Procedural learning and automatization process in children with developmental coordination disorder and/or developmental dyslexia

ObjectiveThere is increasing evidence to suggest that developmental dyslexia (DD) and developmental coordination disorder (DCD) actually form part of a broader disorder. Their frequent association could be justified by a deficit of the procedural memory system, that subtends many of the cognitive, motor and linguistic abilities that are impaired in both DD and DCD. However, studies of procedural learning in these two disorders have yielded divergent results, and in any case no studies have so far addressed the issue of automatization (dual-task paradigm).MethodsWe administered a finger tapping task to participants aged 8–12 years (19 DCD, 18 DD, and 22 with both DD and DCD) to explore procedural learning and automatic movements in these three groups of children, comparing motor performances at the prelearning stage, after 2 weeks of training, and in a post-training dual-task condition.ResultsFirst, results indicated that all the children were able to learn a sequence of movements and even automatize their movements. Second, they revealed between-groups differences in procedural/automatization learning abilities, setting the DCD group apart from the other two. Third, contrary to our expectations concerning comorbidity, they suggested that the DD + DCD association does not have an additional impact on behavioral performances.     

Fine motor deficiencies in children with developmental coordination disorder and learning disabilities: an underlying open-loop control deficit

Thirty-two children with Developmental Coordination Disorder (DCD) and learning disabilities (LD) and their age-matched controls attending normal primary schools were investigated using kinematic movement analysis of fine-motor performance. Three hypotheses about the nature of the motor deficits observed in children with LD were tested: general slowness hypothesis, limited information capacity hypothesis, and the motor control mode hypothesis. Measures of drawing movements were analyzed under different task conditions using a Fitts' paradigm. In a reciprocal aiming task, the children drew straight-line segments between two targets 2.5 cm apart. Three Target Sizes were used (0.22, 0.44, and 0.88 cm). Children used an electronic pen that left no trace on the writing tablet. To manipulate the degree of open-loop movement control, the aiming task was performed under two different control regimes: discrete aiming and cyclic aiming. The kinematic analysis of the writing movements of the 32 children with DCD/LD that took part in the experimental study confirmed that besides learning disabilities they have a motor learning problem as well. Overall, the two groups did not differ in response time, nor did they respond differently according to Fitts' Law. Both groups displayed a conventional trade-off between Target Size and average Movement Time. However, while movement errors for children with DCD/LD were minimal on the discrete task, they made significantly more errors on the cyclic task. This, together with faster endpoint velocities, suggests a reduced ability to use a control strategy that emphasizes the terminal control of accuracy. Taken together, the results suggest that children with DCD/LD rely more on feedback during movement execution and have difficulty switching to a feedforward or open-loop strategy.     

Development of motor imagery ability in children with developmental coordination disorder – A goal-directed pointing task

Children with developmental coordination disorder (DCD) have difficulties with the predictive control of movements. This was shown in studies that target motor imagery and motor planning, and appears to become particularly evident with increases in task complexity. In this study, we used a complex mental chronometry paradigm to examine the development of motor imagery ability in children with DCD, using a longitudinal design. Thirty children were included in the DCD group (aged 6–11 years) and age- and gender-matched to 30 controls. The DCD group had a Movement Assessment Battery for Children-2 score ≤16th percentile and the control group ≥25th percentile. Results of this study showed that children with DCD indeed had a significantly lower correlation between executed and imagined movements. Importantly, the increase in the correlation and linear fit during subsequent measurements was comparable for the DCD and control group. Together, these findings suggest a delayed developmental onset of motor imagery ability in DCD, but a similar rate of development over time compared to the control group. Based on these results, it seems likely that explicit motor imagery instructions can be used to improve predictive control in children with DCD.     

