http://informahealthcare.com/dre ISSN 0963-8288 print/ISSN 1464-5165 online Disabil Rehabil, Early Online: 1–7 ! 2015 Informa UK Ltd. DOI: 10.3109/09638288.2015.1014067
RESEARCH PAPER
Fundamental movement skills proficiency in children with developmental coordination disorder: does physical self-concept matter? Disabil Rehabil Downloaded from informahealthcare.com by University of Victoria on 02/26/15 For personal use only.
Jie Yu1, Cindy H. P. Sit1, Catherine M. Capio2, Angus Burnett3, Amy S. C. Ha1, and Wendy Y. J. Huang1,4 1
Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, Hong Kong, 2Institute of Human Performance, The University of Hong Kong, Pok Fu Lam, Hong Kong, 3ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar, and 4Department of Physical Education, Hong Kong Baptist University, Kowloon Tong, Hong Kong Abstract
Keywords
Purpose: The purpose of this study was to (1) examine differences in fundamental movement skills (FMS) proficiency, physical self-concept, and physical activity in children with and without developmental coordination disorder (DCD), and (2) determine the association of FMS proficiency with physical self-concept while considering key confounding factors. Method: Participants included 43 children with DCD and 87 age-matched typically developing (TD) children. FMS proficiency was assessed using the Test of Gross Motor Development – second edition. Physical self-concept and physical activity were assessed using self-report questionnaires. A two-way (group by gender) ANCOVA was used to determine whether between-group differences existed in FMS proficiency, physical self-concept, and physical activity after controlling for age and BMI. Partial correlations and hierarchical multiple regression models were used to examine the relationship between FMS proficiency and physical self-concept. Results: Compared with their TD peers, children with DCD displayed less proficiency in various components of FMS and viewed themselves as being less competent in physical coordination, sporting ability, and physical health. Physical coordination was a significant predictor of ability in object control skills. DCD status and gender were significant predictors of FMS proficiency. Conclusions: Future FMS interventions should target children with DCD and girls, and should emphasize improving object control skills proficiency and physical coordination.
Children, developmental coordination disorder, motor skills, physical self-concept History Received 28 July 2014 Revised 26 January 2015 Accepted 28 January 2015 Published online 20 February 2015
ä Implications for Rehabilitation
Children with DCD tend to have not only lower FMS proficiency than age-matched typically developing children but also lower physical self-concept. Self-perceptions of physical coordination by children with DCD are likely to be valuable contributors to development of object control skills. This may then help to develop their confidence in performing motor skills. Children with DCD need supportive programs that facilitate the development of object control skills. Efficacy of training programs may be improved if children experience a greater sense of control and success when performing object control skills.
Introduction Fundamental movement skills (FMS) provide the foundation for developing specialized and context-specific motor skills [1]. FMS are developed in early childhood and consist of locomotor skills (e.g. running and jumping) and object control skills (e.g. throwing and catching). Developing FMS competence is one of the main
Address for correspondence: Cindy H. P. Sit, Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. Tel: +852 3943 4126. Fax: +852 2603 5781. E-mail: [email protected]
physical education curricula in primary school in many cities including Hong Kong [2]. FMS proficiency is critical to help children engage in various forms of movement and children who exhibit high levels of FMS proficiency are less likely to be overweight [3] and are more likely to be physically active [4]. The acquisition of FMS during childhood has also been found to be associated with a lifelong commitment to physical activity [5] and this supports the importance of FMS proficiency in attaining better health. Physical self-concept (i.e. an individual’s perception of his/her own physical competence) is an important correlate of FMS proficiency in children [6]. It has been reported that children with
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higher physical self-concept display better FMS performance (e.g. jumping) than those with lower physical self-concept [7]. The association of physical self-concept with the development of FMS proficiency can be explained by the competence-motivation theory [8]. According to this theory, children can display differences in specific domains of competence (e.g. physical competence) and they are able to make meaningful and accurate judgments about their competence [9]. This theory also posits that children who perceive themselves as physically competent tend to exert greater effort on motor skills and mastery attempts than those who have poor self-perceived physical competence. As part of physical competence, motor coordination plays an important role in more advanced movements [10]. Few studies, however, have considered the impact of low levels of motor coordination on FMS proficiency and physical self-concept in primary school children. Children with poor motor coordination in the absence of any known medical condition or neurological impairments are diagnosed as having developmental coordination disorder (DCD) [11]. The prevalence of DCD has been reported to be approximately 5–6% of school-aged children worldwide [11], with the ratio of boys to girls ranging between 3:1 and 7:1 [12]. It has been believed that DCD provides a useful framework to examine the effects of lower levels of motor coordination in children [7]. As expected, children with DCD have poor performance in motor skills [13]. Compared with their typically developing (TD) peers, children with DCD tend to be more overweight, have higher levels of obesity [14], and are at higher risk of having obesityrelated chronic diseases [15]. They also tend to be less physically active [16], have lower participation rates in both structured physical activity and free play during leisure time [17], and view themselves as less competent with regard to physical abilities [18]. However, there is a paucity of research examining the correlation of FMS proficiency with physical self-concept in children with DCD and their TD peers. Confounding factors such as gender and body mass index (BMI) need to be considered when investigating FMS proficiency and its relationship with physical self-concept in children. It has been reported that girls tend to have poorer FMS proficiency and lower physical self-concept than boys [7,19,20], and that overweight and obese children report poorer motor performance and lower physical self-concept than their non-overweight counterparts [19,21]. Considering that FMS develop as children grow [22], age should also be treated as an influencing factor in the relationship between FMS proficiency and physical selfconcept in children. Additionally, physical activity may act as an influencing factor on FMS proficiency in children. Previous studies have shown a positive association between physical activity and motor skill proficiency in this group [23,24], and this relationship is considered to be reciprocal [4,25]. Children with higher levels of motor skill competence are more likely to participate in physical activity, while increased physical activity provides further opportunities to develop motor skills [26]. More needs to be known about the association of FMS competence with physical self-concept while considering confounding factors. Therefore, using the competence-motivation theory as a theoretical framework, the purpose of this study was (1) to examine significant differences in FMS proficiency, physical selfconcept, and physical activity of children with DCD and a group of aged-matched TD children, and (2) to determine the association of FMS proficiency with physical self-concept in children while considering the effects of confounding factors (i.e. age, gender, BMI, and physical activity). First, we hypothesized that, children with DCD would show poorer FMS proficiency and physical selfconcept, and would be less physically active when compared to
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TD children. Second, FMS proficiency would be positively associated with variables of physical self-concept after controlling for confounding factors.
