Human Movement Science 39 (2015) 101–108

Contents lists available at ScienceDirect

Human Movement Science

journal homepage: www.elsevier.com/locate/humov

Co-occurring motor, language and

emotional–behavioral problems
in children 3–6 years of age
Sara King-Dowling a,e,⇑, Cheryl Missiuna b,e, M. Christine Rodriguez c,e,
Matt Greenway d, John Cairney a,c,e
a
McMaster University, Department of Kinesiology, Hamilton, Ontario, Canada
b
McMaster University, School of Rehabilitation Science and CanChild, Hamilton, Ontario, Canada
c
McMaster University, Department of Family Medicine, Hamilton, Ontario, Canada
d
Brock University, Department of Kinesiology, St. Catharines, Ontario, Canada
e
Infant and Child Health Lab, McMaster University, Hamilton, Ontario, Canada

a r t i c l e i n f o a b s t r a c t

Article history: Purpose: Developmental Coordination Disorder (DCD) has been

shown to co-occur with behavioral and language problems in
school-aged children, but little is known as to when these
PsycINFO classification: problems begin to emerge, or if they are inherent in children with
3200
DCD. The purpose of this study was to determine if deficits in
Keywords: language and emotional–behavioral problems are apparent in
Developmental coordination disorder preschool-aged children with movement difficulties.
Movement difficulties Method: Two hundred and fourteen children (mean age 4 years
Language delay 11 months, SD 9.8 months, 103 male) performed the Movement
Behavior Assessment Battery for Children 2nd Edition (MABC-2). Children
Co-occurrence falling at or below the 16th percentile were classified as being at
Preschool risk for movement difficulties (MD risk). Auditory comprehension
and expressive communication were examined using the Preschool
Language Scales 4th Edition (PLS-4). Parent-reported emotional
and behavioral problems were assessed using the Child Behavior
Checklist (CBCL).
Results: Preschool children with diminished motor coordination
(n = 37) were found to have lower language scores, higher exter-
nalizing behaviors in the form of increased aggression, as well as
increased withdrawn and other behavior symptoms compared
with their typically developing peers.

⇑ Corresponding author at: Department of Kinesiology, McMaster University, 1280 Main St. West, Hamilton, Ontario L8S 4L8,
Canada. Tel.: +1 905 525 9140x20303.
E-mail address: [email protected] (S. King-Dowling).

http://dx.doi.org/10.1016/j.humov.2014.10.010
0167-9457/Ó 2014 Elsevier B.V. All rights reserved.
102 S. King-Dowling et al. / Human Movement Science 39 (2015) 101–108

Conclusions: Motor coordination, language and emotional–behavioral

difficulties tend to co-occur in young children aged 3–6 years. These
results highlight the need for early intervention.
Ó 2014 Elsevier B.V. All rights reserved.

1. Introduction

Developmental Coordination Disorder (DCD) is a neuro-developmental disorder characterized by

