The Differences in Coordination between Children

with ADHD and Healthy Children Based on Two-

way ANOVA Analysis
jiahai Liu1 gao Yang1 fangzhong Xu minyan Zhou1
ˎ

1:Zhejiang University City College, Hangzhou, China

2:Zhejiang Palit Hospital, Hangzhou,China

Abstract—This study attempts to invest the differences in than those of control group, and the number of misstatements
movement coordination between children with ADHD and and omissions are significantly higher than those of control
healthy children using two-way ANOVA. The experimental tasks group. However, And Gayle finds that hit rate of ADHD
are divided into simple task and complex task. The goal of the children is lower than that of normal control group in the
experiments is to study the interaction in hand movements’ single-target CPT, but in the sustained attention task there is no
rhythm, accuracy and error key response between task difficulty significant difference between them. The reason may be the
and subjects grouping while doing visual-motor integration tasks. study ignores the temporal characteristics attention, we should
The results show that: (1) There are no significant differences in
notice that attention changes over time, itself will produce the
all parameters except error number within group differences. (2)
ups and downs over time, the performance of subjects is good
There are significant differences in all parameters except correct
response time between group differences.
at the beginning of the test, and then declines. The researches
on ADHD children’s cognitive mechanisms have unanimously
Keywords-task difficulty; ADHD; grouping; movement recognized that children with ADHD lose more short-term
coordination attention that normal children, and the short-time attention of
them have great fluctuations than that of normal children.
Besides that, children appear to lose attention to the test if the
I. INTRODUCTION test is distracting, this also needs to be examined depending on
Attention deficit hyperactivity disorder (ADHD) is very the time.
common in clinical, it is one of the most widely studied
diseases in child psychiatry[1-5]. In recent years, it ranks in the Raising the level of any researches are inseparable from the
first or second place in the child-patient cases, causing the improvement of methods. Traditional ADHD researches are
whole society's attention on children with ADHD. usually horizontal studies, often using large samples, real-time
facilities to measure and compare the mean, variance analysis,
Children with ADHD often accompany with developmental differences in test, and finally get the conclusions. Longitudinal
disabilities, the most common is developmental coordination study is an extension in the psychology research methods, it is
disorder (DCD). This is a special developmental disorder, is closer to the true law of development of the psychological
characterized by obvious damage in the motion coordination[4- phenomenon. Time series test is a longitudinal study, it refers
5]. Although motor coordination disorder and ADHD are two to the values of certain indicators at different times,
different developmental disorders, but the studies find that chronologically arranged in the series; also refers to a system in
ADHD often accompanies with motor coordination response to the different "time" which is its own historical
disorders[6,7]. Although many of the motor need the behavior objective record. Time series tests can observe long-
participation of many senses, but visual sense is the most term trend of variables and the trend of the psychological
important. Visual - motor integration is developed firstly in development of individuals. They can also determine the causal
sensorimotor integration, coordination between visual relationship between the variables on the dynamic changes, as
perception and hand movements reflects the coordination and well as long-term prediction and control of human psychology
unification between visual perception and activities[8]. and behavior.
At present, continuous performance tests (CPT) are used to Previous studies of motor coordination in children with
evaluate attention disorder among children. A series of ADHD use several common sensory integration scales, the
numbers or characters are showed on a computer monitor as results depend on the observation, are not subjective. And the
stimulants in a CPT, subjects are required to make response to studies only examine motor coordination in children with
certain target, the reaction results are used to evaluate attention ADHD, haven’t studied the factors affect coordination.
deficit. Error number in the tests is used to reflect the subjects’ Therefore, this article studies the difference of coordination
attention deficit, false number reflects the impulse of subjects. between children with ADHD and normal children, and tries to
As that, the objectivity of evaluation has been improved greatly explore the influence of difficulty levels of tasks on motor
and the accuracy of clinical diagnostic is higher. Andrew L. coordination, with a goal to provide new experimental
Cohen [4] considers that CPT has moderate reliability and evidence to coordination study of ADHD.
validity in the diagnosis of ADHD. Wang shu-yu[5], finds that
in auditory continuity tests and audio-visual continuity test, the
reaction time of children with all ADHD subtypes are longer

