The Differences in Coordination between Children with ADHD and Healthy Children Based on Two-
way ANOVA Analysis jiahai Liu1 gao Yang1 fangzhong Xu minyan Zhou
1:Zhejiang University City College, Hangzhou, China
2:Zhejiang Palit Hospital, Hangzhou,China
Abstract—This study attempts to invest the differences in movement coordination between children with ADHD and healthy children using two-way ANOVA. The experimental tasks are divided into simple task and complex task. The goal of the experiments is to study the interaction in hand movements’ rhythm, accuracy and error key response between task difficulty and subjects grouping while doing visual-motor integration tasks. The results show that: (1) There are no significant differences in all parameters except error number within group differences. (2) There are significant differences in all parameters except correct response time between group differences.
Keywords-task difficulty; ADHD; grouping; movement coordination
I. INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is very
common in clinical, it is one of the most widely studied diseases in child psychiatry[1-5]. In recent years, it ranks in the first or second place in the child-patient cases, causing the whole society’s attention on children with ADHD.
Children with ADHD often accompany with developmental disabilities, the most common is developmental coordination disorder (DCD). This is a special developmental disorder, is characterized by obvious damage in the motion coordination[4- 5]. Although motor coordination disorder and ADHD are two different developmental disorders, but the studies find that ADHD often accompanies with motor coordination disorders[6,7]. Although many of the motor need the participation of many senses, but visual sense is the most important. Visual – motor integration is developed firstly in sensorimotor integration, coordination between visual perception and hand movements reflects the coordination and unification between visual perception and activities.
At present, continuous performance tests (CPT) are used to evaluate attention disorder among children. A series of numbers or characters are showed on a computer monitor as stimulants in a CPT, subjects are required to make response to certain target, the reaction results are used to evaluate attention deficit. Error number in the tests is used to reflect the subjects’ attention deficit, false number reflects the impulse of subjects. As that, the objectivity of evaluation has been improved greatly and the accuracy of clinical diagnostic is higher. Andrew L. Cohen  considers that CPT has moderate reliability and validity in the diagnosis of ADHD. Wang shu-yu, finds that in auditory continuity tests and audio-visual continuity test, the reaction time of children with all ADHD subtypes are longer
than those of control group, and the number of misstatements and omissions are significantly higher than those of control group. However, And Gayle finds that hit rate of ADHD children is lower than that of normal control group in the single-target CPT, but in the sustained attention task there is no significant difference between them. The reason may be the study ignores the temporal characteristics attention, we should notice that attention changes over time, itself will produce the ups and downs over time, the performance of subjects is good at the beginning of the test, and then declines. The researches on ADHD children’s cognitive mechanisms have unanimously recognized that children with ADHD lose more short-term 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 test is distracting, this also needs to be examined depending on the time.
Raising the level of any researches are inseparable from the improvement of methods. Traditional ADHD researches are usually horizontal studies, often using large samples, real-time facilities to measure and compare the mean, variance analysis, differences in test, and finally get the conclusions. Longitudinal study is an extension in the psychology research methods, it is closer to the true law of development of the psychological phenomenon. Time series test is a longitudinal study, it refers to the values of certain indicators at different times, chronologically arranged in the series; also refers to a system in response to the different “time” which is its own historical behavior objective record. Time series tests can observe long- term trend of variables and the trend of the psychological development of individuals. They can also determine the causal relationship between the variables on the dynamic changes, as well as long-term prediction and control of human psychology and behavior.
Previous studies of motor coordination in children with ADHD use several common sensory integration scales, the results depend on the observation, are not subjective. And the studies only examine motor coordination in children with ADHD, haven’t studied the factors affect coordination. Therefore, this article studies the difference of coordination between children with ADHD and normal children, and tries to explore the influence of difficulty levels of tasks on motor coordination, with a goal to provide new experimental evidence to coordination study of ADHD.
Zhejiang Provincial Natural Science Foundation (Y2080622)
2972 978-1-4577-1415-3/12/$26.00 ©2012 IEEE
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A. Subjects Experimental group: Randomly select 20 children with
ADHD from Tongde Provincial Hospital, Hangzhou, aged 7-14 years old. Inclusion criteria: (1) Comply with the American Psychiatric Association “Diagnostic and Statistical Manual of Mental Disorders,” Fourth Edition (DSM-IV) ADHD diagnostic criteria. (2) Exclude people with physical disease and extensive mental disorders, mental retardation, emotional disorders and other diseases. (3) All cases are not under spiritual drug treatment. (4) All cases are right-handed.