Methods Participants A total of 312 children aged 7–10 years from local primary schools in Hong Kong were assessed after informed consent was provided by their parents. Using the Diagnostic and Statistical Manual of Mental Disorder – fourth edition, Text Revision diagnostic criteria of DCD [11], 66 of these children were identified at risk for DCD (i.e. at or below the 15th percentile on the Movement Assessment Battery for Children – second edition (MABC-2) [27]. Teachers confirmed difficulties in motor functioning of all children at risk for DCD using the MABC-2 Checklist. A total of 130 children were recruited for follow-up testing. There were 43 (17 girls and 26 boys) children with DCD (mean age 8.12 ± 0.91 years) and 87 (43 girls and 44 boys) TD children (mean age 8.31 ± 1.00 years). No participants had a known health condition that was contraindicated to engagement in physical activity. The study was approved by the University’s Survey and Behavioral Research Ethics Committee. Study design and procedures This study utilized a cross-sectional design. Five research assistants led by the first author, and extensively trained by an experienced physiotherapist, conducted the MABC-2 test and an assessment of FMS proficiency. Children reported their physical self-concept and recalled their physical activity levels during the previous 7 d. BMI was determined from height and weight measurements taken by trained research assistants. Measurements FMS proficiency was assessed using five components of the Test of Gross Motor Development – second edition (TGMD-2) [22]. The TGMD-2 has high internal reliability and validity and has been used in studies involving children with DCD and TD children [28]. The TGMD-2 examines the quality of movement patterns based on a number of qualitative criteria (3–5, depending on the specific skill). The presence or absence of a criterion is scored 1 or 0, yielding a maximum score of 3–5 points per trial. Higher scores indicate better motor skills. In this study, five FMS components (locomotor: running, jumping; object control: catching, kicking and throwing) were assessed, as they have been deemed to be relevant activities for common forms of physical activity in children such as sports and recreation [29]. All FMS assessments were conducted by the trained research assistants during physical education lessons. All assessments were videotaped and post-hoc analysis of these videos by the first author showed good agreement (ICC ¼ 0.86) with the testers’ scores. Physical self-concept was measured using the Physical Self Description Questionnaire (PSDQ) – Chinese version with its 10 subscales: health, coordination, body fat, sporting ability, appearance, strength, flexibility, fitness, self-esteem, and general selfconcept [30,31]. Higher scores represent better physical selfconcept in a specific area. The PSDQ has good internal consistency (median ¼ 0.92) and temporal stability (median r ¼ 0.83 after 3 months) [32]. The Chinese version of the PSDQ has been used in Chinese children aged 7–15 years and has demonstrated good reliability with subscales having Cronbach’s alpha values ranging from 0.67 to 0.92 [31]. In the present study, the internal consistency for the subscales ranged between 0.62 and 0.90. Physical activity was assessed using the Physical Activity Questionnaire for Older Children (PAQ-C) – Chinese version [33],
Fundamental movement skills in children with DCD
DOI: 10.3109/09638288.2015.1014067
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Table 1. Differences on fundamental movement skills proficiency between children with DCD and TD children. DCD group (n ¼ 43) Variable
Mean (SD)
Locomotor skills Runningy Jumping Object control skillsy Catching Kickingy Throwingz
9.18 5.77 3.42 15.89 4.47 6.16 5.26
(3.39) (2.15) (1.93) (2.85) (1.44) (1.25) (1.98)
[95% CI] [8.14, 12.23] [5.10, 6.43] [2.82, 4.01] [15.01, 16.76] [4.02, 4.91] [5.78, 6.55] [4.65, 5.87]
TD group (n ¼ 87) Mean (SD) 11.56 6.79 4.77 17.21 5.06 6.53 5.62
(3.21) (1.59) (2.32) (3.24) (1.21) (1.60) (1.86)
[95% CI]
F
2
[10.88,12.25] [6.46, 7.13] [4.28, 5.26] [16.52, 17.90] [4.80, 5.32] [6.19, 6.87] [5.22, 6.02]
9.08** 5.65* 6.35* 9.01* 6.39** 1.98 3.47
0.068 0.044 0.049 0.008 0.049 0.016 0.027
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DCD, developmental coordination disorder; TD, typically developing; SD, standard deviation; CI, confidence interval. After controlling age and body mass index. Significant gender difference: yp50.05; zp50.01; significant group difference: *p50.05; **p50.01.
which is a 7-day recall, self-report instrument to assess general levels of physical activity in school-aged children. The instrument has nine items and higher means of these values indicate higher levels of physical activity. The PAQ-C has been demonstrated to have good test-retest reliability (males, r ¼ 0.75 and females, r ¼ 0.82), internal consistency ( ¼ 0.89) [33], and convergent validity through moderate correlation with total moderate to vigorous physical activity (r ¼ 0.53) [34]. The PAQ-C has been translated into Chinese to evaluate physical activity in Chinese children including those in Hong Kong [35]. In the present study, the internal consistency of this instrument was 0.80.
(aggregate score of running and jumping; p ¼ 0.003) and object control skills (aggregate score of catching, kicking, and throwing; p ¼ 0.013) (Table 1). Specifically, children with DCD showed significantly poorer FMS proficiency with respect to running (p ¼ 0.019), jumping (p ¼ 0.013), and catching (p ¼ 0.004) than the TD group. When the TD and DCD groups were combined, significant gender differences were found in running (p ¼ 0.015), object control skills (p ¼ 0.018), kicking (p ¼ 0.047), and throwing (p ¼ 0.011), with girls having the lower scores than boys on all these measures. Physical self-concept
Data analysis Descriptive statistics, namely, means, standard deviations, confidence intervals, and standard errors, were obtained for all the variables. Chi-square statistics were used to compare the number of children with DCD and TD children by gender. A group (DCD versus TD) by gender (girls versus boys) factorial analysis of variance was performed to examine whether significant differences existed in age and BMI. A group by gender factorial analysis of covariance was then used to determine differences in FMS proficiency, physical self-concept, and physical activity while controlling for age and BMI. Partial correlations were used to determine the associations of FMS proficiency with physical self-concept and to examine the relationships among variables of physical self-concept. Correlation coefficients between 0.2 and 0.4 were considered weak, 0.4–0.7 as moderate and greater than 0.7 as strong [36]. Finally, hierarchical multiple regression models were used to examine the ability of individual factors (i.e. group and gender), physical activity, and chosen variables of physical self-concept to predict FMS proficiency (i.e. locomotor skills score and object control skills score), after controlling for age and BMI. Preliminary analyses were performed to ensure no violations of the assumptions of normality, linearity, multicollinearity and homoscedasticity were present. All data were analyzed using SPSS 20.0 (SPSS Inc., Chicago, IL) and statistical significance was set at p50.05 for all tests.
Results Demographic data and BMI No significant Chi-square statistics were evident for DCD classification by gender (p40.05). The results revealed a significant group effect in BMI score with the DCD group having a significantly higher BMI than the TD group (p ¼ 0.0001). FMS proficiency Compared with the TD group, children with DCD displayed significantly lower scores in both locomotor skills
Compared with the TD group, children with DCD reported significantly poorer physical self-concept on health (p ¼ 0.004), coordination (p ¼ 0.039), and sporting ability (p ¼ 0.024) (Table 2). A significant gender difference was found for appearance, with girls reporting better appearance than boys (p ¼ 0.004). Physical activity Girls displayed a significantly lower level of physical activity than boys (p ¼ 0.041). As shown in Figure 1, a significant group by gender interaction was found (p ¼ 0.029), with girls with DCD having a significantly lower level of physical activity than the other three groups. Additionally, physical activity was found to be positively correlated with FMS proficiency in children with respect to locomotor skill (r ¼ 0.21, p50.05) and running (r ¼ 0.26, p50.01). Associations of FMS proficiency with physical self-concept As shown in Table 3, proficiency in locomotor skills was positively associated with coordination (p50.05), sporting ability (p50.01), fitness (p50.01), and self-esteem (p50.05). When scores for running and jumping were examined individually, running was positively related to sporting ability (p50.01), strength (p50.05), and self-esteem (p50.05). Jumping was positively associated with sporting ability, fitness, and appearance (all p50.01). In addition, proficiency in object control skills was positively associated with health and coordination (both p50.05). Catching was positively associated with coordination (p50.05), while throwing was positively correlated to coordination, sporting ability, and strength (all p50.05). To avoid the problem of multi-collinearity, only variables (i.e. health, coordination, sporting ability, strength, fitness and selfesteem) that were significantly associated with FMS proficiency were entered into regression models. Prior to entry into the models, correlations between the chosen physical self-concept variables were assessed and inter-correlations of these variables all met the suggested criterion (r50.70) [37].
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Table 2. Differences on physical self-concept between children with DCD and TD children. DCD group (n ¼ 43) Variable
Mean (SD)
Health Coordination Body fat Sporting ability Appearancez Strength Flexibility Fitness Self-esteem General self-concept
4.46 3.96 4.04 3.74 3.86 4.08 4.21 3.61 4.13 4.13
(0.97) (1.30) (1.70) (1.50) (1.25) (1.21) (1.18) (1.44) (1.14) (1.43)
TD group (n ¼ 87)
[95% CI] [4.17, [3.56, [3.51, [3.28, [3.47, [3.71, [3.85, [3.16, [3.78, [3.69,
4.76] 4.36] 4.57] 4.20] 4.24] 4.46] 4.57] 4.05] 4.48] 4.57]
Mean (SD) 4.90 4.64 5.03 4.49 4.08 4.13 4.70 4.12 4.39 4.71
(0.85) (0.95) (1.15) (1.02) (1.09) (0.92) (0.95) (1.10) (0.88) (1.13)
[95% CI] [4.72, [4.44, [4.79, [4.27, [3.85, [3.94, [4.50, [3.89, [4.20, [4.46,
5.08] 4.84] 5.28] 4.70] 4.31] 4.33] 4.90] 4.35] 4.58] 4.95]
F
2
8.10** 4.36* 2.33 5.21* 0.03 0.35 1.67 2.12 1.02 1.43
0.063 0.034 0.018 0.040 0.001 0.003 0.013 0.017 0.008 0.011
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DCD, developmental coordination disorder; TD, typically developing; SD, standard deviation; CI, confidence interval. After controlling age and body mass index. Significant gender difference: zp50.01; significant group difference: *p50.05; **p50.01.