Zhejiang Provincial Natural Science Foundation (Y2080622)

978-1-4577-1415-3/12/$26.00 ©2012 IEEE

2972
 II. METHODS to remain vigilant. During the experiment, Arabic numerals 1-3
will randomly appear in the middle of the computer screen.
A. Subjects Stimulus duration is 100ms, the time between two appearances
Experimental group: Randomly select 20 children with is 900ms, when the subjects see the number appears, they are
ADHD from Tongde Provincial Hospital, Hangzhou, aged 7-14 asked to press the corresponding number key.
years old. Inclusion criteria: (1) Comply with the American
Psychiatric Association "Diagnostic and Statistical Manual of III. RESULTS
Mental Disorders," Fourth Edition (DSM-IV) ADHD Table 1&2 show the reaction time (RT), reaction time
diagnostic criteria. (2) Exclude people with physical disease fluctuations, the correct key number, missing number, wrong
and extensive mental disorders, mental retardation, emotional number and extra number while two groups doing simple
disorders and other diseases. (3) All cases are not under experiment and complex experiment. Independent samples T-
spiritual drug treatment. (4) All cases are right-handed. test in table 1 show that there are significant differences in
Control group: Randomly select 20 normal children from reaction time fluctuations, correct number, wrong number and
primary school grades 1-6, Hangzhou, aged 7-14 years old. extra number between two groups. Compared with normal
Exclude people with physical disease and mental illness. children, children with ADHD have large reaction time
Children are right-handed. fluctuations which means children with ADHD have larger
change in rhythm and their movement is more instable.
B. Laboratory instruments and materials Children with ADHD have less correct number and more
wrong number than normal children, which means the visual-
The experiment is controlled by a personal computer, the motor integration accuracy and hand motor coordination of
screen resolution was 1024 × 768. Stimulus materials are the Children with ADHD are worse than those of normal children.
Arabic numerals 1-3, the size is 3cm × 3cm, the color is red. Children with ADHD also have more extra number than
Stimuli are presented in the center of 14-inch color display, normal children, it reflects that hand movements of ADHD
response keys were "1", "2", "3". children are more confused and have less coordination. There
is no significant difference in reaction time between two groups,
C. Experiment design indicating that there are no difference in speed of visual-motor
The experiment takes a two-factor variable(subjects: integration and speed of hands movement between two groups.
children with ADHD and normal children ×difficulty levels of
tasks: simple and complex ) in experiment design. Dependent TABLE I. THE DIFFERENCE IN PARAMETERS BETWEEN TWO
variables are reaction time (RT), reaction time fluctuations, EXPERIMENTS AMONG CHILDREN WITH ADHD
the correct key number, missing number, wrong number and Simple task Complex task
extra number. Among them, reaction time fluctuations(ᇞ RT) Mean Std. Mean Std.
means the absolute value of the difference between adjacent Deviation Deviation
two reaction time. Reaction time 343.2000 51.5855 366.1000 58.7829
Reaction time 202.9000 40.8260 213.1000 36.7709
D. Experiment process fluctuations
Correct number 595.6000 202.4034 527.8000 114.2509
This study takes place in the psychological tests room, it’s a Wrong number 157.6000 94.1348 296.6000 103.8890
quiet test environment without any interference. First Miss number 163.7000 229.8478 103.6000 55.2272
experimental objects are informed to the subjects. Before the Extra number 566.8000 763.2151 426.300 274.0170
experiment, participants take enough practices. During the test,
random number from 0 to 9 are displayed in the middle of the TABLE II. THE DIFFERENCE IN PARAMETERS BETWEEN TWO
screen, each number lasts for 100ms and the duration of two EXPERIMENTS AMONG HEALTHY CHILDREN