Control group: Randomly select 20 normal children from primary school grades 1-6, Hangzhou, aged 7-14 years old. Exclude people with physical disease and mental illness. Children are right-handed.
B. Laboratory instruments and materials The experiment is controlled by a personal computer, the
screen resolution was 1024 × 768. Stimulus materials are the Arabic numerals 1-3, the size is 3cm × 3cm, the color is red. Stimuli are presented in the center of 14-inch color display, response keys were “1”, “2”, “3”.
C. Experiment design The experiment takes a two-factor variable(subjects:
children with ADHD and normal children ×difficulty levels of tasks: simple and complex ) in experiment design. Dependent variables are reaction time (RT), reaction time fluctuations, the correct key number, missing number, wrong number and extra number. Among them, reaction time fluctuations( RT) means the absolute value of the difference between adjacent two reaction time.
D. Experiment process This study takes place in the psychological tests room, it’s a
quiet test environment without any interference. First experimental objects are informed to the subjects. Before the experiment, participants take enough practices. During the test, random number from 0 to 9 are displayed in the middle of the screen, each number lasts for 100ms and the duration of two numbers is 1900ms. After subjects see the number, they are asked to press the same number on the keyboard. The whole test lasts for 40 minutes, and every minute is a sequence, every number will be displayed once in a sequence. The computer automatically records correct number, miss number, error number and average reaction time. The correct number is used to mainly reflect the sustained attention in the study.
Simple experiment: During the experiment, Arabic numerals 1-3 will randomly appear in the middle of the computer screen, each number will continue to appear 3 times. Stimulus duration is 100ms, the time between two appearances is 900ms, when the subjects see the number appears, they are asked to press the corresponding number key.
Complex experiment: Based on the sub-experiment 1, computer randomly set the occurrences of number, it’s unpredictable, increasing task difficulty, and subjects are asked
to remain vigilant. During the experiment, Arabic numerals 1-3 will randomly appear in the middle of the computer screen. Stimulus duration is 100ms, the time between two appearances is 900ms, when the subjects see the number appears, they are asked to press the corresponding number key.
III. RESULTS Table 1&2 show the reaction time (RT), reaction time
fluctuations, the correct key number, missing number, wrong number and extra number while two groups doing simple experiment and complex experiment. Independent samples T- test in table 1 show that there are significant differences in reaction time fluctuations, correct number, wrong number and extra number between two groups. Compared with normal children, children with ADHD have large reaction time fluctuations which means children with ADHD have larger change in rhythm and their movement is more instable. Children with ADHD have less correct number and more wrong number than normal children, which means the visual- motor integration accuracy and hand motor coordination of Children with ADHD are worse than those of normal children. Children with ADHD also have more extra number than normal children, it reflects that hand movements of ADHD children are more confused and have less coordination. There is no significant difference in reaction time between two groups, indicating that there are no difference in speed of visual-motor integration and speed of hands movement between two groups.
TABLE I. THE DIFFERENCE IN PARAMETERS BETWEEN TWO EXPERIMENTS AMONG CHILDREN WITH ADHD
Simple task Complex task Mean Std.
Deviation Mean Std.
Deviation Reaction time 343.2000 51.5855 366.1000 58.7829 Reaction time fluctuations
202.9000 40.8260 213.1000 36.7709
Correct number 595.6000 202.4034 527.8000 114.2509 Wrong number 157.6000 94.1348 296.6000 103.8890 Miss number 163.7000 229.8478 103.6000 55.2272 Extra number 566.8000 763.2151 426.300 274.0170
TABLE II. THE DIFFERENCE IN PARAMETERS BETWEEN TWO EXPERIMENTS AMONG HEALTHY CHILDREN
Simple task Complex task Mean Std.
Deviation Mean Std.