Figure 1. Physical activity between children with DCD and TD children by gender. DCD, developmental coordination disorder; TD, typically developing. *p50.05, compared with girls with DCD.
As shown in Table 4, better locomotor skills proficiency was observed in older children, TD children, and those children with lower BMI. No chosen variables of physical self-concept were found to be significant predictors for locomotor skills proficiency. The final model explained 23.9% of the variance in locomotor skills proficiency. For object control skills proficiency, older children, boys (compared with girls), TD children, and those having higher coordination demonstrated better results. The chosen variables explained 8.3% of the variance; however, only coordination was a significant predictor. The final model predicted 31.3% of the variance.
Discussion The current study found that compared with TD children, children with DCD displayed poorer performance in locomotor skills (including running and jumping) and object control skills (including catching). Children with DCD also viewed themselves as being less competent in their coordination, sporting ability, and health. Consistent with previous research, children with DCD showed less FMS proficiency [13] and reported lower levels of physical self-concept [38], and this was especially in the domains of coordination, sporting ability and health. These findings are in accordance with the competence-motivation theory [9].
Given that children with DCD have poor motor coordination, it is understandable that this group of children is more concerned by their low levels of coordination and sporting ability, as these are pre-requisites for ball games and more complex activities. However, poor physical self-concept has received limited attention in the literature that examines children with DCD. In addition to assessing actual motor skills proficiency, we suggest that physical self-concept of children with DCD should be considered in attempting to understand mechanisms that lead to movement-related behaviors. Understanding physical self-concept is particularly important for professionals who provide supportive programs for children with DCD during their early elementary age as this is when children’s self-perceptions of physical competence emerge. Girls were found to be less proficient in running, kicking, and throwing and less active than boys and this is congruent with the previous findings [39]. This may be attributable to gender norms and high expectations of being physically competent and active for boys rather than girls [26]. Although girls were less competent in FMS and less physically active, they perceived themselves as having better physical appearance than boys. This finding may suggest that girls have more positive perceptions of their aesthetic appearance than their physical ability [19]. It has been previously suggested that impairments in motor abilities may cause restrictions in activities and participation in children including those with DCD [40]. In the present study, girls with DCD were found to be less physically active than boys with DCD and TD girls and boys, and this is consistent with past research [41]. Due to the existence of social norms, DCD has an adverse impact on activity participation, which may result in fewer opportunities in motor skill practice and hence activity deficits may result in girls [17,42]. Although the majority of children with DCD are boys, development of FMS in both boys and girls with DCD should receive attention in rehabilitation efforts. The long-term impact of poor motor proficiency in girls has been recently shown in a 20-year follow-up study, which reported that motor skill proficiency in girls at the age of six was positively related to levels of physical activity when they were young women [43]. There were significant associations between FMS proficiency and some domains of physical self-concept, and this provides further theoretical and empirical evidence relating to the multidimensional approach that should be used to fully understand FMS competence. In particular, physical self-concept relating to coordination was found to be linked to both locomotor skills and object control skills in children. Further, it was a significant predictor of object control skills proficiency. Physical coordination is expected to have an impact on object control skills because such skills require hand-eye coordination [44]. Therefore, the self-perception
Fundamental movement skills in children with DCD
DOI: 10.3109/09638288.2015.1014067
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Table 3. Associations of fundamental movement skills proficiency with physical self-concept (r-values). Locomotor skills
Health Coordination Body fat Sporting ability Appearance Strength Flexibility Fitness Self-esteem General self-concept
Object control skills
Total
Running
Jumping
Total
Catching
Kicking
Throwing
0.10 0.19* 0.13 0.29** 0.14 0.10 0.16 0.26** 0.17* 0.12
0.10 0.16 0.14 0.25** 0.01 0.21** 0.09 0.16 0.18* 0.03
0.06 0.15 0.08 0.22** 0.20** 0.01 0.16 0.25** 0.12 0.15
0.19* 0.21* 0.07 0.10 0.01 0.05 0.10 0.10 0.01 0.04
0.14 0.25** 0.08 0.09 0.03 0.02 0.14 0.10 0.01 0.11
0.08 0.01 0.03 0.09 0.16 0.13 0.01 0.01 0.10 0.07
0.16 0.17* 0.03 0.17* 0.10 0.17* 0.07 0.09 0.05 0.05
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After controlling age and body mass index. *p50.05; **p50.01.
Table 4. Predictors of locomotor skills and object control skills proficiency. Locomotor skills Predictor Step 1 Age BMI Step 2 Group (DCD versus TD) Gender (girls versus boys) Step 3 Physical activity Step 4 Health Coordination Sporting ability Strength Fitness Self-esteem
[95% CI]
R
2
0.089 0.201* 0.239**
[0.12, 1.31] [0.39, 0.07]
0.262** 0.118
[3.19, 0.64] [1.95, 0.33] 0.185
DR
DF
[0.62, [1.01, [0.19, [1.25, [0.40, [0.23,
[95% CI]
6.183** 5.96*** 5.62***
0.071 0.025
3.37***
0.71] 0.61] 1.33] 0.24] 0.97] 1.15]
0.054
R2
F
DR2
DF
0.118
8.54***
0.230
9.32***
0.111
9.03***
0.230
7.40***
0.000
0.001
0.313
4.89***
0.083
2.39*
[0.42, 1.49] [0.01, 0.28]
5.32** 0.265** 0.236**
[2.90, 0.65] [2.49, 0.49]
0.003
[0.68, 0.071]
0.116 0.428** 0.140 0.049 0.058 0.126
[0.18, 0.98] [0.50, 1.92] [1.02, 0.31] [0.80, 0.50] [0.74, 0.45] [1.01, 0.19]
3.74
[0.02, 1.54] 0.239
0.012 0.065 0.206 0.149 0.103 0.131
F
0.294** 0.154 0.160
0.160
Object control skills 2
1.40
BMI, body mass index; DCD, developmental coordination disorder; TD, typically developing; CI, confidence interval; b, standardized coefficients. Group: TD children coded as ‘‘0’’ ¼ reference group; gender: boys coded as ‘‘0’’ ¼ reference group. *p50.05, **p50.01, ***p50.001.
of coordination may be a relevant variable to consider in the development of object control skills. Specifically, if children judge themselves to be well coordinated, they are more likely to engage in object control tasks [45]. Our results underscore the importance of physical self-concept in the development of FMS proficiency in children. We suggest that when children perceive themselves as being less physically competent, the development of their motor skills may be compromised. We could speculate that such low physical selfconcept may hinder performance, and thus the practice of motor skills. Rehabilitation professionals and educators working with children with DCD may consider activities that promote successful movement experiences that support positive physical selfconcept in this group of children. This may then, in turn, cultivate the level of confidence in these children to subsequently perform motor skills. The efficacy of treatment to improve motor skills may then be more effective and sustainable if the program is designed to let children with DCD experience increased success and greater levels of enjoyment. For example, the difficulty of tasks may be manipulated to allow this group of children to experience a greater sense of control, particularly at the commencement of training. However, this notion still needs to be examined in future studies. There was a weak and positive association between locomotor skill proficiency and physical activity in children. Previous research has reported a positive relationship between physical
activity and motor performance in children [23]. However, regression modeling revealed that physical activity was not a significant predictor of FMS (both locomotor and object control skills) proficiency. This is contrary to previous findings which have suggested that active children tend to be more skillful [25]. Additionally, DCD status and gender were significant predictors of FMS proficiency. This suggests that children with DCD need well-designed training programs for FMS proficiency. In particular, interventions should place more emphasis on improving object skills proficiency for both boys and girls, despite the majority of children with DCD being boys. Study limitations This study utilized a cross-sectional design, therefore, cause and effect cannot be determined. Second, small and unequal sample size may underestimate the strength of associations among the variables, and may then lead to a lack of generalizability. Third, FMS were limited to five skills that cannot provide a more comprehensive representation of FMS proficiency. Fourth, physical activity assessment was based on a self-report instrument thus there may be possibility of recall error.
