Relations between gross motor skills and executive functions, controlling for the role of information processing and lapses of attention in 8-10 year old children

Motor skills and neurological soft signs: Are they only clinical differences or reflection of distinct etiopathogenesis in tic disorder and primary stereotypic movement disorder?

BACKGROUND

While tic disorders and stereotypic movement disorder are commonly comorbid in pediatric clinics, their clinical and etiological differences remain poorly understood.

OBJECTIVES

We aimed to investigate the clinical features that differentiate between tic disorders and primary stereotypic movement disorder by evaluating neurological soft signs and motor skills.

METHODS

The Kiddie-Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version DSM-5 and Sociodemographic and Clinical Data Form were administered to the children. The clinician completed Yale Global Tic Severity Scale, Repetitive Behavior Scale-Revised and Neurological Evaluation Scale. Nine-Hole Peg Test was used for fine motor skills, 1-Minute Sit-to-Stand Test for gross motor skills, Flamingo Balance Test for static balance, Finger-to-Nose Test for bilateral coordination. Parents completed the Conners Parent Rating Scale-Revised Short Form and the Revised Developmental Coordination Disorder Questionnaire.

RESULTS

Our sample consisted of 20 tic disorders, 20 primary stereotypic movement disorder, 13 attention deficit hyperactivity disorder patients, and 20 healthy controls. Sequencing of the complex motor acts scores of Neurological Evaluation Scale were significantly higher in the primary stereotypy group than in healthy controls. The primary stereotypy group demonstrated significantly lower dominant hand performance on the Nine-Hole Peg Test than the tic group. Children with stereotypy had significantly lower scores of 1-min sit-to-stand test; higher total and subscale scores of Revised Developmental Coordination Disorder Questionnaire. and higher developmental coordination disorder risk than healthy controls.

CONCLUSIONS

Our findings offer valuable insights into the distinct etiopathogenesis of tic disorders and primary stereotypic movement disorder, providing a foundation for future neurobiological research.

Motor activities and executive functions in early adolescence after hypothermia-treated neonatal hypoxic-ischemic encephalopathy

AIM

To explore the relationship between motor activities and executive functions (EF) in children (aged 10-12 years) with a history of neonatal hypothermia-treated hypoxic-ischemic encephalopathy (HIE).

MATERIAL AND METHODS

Forty-five children (mean age 11 years) with a history of neonatal hypothermia-treated HIE in Stockholm (2007-2009) were included in this cross-sectional study. The children were assessed with Movement Assessment Battery for Children-2 (MABC-2) and Wechsler Intelligence Scale for Children-V (WISC-V). Their parents completed Behavior Rating Inventory of Executive Function-2 (BRIEF-2), Five to Fifteen-R, and MABC-2 Checklist.

RESULTS

Associations between motor capacity and EF, specifically Processing Speed, Working Memory, Flexibility, and Inhibition, were detected. Children scoring below the 15th percentile on MABC-2 had weaker EF, evident in Cognitive Proficiency Index from WISC-V (t43 = 2.515, p = 0.016) and a higher mean Global Executive Composition Score from BRIEF-2 (t43 = -2.890, p = 0.006). Children with stronger EF exhibited better motor capacity. Parental questionnaires indicated everyday difficulties in 52% of the children.

CONCLUSIONS

Weaker EF were associated with difficulties in motor activities in early adolescence following hypothermia-treated HIE. These results highlight the importance of evaluating both motor activities and EF to understand children's everyday challenges.

Effect of goal-directed perceptual-motor exercise on children with specific learning difficulties: a randomized controlled trial

BACKGROUND

Although perceptual interventions focus on sensory and cognitive skills, they significantly enhance the effectiveness of motor interventions by improving coordination, decision-making, and overall engagement in physical activities. A comprehensive literature review has demonstrated that incorporating perceptual interventions into motor exercises is beneficial. While there are several treatment strategies for SLD-diagnosed children, the potential role of goal-directed perceptual-motor exercises has not been studied. This study examined the effectiveness of goal-directed perceptual-motor training on attention, motor skills, and quality of life in children with Specific Learning Disorder (SLD).

METHODS

This was a randomized clinical study with 38 children diagnosed with SLD between September 2021 and April 2022. The control group (n = 19) received a standard intervention protocol, and the intervention group (n = 19) additionally received a perceptual-motor training program. Bourdon Attention Test, the Bruininks-Oseretsky Test 2-Short Form (BOT2- SF), and the Pediatric Quality of Life Inventory (PEDSQL) were used as outcome measures.

RESULTS

The intervention significantly improved attention, fine and gross motor skills, and life quality as evidenced by the within- and between-group comparisons at the end of therapy.

CONCLUSIONS

Goal-directed perceptual-motor physical training with cognitive aspects may enhance academic performance, social participation, and life quality for children with SLD by improving basic motor skills. Therefore, the inclusion of physical and task-specific perceptual-motor exercises in educational programs may offer several avenues for cognitive skill development in SLD children.

TRIAL REGISTRATION

The protocol is retrospectively registered with http://clinicaltrials.gov/ (16/August/2023, Clinical Trial, NCT05998083).