diminished fine and/or gross motor coordination that affects approximately 5–6% of children
(American Psychiatric Association, 2013). In addition to difficulties with motor skills, many of these
children display other developmental and behavioral difficulties. Notably, DCD has been shown to
co-occur with language difficulties (i.e. reading disability, specific language impairment) and
emotional/behavioral problems, such as ADHD (Cairney, Veldhuizen, & Szatmari, 2010; Dewey &
Wilson, 2001; Flapper & Schoemaker, 2013; Zwicker, Harris, & Klassen, 2012). Most research on
concurrent disorders in DCD has involved school age children, mainly because DCD is not typically
diagnosed until middle childhood (Barnhart, Davenport, Epps, & Nordquist, 2003).
Schoemaker and Kalverboer (1994) were among the first to examine the relationship between
movement problems and social and affective problems in young children (aged 6–7 years). They found
that children who had motor coordination difficulties were more anxious than their typically
developing peers. Since then, several studies have found similar associations between motor ability
and internalizing behaviors (Green, Baird, & Sugden, 2006; Tseng, Howe, Chuang, & Hsieh, 2007) only
one of which focused solely on children of kindergarten age (Piek, Bradbury, Elsley, & Tate, 2008).
Longitudinal research has implicated variable early motor development (from 4 months to 4 years)
to be predictive of higher anxious/depressive symptomatology at age 6–12 and that childhood motor
skills may be a risk factor for adolescent anxiety levels (Piek, Barrett, Smith, Rigoli, & Gasson, 2010;
Sigurdsson, Van Os, & Fombonne, 2002).
In addition to internalizing disorders, such as depression and anxiety, motor coordination has also
been linked to externalizing behaviors. Co-occurrence rates with DCD and attention deficit/
hyperactivity disorder (ADHD) have been found to be as high as 50% (Kadesjo & Gillberg, 1999;
Pitcher, Piek, & Hay, 2003); however, these co-morbidities are typically studied in children who are
already in mid- to late childhood. Only a couple of studies have examined the relationship between
motor competence and externalizing behaviors in children under 6 years old. Better motor
performance in 5–6-year-old children has been shown to relate to lower externalizing behaviors
(Livesey, Keen, Rouse, & White, 2006), and increased aggression has been observed in preschool
children with DCD during free-play (Kennedy-Behr, Rodger, & Mickan, 2013). In contrast, one study
on children with DCD aged 6–10 reported lower levels of aggression (Chen, Tseng, Hu, & Cermak,
2009) and therefore this relationship needs further examination.
Language difficulties have also been reported to co-occur with motor difficulties. Flapper and
Schoemaker (2013) found the prevalence of DCD in 5–8 year old children with specific language
impairment was approximately 33%, significantly above the population prevalence of DCD. Early lan-
guage delay, in toddlers and preschoolers, has also been reported to relate to later motor impairment
in kindergarten and school-age children, respectively (Gaines & Missiuna, 2007; Webster, Majnemer,
Platt, & Shevell, 2005). Language concerns in the DCD population are particularly important because
some children with language impairments tend to struggle with social skills and may be at increased
risk of developing behavioral and social problems (Horowitz, Jansson, Ljungberg, & Hedenbro, 2005;
Ketelaars, Cuperus, Jansonius, & Verhoeven, 2010; Lindsay & Dockrell, 2000; Willinger et al., 2003).
Collectively, this body of research suggests that motor development is related to various aspects of
child development. However due to the limited research on emotional–behavioral and language
difficulties in pre-school children with motor difficulties, we aimed to further investigate these
relationships. The purpose of this study was to determine if a community based sample of preschool
S. King-Dowling et al. / Human Movement Science 39 (2015) 101–108 103

children at risk for motor coordination problems also experience more emotional/behavioral and
language difficulties compared to their typically developing peers. This research will be the first to
examine these three areas of child development concurrently in preschool children in hopes to shed
light on when these problems begin to emerge, and to contribute to the limited literature available on
these relationships in early childhood.

2. Methods

2.1. Participants

218 parent–child pairs were recruited from various community organizations in Southern Ontario
from 2010 to 2011; details of the study design are provided in a previous publication (Parmar, Kwan,
Rodriguez, Missiuna, & Cairney, 2014). Children ranged in age from 44 to 80 months (48% male).
Children with known physical impairments (e.g. blindness, deafness or genetic syndromes) or who
did not speak English were not eligible to participate. Informed, written consent was given by
parents/guardians of all participants. Ethical approval was obtained from the McMaster University
Faculty of Health Science and Hamilton Health Sciences Research Ethics Boards.

2.2. Measures

2.2.1. Movement difficulties

In order to measure motor ability, 218 children performed the Movement Assessment Battery for
Children 2nd Edition (MABC-2) (Henderson, Sugden, Barnett, & Smits-Engelsman, 1992). This is one of
the most widely used tools for assessing movement proficiency (Schulz, Henderson, Sugden, & Barnett,
2011). The test was administered by a trained research assistant at the child’s home or other conve-
nient location. The MABC-2 consists of 8 items divided into 3 subscales: manual dexterity, aiming &
catching, and balance (static & dynamic). Raw scores on each item are converted into standard scores
based on the child’s age. These standard scores are tallied resulting in an overall standard score and
corresponding percentile. In accordance with the MABC-2 guidelines, children falling at or below
the 16th percentile were classified as being at risk for movement difficulties (MD risk); children above
the 16th percentile were considered typically developing (TD). Only children who completed all
MABC-2 items were included in the analysis.