Conclusions To our best knowledge, this is the first study to examine the association of FMS proficiency and physical self-concept in
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children with DCD while considering confounding factors. The study concluded that children with DCD have poorer proficiency in both locomotor and object control skills, and lower physical self-concept in terms of coordination, sporting ability and health. Girls showed poorer performance in FMS and most specific areas of physical self-concept, and girls with DCD engaged in less physical activity. Physical self-concept was positively correlated with FMS proficiency and coordination acted as a predictor of object control skills. Future interventions aimed at improving FMS proficiency of children with DCD should emphasize improving object control skills proficiency, and consider selfconcept in coordination in girls, in particular.
Acknowledgements
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We thank all the participating children, parents and teachers from primary schools involved in this study.
Declaration of interest No grant was received from any funding agency (public, commercial or not-for-profit) to conduct this study. Further, the authors report no conflict of interest.
References 1. Burton AW. Movement skill assessment. Champaign (IL): Human Kinetics; 1998. 2. Curriculum Development Institute. An overview of the learning topics in the six strands of PE KLA (2013): Fundamental movement. HKSAR: Education Bureau; 2013. 3. Okely AD, Booth ML. Relationships between body composition and fundamental movement skills among children and adolescents. Res Q Exerc Sport 2004;75:238–47. 4. Stodden DF, Goodway JD, Stephen JL, et al. A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship. Quest 2008;60:290–306. 5. Lubans DR, Morgan PJ, Cliff DP, et al. Fundamental movement skills in children and adolescents: review of associated health benefits. Sports Med 2010;40:1019–35. 6. Robinson LE. The relationship between perceived physical competence and fundamental motor skills in preschool children. Child Care Health Dev 2011;37:589–96. 7. Piek JP, Baynam GB, Barrett NC. The relationship between fine and gross motor ability, self-perceptions and self-worth in children and adolescents. Hum Mov Sci 2006;25:65–75. 8. Harter S. The construction of the self: a developmental perspective. New York: Guilford; 1999. 9. Harter S. The Perceived Competence Scale for children. Child Dev 1982;53:87–97. 10. Lopes VP, Rodrigues LP, Maia JAR, Malina RM. Motor coordination as predictor of physical activity in childhood. Scand J Med Sci Sports 2011;21:663–9. 11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association; 2000. 12. Zwicker JG, Missiuna C, Harris SR, Boyd LA. Developmental coordination disorder: a review and update. Eur J Paediatr Neurol 2012;16:573–81. 13. Willoughby C, Polatajko HJ. Motor problems in children with developmental coordination disorder: review of the literature. Am J Occup Ther 1995;49:787–94. 14. Silman A, Cairney J, Hay J, et al. Role of physical activity and perceived adequacy on peak aerobic power in children with developmental coordination disorder. Hum Mov Sci 2011;30: 672–81. 15. Hands B. Changes in motor skill and fitness measures among children with high and low motor competence: a five-year longitudinal study. J Sci Med Sport 2008;11:155–62. 16. Rivilis I, Hay J, Cairney J, et al. Physical activity and fitness in children with developmental coordination disorder: a systematic review. Res Dev Disabil 2011;32:894–910.
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17. Cairney J, Hay J, Faught BE, et al. Developmental coordination disorder, age, and play: a test of the divergence in activity-deficit with age hypothesis. Adapt Phys Activ Q 2006;23:261–76. 18. Engel-Yeger B, Hanna Kasis A. The relationship between developmental co-ordination disorders, child’s perceived self-efficacy and preference to participate in daily activities. Child Care Health Dev 2010;36:670–7. 19. Morano M, Colella D, Robazza C, et al. Physical self-perception and motor performance in normal-weight, overweight and obese children. Scand J Med Sci Sports 2011;21:465–73. 20. Rudisill ME, Mahar MT, Meaney KS. The relationship between children’s perceived and actual motor competence. Percept Mot Skills 1993;76:859–906. 21. Toftegaard-Stoeckel J, Groenfeldt V, Andersen LB. Children’s selfperceived bodily competencies and associations with motor skills, body mass index, teachers’ evaluations, and parents’ concerns. J Sports Sci 2010;28:1369–75. 22. Ulrich D. Test of gross motor develpment. 2nd ed. Texas: Pro-Ed; 2000. 23. Williams HG, Pfeiffer KA, O’Neill JR, et al. Motor skill performance and physical activity in preschool children. Obesity 2008;16:1421–6. 24. Wrotniak BH, Epstein LH, Dorn JM, et al. The relationship between motor proficiency and physical activity in children. Pediatrics 2006; 118:e1758–65. 25. Barnett LM, Morgan PJ, Van Beurden E, et al. A reverse pathway? Actual and perceived skill proficiency and physical activity. Med Sci Sports Exerc 2011;43:898–904. 26. Hardy LL, Reinten-Reynolds T, Espinel P, et al. Prevalence and correlates of low fundamental movement skill competency in children. Pediatrics 2012;130:e390–e8. 27. Henderson SE, Sugden DA, Barnett AL. Movement assessment battery for children. 2nd ed. London, UK: The Psychological Corporation; 2007. 28. Slater LM, Hillier SL, Civetta LR. The clinometric properties of performance-based gross motor tests used for children with developmental coordination disorder: a systematic review. Pediatr Phys Ther 2010;22:170–9. 29. Capio CM, Sit CHP, Abernethy B. Fundamental movement skills testing in children with cerebral palsy. Disabil Rehabil 2011;33: 2519–28. 30. Marsh HW, Richards GE, Johnson S, et al. Physical Self-Description Questionnaire: psychometric properties and a multitrait-multimethod analysis of relations to existing instruments. J Sport Exerc Psychol 1994;16:270–305. 31. Marsh HW, Hau KT, Sung RY, Yu CW. Childhood obesity, gender, actual-ideal body image discrepancies, and physical self-concept in Hong Kong children: cultural differences in the value of moderation. Dev Psychol 2007;43:647–62. 32. Marsh HW. Physical Self Description Questionnaire: stability and discriminant validity. Res Q Exerc Sport 1996;67:249–64. 33. Crocker PRE, Bailey DA, Faulkner RA, et al. Measuring general levels of physical activity: preliminary evidence for the Physical Activity Questionnaire for Older Children. Med Sci Sports Exerc 1997;29:1344–9. 34. Kowalski KC, Crocker PRE, Faulkner RA. Validation of the physical activity questionnaire for older children. Pediatr Exerc Sci 1997;9: 174–86. 35. Lau PWC, Lam MHS, Leung BWC. National identity and the Beijing Olympics: school children’s responses in mainland China. Proc Soc Behav Sci 2010;2:6729–38. 36. Johnston I. I’ll give you a definite maybe: an introductory handbook on probability, statistics, and excel. 2000. Available from: https:// records.viu.ca/johnstoi/maybe/maybe4.htm [last accessed 22 Apr 2014]. 37. Tabachnick BG, Fidell LS. Using multivariate statistics. 5th ed. Boston: Pearson/Allyn & Bacon; 2007. 38. Cairney J, Hay JA, Faught BE, et al. Developmental coordination disorder, generalized self-efficacy toward physical activity, and participation in organized and free play activities. J Pediatr 2005; 147:515–20. 39. Okely AD, Booth ML. Mastery of fundamental movement skills among children in New South Wales: prevalence and sociodemographic distribution. J Sci Med Sport 2004;7:358–72. 40. World Health Organization. International Classification of Functioning, Disability and Health: Children and Youth version: ICF-CY. Geneva, Switzerland: World Health Organization; 2007.
DOI: 10.3109/09638288.2015.1014067
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41. Cairney J, Kwan MYW, Hay JA, Faught BE. Developmental coordination disorder, gender, and body weight: examining the impact of participation in active play. Res Dev Disabil 2012;33: 1566–73. 42. Cairney J, Hay JA, Veldhuizen S, et al. 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 2010;52: e67–72.
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43. Lloyd M, Saunders TJ, Bremer E, Tremblay MS. Long-term importance of fundamental motor skills: a 20-year follow-up study. Adapt Phys Act Q 2014;31:67–8. 44. Telford RD, Cunningham RB, Telford RM, et al. Benefits of early development of eye-hand coordination: evidence from the LOOK longitudinal study. Scand J Med Sci Sports 2013;23:e263–9. 45. Vedul-Kjelsa˚s V, Sigmundsson H, Stensdotter AK, Haga M. The relationship between motor competence, physical fitness and selfperception in children. Child Care Health Dev 2012;38:394–402.