Physical Fitness, Executive Functions, and Academic Performance in Children and Youth: A Cross-Sectional Study

The aim of this cross-sectional study was to investigate the relationship between physical fitness, executive function, and academic performance in children and adolescents. A total of 131 students (49% female) aged 10-15 years from a public school in Rio de Janeiro were assessed in executive functions (hearts and flowers, Corsi's block, and digit span tasks), academic performance (Portuguese, reading, math, and overall school grade), physical tests (touch test disc, agility, lower limb and upper limb explosive strength), and anthropometric measurements. Regression results showed that the composite of sports-related fitness measures was the best predictor of executive functions (β = 0.472; t = -6.075 p < 0.001). Decision tree classifier analysis showed that the combination of factors that discriminated better and worse executive function groups were better performance in hand-eye coordination (TTD), math, and upper limb strength (ULEST). Sports-related fitness is significantly correlated with executive function. Hand-eye motor coordination has been identified as the most important predictor of improved cognitive outcomes, surpassing even academic skills. These findings should be considered in the design of physical activity programs in school settings, which may have a positive impact on child development, reflected in the reduction of academic and socioeconomic disparities.

PASS Theory and Movement Disorders: Methodology for Assessment and Intervention

BACKGROUND/OBJECTIVES

Executive dysfunction appears to be a significant secondary characteristic frequently linked with movement disorders. Planning is a high-level cognitive process integral to our executive functions. Children who show deficits in their planning ability usually have difficulties in making decisions or problem-solving, such as initiating tasks or mentally organizing a project, and monitoring and controlling their behavior effectively. These difficulties can significantly impact their academic performance and daily functioning even in adulthood. However, the existing research on the relationships between motor performance and planning abilities is limited and inconsistent.

METHODS

This study aimed to explore the potential associations between motor and planning skills in 30 preschool-aged children with Developmental Coordination Disorder (DCD) and 30 healthy controls matched for age, including utilizing the PASS theory and Cognitive Assessment System (CAS).

RESULTS

The findings highlighted balance, total motor score, and planned codes as the primary factors distinguishing the two groups. A significant Pearson's correlation was observed between the overall MABC-2 scores and the subdomain scores, along with the Planning Scale indices for both groups, suggesting a substantial relationship between these assessments. Among the Planned codes items, the most notable predictor of overall motor performance in children was identified. Furthermore, the total score for Planned Connections emerged as the most robust predictor for tasks associated with manual dexterity.

CONCLUSIONS

The relationship between motor skills and executive functions in early childhood plays a vital role in the development of early intervention strategies that utilize cognitive-motor tools.

Associations Between Motor Competence and Executive Functions in Children and Adolescents: A Systematic Review and Meta-analysis

BACKGROUND

Motor competence and executive functions co-develop throughout childhood and adolescence, and there is emerging evidence that improvements in motor competence may have cognitive benefits in these populations. There is a need to provide a quantitative synthesis of the cross-sectional, longitudinal and experimental studies that have examined the association between motor competence and executive functions in school-aged youth.

OBJECTIVES

The primary aim of our systematic review was to synthesise evidence of the association between motor competence and executive functions in school-aged children and adolescents (5-18 years). Our secondary aim was to examine key moderators of this association.

METHODS

We searched the PubMed, PsycINFO, Scopus, Ovid MEDLINE, SPORTDiscus and EMBASE databases from inception up to 27 June 2023. We included cross-sectional, longitudinal and experimental studies that assessed the association between motor competence (e.g., general motor competence, locomotor skills, object control skills and stability skills) and executive functions (e.g., general executive functions, inhibition, working memory and cognitive flexibility) in children and adolescents aged 5-18 years.

RESULTS

In total, 12,117 records were screened for eligibility, and 44 studies were included. From the 44 included studies, we meta-analysed 37 studies with 251 effect sizes using a structural equation modelling approach in the statistical program R. We found a small positive association (r = 0.18, [95% confidence interval (CI) 0.13-0.22]) between motor competence and executive functions. The positive associations were observed in cross-sectional (r = 0.17, [95% CI 0.13-0.22]), longitudinal (r = 0.15, [95% CI 0.03-0.28]) and experimental studies (r = 0.25, [95% CI 0.01-0.45]). We also found that general motor competence (r = 0.25, [95% CI 0.18-0.33]), locomotor (r = 0.15, [95% CI 0.09-0.21]), object control (r = 0.14, [95% CI 0.08-0.20]) and stability (r = 0.14, [95% CI 0.08-0.20]) skills were associated with executive functions. We did not find any moderating effects for participants' age on the associations between motor competence and executive functions.

CONCLUSIONS

Our findings suggest a small-to-moderate positive association between motor competence and executive functions in children and adolescents. The small number of experimental studies included in this review support the assertion that interventions targeting children's motor competence may be a promising strategy to improve their executive functions; however, more research is needed to confirm these findings. Future studies should explore the underlying mechanisms linking motor competence and executive functions as their comprehension may be used to optimise future intervention design and delivery.

PROSPERO REGISTRATION

CRD42021285134.

Associations Between Object Control Skills and Cognitive Functions in Boys, Younger and Older Men: Across-Sectional Study

Purpose: This study aimed to explore the association of cognitive function and process- as well product-oriented outcomes of object control skills (OCS) in boys, younger and older men. Methods: A total of 77 male participants took part in this study, including 35 primary school children (9.04 ± 0.53 years), 22 younger adults (23.5 ± 2.34 years), and 20 older adults (69.5 ± 4.43 years). We assessed the process-oriented performance of throwing, kicking, and catching performance using the component approach. For the product-oriented performance, throwing and kicking velocity was recorded with a STALKER SOLO 2.0 radar gun. For catching, the number of caught balls was assessed. Cognitive function was evaluated using the Trail-Making-Test (TMT) one day later. Results: Younger adults performed better in both domains than the other two groups. The results of the children and older adults were comparable in the motor and cognitive domains. However, the older adults yielded significantly better results for the process-oriented catching and product-oriented throwing performances. Moderate to strong correlations exist between OCS- and TMT performance, with significant correlations predominantly between product-oriented OCS results and TMT in children. Conclusion: The results of both domains support a hypothetical lifespan developmental trajectory with a progression from childhood to younger adult age and a degression in older adults. Furthermore, our results suggest that the suspected relationship between motor and cognitive function depends on age, the analyzed cognitive and motor skills, and the applied methodological approach (process-oriented vs. product-oriented).