Graphomotor skills in children with developmental coordination disorder (DCD): Handwriting and learning a new letter

The aim of the present study was to analyze handwriting difficulties in children with developmental coordination disorder (DCD) and investigate the hypothesis that a deficit in procedural learning could help to explain them. The experimental set-up was designed to compare the performances of children with DCD with those of a non-DCD group on tasks that rely on motor learning in different ways, namely handwriting and learning a new letter. Ten children with DCD and 10 non-DCD children, aged 8–10 years, were asked to perform handwriting tasks (letter/word/sentence; normal/fast), and a learning task (new letter) on a graphic tablet. The BHK concise assessment scale for children’s handwriting was used to evaluate their handwriting quality. Results showed that both the handwriting and learning tasks differentiated between the groups. Furthermore, when speed or length constraints were added, handwriting was more impaired in children with DCD than in non-DCD children. Greater intra-individual variability was observed in the group of children with DCD, arguing in favor of a deficit in motor pattern stabilization. The results of this study could support both the hypothesis of a deficit in procedural learning and the hypothesis of neuromotor noise in DCD.     

Sleep-dependent consolidation of procedural motor memories in children and adults: the pre-sleep level of performance matters

In striking contrast to adults, in children sleep following training a motor task did not induce the expected (offline) gain in motor skill performance in previous studies. Children normally perform at distinctly lower levels than adults. Moreover, evidence in adults suggests that sleep dependent offline gains in skill essentially depend on the pre-sleep level of performance. Against this background, we asked whether improving children's performance on a motor sequence learning task by extended training to levels approaching those of adults would enable sleep-associated gains in motor skill in this age group also. Children (4-6 years) and adults (18-35 years) performed on the motor sequence learning task (button-box task) before and after ~2-hour retention intervals including either sleep (midday nap) or wakefulness. Whereas one group of children and adults, respectively, received the standard amount of 10 blocks of training before retention intervals of sleep or wakefulness, a further group of children received an extended training on 30 blocks (distributed across 3 days). A further group of adults received a restricted training on only two blocks before the retention intervals. Children after standard training reached lowest performance levels, whereas in adults performance after standard training was highest. Children with extended training and adults after reduced training reached intermediate performance levels. Only at these intermediate performance levels did sleep induce significant gains in motor sequence skill, whereas performance did not benefit from sleep in the low-performing children or in the high-performing adults. Spindle counts in the post-training nap were correlated with performance gains at retrieval only in the adults benefitting from sleep. We conclude that, across age groups, sleep induces the most robust gain in motor skill at an intermediate pre-sleep performance level. In low-performing children sleep-dependent improvements in skill may be revealed only after enhancing the pre-sleep performance level by extended training.     

Increased visual bias in children with developmental coordination disorder: Evidence from a visual-tactile temporal order judgment task

BackgroundPrevious studies have suggested that children with developmental coordination disorder (DCD) rely heavily on vision to perform movements, which may contribute to their clumsy movements. However, few studies have objectively and quantitatively investigated the perceptual biases of children with DCD.MethodsA visual-tactile temporal order judgment (TOJ) task was used to measure and compare the perceptual biases of 19 children with DCD and 19 age- and sex-matched typically developing children. The point of subjective equality, which demonstrates when “visual first” and “tactile first” judgment probabilities are equal (50%), obtained by analyzing the results of the visual-tactile TOJ task, was used as an indicator of perceptual biases. Further, variables (age and manual dexterity in all participants; motor function, autism spectrum disorder and attention-deficit hyperactivity disorder traits, and depressive symptoms in children with DCD) associated with perceptual biases were examined with correlation analysis.ResultsChildren with DCD had significantly stronger visual bias than typically developing children. Overall correlation analysis showed that increased visual bias was significantly correlated with poor manual dexterity.ConclusionChildren with DCD had a strong visual bias, which was associated with poor manual dexterity.     