Deviation Reaction time 371.5000 64.8249 385.5000 48.4865 Reaction time fluctuations
128.7000 30.2142 102.9000 21.5481
Correct number 797.1000 69.7176 771.1000 56.0306 Wrong number 47.5000 36.2713 78.4000 32.1565 Miss number 51.6000 51.0385 53.5000 44.6672 Extra number 54.3000 47.5863 71.6000 51.2622
Independent samples T-test in table 2 shows: (1) There are differences in reaction time fluctuations, correct key number, wrong number of keys and extra number keys between children with ADHD and healthy children both in simple task and complex task; (2) There is no difference in reaction time between children with ADHD and normal children, we indicate that there is no significant difference in the speed of visual – motor integration between two groups, maybe there is no
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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 n time
Reactio n time
s gro upi ng
F=1.796 F=77.34 9
F=4.350 F=11.35 2
P=.189 P=.000* **
diff icul ty
F=1.075 F=.554 F=1.149 F=13.11 9
P=.307 P=.462 P=.241 P=.001* P=.459 P=.635
Inte ract ion
F=.063 F=2.938 F=.282 F=5.311 F=.636 F=.376 P=.804 P=.095 P=.599 P=.027* P=.431 P=.544
TABLE IV. SIMPLE MAIN EFFECTS OF SUBJECTS GROUPING AND TASK DIFFICULTY
Mean Std. Deviation
Simple task Healthy children
47.5000 36.2713 11.911 .003**
Children with ADHD
78.4000 32.1565 40.256 .000***
Children with ADHD
Simple task 47.5000 36.2713 4.064 .059
Children with ADHD
Simple task 157.6000 94.1348 9.830 .006**
Figure 1. Interaction between subjects grouping and task difficulty on error number
Simple main effects analysis shows that there are significant differences both within groups and between groups. The difference is even more significant while doing complex task, which means that task difficulty has influence on the accuracy of visual-motor integration, the more complex the task is, the greater the impact is. There is significant difference between two levels of task difficulty only in children with ADHD, however there is no significant differences in healthy children. The results show that task difficulty does not affect the error number of healthy children, but has a certain effect on that of children with ADHD, the error number significantly increased while children with ADHD are doing complex task. It shows that among children with ADHD, the more complex the task is, the worse accuracy of visual – motor integration is, and the worse movement coordination is.
IV. DISCUSSION 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
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with ADHD and normal children, we indicate that there is no significant difference in the speed of visual – motor integration between two groups, maybe there is no difference in some terms of cognitive processing between them, but it needs further experimental verification.
REFERENCES  LIU Yu-xin, WANG Yu-feng. Cognitive functions of children with
attention deficit/hyperactivity disorder.National Medical Journal of China. 2002,82(6):389-392
 LAN Li, LI Gong-zheng. The relationship between visual-motor integration and learning behavior of children.Chinese Journal of Behavioral Medical Science.2001,10(5):480-481
 ZHANG Fen, YAO Kai-nan, YANG Yu-fen. The study on visual-motor integration development of children with different temperament types.Chinese Journal of Behavioral Medical Science.2002,11(2) 218- 219
 Harvey WJ, Reid G.Motor performance of children with attention deficit hyperactivity disorder: A preliminary.Adap ted Physical Activity Quarterly.1997,14:189-202.
 Licari,Larkin,Miyahara.The influence of developmental coordination disorder and attention deficit on associated movements in children. Hum Mov Sci, 2006, 25: 90-99.
 Jan P.Piek,Murray J.Dyck.Sensory-motor deficits in children with developmental coordination disorder,attention deficit hyperactivity disorder and autistic disorder.Human Movement Science 2004 475- 488.
 E.Fliers,Rommelse.Motor coordination problems in children and adolescents with ADHD rated by parents and teachers: effects of age and gender.Neural Transm 2008 115:211-220.
 CHENG Hong, FANG Ron, LI Gong-zheng. Multi-factor analysis of visual-motor integration development.Chinese Journal of School Health.2010,31:438-439
 G. Eason, B. Noble, and I. N. Sneddon, “On certain integrals of Lipschitz-Hankel type involving products of Bessel functions,” Phil. Trans. Roy. Soc. London, vol. A247, pp. 529–551, April 1955. (references)
 J. Clerk Maxwell, A Treatise on Electricity and Magnetism, 3rd ed., vol. 2. Oxford: Clarendon, 1892, pp.68–73.
 I. S. Jacobs and C. P. Bean, “Fine particles, thin films and exchange anisotropy,” in Magnetism, vol. III, G. T. Rado and H. Suhl, Eds. New York: Academic, 1963, pp. 271–350.
 Nanda,.Rommelse,Marieke.Altink ,Jaap Oosterlaan ÆLeo Beem Cathelijne.Buschgens Jan Buitelaar Joseph A.Sergeant.Speed, Variability, and Timing of Motor Output in ADHD:Which Measures are Useful for Endophenotypic Research?[J].Behav Genet 2008,38:121–132.
 R. Nicole, “Title of paper with only first word capitalized,” J. Name Stand. Abbrev., in press.
 Y. Yorozu, M. Hirano, K. Oka, and Y. Tagawa, “Electron spectroscopy studies on magneto-optical media and plastic substrate interface,” IEEE Transl. J. Magn. Japan, vol. 2, pp. 740–741, August 1987 [Digests 9th Annual Conf. Magnetics Japan, p. 301, 1982].
 M. Young, The Technical Writer’s Handbook. Mill Valley, CA: University Science, 1989.
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