Association between motor skills and executive function of children with autism spectrum disorder in Taiwan and the United States

Objective

The purpose of this study was to examine the relationship between parent ratings of motor skills and executive function (EF) in children with autism spectrum disorder (ASD) in the United States and Taiwan.

Materials and method

One hundred and seventy-two parents/legal guardians of children (4-6 years and 11 months old) with ASD were recruited from two countries, Taiwan (n = 100) and the United States (n = 72). The parents or guardians of the child with ASD completed a questionnaire including demographic information, child's motor skills (using Children Activity Scale - Parents, ChAS-P), and child's EF (using Childhood Executive Functioning Inventory, CHEXI). A series of hierarchical multiple regressions were conducted to determine whether ChAS-P (total motor score, fine motor skills, and gross motor skill) was associated with CHEXI (total EF score, working memory, and inhibition), after controlling for covariates (i.e., age, gender, race, body mass index, whether children received physical activity or cognitive training, parental education level).

Results

Total motor skills, fine motor skills, and gross motor skills were significantly associated with EF in both working memory and inhibition as rated by parents in both countries (β = 0.21-0.57, p < 0.01), with the exception of a non-significant association between parent-rated total motor skills, fine motor skills, and gross motor skills, and inhibition among Taiwanese children with ASD. In addition, the associations between parent ratings of motor skills (i.e., fine motor and gross motor skills) and EF (i.e., working memory and inhibition) were similar between the two countries.

Conclusion

Positive associations with specific aspects of parent ratings of fine motor and gross motor skills and working memory and inhibition were found in children with ASD from both countries. These findings have implications for future interventions and programs focused on improving early motor skills and EF development for young children with ASD from Taiwan and the United States.

Physical activity in relation to motor performance, exercise capacity, sports participation, parental perceptions, and overprotection in school aged children with a critical congenital heart defect

OBJECTIVE

To depict objectively measured moderate-to-vigorous physical activity (MVPA), motor performance (MP), cardiorespiratory fitness (CRF), organized sports participation, parental perceptions of vulnerability and parenting style in children with a Critical Congenital Heart Disease (CCHD), and to explore whether these factors are associated with MVPA.

STUDY DESIGN

A prospective observational cohort study in 62 7-10 years old children with a CCHD.

RESULTS

On average, children with CCHD spent 64 min on MVPA per day (accelerometry), 61 % met the international WHO physical activity guideline. Only 12 % had >60 min of MVPA daily. Eighteen percent had a motor delay (movement-assessment-battery-for children-II) and 38 % showed a below average CRF (cardiopulmonary exercise test using the Godfrey ramp protocol). Seventy-seven percent participated in organized sports activities at least once a week. Twenty-one percent of the parents are classified as overprotective (parent protection scale) and 7.3 % consider their child as being vulnerable (child vulnerability scale). A significant positive association was found between MVPA and MP (rs = 0.359), CRF(V̇O2peak/ml/kg: rs = 0.472 and Wpeak/kg: rs = 0.396) and sports participation (rs = 0.286). Children who were perceived as vulnerable by their parents showed a significantly lower MVPA (rs = -0.302). No significant associations were found between mean MVPA and parental overprotection.

CONCLUSION

Even though the majority of school aged children with a CCHD is sufficiently active, counseling parents regarding the importance of sufficient MVPA and sports participation, especially in parents who consider their child being vulnerable, could be useful. Since motor delays can be detected at an early age, motor development could be an important target to improve exercise capacity and sports participation to prevent inactivity in children with a CCHD.

Unimodal versus bimodal auditory stimulation in inner ear malformations: Cognitive, language, and motor performance

Purpose

New perspectives on rehabilitation options for inner ear malformations have still been studied in the literature. This study investigated the cognitive, language, and motor skills of auditory brainstem implant (ABI) users in unimodal and bimodal groups.

Methods

The motor competency of the participants was assessed with Bruininks-Oseretsky Motor Proficiency Test-2 Short Form (BOT2 SF). Language performance was evaluated by the test of Early Language Development-3 and Speech Intelligibility Rating. Word identification, sentence recognition tests, and Categories of Auditory Performance were used to assess auditory perception skills. To examine the cognitive performance, Cancellation Test and Gesell Copy Form were administered. All the tests were conducted in a quiet environment without any distractions.

Results

The participants were divided into two groups: (1) 17 children in the unimodal group and (2) 11 children in the bimodal (who used a cochlear implant on one side and ABI on the other side) group. There were significant correlations between the chronological age of participants and BOT2 SF total score, cancellation tests, auditory perception tests, and language performance. Similarly, there were significant correlations between the duration of ABI use and auditory perception tests, language performance, cancellation test, and some BOT2 SF subtests (r = -0.47 to -0.60, p < .001). There was no significant difference between the unimodal and bimodal groups in any task (p > .05). However, there were moderate-to-strong correlations among the auditory perception tests, cancellation test, language test, and BOT2 SF total score and subtests (r = 0.40 to 0.55, p < .05).

