Revista Brasileira de Psiquiatria.

2015;37:228–234
Associac¸ão Brasileira de Psiquiatria
doi:10.1590/1516-4446-2014-1533

ORIGINAL ARTICLE

Motor development of children with attention deficit

hyperactivity disorder
Francisco Rosa Neto,1 Juliana B. Goulardins,2 Daniela Rigoli,3 Jan P. Piek,3 Jorge A. de Oliveira2
1
Department of Human Movement, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil. 2Laboratory of Motor
Behavior, School of Physical Education and Sport, Universidade de São Paulo (USP), São Paulo, SP, Brazil. 3School of Psychology and
Speech Pathology, Curtin University, Perth, Australia.

Objective: To compare both global and specific domains of motor development of children with
attention deficit hyperactivity disorder (ADHD) with that of typically developing children.
Methods: Two hundred children (50 children with clinical diagnoses of ADHD, according to the
DSM-IV-TR and 150 typically developing controls), aged 5 to 10 years, participated in this cross-
sectional study. The Motor Development Scale was used to assess fine and global motricity, balance,
body schema, and spatial and temporal organization.
Results: Between-group testing revealed statistically significant differences between the ADHD and
control groups for all domains. The results also revealed a deficit of nearly two years in the motor
development of children with ADHD compared with the normative sample.
Conclusion: The current study shows that ADHD is associated with a delay in motor development
when compared to typically developing children. The results also suggested difficulties in certain
motor areas for those with ADHD. These results may point to plausible mechanisms underlying the
relationship between ADHD and motor difficulties.
Keywords: Attention deficit hyperactivity disorder; child psychiatry; interdisciplinary relations;
behavioral neurology; rehabilitation

Introduction Previous research has investigated specific motor

difficulties (e.g., fine or gross motor ability) in ADHD4 as
Attention deficit hyperactivity disorder (ADHD) is a highly well as the relationship between the cardinal symptoms of
comorbid and heterogeneous condition characterized by ADHD and motor performance.5,6 Other studies have
inattention, impulsivity, and hyperactivity.1 Research has examined motor development in children with ADHD,
reported ADHD prevalence estimates of approximately namely an assessment of motor ability involving many
5.9-7.1% in children and adolescents with a male to facets of a child’s performance, such as balance, fine and
female ratio of approximately 3:1 in population samples gross motor skills, and cognitive aspects related to the
and up to 10:1 in clinical samples.1 While research has motor act (e.g., temporal and spatial organization).7-9
also reported various etiological factors contributing to Findings have revealed a wide range of motor problems in
ADHD, there is general consensus that ADHD may be ADHD, including excessive overflow movements, poor
classified as a neurodevelopmental disorder. In fact, the timing, force control and greater variability in motor
recently released DSM-5 has included it as part of this outcomes, poor balancing, difficulties in both learning
class of disorders.2 The DSM-5 also notes an important and performing a variety of motor skills, and deficits in fine
relationship between ADHD and motor difficulties; how- motor skills.4 Pitcher et al.4 also demonstrated that
ever, it states that although mild motor delays often co- children with ADHD had significantly poorer fine and
occur with ADHD, these are not specific to the disorder.2 gross motor ability when compared with control children
Furthermore, it is noted that any marked motor delays or with typical development. Furthermore, children with
‘‘clumsiness’’ found in those with ADHD should be ADHD have also scored significantly lower on tasks
diagnosed separately. Further research in this area is demanding upper limb and eye-hand coordination and
needed as the basis of the relationship between ADHD visual-motor integration compared with controls.10
and motor delay remains poorly understood.3,4 In addi- Tseng et al.5 investigated the relationship between
tion, motor problems may have a severe impact on motor performance, attention, impulse control, and
children’s daily lives and occur in 30-50% of those with hyperactivity in children with ADHD, and found that
ADHD.3,4 attention and impulse control were important predictors
of both fine and gross motor skills in children with ADHD.5
Kroes et al.6 examined whether quantitative and/or
Correspondence: Juliana Barbosa Goulardins, Av. Prof. Mello Moraes,
65, Cidade Universitária, CEP 05508-030, São Paulo, SP, Brazil. qualitative aspects of motor performance in 5- and
E-mail: [email protected] 6-year-old children could predict ADHD, and found that
Submitted Aug 08 2014, accepted Nov 23 2014. two of the four qualitative domains (Dynamic Balance and
 Motor development of children with ADHD 229