Development of motor imagery and anticipatory action planning in children with developmental coordination disorder – A longitudinal approach

Children with impaired motor coordination (or Development Coordination Disorder – DCD) have difficulty with the predictive control of movements, evidenced by cross-sectional studies that show impaired motor imagery and action planning abilities. What remains unclear is whether this deficit in predictive control reflects immaturity of the motor system (a developmental delay) or some deviation from normal development (a disorder). To advance this discussion the present study used a longitudinal design to examine the development of motor imagery and action planning in children with DCD. Thirty children were included in the DCD group (aged 6–11 years) and age- and gender-matched to 30 controls. The DCD group had a mABC-2 score ≤ 16th percentile, the control group > 20th percentile. Motor imagery was assessed with the hand rotation task, action planning with a test for end-state comfort. Children participated in three measurements, with one year in between measurements. Results showed that children with DCD were slower and less accurate than their typically developing peers in all subsequent years but were able to improve their motor imagery ability over time. Furthermore, children with DCD showed less planning for ESC at the start of the present study, but were able to catch up with their peers during two-year follow up. These results exemplify that improvement of motor imagery and action planning ability is possible in DCD, and they lend theoretical support to the use of new training techniques that focus on training motor imagery to improve motor skills in children with DCD.     

Procedural learning,consolidation, and transfer of a new skill in Developmental Coordination Disorder

The aim of this study was to explore the differences in procedural learning abilities between children with DCD and typically developing children by investigating the steps that lead to skill automatization (i.e., the stages of fast learning, consolidation, and slow learning). Transfer of the skill to a new situation was also assessed. We tested 34 children aged 6–12 years with and without DCD on a perceptuomotor adaptation task, a form of procedural learning that is thought to involve the cerebellum and the basal ganglia (regions whose impairment has been associated with DCD) but also other brain areas including frontal regions. The results showed similar rates of learning, consolidation, and transfer in DCD and control children. However, the DCD children's performance remained slower than that of controls throughout the procedural task and they reached a lower asymptotic performance level; the difficulties observed at the outset did not diminish with practice.     

Multi-limb coordination and rhythmic variability under varying sensory availability conditions in children with DCD

Children with Developmental Coordination Disorder (DCD) have sensory processing deficits; how do these influence the interface between sensory input and motor performance? Previously, we found that children with DCD were less able to organize and maintain a gross motor coordination task in time to an auditory cue, particularly at higher frequencies [Whitall, J., Getchell, N., McMenamin, S., Horn, C., Wilms-Floet, A., & Clark, J. (2006). Perception-action coupling in children with and without DCD: Frequency locking between task relevant auditory signals and motor responses in a dual motor task. Child: Care, Health, and Development, 32, 679-692]. In the present study, we examine the same task (clapping in-phase to marching on a platform) under conditions involving the removal of vision and hearing. Eleven children with DCD (mean=7.21, SD=0.52 years), 7 typically developing (TD) children (mean=6.95+/-0.72 years), and 10 adults performed continuous clapping while marching under four conditions: with vision and hearing, without vision, without hearing, and without both. Results showed no significant condition effects for any measure taken. The DCD group was more variable in phasing their claps and footfalls than both the adult group and the TD group. There were also significant group effects for inter-clap interval coefficient of variation and inter-footfall interval coefficient of variation, with the DCD group being the most variable for both measures. Coherence analysis between limb combinations (e.g., left arm-right arm, right arm-left leg) revealed that the adults exhibited significantly greater coherence for each combination than both of the children's groups. The TD group showed significantly greater coherence than the DCD group for every limb combination except foot-foot and left hand-right foot. Measures of approximate entropy indicated that adults differed from children both with and without DCD in the structure of the variability across a trial with adults showing more complexity. Children with DCD are able to accomplish a self-initiated gross-motor coordination task but with increased variability for most but not all measures compared to typically developing children. The availability of visual and/or auditory information does not play a significant role in stabilizing temporal coordination of this task, suggesting that these are not salient sources of information for this particular task.     

On the development of procedural knowledge

Amnesic patients demonstrate by their performance on a serial reaction time task that they learned a repeating spatial sequence despite their lack of awareness of the repetition (Nissen & Bullemer, 1987). In the experiments reported here, we investigated this form of procedural learning in normal subjects. A subgroup of subjects showed substantial procedural learning of the sequence in the absence of explicit declarative knowledge of it. Their ability to generate the sequence was effectively at chance and showed no savings in learning. Additional amounts of training increased both procedural and declarative knowledge of the sequence. Development of knowledge in one system seems not to depend on knowledge in the other. Procedural learning in this situation is neither solely perceptual nor solely motor. The learning shows minimal transfer to a situation employing the same motor sequence.     