numbers is 1900ms. After subjects see the number, they are Simple task Complex task
asked to press the same number on the keyboard. The whole Mean Std. Mean Std.
test lasts for 40 minutes, and every minute is a sequence, every Deviation Deviation
number will be displayed once in a sequence. The computer Reaction time 371.5000 64.8249 385.5000 48.4865
Reaction time 128.7000 30.2142 102.9000 21.5481
automatically records correct number, miss number, error fluctuations
number and average reaction time. The correct number is used Correct number 797.1000 69.7176 771.1000 56.0306
to mainly reflect the sustained attention in the study. Wrong number 47.5000 36.2713 78.4000 32.1565
Miss number 51.6000 51.0385 53.5000 44.6672
Simple experiment: During the experiment, Arabic Extra number 54.3000 47.5863 71.6000 51.2622
numerals 1-3 will randomly appear in the middle of the
Independent samples T-test in table 2 shows: (1) There are
computer screen, each number will continue to appear 3 times.
differences in reaction time fluctuations, correct key number,
Stimulus duration is 100ms, the time between two appearances
wrong number of keys and extra number keys between children
is 900ms, when the subjects see the number appears, they are
with ADHD and healthy children both in simple task and
asked to press the corresponding number key.
complex task; (2) There is no difference in reaction time
Complex experiment: Based on the sub-experiment 1, between children with ADHD and normal children, we indicate
computer randomly set the occurrences of number, it’s that there is no significant difference in the speed of visual -
unpredictable, increasing task difficulty, and subjects are asked motor integration between two groups, maybe there is no

2973
difference in some terms of cognitive processing between them,
but it needs further experimental verification.
Table 3 shows the influence of subjects grouping and task
difficulty on parameters based on two-way ANOVA. The
results show that there is difference in error number between
two groups and the interaction is shown in figure 1. The results
of simple main effects test are shown in table 4.

TABLE III. THE INFLUENCE OF SUBJECTS GROUPING AND TASK

DIFFICULTY ON PARAMETERS

Reactio Reactio Correct Wrong Miss Extra

n time n time number number number number
fluctuati
ons
Sub F=1.796 F=77.34 F=31.90 F=48.98 F=4.350 F=11.35
ject 9 0 2 2
s P=.189 P=.000* P=.000* P=.000* P=.044* P=.002*
gro ** ** **
upi
ng
Tas F=1.075 F=.554 F=1.149 F=13.11 F=.560 F=.229
k 9
diff P=.307 P=.462 P=.241 P=.001* P=.459 P=.635
icul
ty Figure 1. Interaction between subjects grouping and task difficulty on error
Inte F=.063 F=2.938 F=.282 F=5.311 F=.636 F=.376 number
ract P=.804 P=.095 P=.599 P=.027* P=.431 P=.544
ion Simple main effects analysis shows that there are
significant differences both within groups and between groups.
TABLE IV. SIMPLE MAIN EFFECTS OF SUBJECTS GROUPING AND TASK The difference is even more significant while doing complex
DIFFICULTY task, which means that task difficulty has influence on the
Mean Std. F P accuracy of visual-motor integration, the more complex the
Deviation task is, the greater the impact is. There is significant difference
Simple task Healthy 47.5000 36.2713 11.911 .003** between two levels of task difficulty only in children with
children ADHD, however there is no significant differences in healthy
Children 157.6000 94.1348
children. The results show that task difficulty does not affect
with ADHD
Complex Healthy 78.4000 32.1565 40.256 .000*** the error number of healthy children, but has a certain effect on
task children that of children with ADHD, the error number significantly
Children 296.6000 103.8890 increased while children with ADHD are doing complex task.
with ADHD It shows that among children with ADHD, the more complex
Healthy Simple task 47.5000 36.2713 4.064 .059 the task is, the worse accuracy of visual - motor integration is,
children and the worse movement coordination is.
Complex 78.4000 32.1565
task
Children Simple task 157.6000 94.1348 9.830 .006**
with ADHD
IV. DISCUSSION
Complex 296.6000 103.8890
task This study invests the differences in movement
coordination between children with ADHD and healthy
children while doing simple task and complex task based on
two-way ANOVA analysis. The study finds that: (1) There are
differences in reaction time fluctuations, correct key number,
error number of keys and extra number keys between children
with ADHD and healthy children regardless of task difficulty;
(2) Task difficulty has no influence on reaction time, reaction
time fluctuations, correct key number and extra number keys.
The reason is that the coordination of children with ADHD is
poor and their performance is bad both in simple task and
complex task. But within the healthy children the task is not
hard enough to make difference performance; (3) Compared
with simple task, the error number of children with ADHD
increases while doing complex task. It shows that children with
ADHD are easier to make mistakes while doing complex tasks;
(4) There is no difference in reaction time between children