RESEARCH PAPER
Fundamental movement skills proficiency in children with developmental coordination disorder: does physical self-concept matter? Disabil Rehabil Downloaded from informahealthcare.com by University of Victoria on 02/26/15 For personal use only.
Jie Yu1, Cindy H. P. Sit1, Catherine M. Capio2, Angus Burnett3, Amy S. C. Ha1, and Wendy Y. J. Huang1,4 1
Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, Hong Kong, 2Institute of Human Performance, The University of Hong Kong, Pok Fu Lam, Hong Kong, 3ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar, and 4Department of Physical Education, Hong Kong Baptist University, Kowloon Tong, Hong Kong Abstract
Keywords
Purpose: The purpose of this study was to (1) examine differences in fundamental movement skills (FMS) proficiency, physical self-concept, and physical activity in children with and without developmental coordination disorder (DCD), and (2) determine the association of FMS proficiency with physical self-concept while considering key confounding factors. Method: Participants included 43 children with DCD and 87 age-matched typically developing (TD) children. FMS proficiency was assessed using the Test of Gross Motor Development – second edition. Physical self-concept and physical activity were assessed using self-report questionnaires. A two-way (group by gender) ANCOVA was used to determine whether between-group differences existed in FMS proficiency, physical self-concept, and physical activity after controlling for age and BMI. Partial correlations and hierarchical multiple regression models were used to examine the relationship between FMS proficiency and physical self-concept. Results: Compared with their TD peers, children with DCD displayed less proficiency in various components of FMS and viewed themselves as being less competent in physical coordination, sporting ability, and physical health. Physical coordination was a significant predictor of ability in object control skills. DCD status and gender were significant predictors of FMS proficiency. Conclusions: Future FMS interventions should target children with DCD and girls, and should emphasize improving object control skills proficiency and physical coordination.
Children, developmental coordination disorder, motor skills, physical self-concept History Received 28 July 2014 Revised 26 January 2015 Accepted 28 January 2015 Published online 20 February 2015
ä Implications for Rehabilitation
Children with DCD tend to have not only lower FMS proficiency than age-matched typically developing children but also lower physical self-concept. Self-perceptions of physical coordination by children with DCD are likely to be valuable contributors to development of object control skills. This may then help to develop their confidence in performing motor skills. Children with DCD need supportive programs that facilitate the development of object control skills. Efficacy of training programs may be improved if children experience a greater sense of control and success when performing object control skills.
Introduction Fundamental movement skills (FMS) provide the foundation for developing specialized and context-specific motor skills [1]. FMS are developed in early childhood and consist of locomotor skills (e.g. running and jumping) and object control skills (e.g. throwing and catching). Developing FMS competence is one of the main
Address for correspondence: Cindy H. P. Sit, Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. Tel: +852 3943 4126. Fax: +852 2603 5781. E-mail: [email protected]
physical education curricula in primary school in many cities including Hong Kong [2]. FMS proficiency is critical to help children engage in various forms of movement and children who exhibit high levels of FMS proficiency are less likely to be overweight [3] and are more likely to be physically active [4]. The acquisition of FMS during childhood has also been found to be associated with a lifelong commitment to physical activity [5] and this supports the importance of FMS proficiency in attaining better health. Physical self-concept (i.e. an individual’s perception of his/her own physical competence) is an important correlate of FMS proficiency in children [6]. It has been reported that children with
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higher physical self-concept display better FMS performance (e.g. jumping) than those with lower physical self-concept [7]. The association of physical self-concept with the development of FMS proficiency can be explained by the competence-motivation theory [8]. According to this theory, children can display differences in specific domains of competence (e.g. physical competence) and they are able to make meaningful and accurate judgments about their competence [9]. This theory also posits that children who perceive themselves as physically competent tend to exert greater effort on motor skills and mastery attempts than those who have poor self-perceived physical competence. As part of physical competence, motor coordination plays an important role in more advanced movements [10]. Few studies, however, have considered the impact of low levels of motor coordination on FMS proficiency and physical self-concept in primary school children. Children with poor motor coordination in the absence of any known medical condition or neurological impairments are diagnosed as having developmental coordination disorder (DCD) [11]. The prevalence of DCD has been reported to be approximately 5–6% of school-aged children worldwide [11], with the ratio of boys to girls ranging between 3:1 and 7:1 [12]. It has been believed that DCD provides a useful framework to examine the effects of lower levels of motor coordination in children [7]. As expected, children with DCD have poor performance in motor skills [13]. Compared with their typically developing (TD) peers, children with DCD tend to be more overweight, have higher levels of obesity [14], and are at higher risk of having obesityrelated chronic diseases [15]. They also tend to be less physically active [16], have lower participation rates in both structured physical activity and free play during leisure time [17], and view themselves as less competent with regard to physical abilities [18]. However, there is a paucity of research examining the correlation of FMS proficiency with physical self-concept in children with DCD and their TD peers. Confounding factors such as gender and body mass index (BMI) need to be considered when investigating FMS proficiency and its relationship with physical self-concept in children. It has been reported that girls tend to have poorer FMS proficiency and lower physical self-concept than boys [7,19,20], and that overweight and obese children report poorer motor performance and lower physical self-concept than their non-overweight counterparts [19,21]. Considering that FMS develop as children grow [22], age should also be treated as an influencing factor in the relationship between FMS proficiency and physical selfconcept in children. Additionally, physical activity may act as an influencing factor on FMS proficiency in children. Previous studies have shown a positive association between physical activity and motor skill proficiency in this group [23,24], and this relationship is considered to be reciprocal [4,25]. Children with higher levels of motor skill competence are more likely to participate in physical activity, while increased physical activity provides further opportunities to develop motor skills [26]. More needs to be known about the association of FMS competence with physical self-concept while considering confounding factors. Therefore, using the competence-motivation theory as a theoretical framework, the purpose of this study was (1) to examine significant differences in FMS proficiency, physical selfconcept, and physical activity of children with DCD and a group of aged-matched TD children, and (2) to determine the association of FMS proficiency with physical self-concept in children while considering the effects of confounding factors (i.e. age, gender, BMI, and physical activity). First, we hypothesized that, children with DCD would show poorer FMS proficiency and physical selfconcept, and would be less physically active when compared to
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TD children. Second, FMS proficiency would be positively associated with variables of physical self-concept after controlling for confounding factors.