Conclusion

Although there were no significant differences between bimodal and unimodal groups, a holistic approach, which indicates that hearing and balance issues can have broader impacts on a person's physical, emotional, social, and psychological aspects, should be used in the assessment process.

Level of Evidence

Level 4.

Associations between Executive Functions and Sensorimotor Performance in Children at Risk for Learning Disabilities

Executive functions (EF) and sensorimotor skills play a critical role in children's goal-directed behavior and school readiness. The aim of the current study is to provide new insights into the relationship between executive functions and sensorimotor development by considering the risks associated with learning difficulties. Therefore, we investigate the predictive role of EF and sensorimotor skills in the development of learning difficulties during preschool years. Ninety-five preschool children (5-7 years old) were tested, comparing the performance of children that are at risk of learning difficulties (n = 55) to the performance of typically developing children (n = 40). Participants completed a battery for the assessment of sensorimotor skills (i.e., Southern California Sensory Integration Test: postural imitation, body midline crossing, bilateral motor coordination, and standing balance with eyes open) and executive functions (i.e., inhibition, cognitive flexibility, and verbal working memory). Our results show that children at risk for learning difficulties exhibited more impairments on sensorimotor and EF measures (inhibition and verbal working memory) when compared with TD children. We ran three separate binary logistic regression analyses to assess the relative influence of EF and sensorimotor functions on predicting risk for learning difficulties. Our findings demonstrated that verbal working memory as EF function (odd ratio (OR) = 0.91, 95% CI 0.78-0.91, P = 0.05) and standing balance skills as a sensorimotor skill (odd ratio (OR) = 0.86, 95% CI 0.81-0.98, P = 0.01) were the strongest predictors of risk for learning difficulties. The findings point to the importance of supporting children's executive function development and promoting sensorimotor development, as both fundamentally influence school readiness.

Long-Term Follow-Up of Daily Life Functioning After Pediatric Intensive Care Unit Admission

OBJECTIVE

To investigate the long-term impact of pediatric intensive care unit (PICU) admission on daily life functioning while exploring the potential mediating role of neurocognitive outcome.

STUDY DESIGN

This cross-sectional observational study compared children aged 6-12 years with previous PICU admission (age ≤1 year) for bronchiolitis requiring mechanical ventilation ("patient group," n = 65) to demographically comparable healthy peers ("control group," n = 76). The patient group was selected because bronchiolitis is not expected to affect neurocognitive functioning in itself. Assessed daily life outcome domains were behavioral and emotional functioning, academic performance, and health-related quality of life (QoL). The role of neurocognitive outcomes in the relationship between PICU admission and daily life functioning was assessed by mediation analysis.

RESULTS

The patient group did not differ from the control group regarding behavioral and emotional functioning but performed poorer on academic performance and school-related QoL (Ps ≤ .04, d = -0.48 to -0.26). Within the patient group, lower full-scale IQ (FSIQ) was associated with poorer academic performance and school-related QoL (Ps ≤ .02). Poorer verbal memory was associated with poorer spelling performance (P = .002). FSIQ mediated the observed effects of PICU admission on reading comprehension and arithmetic performance.

CONCLUSIONS

Children admitted to the PICU are at risk for long-term adverse daily life outcomes in terms of academic performance and school-related QoL. Findings suggest that lower intelligence may contribute to academic difficulties after PICU admission. Findings underline the importance of monitoring daily life and neurocognitive functioning after PICU admission.

Predicting Cyberbullying Perpetration in US Elementary School Children

Cyberbullying has emerged as a societal issue, and the majority of the research examining cyberbullying perpetration samples adolescent and/or emerging adult populations. A paucity of empirical attention has focused on young children (aged 8-10) regarding their cyberbullying frequency and predictors. The current study sampled 142 US youth aged 8-10 years and assessed their cyberbullying perpetration rate and cellular phone ownership. Results indicated that (a) older participants were more likely to cyberbully than their younger peers; (b) higher rates of cyberbullying were found for youth who already owned a cellular phone; and (c) an interaction between participant age and cellular phone ownership was found, suggesting that cyberbullying was highest for only the 10-year-old group who owned a cellular phone. These findings have implications for (a) parents, school administrators, health care providers, and anyone else interested in better understanding the predictors of cyberbullying perpetration; (b) intervention specialists focused on reducing cyberbullying in youth; and (c) a researcher interested in understanding the basic theoretical underpinnings of cyberbullying. Based on these findings, we recommend that (a) cyberbullying interventions be administered to youth as early as elementary school; (b) parents/guardians carefully consider the positive and negative consequences of youth cellular phone usage; and (c) increased communication between youth and parents/guardians concerning youth cellular phone activities.

The mediating role of neurocognitive functions in the relation between physical competencies and academic achievement of primary school children

Previous studies into associations between physical, neurocognitive and academic skills have reported inconsistent results. This study aimed to get more insight into these relations by examining all three domains simultaneously, testing a complete mediational model including measures of physical competencies (cardiovascular fitness and motor skills), neurocognitive skills (attention, information processing, and core executive functions), and academic achievement (reading, mathematics, and spelling). Dutch primary school students (n = 891, 440 boys, mean age 9.17 years) were assessed on the Shuttle Run Test (cardiovascular fitness), items of the Körperkoordinationstest für Kinder and Bruininks-Oseretsky Test-II (fundamental motor skills), computerized neurocognitive tests, and standardized academic achievement tests. A multilevel structural equation model showed that physical competencies were only indirectly related to academic achievement, via specific neurocognitive functions depending on the academic domain involved. Results provide important implications, highlighting the importance of well-developed physical competencies in children.