Sequence‐specific procedural learning deficits in children with specific language impairment

This study tested the procedural deficit hypothesis of specific language impairment (SLI) by comparing children's performance in two motor procedural learning tasks and an implicit verbal sequence learning task. Participants were 7‐ to 11‐year‐old children with SLI (n = 48), typically developing age‐matched children (n = 20) and younger typically developing children matched for receptive grammar (n = 28). In a serial reaction time task, the children with SLI performed at the same level as the grammar‐matched children, but poorer than age‐matched controls in learning motor sequences. When tested with a motor procedural learning task that did not involve learning sequential relationships between discrete elements (i.e. pursuit rotor), the children with SLI performed comparably with age‐matched children and better than younger grammar‐matched controls. In addition, poor implicit learning of word sequences in a verbal memory task (the Hebb effect) was found in the children with SLI. Together, these findings suggest that SLI might be characterized by deficits in learning sequence‐specific information, rather than generally weak procedural learning.     

Navigating through apertures: perceptual judgements and actions of children with Developmental Coordination Disorder

Passing through a narrow gap/aperture involves a perceptual judgement regarding the size of the gap and an action to pass through. Children with DCD are known to have difficulties with perceptual judgements in near space but whether this extends to far space is unknown. Furthermore, in a recent study it was found that adults with DCD do not scale movements when walking through an aperture in the same way as their peers. The current study, therefore, considered perceptual judgements and motor behaviour of children with DCD while looking at or walking through apertures. Twenty‐nine children with DCD and 29 typically developing (TD) children took part. In Experiment 1, participants completed a perceptual task, where they made passability judgements. Children with DCD showed a significantly smaller critical ratio (aperture size at which a participant first rotates the shoulders to pass through) compared to their TD peers. In Experiment 2, participants completed an action task where they walked through the same apertures. Children with DCD showed a significantly larger critical ratio than TD peers when body size alone was accounted for. Taken together these results suggest that perception within a static context is different from that within a dynamic context for children with DCD. However, despite this difference we have demonstrated a clear relationship between perception and action in children with DCD. A video abstract of this article can be viewed at: https://youtu.be/SABXFrAJtF8     

左侧背外侧前额叶在程序性运动学习中的作用

程序性运动学习包括序列学习和随机学习。神经影像学研究表明背外侧前额叶皮层(DLPFC)和初级运动皮层(M1)在程序性运动学习中发挥重要作用, 但DLPFC和M1之间的联通性及其与不同程序性运动学习的关系尚不明确。本研究采用连续反应时间任务, 结合经颅磁刺激(TMS)方法, 探讨左侧DLPFC到M1的联通性在不同程序性运动学习中的差异。实验1采用两连发TMS探测DLPFC到M1的最佳投射时间点; 实验2, 被试分为2组, 分别进行序列学习和随机学习, 在学习前、后采集行为学数据, 以及M1的运动诱发电位和DLPFC-M1联通性的电生理学数据。行为学结果发现序列学习组的学习效果更佳; 电生理学结果发现, 两组被试学习前、后M1的运动诱发电位均未发生改变; 在最佳时间投射点、适当刺激强度下, 序列学习组DLPFC-M1联通性发生改变, 且与学习成绩相关, 而随机学习组没有改变。结果说明DLPFC到M1的联通性增强可能是序列学习成绩更佳的重要原因, 这一结果从电生理角度为DLPFC在运动学习中的作用提供了重要证据。     

Auditory-motor coupling of bilateral finger tapping in children with and without DCD compared to adults