2.2.2. Language skills

Language abilities were assessed using the Preschool Language Scales 4th Edition (PLS-4)
(Zimmerman, Steiner, & Pond, 2002). A trained research assistant individually administered the test.
The PLS-4 is a reliable and valid standardized tool for assessing language skills in children from birth
to age 6 years 11 months (Zimmerman & Castilleja, 2005). This measure assesses both how much
language the child understands (auditory comprehension) and how well the child can communicate
with others (expressive communication). Total raw scores as well as raw scores for each domain were
totaled and converted into standard scores and corresponding percentile rankings based on the child’s
age.

2.2.3. Emotional–behavioral functioning

Emotional and behavioral problems were assessed using the Child Behavior Checklist (CBCL). This
is one of the most widely used tools for the assessment of mental health in children (Moretti & Obsuth,
2010). The questionnaire was filled out by the parent or person most knowledgeable (PMK) about the
child; in 98% of children, this was the birth mother. The CBCL consists of 99 statements covering a
wide range of emotional–behavioral symptoms. PMKs answered each item on a scale of 0–2, 0 being
not true of the child, with 2 being very true or often true of the child. The CBCL scales are divided into
eight syndrome scales: emotional reactivity, anxious/depressive, somatic complaints and withdrawn
(together comprise the internalizing behavior domain); attention problems and aggressive behavior
(together comprise the externalizing problem domain); and sleep problems and other problems being
104 S. King-Dowling et al. / Human Movement Science 39 (2015) 101–108

the final two syndrome scales. Raw scores for each syndrome scale were totaled. Raw scores for the
entire questionnaire and for the internalizing and externalizing domains were calculated and
converted into total problem scores (t-scores). Higher t-scores are indicative of more emotional–
behavioral problems, with t-scores >60 considered being in the clinical range.

2.2.4. Intelligence quotient (IQ)

All children completed the Kaufman Brief Intelligence Test, 2nd edition (KBIT-2) (Kaufman &
Kaufman, 2004) to provide an estimate of verbal and non-verbal intelligence.

2.3. Statistical analyses

Independent sample t-tests were conducted to determine group differences on percentile rankings
on the language scales, total problem scores (t-scores) on the internalizing, externalizing and total
behavioral domains, and standard IQ scores between the MD risk and TD groups. A one-way MANOVA
was conducted to determine if there were significant overall raw score differences on the eight
behavioral syndrome scales between MD risk and TD children. Pillai’s Trace was used as the criterion
for testing significant multivariate effects. Significant multivariate effects were followed up with one-
way univariate ANOVAs. Assumptions of the univariate t-tests were tested using the Levene’s Test for
equality of variances. Cohen’s d was calculated to determine the effect size of all main group compar-
isons, where 0.2 is considered small, 0.5 is medium and 0.8 is considered a large effect size. In order to
compare the proportion of children falling into the clinical range on the CBCL, as well as the proportion
of males in each group, Pearson’s chi square analysis was conducted. Significance level was set to
p < .05 for all analyses. All analyses were conducted using SPSS Version 20.

3. Results

3.1. Movement difficulties

Of the 258 parents who consented and enrolled their children into the study, 218 assessments were
conducted. Of these, two children were excluded due to a significant language barrier and two
children had an incomplete motor assessment, resulting in a total of 214 children included in the final
analysis. The children were 48% male and ranged in age from 3 years 8 months to 6 years 8 months,
with a mean age of 59 (SD 9.8) months. In the current sample MABC-2 scores ranged from 0.1 to
99.9 percentiles, with 37 children falling into the MD risk category. The MD risk group was over-
represented by boys (78%). There were no significant differences in overall measured intelligence or
age between the groups, however verbal intelligence was significantly lower in the MD risk group
(Table 1).

3.2. Language difficulties

The results of the independent t-tests indicate that the MD risk group had significantly lower
percentile rankings on total language (70.5%ile vs. 81.8%ile), t(212) = 2.86, p = .006, d = 0.57 as well

Table 1
Sample characteristics.

MD risk TD v2 p
*
N (% male) 37 (78) 177 (42) 15.88 <.001
t(212) p
Age, mean (SD) 4 years 11 months (9 months) 4 years 11 months (10 months) .49 .63
MABC-2 %ile (SD)* 11.2 (5.0) 66.9 (25.8) 13.03 <.001
IQ composite (SD) 95.1 (13.9) 98.9 (13.5) 1.55 .12
Verbal IQ St score* 99.2 (15.9) 105.6 (15.5) 2.26 .03
Non-verbal IQ St score 91.0 (14.4) 92.2 (13.2) 0.52 .61
*
Significant group differences (p < .05).
S. King-Dowling et al. / Human Movement Science 39 (2015) 101–108 105

100 * * * MD risk
80 TD

Percentile
60

40

20

0
Total Language AC EC

Fig. 1. Language domains. AC = auditory comprehension, EC = expressive communication. ⁄p < .05.