Diadochokinesis and Manual Dexterity) as well as the (UNISUL) (n. 07.374.4.01.III) and the State Secretary of
total qualitative score at 5 and 6 years of age predicted Education of Santa Catarina, Brazil. An invitation to
ADHD diagnosis one year later. participate in this study was sent to ten public schools
Although research linking ADHD with motor skills has within the Tubarão area, Santa Catarina, Brazil. Parental
increased, few studies have examined the extent of the consent forms were obtained for all participants included
delay in motor development in children with ADHD. in this study.
In their study, Goulardins et al.8 identified a delay of over
one year between the motor age and chronological age of Participants
children with ADHD. The authors suggested that the
cortical maturation delay in the prefrontal areas demon- A total of 1,666 children from ten public schools in Brazil
strated by Shaw et al.11 might partially explain these were involved in this study. Of these, 200 children, aged
findings. The delay in reaching peak of cortical thickness between 5 and 10 years, completed the entire testing and
for those with ADHD was most prominent in prefrontal were divided into two groups: a group of 50 children with
regions linked to the ability to inhibit unwanted thoughts clinical diagnoses of ADHD (five girls and 45 boys; mean
and responses, executive control of attention, evaluation age: 8 years and 11 months) and a control group of 150
of rewards of action, working memory, and the motor typically developing children (20 girls and 130 boys, mean
control necessary and appropriate for an expected age 8 years and 8 months). Because of the gender
action.11 differences related to ADHD diagnosis,1 the male:female
The understanding of ADHD must consider the context ratio was purposely maintained in the control group in
of what is developmentally appropriate and consider the order to ensure the homogeneity of the samples.
age-related changes in the neurobiology of patients at The exclusion criteria for both groups were intellectual
different ages. However, despite the clinical complexity of disability, autism, physical conditions (i.e., visual, hearing,
this disorder, it is possible to identify different cognitive, heart, rheumatic, orthopedic), neurological disorder, and
motor, and emotional processes that might, if altered, regular use of medication. No children were receiving
influence ADHD symptomatology.12 Therefore, investiga- medication for ADHD symptomatology. This information
tions into delayed motor development in children with was obtained through a parent-rated psychosocial ques-
ADHD may provide important information about these tionnaire, which includes questions about pregnancy,
children’s wellbeing, monitor developmental alterations, childbirth, motor development, previous diagnosis, socio-
identify delays, and verify the effectiveness of intervention economic conditions, and child behavior.
strategies. In addition, identifying whether there is global The initial screening process of the ADHD group
delay or impact on specific aspects of motor development consisted of providing teachers with an information guide
is crucial in understanding the basis of these delays as describing ADHD symptoms. Next, the teachers identified
well as highlighting particular strengths and weaknesses 200 children as potential subjects. Subsequently, the
of these individuals.13 teachers and parents of these nominated children were
It is important to note the impact on quality of life for asked to complete the Swanson, Nolan, and Pelham-IV
children with ADHD regardless of motor problems, since (SNAP-IV) Rating Scale. Those children who presented
ADHD is a biopsychosocial disorder. However, there is with six inattentive subtype symptoms and/or six hyper-
strong evidence for a poorer prognosis in those indivi- active/impulsive symptoms, according to both parents
duals with both ADHD and motor problems, including and teachers, were then referred for formal assessment.
poorer psychosocial and emotional functioning (e.g., A multidisciplinary team and a specialist medical doctor
higher levels of depressive symptomatology).14 Further- carried out further assessment, and ADHD was diag-
more, a positive relationship has been found between nosed according to DSM-IV-TR criteria.15 The DSM-IV-
quality of life and motor development in children with TR was used in the current study as data collection
ADHD; therefore, it is plausible that improving motor occurred prior to the publication of the DSM-5. However,
performance may ultimately develop skills, prevent this does not affect the characteristics of the groups
children from acting impulsively on their feelings, and because ADHD diagnostic criteria for children and
improve their self-concept and self-esteem.7 adolescents have not changed. The comorbidities that
The current study aimed to further examine the extent commonly occur with ADHD, such as developmental
of the relationship between motor coordination and ADHD coordination disorder (DCD), learning disorders, mood
in children from Brazil, and identify the types of motor disorders, oppositional defiant disorder, and conduct
skills that are impacted. Thereby, the objective was to disorder were not screened, and therefore were not
compare both global and specific domains of motor excluded from the current study.
development in children with ADHD and typically devel- One hundred and twenty children were assessed by the
oping children. multidisciplinary team. Of these, 50 were diagnosed with
ADHD, and the remaining 70 were excluded from the
Methods study. Once the ADHD diagnosis was confirmed by the
multidisciplinary team, all children were further assessed
Procedures by the main researcher. Following data collection, the
children were referred to be treated by a multidisciplinary
This was a cross-sectional study, approved by the Ethics team at the Mother and Child Outpatient Clinic, School of
Committee of the Universidade do Sul de Santa Catarina Medicine, UNISUL, Brazil.