The Impact of Gross Motor Skills on the Development of Emotion Understanding in Children Aged 3-6 Years: The Mediation Role of Executive Functions

This study investigates the impact of gross motor skills on the development of emotion understanding and the role of executive function in the relation between gross motor skills and emotion understanding. A total of 662 children were tested for gross motor skills, emotion understanding, and executive function. Regression analysis showed that gross motor skills were significantly related to executive function. Multiple regression analyses showed that gross motor skills and executive function were significant predictors for emotion understanding. Furthermore, mediation analysis showed that executive function mediated the impact of gross motor skills on emotion understanding. Gross motor skills contributed to emotion understanding by improving children's executive function. The findings imply that a pathway from gross motor skills to emotion understanding is mediated by executive function, which offers a novel perspective on the developmental mechanisms of children's emotion understanding.

Aerobic fitness and fine motor skills are related to switching and updating in typically developing children

Movement is essential for everyday life and closely related to cognitive skills. The aim of the current research was to investigate whether different aspects of physical activity, i.e., aerobic fitness and motor skills, contribute above and beyond each other to the variance in children's executive functioning. Children aged 8-13 years (N = 129, 58 females, M_age = 10.7 years, SD_age = 1.6 years) participated in the current cross-sectional study. Aerobic fitness was assessed by the Progressive Aerobic Cardiovascular Endurance Run (PACER). Motor skills were assessed using the standardized Movement Assessment Battery for Children 2nd edition (M-ABC-2), including fine motor skills, balance skills, and object control. Components of executive functions (inhibition, switching, updating) were assessed using the following tasks: an animal Stroop task, a local-global task, and a 2n-back task. Hierarchical regressions were conducted to analyze the relative importance of aerobic fitness and motor skills for children's executive functions. Results indicated that aerobic fitness and fine motor skills were significantly related to switching and updating, whereas relations to inhibition were non-significant. Furthermore, it was found that fine motor skills explained additional variance above aerobic fitness in switching and updating whereas aerobic fitness did not add additional variance above fine motor skills in switching and updating. Balance and object control skills were not related to the three core executive functions. Results support the notion that aerobic fitness and fine motor skills are differently related to executive functions and highlight the importance of considering multiple components of constructs in future research.

Sex differences on the relation among gross motor competence, cognition, and academic achievement in children

An association between gross motor competence (GMC) and academic achievement (AA) has been described, but the potential mechanisms behind this association are still unknown. It is not known either whether these mechanisms are similar for boys and girls. The aim of this study was to analyse whether the association between GMC and AA is mediated by executive functions (EFs), and to investigate whether this mediation differs by sex. This cross-sectional study involved 451 children aged 8 to 10 (234 girls; mean age 9.95 ± 0.59). The Movement Assessment Battery for Children-Second Edition (MABC-2), NIH Toolbox, and grades in language and mathematics were used to test GMC, EFs, and AA, respectively. Multifactorial structural equation model (SEM) was used to evaluate a possible relation between variables, controlling for confounders. The differences by sex were examined using a multi-group SEM approach. The results showed that EFs acted as a full mediator of the relationship between GMC and AA in boys (β = 0.14, p = 0.012) but not in girls (β = 0.10, p = 0.326). These results show that the benefit of GMC on AA is mediated by EFs in boys but not in girls. Nevertheless, these conclusions should be carefully considered due to the cross-sectional nature of the study.

Early Determinants of Adverse Motor Outcomes in Preschool Children with a Critical Congenital Heart Defect

Neurodevelopmental disabilities are common in infants with critical congenital heart disease (CCHD). A prospective, longitudinal cohort study was conducted to establish the prevalence and early determinants of adverse motor outcomes in infants who underwent cardiac surgery with cardiopulmonary bypass before six months of age. Motor development was assessed in 147 preschoolers using the Movement Assessment Battery for children-II. Although the majority displayed an average motor development, 22% of preschool children with CCHD deteriorated in their motor developmental score compared to their previous assessment at 18 months, especially in those with an aortic arch anomaly (AAA) (35%). Individual stability over time appeared to be moderate and the number of children with a motor delay increased, up to 20% in children with AAA. Motor development up to 42 months was best predicted by gestational age, cardio pulmonary bypass time, aortic cross clamp time, number of heart catheterizations up to 18 months and early motor outcomes. The increase in number of preschool children with a motor delay underlines the importance of longitudinal screening of motor skills in children with CCHD at risk for adverse motor outcomes. Offering early interventions may protect their current and future cardiovascular health as motor development is an independent predictor of exercise capacity, physical activity and participation in daily living.

The Directionality of the Relationship Between Executive Functions and Language Skills: A Literature Review

It has been demonstrated that executive functions play a significant role in different aspects of the development of children. Development of language is also one of the most important accomplishments of the preschool years, and it has been linked to many outcomes in life. Despite substantial research demonstrating the association between executive function and language development in childhood, only a handful of studies have examined the direction of the developmental pathways between EF skills and language skills, therefore little is known about how these two constructs are connected. In this review paper, we discuss three possible directional relationships between EFs and language development throughout childhood. First, we discuss how EF might affect language functioning. Next, we discuss how language functioning might affect EF. Lastly, we consider other possible relationships between EF and language. Given that children with better EF and language skills are more likely to succeed in educational settings and demonstrate greater social–emotional competencies, investigating the relationship between EF and language in the preschool period provides insight into mechanisms that have not been extensively studied. Furthermore, it could create new opportunities for designing effective and efficient interventions aimed at addressing EF and language deficits during the preschool period which could in turn influence later development.