Methods Participants A total of 312 children aged 7–10 years from local primary schools in Hong Kong were assessed after informed consent was provided by their parents. Using the Diagnostic and Statistical Manual of Mental Disorder – fourth edition, Text Revision diagnostic criteria of DCD [11], 66 of these children were identified at risk for DCD (i.e. at or below the 15th percentile on the Movement Assessment Battery for Children – second edition (MABC-2) [27]. Teachers confirmed difficulties in motor functioning of all children at risk for DCD using the MABC-2 Checklist. A total of 130 children were recruited for follow-up testing. There were 43 (17 girls and 26 boys) children with DCD (mean age 8.12 ± 0.91 years) and 87 (43 girls and 44 boys) TD children (mean age 8.31 ± 1.00 years). No participants had a known health condition that was contraindicated to engagement in physical activity. The study was approved by the University’s Survey and Behavioral Research Ethics Committee. Study design and procedures This study utilized a cross-sectional design. Five research assistants led by the first author, and extensively trained by an experienced physiotherapist, conducted the MABC-2 test and an assessment of FMS proficiency. Children reported their physical self-concept and recalled their physical activity levels during the previous 7 d. BMI was determined from height and weight measurements taken by trained research assistants. Measurements FMS proficiency was assessed using five components of the Test of Gross Motor Development – second edition (TGMD-2) [22]. The TGMD-2 has high internal reliability and validity and has been used in studies involving children with DCD and TD children [28]. The TGMD-2 examines the quality of movement patterns based on a number of qualitative criteria (3–5, depending on the specific skill). The presence or absence of a criterion is scored 1 or 0, yielding a maximum score of 3–5 points per trial. Higher scores indicate better motor skills. In this study, five FMS components (locomotor: running, jumping; object control: catching, kicking and throwing) were assessed, as they have been deemed to be relevant activities for common forms of physical activity in children such as sports and recreation [29]. All FMS assessments were conducted by the trained research assistants during physical education lessons. All assessments were videotaped and post-hoc analysis of these videos by the first author showed good agreement (ICC ¼ 0.86) with the testers’ scores. Physical self-concept was measured using the Physical Self Description Questionnaire (PSDQ) – Chinese version with its 10 subscales: health, coordination, body fat, sporting ability, appearance, strength, flexibility, fitness, self-esteem, and general selfconcept [30,31]. Higher scores represent better physical selfconcept in a specific area. The PSDQ has good internal consistency (median ¼ 0.92) and temporal stability (median r ¼ 0.83 after 3 months) [32]. The Chinese version of the PSDQ has been used in Chinese children aged 7–15 years and has demonstrated good reliability with subscales having Cronbach’s alpha values ranging from 0.67 to 0.92 [31]. In the present study, the internal consistency for the subscales ranged between 0.62 and 0.90. Physical activity was assessed using the Physical Activity Questionnaire for Older Children (PAQ-C) – Chinese version [33],
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Table 1. Differences on fundamental movement skills proficiency between children with DCD and TD children. DCD group (n ¼ 43) Variable
Mean (SD)
Locomotor skills Runningy Jumping Object control skillsy Catching Kickingy Throwingz
9.18 5.77 3.42 15.89 4.47 6.16 5.26
(3.39) (2.15) (1.93) (2.85) (1.44) (1.25) (1.98)
[95% CI] [8.14, 12.23] [5.10, 6.43] [2.82, 4.01] [15.01, 16.76] [4.02, 4.91] [5.78, 6.55] [4.65, 5.87]
TD group (n ¼ 87) Mean (SD) 11.56 6.79 4.77 17.21 5.06 6.53 5.62
(3.21) (1.59) (2.32) (3.24) (1.21) (1.60) (1.86)
[95% CI]
F
2
[10.88,12.25] [6.46, 7.13] [4.28, 5.26] [16.52, 17.90] [4.80, 5.32] [6.19, 6.87] [5.22, 6.02]
9.08** 5.65* 6.35* 9.01* 6.39** 1.98 3.47
0.068 0.044 0.049 0.008 0.049 0.016 0.027
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DCD, developmental coordination disorder; TD, typically developing; SD, standard deviation; CI, confidence interval. After controlling age and body mass index. Significant gender difference: yp50.05; zp50.01; significant group difference: *p50.05; **p50.01.
which is a 7-day recall, self-report instrument to assess general levels of physical activity in school-aged children. The instrument has nine items and higher means of these values indicate higher levels of physical activity. The PAQ-C has been demonstrated to have good test-retest reliability (males, r ¼ 0.75 and females, r ¼ 0.82), internal consistency ( ¼ 0.89) [33], and convergent validity through moderate correlation with total moderate to vigorous physical activity (r ¼ 0.53) [34]. The PAQ-C has been translated into Chinese to evaluate physical activity in Chinese children including those in Hong Kong [35]. In the present study, the internal consistency of this instrument was 0.80.
(aggregate score of running and jumping; p ¼ 0.003) and object control skills (aggregate score of catching, kicking, and throwing; p ¼ 0.013) (Table 1). Specifically, children with DCD showed significantly poorer FMS proficiency with respect to running (p ¼ 0.019), jumping (p ¼ 0.013), and catching (p ¼ 0.004) than the TD group. When the TD and DCD groups were combined, significant gender differences were found in running (p ¼ 0.015), object control skills (p ¼ 0.018), kicking (p ¼ 0.047), and throwing (p ¼ 0.011), with girls having the lower scores than boys on all these measures. Physical self-concept
Data analysis Descriptive statistics, namely, means, standard deviations, confidence intervals, and standard errors, were obtained for all the variables. Chi-square statistics were used to compare the number of children with DCD and TD children by gender. A group (DCD versus TD) by gender (girls versus boys) factorial analysis of variance was performed to examine whether significant differences existed in age and BMI. A group by gender factorial analysis of covariance was then used to determine differences in FMS proficiency, physical self-concept, and physical activity while controlling for age and BMI. Partial correlations were used to determine the associations of FMS proficiency with physical self-concept and to examine the relationships among variables of physical self-concept. Correlation coefficients between 0.2 and 0.4 were considered weak, 0.4–0.7 as moderate and greater than 0.7 as strong [36]. Finally, hierarchical multiple regression models were used to examine the ability of individual factors (i.e. group and gender), physical activity, and chosen variables of physical self-concept to predict FMS proficiency (i.e. locomotor skills score and object control skills score), after controlling for age and BMI. Preliminary analyses were performed to ensure no violations of the assumptions of normality, linearity, multicollinearity and homoscedasticity were present. All data were analyzed using SPSS 20.0 (SPSS Inc., Chicago, IL) and statistical significance was set at p50.05 for all tests.
Results Demographic data and BMI No significant Chi-square statistics were evident for DCD classification by gender (p40.05). The results revealed a significant group effect in BMI score with the DCD group having a significantly higher BMI than the TD group (p ¼ 0.0001). FMS proficiency Compared with the TD group, children with DCD displayed significantly lower scores in both locomotor skills
Compared with the TD group, children with DCD reported significantly poorer physical self-concept on health (p ¼ 0.004), coordination (p ¼ 0.039), and sporting ability (p ¼ 0.024) (Table 2). A significant gender difference was found for appearance, with girls reporting better appearance than boys (p ¼ 0.004). Physical activity Girls displayed a significantly lower level of physical activity than boys (p ¼ 0.041). As shown in Figure 1, a significant group by gender interaction was found (p ¼ 0.029), with girls with DCD having a significantly lower level of physical activity than the other three groups. Additionally, physical activity was found to be positively correlated with FMS proficiency in children with respect to locomotor skill (r ¼ 0.21, p50.05) and running (r ¼ 0.26, p50.01). Associations of FMS proficiency with physical self-concept As shown in Table 3, proficiency in locomotor skills was positively associated with coordination (p50.05), sporting ability (p50.01), fitness (p50.01), and self-esteem (p50.05). When scores for running and jumping were examined individually, running was positively related to sporting ability (p50.01), strength (p50.05), and self-esteem (p50.05). Jumping was positively associated with sporting ability, fitness, and appearance (all p50.01). In addition, proficiency in object control skills was positively associated with health and coordination (both p50.05). Catching was positively associated with coordination (p50.05), while throwing was positively correlated to coordination, sporting ability, and strength (all p50.05). To avoid the problem of multi-collinearity, only variables (i.e. health, coordination, sporting ability, strength, fitness and selfesteem) that were significantly associated with FMS proficiency were entered into regression models. Prior to entry into the models, correlations between the chosen physical self-concept variables were assessed and inter-correlations of these variables all met the suggested criterion (r50.70) [37].
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Table 2. Differences on physical self-concept between children with DCD and TD children. DCD group (n ¼ 43) Variable
Mean (SD)
Health Coordination Body fat Sporting ability Appearancez Strength Flexibility Fitness Self-esteem General self-concept
4.46 3.96 4.04 3.74 3.86 4.08 4.21 3.61 4.13 4.13
(0.97) (1.30) (1.70) (1.50) (1.25) (1.21) (1.18) (1.44) (1.14) (1.43)
TD group (n ¼ 87)
[95% CI] [4.17, [3.56, [3.51, [3.28, [3.47, [3.71, [3.85, [3.16, [3.78, [3.69,
4.76] 4.36] 4.57] 4.20] 4.24] 4.46] 4.57] 4.05] 4.48] 4.57]
Mean (SD) 4.90 4.64 5.03 4.49 4.08 4.13 4.70 4.12 4.39 4.71
(0.85) (0.95) (1.15) (1.02) (1.09) (0.92) (0.95) (1.10) (0.88) (1.13)
[95% CI] [4.72, [4.44, [4.79, [4.27, [3.85, [3.94, [4.50, [3.89, [4.20, [4.46,
5.08] 4.84] 5.28] 4.70] 4.31] 4.33] 4.90] 4.35] 4.58] 4.95]
F
2
8.10** 4.36* 2.33 5.21* 0.03 0.35 1.67 2.12 1.02 1.43
0.063 0.034 0.018 0.040 0.001 0.003 0.013 0.017 0.008 0.011
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DCD, developmental coordination disorder; TD, typically developing; SD, standard deviation; CI, confidence interval. After controlling age and body mass index. Significant gender difference: zp50.01; significant group difference: *p50.05; **p50.01.