Rev Bras Psiquiatr. 2015;37(3)

230 F Rosa Neto et al.

The control group comprised 150 typically developing months), for general motor age (mean of all motor ages),
children selected by their teachers for having an average and for motor quotients (motor age for each domain or
school performance and no significant problems related to general motor age divided by chronological age and
inattention or hyperactivity/impulsivity. Furthermore, any multiplied by 100). Positive ages or negative ages are
child with a previous diagnosis of ADHD according to the determined by the difference between chronological age
parent-rated psychosocial questionnaire was excluded and general motor age. Motor ages demonstrate the
from the control group. extent of the delay in relation to the chronological age for
the general and specific domains. The MDS motor
Measures quotients classify levels of motor development, ranging
from very low (equal to or below 69 points), lower (70-79
The SNAP-IV – Teacher and Parent Rating Scale is a points), normal low (80-89 points), normal medium (90-
behavior rating scale, including nine items of inattention 109 points), normal high (110-119 points), high (120-129
and nine hyperactivity/impulsivity items, based on DSM- points), and very high (equal to or up to 130 points).
IV-TR criteria.15 The Brazilian reduced version of the According to the MDS, normal low, lower, and very low
SNAP-IV (18 items) was used in the current study. The correspond to mild, moderate, and severe risk for delayed
scale allows parents and teachers to rate each symptom motor development, respectively.13 The MDS has shown
on a four-point scale from 0 (not at all) to 3 (very much). to be a reliable and valid instrument to assess motor
A clinical cutoff of six inattentive subtype items and/or six development in the Brazilian population.13 The MDS was
hyperactive/impulsive items was used in this study, individually administered to the ADHD and the control
according to DSM-IV-TR criteria.16 The SNAP-IV scale children in a single, 40-minute session.
is widely used to assess ADHD symptoms. It has been
used in many treatment studies, including the Multimodal Statistical analysis
Treatment Study for ADHD, and has shown acceptable
internal consistency.17 Tests of normality (Kolmogorov-Smirnov and Shapiro-
The Motor Development Scale (MDS)13 was designed Wilk) revealed non-normal distributions for most of the
to assess the following domains: fine and global motricity, motor variables in both groups. Therefore, the Mann-
balance, body schema, spatial and temporal organization, Whitney Test (U statistic) was used to compare the
and the level of motor development in 2- to 11-year-old difference between groups. All statistical analyses were
children.13 It includes specific tasks for each age, with the performed using the SPSS version 20. Significance level
complexity of tasks increasing with age. Examinees was set at p o 0.05.
proceed to tasks at the previous or next developmental
age depending on task success. Fine motricity assesses Results
fine motor and visuomotor skills and was based on the
performance of tasks such as tying a knot, drawing trail, As expected, more males than females1 were diagnosed
threading, throwing a small ball at a target, and touching with ADHD, with a male to female ratio of 9:1. However,
the finger tips with the thumb. The global motricity domain gender ratios between the ADHD and control groups did
involves gross motor as well as dynamic balance tasks not differ (p = 0.54). In addition, there was no statistically
including jumping on one foot and walking on a straight significant difference for chronological age between
line. Balance includes static balance tasks of standing on groups (p = 0.11).
tiptoe, standing on one foot with eyes open and closed, The difference between chronological age and general
and stork balance. Body schema includes tasks such as motor age revealed only negative ages for both groups.
imitation of gestures and graphic speed. Spatial organiza- The descriptive analysis of the distribution of the motor
tion comprises laterality tasks (self and others’ body ages between groups is shown in Table 1. When
perspective) as well as constructing a rectangle from two compared with the normative sample from the MDS, the
triangles. Temporal organization includes tasks such as results revealed a negative age of 23.4 months for the
repeating verbal phrases and reproducing visual or ADHD group and 7.8 months for the control group,
auditory stimuli. The MDS provides values for motor ages suggesting that both the ADHD and control groups have
for each domain (sum of task results, expressed in lower than average motor scores.