60
* * MD risk
TD
40
T-Score

20

0
Internalizing Externalizing Total Behaviour

Fig. 2. Child behavior checklist domains. t-score = total problems score. ⁄p < .05.

as the auditory comprehension (69.9%ile vs. 79.5%ile), t(212) = 2.79, p = .006, d = 0.46 and expressive
communication (67.6%ile vs. 78.7%ile), t(212) = 2.80, p = .008, d = 0.55 subscales of the PLS-4 (Fig. 1).

3.3. Emotional–behavioral problems

The results from analysis of the CBCL indicate that the MD risk group had significantly higher total
problem scores on externalizing behavior (46.2 vs. 42.7, t(212) = 2.25, p = .036, d = 0.38) and total
behavior domains (46.6 vs. 42.7, t = 1.99, p = .047, d = 0.35), but there were no significant group
differences on the internalizing subscale (47.8 vs. 45.4, t = 1.251, p = .21, d = 0.2) (Fig. 2). Only 9
children fell into the clinical range on the total behavior score, 3 (8%) in the MD Risk group and 6
(3%) in the TD group (v2 = 1.69, p = .19).
Further examination into the 8 specific CBCL syndrome scales found a significant omnibus effect,
Pillai’s Trace = 0.093, F(8, 205) = 2.641, (p = .009). Follow-up one-way univariate ANOVAs indicated
the MD risk group had significantly higher raw scores on aggression (8.2 vs. 5.8, F(1, 212) = 4.89,
p = .03, d = 0.36), withdrawn symptoms (1.78 vs. 1.06, F = 6.05, p = .02, d = 0.38) and other problems
(7.6 vs. 5.1, F = 7.52, p = .007, d = 0.44) compared with the TD group (Fig. 3).

4. Discussion

The results of this study indicate that young children with motor difficulties tend to have lower
language abilities and more emotional–behavioral problems when compared with their typically
developing peers. More specifically, children at risk for movement difficulties showed decreased audi-
tory comprehension and expressive communication scores, as well as a higher frequency of aggressive
and withdrawn behaviors. Parents of children in the MD risk group also reported higher scores on the
‘‘other behavior’’ syndrome scale, which comprises a wide variety of negative behaviors that are not
captured by the other CBCL syndrome scales (e.g., doesn’t get along with peers, afraid to try new
106 S. King-Dowling et al. / Human Movement Science 39 (2015) 101–108

10
* *
MD risk
TD
8

Raw Score
6

4
*
2

s
n

s
ed

m
nt

m
iv
aw

io
ss

ct

le
ai

le
ss

le
dr

ea

ob

ob
pl

ob
re

re
ith

om
ep

Pr
Pr
g

Pr
W

Ag
lly
D

p
n

er
s/

ee
io
na

ic

th
ou

nt
at

Sl
io

O
te
m
xi

ot

At
An

So
Em

Fig. 3. Child behavior checklist syndrome scales. ⁄p < .05.