Figure 1. Physical activity between children with DCD and TD children by gender. DCD, developmental coordination disorder; TD, typically developing. *p50.05, compared with girls with DCD.
As shown in Table 4, better locomotor skills proficiency was observed in older children, TD children, and those children with lower BMI. No chosen variables of physical self-concept were found to be significant predictors for locomotor skills proficiency. The final model explained 23.9% of the variance in locomotor skills proficiency. For object control skills proficiency, older children, boys (compared with girls), TD children, and those having higher coordination demonstrated better results. The chosen variables explained 8.3% of the variance; however, only coordination was a significant predictor. The final model predicted 31.3% of the variance.
Discussion The current study found that compared with TD children, children with DCD displayed poorer performance in locomotor skills (including running and jumping) and object control skills (including catching). Children with DCD also viewed themselves as being less competent in their coordination, sporting ability, and health. Consistent with previous research, children with DCD showed less FMS proficiency [13] and reported lower levels of physical self-concept [38], and this was especially in the domains of coordination, sporting ability and health. These findings are in accordance with the competence-motivation theory [9].
Given that children with DCD have poor motor coordination, it is understandable that this group of children is more concerned by their low levels of coordination and sporting ability, as these are pre-requisites for ball games and more complex activities. However, poor physical self-concept has received limited attention in the literature that examines children with DCD. In addition to assessing actual motor skills proficiency, we suggest that physical self-concept of children with DCD should be considered in attempting to understand mechanisms that lead to movement-related behaviors. Understanding physical self-concept is particularly important for professionals who provide supportive programs for children with DCD during their early elementary age as this is when children’s self-perceptions of physical competence emerge. Girls were found to be less proficient in running, kicking, and throwing and less active than boys and this is congruent with the previous findings [39]. This may be attributable to gender norms and high expectations of being physically competent and active for boys rather than girls [26]. Although girls were less competent in FMS and less physically active, they perceived themselves as having better physical appearance than boys. This finding may suggest that girls have more positive perceptions of their aesthetic appearance than their physical ability [19]. It has been previously suggested that impairments in motor abilities may cause restrictions in activities and participation in children including those with DCD [40]. In the present study, girls with DCD were found to be less physically active than boys with DCD and TD girls and boys, and this is consistent with past research [41]. Due to the existence of social norms, DCD has an adverse impact on activity participation, which may result in fewer opportunities in motor skill practice and hence activity deficits may result in girls [17,42]. Although the majority of children with DCD are boys, development of FMS in both boys and girls with DCD should receive attention in rehabilitation efforts. The long-term impact of poor motor proficiency in girls has been recently shown in a 20-year follow-up study, which reported that motor skill proficiency in girls at the age of six was positively related to levels of physical activity when they were young women [43]. There were significant associations between FMS proficiency and some domains of physical self-concept, and this provides further theoretical and empirical evidence relating to the multidimensional approach that should be used to fully understand FMS competence. In particular, physical self-concept relating to coordination was found to be linked to both locomotor skills and object control skills in children. Further, it was a significant predictor of object control skills proficiency. Physical coordination is expected to have an impact on object control skills because such skills require hand-eye coordination [44]. Therefore, the self-perception
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Table 3. Associations of fundamental movement skills proficiency with physical self-concept (r-values). Locomotor skills
Health Coordination Body fat Sporting ability Appearance Strength Flexibility Fitness Self-esteem General self-concept
Object control skills
Total
Running
Jumping
Total
Catching
Kicking
Throwing
0.10 0.19* 0.13 0.29** 0.14 0.10 0.16 0.26** 0.17* 0.12
0.10 0.16 0.14 0.25** 0.01 0.21** 0.09 0.16 0.18* 0.03
0.06 0.15 0.08 0.22** 0.20** 0.01 0.16 0.25** 0.12 0.15
0.19* 0.21* 0.07 0.10 0.01 0.05 0.10 0.10 0.01 0.04
0.14 0.25** 0.08 0.09 0.03 0.02 0.14 0.10 0.01 0.11
0.08 0.01 0.03 0.09 0.16 0.13 0.01 0.01 0.10 0.07
0.16 0.17* 0.03 0.17* 0.10 0.17* 0.07 0.09 0.05 0.05
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After controlling age and body mass index. *p50.05; **p50.01.
Table 4. Predictors of locomotor skills and object control skills proficiency. Locomotor skills Predictor Step 1 Age BMI Step 2 Group (DCD versus TD) Gender (girls versus boys) Step 3 Physical activity Step 4 Health Coordination Sporting ability Strength Fitness Self-esteem
[95% CI]
R
2
0.089 0.201* 0.239**
[0.12, 1.31] [0.39, 0.07]
0.262** 0.118
[3.19, 0.64] [1.95, 0.33] 0.185
DR
DF
[0.62, [1.01, [0.19, [1.25, [0.40, [0.23,
[95% CI]
6.183** 5.96*** 5.62***
0.071 0.025
3.37***
0.71] 0.61] 1.33] 0.24] 0.97] 1.15]
0.054
R2
F
DR2
DF
0.118
8.54***
0.230
9.32***
0.111
9.03***
0.230
7.40***
0.000
0.001
0.313
4.89***
0.083
2.39*
[0.42, 1.49] [0.01, 0.28]
5.32** 0.265** 0.236**
[2.90, 0.65] [2.49, 0.49]
0.003
[0.68, 0.071]
0.116 0.428** 0.140 0.049 0.058 0.126
[0.18, 0.98] [0.50, 1.92] [1.02, 0.31] [0.80, 0.50] [0.74, 0.45] [1.01, 0.19]
3.74
[0.02, 1.54] 0.239
0.012 0.065 0.206 0.149 0.103 0.131
F
0.294** 0.154 0.160
0.160
Object control skills 2
1.40
BMI, body mass index; DCD, developmental coordination disorder; TD, typically developing; CI, confidence interval; b, standardized coefficients. Group: TD children coded as ‘‘0’’ ¼ reference group; gender: boys coded as ‘‘0’’ ¼ reference group. *p50.05, **p50.01, ***p50.001.
of coordination may be a relevant variable to consider in the development of object control skills. Specifically, if children judge themselves to be well coordinated, they are more likely to engage in object control tasks [45]. Our results underscore the importance of physical self-concept in the development of FMS proficiency in children. We suggest that when children perceive themselves as being less physically competent, the development of their motor skills may be compromised. We could speculate that such low physical selfconcept may hinder performance, and thus the practice of motor skills. Rehabilitation professionals and educators working with children with DCD may consider activities that promote successful movement experiences that support positive physical selfconcept in this group of children. This may then, in turn, cultivate the level of confidence in these children to subsequently perform motor skills. The efficacy of treatment to improve motor skills may then be more effective and sustainable if the program is designed to let children with DCD experience increased success and greater levels of enjoyment. For example, the difficulty of tasks may be manipulated to allow this group of children to experience a greater sense of control, particularly at the commencement of training. However, this notion still needs to be examined in future studies. There was a weak and positive association between locomotor skill proficiency and physical activity in children. Previous research has reported a positive relationship between physical
activity and motor performance in children [23]. However, regression modeling revealed that physical activity was not a significant predictor of FMS (both locomotor and object control skills) proficiency. This is contrary to previous findings which have suggested that active children tend to be more skillful [25]. Additionally, DCD status and gender were significant predictors of FMS proficiency. This suggests that children with DCD need well-designed training programs for FMS proficiency. In particular, interventions should place more emphasis on improving object skills proficiency for both boys and girls, despite the majority of children with DCD being boys. Study limitations This study utilized a cross-sectional design, therefore, cause and effect cannot be determined. Second, small and unequal sample size may underestimate the strength of associations among the variables, and may then lead to a lack of generalizability. Third, FMS were limited to five skills that cannot provide a more comprehensive representation of FMS proficiency. Fourth, physical activity assessment was based on a self-report instrument thus there may be possibility of recall error.
Conclusions To our best knowledge, this is the first study to examine the association of FMS proficiency and physical self-concept in
6
J. Yu et al.
children with DCD while considering confounding factors. The study concluded that children with DCD have poorer proficiency in both locomotor and object control skills, and lower physical self-concept in terms of coordination, sporting ability and health. Girls showed poorer performance in FMS and most specific areas of physical self-concept, and girls with DCD engaged in less physical activity. Physical self-concept was positively correlated with FMS proficiency and coordination acted as a predictor of object control skills. Future interventions aimed at improving FMS proficiency of children with DCD should emphasize improving object control skills proficiency, and consider selfconcept in coordination in girls, in particular.