The ability to modulate bilateral finger tapping in time to different frequencies of an auditory beat was studied. Twenty children, 7 years of age, 10 with and 10 without developmental coordination disorder (DCD), and 10 adults tapped their left index and right middle fingers in an alternating pattern in time with an auditory signal for 15s (four trials each, randomly, at 0.8, 1.6, 2.4, 3.2 Hz per finger). Dominant and non-dominant finger data were collapsed since no differences emerged. All three groups were able to modulate their finger frequency across trials to closely approximate the signal frequency but children with DCD were unable to slow down to the lowest frequency. Children with DCD were more variable in tap accuracy (SD of relative phase) and between finger coordination than typically developing children who were respectively more variable than the adults. Children with DCD were unable to consistently synchronize their finger with the beat. Adults were tightly synchronized and often ahead of the beat while children without DCD tended to be behind the beat. Overall, these results indicated that children with DCD can only broadly match their finger movements to an auditory signal with variability and poor synchronicity as key features of their auditory-fine-motor control. Individual inspection of the data revealed that five children with DCD had difficulty matching the slowest frequencies and that these children also had higher variability and lower percentile MABC scores from the movement assessment battery for children (MABC) than other children with DCD. Three children with DCD were more variable only at higher frequencies and two performed like typically developing children.     

Developmental coordination disorder: associated problems in attention,learning, and psychosocial adjustment

This study investigated the problems of attention, learning and psychosocial adjustment evidenced by children with developmental coordination disorder (DCD). Forty-five children identified with DCD, 51 children identified as being suspect for DCD and 78 comparison children without motor problems on standardized tests of motor function participated in this study. Results revealed that both children with DCD and children suspect for DCD obtained significantly poorer scores on measures of attention and learning (reading, writing and spelling) than comparison children. Children with DCD and those suspect for DCD were also found to evidence a relatively high level of social problems and display a relatively high level of somatic complaints based on parent report. These findings indicate that all children with movement problems are at risk for problems in attention, learning and psychosocial adjustment. Assessment of children with movement problems, regardless of the degree or severity of these problems should examine a wide range of functions in addition to motor functioning. Such an approach, would assist in determining the types of intervention that would provide the most benefit to these children.     

A comparison of characteristics,developmental disorders and motor progression between children with and without developmental coordination disorder

Background and aimChildren with Developmental Coordination Disorder (DCD) have difficulty in the development of motor coordination and with learning new motor skills. Studies demonstrate that children with DCD differ in terms of the nature and severity of their motor difficulties, the incidence of co occurring conditions and family background. However, little is known whether these profiles may relate to motor progression over time. The aim of this study was to describe the profiles of children with and without DCD and track motor progression over time.MethodThe characteristics of thirty-four 7–14 year old children (M = 10.07, 85.3% boys) with and without DCD were compared and their motor progression monitored over a two academic years. DCD was identified using DSM5 criteria. The Movement Assessment Battery for Children-2 (MABC-2) was used to classify children as TD (≥25th percentile), having moderate motor coordination difficulties (6-16th percentile) or severe motor coordination difficulties (≤ 5th percentile). The Kaufman Brief Intelligence Test – 2 (KBIT-2) was used to measure full scale IQ. Parent questionnaires were used to gather information on socio economic status and co occurrence of other developmental disorders. We used ANOVA to assess whether there were differences in characteristics between the TD children, children with severe motor coordination difficulties and children with moderate motor coordination difficulties. Linear mixed effect modelling was used to estimate any change in motor performance over time and whether this differed between the three groups of children.ResultsChildren with severe motor coordination difficulties had distinct profiles in motor and non-motor domains, lower IQ and a greater likelihood of having associated characteristics of 2 or more developmental disorders. We found significant differences between the poor motor performance of the severe group compared to the other two groups. Longitudinal analyses revealed stable, persistent and lower motor competence for the severe group. The rate of change in motor proficiency for the typical and severe groups was similar. However, the group with moderate motor difficulties gained on average more points per week compared to the typical group and achieved motor scores in the typically developing range over time.ConclusionsThis is one of the first studies to compare the characteristics and rate of motor progression of children with and without DCD using different motor proficiency cut off scores. The children with severe motor coordination difficulties progressed at the same rate as typically developing peers but remained in the severe group over time, whereas the children with moderate motor coordination difficulties caught up to TDC. The results indicate that different intervention may be required according to the nature and severity of the characteristics in both the motor and non-motor domains of children with DCD.     