things, doesn’t leave home, etc.). Although no overall IQ differences were noted between groups, the
MD risk group scored significantly lower, although still in the average range, on the verbal intelligence
subsection of the K-BIT. This finding provides additional support to the language results as there is
significant content overlap between verbal intelligence and auditory comprehension. Our results
are concerning because poor motor abilities tend to persist from early childhood throughout adoles-
cence (Barnett, van Beurden, Morgan, Brooks, & Beard, 2010; Cantell, Smyth, & Ahonen, 2003), and
may be associated with ongoing language, social and emotional difficulties. At the same time, it is
important to point out that while children at risk for movement difficulties have increased problems
related to language and emotional–behavioral issues, few are scoring in the clinical range on these
measures. Our results therefore suggest increased risk, rather than diagnosable problems per se.
The existing literature on DCD and externalizing behaviors in young childhood is somewhat con-
tradictory. Our study did not find higher rates of attention problems in children at risk for movement
difficulties, which is in contrast to the high co-occurrence rates of DCD and ADHD typically found in
older children (Kadesjo & Gillberg, 1999). However this may be due to the fact that many of these
children were not yet in school full time, and therefore difficulties with attention may be harder to
recognize. It also may suggest that ADHD is not inherently comorbid with DCD, and attention and
hyperactivity behavior may be a result of difficulties children with DCD face once they enter school,
both in the classroom and during unstructured and structured play with their peers (Cairney et al.,
2010). Although we did not find differences in symptoms related to inattention, our results did
indicate higher aggressive tendencies in young children with poor motor abilities, which supports
Kennedy-Behr, Rodger, and Mickan (2013) observational work with preschoolers. The MD risk group
in our study was over-represented with boys, which may explain our results as young boys tend to be
viewed as more physically and verbally aggressive (Ostrov & Keating, 2004). A similar argument can
be made for the typically high rate of co-morbidity of ADHD and DCD seen in older children: this too
may be a function of the fact that boys are over-represented in children with DCD and in externalizing
disorders such as ADHD. In our sample, the sample size of girls with movement difficulties was too
small to examine the effect of sex on the co-occurrence of MD risk and aggression. This is only the sec-
ond study to identify higher aggressive tendencies in very young children with movement difficulties,
and therefore more research into motor skill development and aggression is required. It seems plau-
sible that boys may act out physically (e.g., pushing, grabbing) in part to deal with the frustrations
associated with having both poor motor skills and the problem of expressing feelings verbally.
Language impairment in childhood has been associated with higher rates of anxiety disorders such
as social phobia as well as antisocial personality disorder in adulthood (Beitchman et al., 2001). As
DCD in middle childhood is also associated with increased risk of anxiety and depression (Cairney
et al., 2010), children with simultaneous motor and language delays, therefore, may be at much
greater risk for later development of psychiatric disorders. Although we did not find that preschool
children at risk for movement difficulties were showing higher overall internalizing behaviors at this
S. King-Dowling et al. / Human Movement Science 39 (2015) 101–108 107

early age, as they did not experience more anxious or depressive symptoms, somatic complaints or
emotional reactivity, they were experiencing more internalizing behaviors in the form of withdrawal.
The finding that children with motor delays are experiencing both increased externalizing
(aggression) and internalizing (withdrawn) behaviors is of concern as children with lower motor
abilities may be susceptible to a wide range of mental and behavioral disorders as they develop
(Fanti & Henrich, 2010). This highlights the importance for early intervention in this population.
As these data are cross-sectional, we cannot ascertain the causal relationships between motor
difficulties, language problems and behavioral symptoms i.e. whether or not aggression is caused
by combined language and motor coordination deficits. Nevertheless, as co-occurring developmental
difficulties may increase the chances of a child having long-term difficulties (Hellgren, Gillberg,
Gillberg, & Enerskog, 1993; Rasmussen & Gillberg, 2000), it will be necessary to determine whether
motor difficulties and its related emotional–behavioral symptoms are caused by a common neurode-
velopmental pathway influenced by genetic and/or environmental factors. It is hypothesized that
comorbid childhood developmental disorders may represent an underlying diffuse ‘‘atypical brain
development’’ (Kaplan, N Wilson, Dewey, & Crawford, 1998; Visser, 2003). Future longitudinal
research is needed in order to examine temporal associations between these constructs.
This is one of the first studies to look at the inter-relationships among motor coordination difficul-
ties, language and behavior in such a young age group. A major limitation of this study is that we could
not assess for DCD, in part due to the very young age range of the sample, but also because not all
criteria for full DCD diagnosis were measured (i.e. no physician evaluations or assessment of impact
on activities of daily living). Another limitation is that emotional/behavioral difficulties were only
assessed by parents, which limits the generalizability of the findings to home-based settings and
not to the classroom or other child-care arrangements. Despite these limitations, the results show that
there may be an important association between these aspects of child development that begin earlier
than previously thought.

Acknowledgements

This study was funded by Ontario’s Ministry of Child and Youth Services. Dr. Cairney is funded by
an endowed professorship in the Department of Family Medicine. The funder was not involved in
study design, data collection, data analysis, manuscript preparation and/or publication decisions.