Table 1 Distribution of motor ages between groups

Control group ADHD group
Mean 6 SD Negative ages* Mean 6 SD Negative ages*
Fine motricity 103.5620.7 -0.8 86.5618.1 -20.5
Global motricity 100.8614.1 -3.5 93.2620.4 -13.8
Balance 98.8622.4 -5.5 79.8623.7 -27.2
Body scheme 96.8619.7 -7.5 90.9621.2 -16.1
Spatial organization 93.4618.8 -10.9 77.5614.1 -29.5
Temporal organization 85.6621.4 -18.7 73.4612.5 -33.6
ADHD = attention deficit hyperactivity disorder; SD = standard deviation.
* Difference between motor ages and chronological ages, in months.

Rev Bras Psiquiatr. 2015;37(3)

 Motor development of children with ADHD 231

Table 3 Distribution of mean, standard deviation, median, minimum and maximum for general motor age and motor quotients and the Motor Development Scale (MDS)

0.35
0.58

0.48
0.34
0.47
0.26
0.39
0.29
Table 2 Distribution in percentage of children for each motor

r
quotient
Classification Control group ADHD group

p-value
o 0.01
o 0.01

0.01
0.01
0.01
0.01
0.01
0.01
Normal high 6.7 0
Normal medium 59.3 6.0

o
o
o
o
o
o
Normal low 26.7 42.0
Lower 7.3 40.0
Very low 0 12.0

Classification

Normal low
Normal low

Normal low
ADHD = attention deficit hyperactivity disorder.

Very low
Lower

Lower
Low
The percentage of children in each motor quotient
classification can be found in Table 2. More than half
(52%) of the children with ADHD were classified as below

Min-max
normal motor development (lower and very low), in

47.6-95
54-106

60-108
52-119
47-107
60-112
46-102
62-97
contrast, only 7.3% of the control group had lower motor

ADHD group
development.
Table 3 describes the MDS results for the control and
ADHD groups, respectively: mean, standard deviation

Median
(SD), median, minimum and maximum values for general

85.5
78.0

82.0
88.0
72.0
84.8
75.0
69.5
motor age, general motor quotient, motor quotients, their
MDS classification on each motor skill, the comparison
between groups, and the effect size. The general motor
quotient classified the motor development of children with

Mean 6 SD
83.6614.7

81.1612.0
87.0613.5
73.8615.2
84.9612.5
73.6613.3
69.8612.6
78.468.0
ADHD as lower (78.4) and normal medium (93.3) for the
control children. Statistically significant differences were
found between the groups in all motor quotients and in

ADHD = attention deficit hyperactivity disorder; Min-max = minimum-maximum; SD = standard deviation.

general motor age.

Normal medium

medium
medium
medium
medium

medium
Classification

Discussion

low
Normal
Normal
Normal
Normal
Normal
Normal
The present study compared the motor development of
ADHD and typically developing children, and revealed a
mean deficit in motor development of 23.4 months for the
ADHD group. Furthermore, the general motor quotient on
the MDS classified the level of motor development of the
Min-max
58-126
72-118

66-145
40-143
49-143
65-135
50-161
50-152
Control group

control group as normal medium (i.e., not at risk) and

lower (i.e., moderate risk for delayed motor development)
for children with ADHD. Thus, the motor profile revealed
that children with ADHD demonstrate difficulties in motor
Median

performance when compared with typically developing

101.0
100.0
96.0
92.5

92.5
91.0
91.0
77.0

children, which is in line with other research.3,8,9

p-values were determined by Mann-Whitney (U statistic).

Below-normal motor development (lower and very low)

was observed in 52% of the children with ADHD, which is
close to the range reported in other studies. Clinical
Mean 6 SD
96.5613.3

99.8615.8
98.2615.7
94.9617.6
93.3613.0
91.1620.3
83.3620.1
93.369.7

and epidemiological studies have reported that 30-50%

of children with ADHD experience motor coordination
problems.3,4,8 It has been noted that the type of motor
assessment, referral sources, and the cutoff points used
may explain the differences between studies.3,4,8
classification of both groups

Although there is strong evidence for the clinically

General motor age (months)

significant coexistence of ADHD and motor coordination

Temporal organization
General motor quotient

problems, several aspects regarding the association

Spatial organization

remain unclear.3 Most studies in the area have examined

Global motricity

the relationship between DCD and ADHD,3,18 a comor-

Body scheme
Fine motricity
Motor quotients

bidity with significant impact. However, little has been

investigated regarding these motor problems as an
Balance

integral symptom of ADHD.7 Other research findings

have classified the level of motor development of children
with ADHD as normal (normal low), although they have

