

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research Areas


Moshe Maiman, PhD, Nancy Raitano Lee, PhD

Principal Investigator

Nancy Raitano Lee, PhD