References

American Psychiatric Association (2013). DSM (5th ed.). American Psychiatric Association.
Barnett, L. M., van Beurden, E., Morgan, P. J., Brooks, L. O., & Beard, J. R. (2010). Gender differences in motor skill proficiency from
childhood to adolescence: A longitudinal study. Research Quarterly for Exercise and Sport, 81, 162–170 [Electronic version].
Barnhart, R. C., Davenport, M. J., Epps, S. B., & Nordquist, V. M. (2003). Developmental coordination disorder. Physical Therapy, 83,
722–731 [Electronic version].
Beitchman, J. H., Wilson, B., Johnson, C. J., Atkinson, L., Young, A., Adlaf, E., et al (2001). Fourteen-year follow-up of speech/
language-impaired and control children: Psychiatric outcome. Journal of the American Academy of Child & Adolescent
Psychiatry, 40, 75–82 [Electronic version].
Cairney, J., Veldhuizen, S., & Szatmari, P. (2010). Motor coordination and emotional–behavioral problems in children. Current
Opinion in Psychiatry, 23, 324–329 [Electronic version].
Cantell, M. H., Smyth, M. M., & Ahonen, T. P. (2003). Two distinct pathways for developmental coordination disorder:
Persistence and resolution. Human Movement Science, 22, 413–431 [Electronic version].
Chen, Y., Tseng, M., Hu, F., & Cermak, S. A. (2009). Psychosocial adjustment and attention in children with developmental
coordination disorder using different motor tests. Research in Developmental Disabilities, 30, 1367–1377 [Electronic version].
Dewey, D., & Wilson, B. N. (2001). Developmental coordination disorder: What is it? Physical & Occupational Therapy in
Pediatrics, 20, 5–27 [Electronic version].
Fanti, K. A., & Henrich, C. C. (2010). Trajectories of pure and co-occurring internalizing and externalizing problems from age 2 to
age 12: Findings from the national institute of child health and human development study of early child care. Developmental
Psychology, 46, 1159 [Electronic version].
Flapper, B. C., & Schoemaker, M. M. (2013). Developmental coordination disorder in children with specific language impairment:
Co-morbidity and impact on quality of life. Research in Developmental Disabilities, 34, 756–763 [Electronic version].
Gaines, R., & Missiuna, C. (2007). Early identification: Are speech/language-impaired toddlers at increased risk for
developmental coordination disorder? Child: Care, Health and Development, 33, 325–332 [Electronic version].
Green, D., Baird, G., & Sugden, D. (2006). A pilot study of psychopathology in developmental coordination disorder. Child: Care,
Health and Development, 32, 741–750 [Electronic version].
108 S. King-Dowling et al. / Human Movement Science 39 (2015) 101–108