Gross motor coordination and their relationship with body mass and physical activity level during growth in Children aged 8-11 years old: a longitudinal and allometric approach

Background

Gross motor coordination (GMC) is fundamental to the harmonious development of physical skills during the growth of children. This research aimed to explore the developmental changes in GMC during childhood, having controlled for the differences in children's body size and shape using a longitudinal, allometric scaling methodology.

Methods

A total of 104 children from North-East Italy of third-fourth- and fifth-grade students and each participant were tested for three consequently years. Subjects performed the short version of korperkoordinationstest fur kinder (KTK3) and the anthropometric characteristics were simultaneously collected. The physical activity questionnaire (PAQ-C) was used to evaluate the weekly physical engagement.

Results

Ontogenetic multiplicative models suggested nonlinear associations with GMC across the children's developmental years. Linear physique was a significant predictor associated with the development of GMC across time. PAQ-C was significantly associated with GMC from 8 to 13 years old.

Conclusion

Growth does not respect linear trends. A greater lean body mass could be assessed as a reliable predictor of GMC in children. The crucial period of life to improve the GMC is 8-10 years, while stabilization becomes evident from 10 to 13 years.

Teacher-Rated Executive Functions, Gender and Relative Age: Independent and Interactive Effects on Observed Fundamental Motor Skills in Kindergarteners

Fundamental motor skills (FMS) of children can be affected by different variables, such as executive functions (EF), gender and relative age. However, the effects of these variables on FMS have been scarce studied, especially in early childhood, and show inconsistent results. To clarify these relationships, this study was carried out. Its aim was to analyze whether EF, gender and relative age influenced FMS in 43 Spanish kindergarteners. A multimethod and mixed methods approach was used. Kindergarteners' teachers completed the Childhood Executive Functioning Inventory to know the children level of EF (working memory and inhibition control). Kindergarteners' parents complimented ad hoc questionnaire reporting the children gender and birth data (to know their relative age). A Nomothetic/Punctual/Multidimensional observational design was used to observe children FMS in their habitual motor sessions at school. Two-way ANOVAs were performed to know the independent and interactive effects of working memory level (lower/higher), inhibition control level (lower/higher), gender (boys/girls) and relative age (according to the birth semester in the year) on FMS. Results showed these variables have independent and interactive effects on some FMS, but not on others. FMS influenced by these variables vary depending what independent variable(s) is/are considered. Therefore, it can be concluded that the influences of teacher-rated EF, gender and relative age on observed FMS in kindergarteners are complex and specific. Results obtained must be taken into to design and implement instructional and intervention strategies, as well as educational and sport policy changes, especially in early childhood, when FMS are more malleable.

Does Physical Activity Improve Cognition and Academic Performance in Children? A Systematic Review of Randomized Controlled Trials

INTRODUCTION

In the last decades, different studies have investigated the effects of exercise or physical activity (PA) on cognitive functions and academic performance in children and adolescents. But given the inconsistencies regarding methodologies and the fact that many studies do not have controlled or randomized designs, a more recent review is needed in order to summarize the different outcomes and methodologies employed and correlate them from an applied perspective.

OBJECTIVES

The purpose of the present review is to systematically review and analyze the effects of acute and chronic PA interventions exclusively from randomized controlled trials (RCTs) on cognitive functions and academic performance of children and adolescents.

METHODS

A literature search was conducted using MEDLINE (via PubMed), EMBASE, Web of Science, and PsycINFO databases for all RCTs published between January 2014 and July 2020. Authors searched these databases using controlled vocabularies, keywords, and Boolean logic, and data were later extracted from the studies. Effect sizes were calculated based on means and SDs at posttest using Hedge's g formula.

RESULTS

A total of 20 studies met the inclusion criteria. They were assessed for eligibility and later included in the review. Although most of the articles did not show any robust effect size and had significant methodological differences, 80% of the studies analyzed showed positive results, indicating a significant impact of exercise or PA on cognition.

DISCUSSION

Due to the heterogeneity in the design of the interventions and the variables analyzed, most of the studies showed small or medium effect sizes. Studies with big effect size in all variables had in common the fact that they involved team game variations and coordination activities. The combination of physical exertion (high intensity) and cognitive engagement with social interactions seems to have the strongest effect on executive functions. This ecological and attractive model reflects children's typical PA and might represent an ideal model for exercise in this population.

CONCLUSIONS

Although grouping different studies based on PA type, control groups, and comparison treatments is a limitation and results should be interpreted with caution, this review suggests that PA interventions, in particular, team game variations and coordination activities, have positive effects on children's cognitive functions.