Role of the striatum and the cerebellum in motor skill acquisition

Motor skill acquisition was investigated in patients with Parkinson's disease (PD) or cerebellar dysfunction using two sensory-guided tracking tasks. The subjects had to learn to track a visual target (a square) on a computer screen by moving a joystick under two different conditions. In the unreversed task, the horizontal target movements were semi-predictable and could be anticipated. In the reversed task, the horizontal movements of a pointer which had to be kept within the target square were mirror-reversed to the joystick movements. PD patients showed intact learning of the semi-predictable task and reduced learning of the mirror-reversed task; patients with cerebellar dysfunction showed the opposite pattern. These findings are discussed in relation to the differential contribution of the cerebellum and the striatum to motor skill acquisition: the cerebellum appears to participate in the implementation of anticipatory movements, whereas the striatum may be critically involved in types of motor learning which require a high degree of internal elaboration.     

Role of the striatum and the cerebellum in motor skill acquisition

Motor skill acquisition was investigated in patients with Parkinson's disease (PD) or cerebellar dysfunction using two sensory-guided tracking tasks. The subjects had to learn to track a visual target (a square) on a computer screen by moving a joystick under two different conditions. In the unreversed task, the horizontal target movements were semi-predictable and could be anticipated. In the reversed task, the horizontal movements of a pointer which had to be kept within the target square were mirror-reversed to the joystick movements. PD patients showed intact learning of the semi-predictable task and reduced learning of the mirror-reversed task; patients with cerebellar dysfunction showed the opposite pattern. These findings are discussed in relation to the differential contribution of the cerebellum and the striatum to motor skill acquisition: the cerebellum appears to participate in the implementation of anticipatory movements, whereas the striatum may be critically involved in types of motor learning which require a high degree of internal elaboration.     

Online corrections in children with and without DCD

Human arm movements need 'online' corrections due to noise in perception and action. A Step-Perturbation paradigm explored online corrections in control children and children with DCD aged between 7 and 13 years. Control children found the task straightforward: a distracter had no effect and they managed to stop relatively quickly. Children with DCD found the task difficult and the apparatus was modified accordingly (decreased postural and force production demands). The distracter affected some children with DCD and some found it difficult to stop. All of the DCD population showed poorer performance in both the perturbation and non-perturbation condition. Nevertheless, there was no interaction between group and condition. Thus, this study found no evidence for specific deficits in online correction mechanisms in DCD. We suggest that: (i) fundamental problems in generating basic movements can account for the documented difficulties in correcting on-going movements, and (ii) such fundamental difficulties make it very difficult to pinpoint specific mechanism deficits.     

Motor imagery during action observation enhances imitation of everyday rhythmical actions in children with and without developmental coordination disorder

Children with developmental coordination disorder (DCD) exhibit deficits both in imitation and motor imagery (MI) compared to typically developing children. Combined action observation and motor imagery (AO + MI) instructions can however enhance automatic imitation in both groups. In the present study we investigated the effects of AO + MI instructions on intentional imitation in children both with (n = 13) and without DCD (n = 12). On each trial participants observed and/or imagined before executing a familiar rhythmical pantomime action. These target actions were either habitually fast (tooth brushing or window wiping) or habitually slow (paint brushing or face washing), in the vertical or horizontal plane. Within each habitual speed, the target action speed was subtly manipulated across trials (fast vs. slow). Instruction condition was manipulated across three blocks of 16 trials: (1) observe before imitating the target action; (2) observe then imagine the action before imitating; (3) observe while imagining the same action before imitating (AO + MI). Kinematic analyses revealed typically developing children imitated the observed cycle times significantly better than children with DCD. A main effect of instruction showed imitation improved for AO + MI compared to the other two instructions. Within-group analyses found a significant advantage in DCD for AO + MI compared to observe then imagine. In typically developing children, imitation was significantly enhanced for AO + MI compared to observe then imitate. Combined AO + MI instructions therefore represent a promising new approach to refining performance of everyday rhythmical actions in children both with and without DCD, with implications for movement therapy and sports training.