Hellgren, L., Gillberg, C., Gillberg, I. C., & Enerskog, I. (1993). Children with deficits in attention, motor control and perception
(DAMP) almost grown up: General health at 16 years. Developmental Medicine & Child Neurology, 35, 881–892 [Electronic
version].
Henderson, S. E., Sugden, D. A., Barnett, A. L., & Smits-Engelsman, C. (1992). Movement assessment battery for children. London:
Psychological Corporation.
Horowitz, L., Jansson, L., Ljungberg, T., & Hedenbro, M. (2005). Behavioural patterns of conflict resolution strategies in preschool
boys with language impairment in comparison with boys with typical language development. International Journal of
Language & Communication Disorders, 40, 431–454 [Electronic version].
Kadesjo, B., & Gillberg, C. (1999). Developmental coordination disorder in Swedish 7-year-old children. Journal of the American
Academy of Child & Adolescent Psychiatry, 38, 820–828 [Electronic version].
Kaplan, B. J., N Wilson, B., Dewey, D., & Crawford, S. G. (1998). DCD may not be a discrete disorder. Human Movement Science, 17,
471–490 [Electronic version].
Kaufman, A. S., & Kaufman, N. L. (2004). KBIT-2: Kaufman brief intelligence test (2nd ed.). Bloomington, MN: Pearson Inc.
Kennedy-Behr, A., Rodger, S., & Mickan, S. (2013). Aggressive interactions during free-play at preschool of children with and
without developmental coordination disorder. Research in Developmental Disabilities, 34, 2831–2837 [Electronic version].
Ketelaars, M. P., Cuperus, J., Jansonius, K., & Verhoeven, L. (2010). Pragmatic language impairment and associated behavioural
problems. International Journal of Language & Communication Disorders, 45, 204–214 [Electronic version].
Lindsay, G., & Dockrell, J. (2000). The behaviour and self-esteem of children with specific speech and language difficulties. British
Journal of Educational Psychology, 70, 583–601 [Electronic version].
Livesey, D., Keen, J., Rouse, J., & White, F. (2006). The relationship between measures of executive function, motor performance
and externalising behaviour in 5- and 6-year-old children. Human Movement Science, 25, 50–64 [Electronic version].
Moretti, M. M., & Obsuth, I. (2010). Child behavior checklist. Corsini Encyclopedia of Psychology [Electronic version].
Ostrov, J. M., & Keating, C. F. (2004). Gender differences in preschool aggression during free play and structured interactions: An
observational study. Social Development, 13, 255–277 [Electronic version].
Parmar, A., Kwan, M., Rodriguez, C., Missiuna, C., & Cairney, J. (2014). Psychometric properties of the DCD-Q-07 in children ages
to 4–6. Research in Developmental Disabilities, 35, 330–339 [Electronic version].
Piek, J. P., Barrett, N. C., Smith, L. M., Rigoli, D., & Gasson, N. (2010). Do motor skills in infancy and early childhood predict
anxious and depressive symptomatology at school age? Human Movement Science, 29, 777–786 [Electronic version].
Piek, J. P., Bradbury, G. S., Elsley, S. C., & Tate, L. (2008). Motor coordination and social–emotional behaviour in preschool-aged
children. International Journal of Disability, Development and Education, 55, 143–151 [Electronic version].
Pitcher, T. M., Piek, J. P., & Hay, D. A. (2003). Fine and gross motor ability in males with ADHD. Developmental Medicine & Child
Neurology, 45, 525–535 [Electronic version].
Rasmussen, P., & Gillberg, C. (2000). Natural outcome of ADHD with developmental coordination disorder at age 22 years: A
controlled, longitudinal, community-based study. Journal of the American Academy of Child & Adolescent Psychiatry, 39,
1424–1431 [Electronic version].
Schoemaker, M. M., & Kalverboer, A. F. (1994). Social and affective problems of children who are clumsy: How early do’’ they
begin? Adapted Physical Activity Quarterly, 11, 140 [Electronic version].
Schulz, J., Henderson, S. E., Sugden, D. A., & Barnett, A. L. (2011). Structural validity of the movement ABC-2 test: Factor structure
comparisons across three age groups. Research in Developmental Disabilities, 32, 1361–1369 [Electronic version].
Sigurdsson, E., Van Os, J., & Fombonne, E. (2002). Are impaired childhood motor skills a risk factor for adolescent anxiety?
Results from the 1958 UK birth cohort and the national child development study. American Journal of Psychiatry, 159,
1044–1046 [Electronic version].
Tseng, M., Howe, T., Chuang, I., & Hsieh, C. (2007). Cooccurrence of problems in activity level, attention, psychosocial
adjustment, reading and writing in children with developmental coordination disorder. International Journal of
Rehabilitation Research, 30, 327–332 [Electronic version].
Visser, J. (2003). Developmental coordination disorder: A review of research on subtypes and comorbidities. Human Movement
Science, 22, 479–493 [Electronic version].
Webster, R. I., Majnemer, A., Platt, R. W., & Shevell, M. I. (2005). Motor function at school age in children with a preschool
diagnosis of developmental language impairment. The Journal of Pediatrics, 146, 80–85 [Electronic version].
Willinger, U., Brunner, E., Diendorfer-Radner, G., Sams, J., Sirsch, U., & Eisenwort, B. (2003). Behaviour in children with language
development disorders. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 48, 607–614 [Electronic version].
Zimmerman, I. L., & Castilleja, N. F. (2005). The role of a language scale for infant and preschool assessment. Mental Retardation
and Developmental Disabilities Research Reviews, 11, 238–246 [Electronic version].
Zimmerman, I., Steiner, V., & Pond, R. (2002). PLS-4: Preschool Language Scale (4th ed.). San Antonio, TX: Pearson Inc.
Zwicker, J., Harris, S., & Klassen, A. (2012). Quality of life domains affected in children with developmental coordination
disorder: A systematic review. Child: Care, Health and Development [Electronic version].