Acknowledgements
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We thank all the participating children, parents and teachers from primary schools involved in this study.
Declaration of interest No grant was received from any funding agency (public, commercial or not-for-profit) to conduct this study. Further, the authors report no conflict of interest.
References 1. Burton AW. Movement skill assessment. Champaign (IL): Human Kinetics; 1998. 2. Curriculum Development Institute. An overview of the learning topics in the six strands of PE KLA (2013): Fundamental movement. HKSAR: Education Bureau; 2013. 3. Okely AD, Booth ML. Relationships between body composition and fundamental movement skills among children and adolescents. Res Q Exerc Sport 2004;75:238–47. 4. Stodden DF, Goodway JD, Stephen JL, et al. A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship. Quest 2008;60:290–306. 5. Lubans DR, Morgan PJ, Cliff DP, et al. Fundamental movement skills in children and adolescents: review of associated health benefits. Sports Med 2010;40:1019–35. 6. Robinson LE. The relationship between perceived physical competence and fundamental motor skills in preschool children. Child Care Health Dev 2011;37:589–96. 7. Piek JP, Baynam GB, Barrett NC. The relationship between fine and gross motor ability, self-perceptions and self-worth in children and adolescents. Hum Mov Sci 2006;25:65–75. 8. Harter S. The construction of the self: a developmental perspective. New York: Guilford; 1999. 9. Harter S. The Perceived Competence Scale for children. Child Dev 1982;53:87–97. 10. Lopes VP, Rodrigues LP, Maia JAR, Malina RM. Motor coordination as predictor of physical activity in childhood. Scand J Med Sci Sports 2011;21:663–9. 11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association; 2000. 12. Zwicker JG, Missiuna C, Harris SR, Boyd LA. Developmental coordination disorder: a review and update. Eur J Paediatr Neurol 2012;16:573–81. 13. Willoughby C, Polatajko HJ. Motor problems in children with developmental coordination disorder: review of the literature. Am J Occup Ther 1995;49:787–94. 14. Silman A, Cairney J, Hay J, et al. Role of physical activity and perceived adequacy on peak aerobic power in children with developmental coordination disorder. Hum Mov Sci 2011;30: 672–81. 15. Hands B. Changes in motor skill and fitness measures among children with high and low motor competence: a five-year longitudinal study. J Sci Med Sport 2008;11:155–62. 16. Rivilis I, Hay J, Cairney J, et al. Physical activity and fitness in children with developmental coordination disorder: a systematic review. Res Dev Disabil 2011;32:894–910.
Disabil Rehabil, Early Online: 1–7
17. Cairney J, Hay J, Faught BE, et al. Developmental coordination disorder, age, and play: a test of the divergence in activity-deficit with age hypothesis. Adapt Phys Activ Q 2006;23:261–76. 18. Engel-Yeger B, Hanna Kasis A. The relationship between developmental co-ordination disorders, child’s perceived self-efficacy and preference to participate in daily activities. Child Care Health Dev 2010;36:670–7. 19. Morano M, Colella D, Robazza C, et al. Physical self-perception and motor performance in normal-weight, overweight and obese children. Scand J Med Sci Sports 2011;21:465–73. 20. Rudisill ME, Mahar MT, Meaney KS. The relationship between children’s perceived and actual motor competence. Percept Mot Skills 1993;76:859–906. 21. Toftegaard-Stoeckel J, Groenfeldt V, Andersen LB. Children’s selfperceived bodily competencies and associations with motor skills, body mass index, teachers’ evaluations, and parents’ concerns. J Sports Sci 2010;28:1369–75. 22. Ulrich D. Test of gross motor develpment. 2nd ed. Texas: Pro-Ed; 2000. 23. Williams HG, Pfeiffer KA, O’Neill JR, et al. Motor skill performance and physical activity in preschool children. Obesity 2008;16:1421–6. 24. Wrotniak BH, Epstein LH, Dorn JM, et al. The relationship between motor proficiency and physical activity in children. Pediatrics 2006; 118:e1758–65. 25. Barnett LM, Morgan PJ, Van Beurden E, et al. A reverse pathway? Actual and perceived skill proficiency and physical activity. Med Sci Sports Exerc 2011;43:898–904. 26. Hardy LL, Reinten-Reynolds T, Espinel P, et al. Prevalence and correlates of low fundamental movement skill competency in children. Pediatrics 2012;130:e390–e8. 27. Henderson SE, Sugden DA, Barnett AL. Movement assessment battery for children. 2nd ed. London, UK: The Psychological Corporation; 2007. 28. Slater LM, Hillier SL, Civetta LR. The clinometric properties of performance-based gross motor tests used for children with developmental coordination disorder: a systematic review. Pediatr Phys Ther 2010;22:170–9. 29. Capio CM, Sit CHP, Abernethy B. Fundamental movement skills testing in children with cerebral palsy. Disabil Rehabil 2011;33: 2519–28. 30. Marsh HW, Richards GE, Johnson S, et al. Physical Self-Description Questionnaire: psychometric properties and a multitrait-multimethod analysis of relations to existing instruments. J Sport Exerc Psychol 1994;16:270–305. 31. Marsh HW, Hau KT, Sung RY, Yu CW. Childhood obesity, gender, actual-ideal body image discrepancies, and physical self-concept in Hong Kong children: cultural differences in the value of moderation. Dev Psychol 2007;43:647–62. 32. Marsh HW. Physical Self Description Questionnaire: stability and discriminant validity. Res Q Exerc Sport 1996;67:249–64. 33. Crocker PRE, Bailey DA, Faulkner RA, et al. Measuring general levels of physical activity: preliminary evidence for the Physical Activity Questionnaire for Older Children. Med Sci Sports Exerc 1997;29:1344–9. 34. Kowalski KC, Crocker PRE, Faulkner RA. Validation of the physical activity questionnaire for older children. Pediatr Exerc Sci 1997;9: 174–86. 35. Lau PWC, Lam MHS, Leung BWC. National identity and the Beijing Olympics: school children’s responses in mainland China. Proc Soc Behav Sci 2010;2:6729–38. 36. Johnston I. I’ll give you a definite maybe: an introductory handbook on probability, statistics, and excel. 2000. Available from: https:// records.viu.ca/johnstoi/maybe/maybe4.htm [last accessed 22 Apr 2014]. 37. Tabachnick BG, Fidell LS. Using multivariate statistics. 5th ed. Boston: Pearson/Allyn & Bacon; 2007. 38. Cairney J, Hay JA, Faught BE, et al. Developmental coordination disorder, generalized self-efficacy toward physical activity, and participation in organized and free play activities. J Pediatr 2005; 147:515–20. 39. Okely AD, Booth ML. Mastery of fundamental movement skills among children in New South Wales: prevalence and sociodemographic distribution. J Sci Med Sport 2004;7:358–72. 40. World Health Organization. International Classification of Functioning, Disability and Health: Children and Youth version: ICF-CY. Geneva, Switzerland: World Health Organization; 2007.
DOI: 10.3109/09638288.2015.1014067
Disabil Rehabil Downloaded from informahealthcare.com by University of Victoria on 02/26/15 For personal use only.
41. Cairney J, Kwan MYW, Hay JA, Faught BE. Developmental coordination disorder, gender, and body weight: examining the impact of participation in active play. Res Dev Disabil 2012;33: 1566–73. 42. Cairney J, Hay JA, Veldhuizen S, et al. 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 2010;52: e67–72.
Fundamental movement skills in children with DCD
7
43. Lloyd M, Saunders TJ, Bremer E, Tremblay MS. Long-term importance of fundamental motor skills: a 20-year follow-up study. Adapt Phys Act Q 2014;31:67–8. 44. Telford RD, Cunningham RB, Telford RM, et al. Benefits of early development of eye-hand coordination: evidence from the LOOK longitudinal study. Scand J Med Sci Sports 2013;23:e263–9. 45. Vedul-Kjelsa˚s V, Sigmundsson H, Stensdotter AK, Haga M. The relationship between motor competence, physical fitness and selfperception in children. Child Care Health Dev 2012;38:394–402.