2974
with ADHD and normal children, we indicate that there is no [7] E.Fliers,Rommelse.Motor coordination problems in children and
significant difference in the speed of visual - motor integration adolescents with ADHD rated by parents and teachers: effects of age and
gender.Neural Transm㸪2008㸪115:211-220.
between two groups, maybe there is no difference in some
[8] CHENG Hong, FANG Ron, LI Gong-zheng. Multi-factor analysis of
terms of cognitive processing between them, but it needs visual-motor integration development.Chinese Journal of School
further experimental verification. Health.2010,31:438-439
[9] G. Eason, B. Noble, and I. N. Sneddon, “On certain integrals of
REFERENCES Lipschitz-Hankel type involving products of Bessel functions,” Phil.
Trans. Roy. Soc. London, vol. A247, pp. 529–551, April 1955.
[1] LIU Yu-xin, WANG Yu-feng. Cognitive functions of children with (references)
attention deficit/hyperactivity disorder.National Medical Journal of
China. 2002,82(6):389-392 [10] J. Clerk Maxwell, A Treatise on Electricity and Magnetism, 3rd ed., vol.
2. Oxford: Clarendon, 1892, pp.68–73.
[2] LAN Li, LI Gong-zheng. The relationship between visual-motor
integration and learning behavior of children.Chinese Journal of [11] I. S. Jacobs and C. P. Bean, “Fine particles, thin films and exchange
Behavioral Medical Science.2001,10(5):480-481 anisotropy,” in Magnetism, vol. III, G. T. Rado and H. Suhl, Eds. New
York: Academic, 1963, pp. 271–350.
[3] ZHANG Fen, YAO Kai-nan, YANG Yu-fen. The study on visual-motor
integration development of children with different temperament [12] Nanda,.Rommelse,Marieke.Altink ,Jaap Oosterlaan ÆLeo Beem
types.Chinese Journal of Behavioral Medical Science.2002,11(2)㸸218- Cathelijne.Buschgens Jan Buitelaar Joseph A.Sergeant.Speed,
219 Variability, and Timing of Motor Output in ADHD:Which Measures are
Useful for Endophenotypic Research?[J].Behav Genet 2008,38:121–132.
[4] Harvey WJ, Reid G.Motor performance of children with attention deficit
hyperactivity disorder: A preliminary.Adap ted Physical Activity [13] R. Nicole, “Title of paper with only first word capitalized,” J. Name
Quarterly.1997,14:189-202. Stand. Abbrev., in press.
[5] Licari,Larkin,Miyahara.The influence of developmental coordination [14] Y. Yorozu, M. Hirano, K. Oka, and Y. Tagawa, “Electron spectroscopy
disorder and attention deficit on associated movements in children. Hum studies on magneto-optical media and plastic substrate interface,” IEEE
Mov Sci, 2006, 25: 90-99. Transl. J. Magn. Japan, vol. 2, pp. 740–741, August 1987 [Digests 9th
[6] Jan P.Piek,Murray J.Dyck.Sensory-motor deficits in children with Annual Conf. Magnetics Japan, p. 301, 1982].
developmental coordination disorder,attention deficit hyperactivity [15] M. Young, The Technical Writer's Handbook. Mill Valley, CA:
disorder and autistic disorder.Human Movement Science㸪2004㸪475- University Science, 1989.
488.

2975