Associations of Motor Performance and Executive Functions: Comparing Children with Down Syndrome to Chronological and Mental Age-Matched Controls

Background. Children with Down syndrome (DS) exhibit lower motor and cognitive performance than typically developing children (TD). Although there is a relationship between these two developmental domains, only a few studies have addressed this association in children with DS compared to groups of the same chronological age (CA) or mental age (MA) within one study. This study aimed to fill this research gap. Method and Procedures. The Movement Assessment Battery for Children-2 and the Trail-Making Test was used to assess motor and cognitive performances in 12 children (M = 10.5 ± 10.08) with DS, 12 CA-matched, and 12 MA-matched controls. Results. There are significant group differences in the motor dimension (total test score; p < 0.001, η²_p = 0.734), for processing speed (p < 0.001, η²_p = 0.396), and cognitive flexibility (p < 0.001, η²_p = 0.498). Between TD-CA and both other groups, the differences in the magnitude of correlations for the motor dimension balance are also significant (compared to DS: z = −2.489; p = 0.006, and to TD-MA: z = −3.12; p < 0.001). Conclusions. Our results suggest that the relationships depend on the studied cognitive and motor skills. It seems crucial to select a wide range of tasks for both domains that are as isolated as possible for future studies, to better understand the relationships between cognitive and motor skills in children with DS.

Motor Developmental Delay After Cardiac Surgery in Children With a Critical Congenital Heart Defect: A Systematic Literature Review and Meta-analysis

PURPOSE

To systematically review evidence regarding the severity and prevalence of motor development in children with a critical congenital heart defect (CCHD) without underlying genetic anomalies.

SUMMARY OF KEY POINTS

Twelve percent of all included studies reported abnormal mean motor developmental scores, and 38% reported below average motor scores. Children with single-ventricle physiology, especially those with hypoplastic left heart syndrome, had the highest severity and prevalence of motor delay, particularly at 0 to 12 months. Most included studies did not differentiate between gross and fine motor development, yet gross motor development was more affected.

RECOMMENDATIONS FOR CLINICAL PRACTICE

We recommend clinicians differentiate between the type of heart defect, fine and gross motor development, and the presence of genetic anomalies. Furthermore, increased knowledge about severity and prevalence will enable clinicians to tailor their interventions to prevent motor development delays in CCHD.

The relationship between white matter microstructure, cardiovascular fitness, gross motor skills, and neurocognitive functioning in children

Recent evidence indicates that both cardiovascular fitness and gross motor skill performance are related to enhanced neurocognitive functioning in children by influencing brain structure and functioning. This study investigates the role of white matter microstructure in the relationship of both cardiovascular fitness and gross motor skills with neurocognitive functioning in healthy children. In total 92 children (mean age 9.1 years, range 8.0-10.7) were included in this study. Cardiovascular fitness and gross motor skill performance were assessed using performance-based tests. Neurocognitive functioning was assessed using computerized tests (working memory, inhibition, interference control, information processing, and attention). Diffusion tensor imaging was used in combination with tract-based spatial statistics to assess white matter microstructure as defined by fractional anisotropy (FA), axial and radial diffusivity (AD, RD). The results revealed positive associations of both cardiovascular fitness and gross motor skills with neurocognitive functioning. Information processing and motor response inhibition were associated with FA in a cluster located in the corpus callosum. Within this cluster, higher cardiovascular fitness and better gross motor skills were both associated with greater FA, greater AD, and lower RD. No mediating role was found for FA in the relationship of both cardiovascular fitness and gross motor skills with neurocognitive functioning. The results indicate that cardiovascular fitness and gross motor skills are related to neurocognitive functioning as well as white matter microstructure in children. However, this study provides no evidence for a mediating role of white matter microstructure in these relationships.

Very preterm birth and cognitive control: The mediating roles of motor skills and physical fitness

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Very preterm birth was associated with impaired response inhibition.

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Impaired behavioral performance was linked with decreased P300, but not N200.

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Motor skills fully mediated the association of preterm birth and P300.

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Cardiorespiratory fitness did not contribute to this mediation.

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Improving motor skills might promise the reduction of cognitive control deficits.

The neurophysiological mechanisms underlying executive function deficits in very preterm born children still remain unclear. Moreover, evidence on factors that can be modified by behavior and exert an influence on these deficits is lacking. The present case-control study examined the association between very preterm birth and neurophysiological indices of response inhibition (i.e. the N200-P300 complex) as well as the potential mediation of this association by aspects of physical fitness. 54 children born very preterm completed a submaximal cycling ergometer test and a motor skill test battery. Event-related potentials elicited by a Go/NoGo task were recorded using electroencephalography. Cases were then matched to full-term children (age: 11 ± 0.7 y). A higher error rate on NoGo trials was found in children born very preterm compared to those born full-term. Path-analyses further revealed that very preterm birth was associated with decreased NoGo P300 amplitude. Motor skills, but not aerobic fitness, fully mediated this association. In early adolescence, very preterm birth is associated with less effective recruitment of attentional resources for stimulus evaluation processes. The improvement of motor skills rather than cardiorespiratory fitness appears promising for reducing this specific impairment in cognitive control.

Rhythmic Physical Activity Intervention: Exploring Feasibility and Effectiveness in Improving Motor and Executive Function Skills in Children

Introduction

Increasing literature has emerged investigating the importance of considering the qualitative characteristics of physical activity (PA) interventions and sports as well as considering the role of motor competence in the exercise-cognition interplay. The purpose of this pilot study was to examine the feasibility and effectiveness of a rhythmic PA intervention compared to a standard physical education program, on motor and hot and cool executive function (EF) skills.

Methods

Children ages 6-11 were enrolled in one of the two programs: a rhythmic program (n = 22) and a physical education program (n = 17), both meeting for 30 min, twice per week, for 7 weeks. The rhythmic program emphasized moving to the beat of music and moving in various rhythmic patterns with whole body movements, clapping, and drumsticks. The children also created their own rhythmic patterns and socially engaged with other children by working in pairs and sharing their routines with the group. The physical education group engaged in ball skills, locomotor patterns, team sports, and moving through stations in small groups, with no emphasis on rhythm. Pretest and posttest measurements included measurement of balance (Movement ABC-2), cool and hot EF (Flanker, SWAN), and social factors, whereas throughout the implementation period data on affective valence, enjoyment, cognitive engagement, perceived exertion, and PA levels were collected at every lesson in both groups.

Results

The rhythmic program used in this study was feasible, scalable, affordable, and able to be implemented with minimal preparatory time. Children in both groups (rhythmic and physical education) engaged in a similar level of PA and had similar positive experiences from the programs. Both groups improved in balance and cool EF, and there were significant correlations in the change scores between balance and cool EF, as well as between cool EF with hot EF and socio-emotional factors.

Discussion

This study contributes to the literature by exploring the potential value of rhythmic programs as a vehicle in helping children develop motor and EF skills while deriving joy and positive social interactions from the program.

Relationships between gross motor skills, cardiovascular fitness, and visuospatial working memory-related brain activation in 8- to 10-year-old children

Relationships between gross motor skills and cardiovascular fitness with visuospatial working memory (VSWM) in children are hypothesized to be mediated by underlying functional brain mechanisms. Because there is little experimental evidence to support this mechanism, the present study was designed to investigate the relationships of gross motor skills and cardiovascular fitness with VSWM-related brain activation in 8- to 10-year-old children. Functional magnetic resonance imaging data obtained during a VSWM-task were analyzed for 80 children from grades 3 (47.5%) and 4 of 21 primary schools in the Netherlands (51.3% girls). Gross motor skills (Korper Koordinationstest für Kinder and Bruininks-Oseretsky Test of Motor Proficiency - 2nd Edition) and cardiovascular fitness (20-meter Shuttle Run Test) were assessed. VSWM-related brain activation was found in a network involving the angular gyrus, the superior parietal cortex, and the thalamus; deactivation was found in the inferior and middle temporal gyri. Although behavioral results showed significant relations of gross motor skills and cardiovascular fitness with VSWM performance, gross motor skills and cardiovascular fitness were not related to VSWM-related brain activation. Therefore, we could not confirm the hypothesis that brain activation underlies the relationship of gross motor skills and cardiovascular fitness with VSWM performance. Our results suggest that either the effects of physical activity on cognition do not necessarily go via changes in gross motor skills and/or cardiovascular fitness, or that brain activation patterns as measured with the blood-oxygen-level dependent (BOLD) signal may not be the mechanism underlying the relationships of gross motor skills and cardiovascular fitness with VSWM.

The Role of Executive Functions for Motor Performance in Preschool Children as Compared to Young Adults

Evidence suggests that executive and motor functions are functionally intertwined, with the interrelation between the two processes influenced by the developmental stage of the individual. This study examined executive and motor functions in preschool children (n = 41; 65-83 months), and investigated if, and how, preschoolers cognitive-motor functioning differs from that of young adults (n = 40; 18-31 years), who served as a control group reflecting the upper bound of cognitive-motor development. As expected, performance of young adults was significantly better than that of preschool children for all cognitive and motor domains tested. The results further showed differential associations among, and between, cognitive and motor functions in preschool children when compared to young adults. While similar correlations among motor variables are found in both groups, correlations among executive functions and between executive and motor variables are only found in preschool children. It thus appears that executive functions (especially working memory) contribute more to successful motor performance in preschool years than in young adulthood. The findings highlight the importance of considering the developmental stage and/or the proficiency level of the individual when examining cognitive-motor interactions or when drawing implications for childhood cognitive-motor training and interventions.

Associations of Heart Rate Measures during Physical Education with Academic Performance and Executive Function in Children: A Cross-Sectional Study

The current evidence for a relation between children’s heart rate measures and their academic performance and executive functioning is infancy. Despite several studies observing dose-response effects of physical activity on academic performance and executive function in children, further research using objective measures of the relative intensity of physical activity (e.g., heart rate) is warranted. The present study aimed to inspect associations between heart rate response and various academic performance indicators and executive function domains. A total of 130 schoolchildren between the ages of 9 and 13 years (M = 10.69, SD 0.96 years old; 56.9% boys) participated in a cross-sectional study. Children’s heart rate data were collected through participation in physical education classes using the polar Team^TM hardware and software. One week before heart rate measures, academic performance was obtained from the school records in maths, Spanish language, Catalan language, physical education, and Grade point average. Executive function was measured by two domains, cognitive flexibility with the Trail Making Test and inhibition with the Stroop test. Associations between children’s heart rate data and academic performance and executive function were analyzed using regression models. Academic performance was found to be positively related to four heart rate measures (β range, 0.191 to 0.275; all p < 0.040). Additionally, the hard heart rate intensity level was positively related to two academic indicators (β range, 0.183 to 0.192; all p < 0.044). Three heart rate measures were associated with two cognitive flexibility subdomains (β range, −0.248 to 0.195; all p < 0.043), and three heart rate measures were related to one inhibition subdomain (β range, 0.198 to 0.278; all p < 0.028). The results showed slight associations of heart rate responses during physical education lessons with academic performance but did not clearly indicate associations with executive function. Future experimental studies testing associations between different bouts of intensity levels are needed to disentangle the relationship with brain function during childhood.