Rev Bras Psiquiatr. 2015;37(3)

232 F Rosa Neto et al.

demonstrated poorer performance when compared with hemispheric differences were due to management or use
typically developing children.7-9 It is possible that the of available cognitive resources rather than inherent
motor problems in ADHD may be partly explained by capacity. Roessner et al.27 argued that attention should
neurological abnormalities found in structures related to also be paid to the left-right aspects of functional and
motor control, such as the cerebellum and basal ganglia.8 structural brain anomalies in ADHD, especially in regard
Morphometric and neuroimaging studies have been to co-existing problems.
performed to identify abnormalities in brain regions for In the present study, temporal organization was the
individuals with ADHD and have demonstrated reductions most impacted domain in children with ADHD, and is
in volumes: total brain, prefrontal cortex, caudate nucleus, related to concepts of order, duration, frequency, and
globus pallidus, anterior cingulate, and cerebellum, espe- rhythm, which involves processes of perception and
cially in the vermis and inferior posterior lobe.19 Further- memory of succession, processing, storage and re-
more, Shaw et al.11 found a delay in the maturation of memorization.13 This concept is typically modified by
cortical thickness in these children compared with healthy the involvement of executive functions. Klimkeit et al. 28
controls, especially in prefrontal regions linked to the ability suggested that ADHD is characterized by slow motor
to inhibit unwanted thoughts and answers, executive preparation (but not motor execution) and deficits in
control of attention, evaluation of rewards action, motor selective attention, vigilance, and executive functions.
control and precision appropriate to the expected action, The very low motor quotient for temporal organization
and working memory. Recent findings have suggested an found for the ADHD group may be explained by
existence of common neurophysiological substrates under- the poorer performance on tasks involving executive
lying both motor and attention problems.20 functions for both children with ADHD and motor
The present study also revealed statistically significant impairment.
differences between the groups for most motor quotients Although children with ADHD demonstrated difficulties
assessed: fine and global motricity, balance, body in fine and global motricity, and body scheme, these
schema, and spatial and temporal organization. Motor domains were classified as normal low range. Fine motor
quotients for each domain demonstrated that typically skills and body scheme involve visuomotor and fine motor
developing children performed within the normal medium skill tasks. Previous studies have indicated that poor fine
range, except for spatial organization. Conversely, chil- motor ability is not a result of the ADHD symptomatology,
dren with ADHD were at risk for delayed development in but rather of the comorbid motor impairments.4,18
all domains, especially for balance, spatial and temporal Children with ADHD and without DCD have demonstrated
organizations. ‘‘proper’’ fine motor fluency and flexibility, but have shown
Previous researches have shown that children with fine motor difficulties when comorbid with DCD.18 Never-
ADHD have balance problems,6,21 suggesting difficulties theless, inattention has been associated with poorer fine
in keeping the trunk in an erect position using the proximal motor skill,5,29,30 and unsmooth movement performance
stabilizing muscles of the column.21 It is plausible that has shown to be significantly related to the severity of
abnormalities in the cerebellum may explain the associa- core ADHD symptoms.18 Children with ADHD without
tion between ADHD and balance as research has DCD have also scored significantly lower on tasks
implicated the cerebellum in both balance difficulties demanding upper limb and eye-hand coordination and
and ADHD.8 Although Buderath et al.22 observed minor visual-motor integration compared with controls.10
balance and stepping disorders in individuals with ADHD, Global motricity and dynamic balance tasks were
these motor deficits were compatible with mild cerebellar considered to be at a mild risk for delayed motor
dysfunction. Also, problems in executive functions com- development for the ADHD group, which is in line with Piek
monly found in ADHD, such as attention, mental calcula- et al.29 who demonstrated that children with both inattention
tion, orientation, and memory, interact with postural and hyperactivity are at risk for difficulties with gross motor
control and are associated with balance functions.23 It is skills. Emck et al.31 also reported that gross motor
important to highlight the significant association between performance is affected in children with psychiatric dis-
the children’s static/dynamic balance ability and socializa- orders, including ADHD. They found a developmental delay
tion behaviors in ADHD, even though this relationship still of approximately 3 years for both locomotion and object
requires further research so that the underlying causes or control, indicating that the psychiatric group performed
mediating factors can be determined.24 significantly worse than typically developing children.28
Children with ADHD also performed in the low Goulardins et al.8 suggested that the impairment of fine
classification ranges for spatial and temporal organiza- and global motricity may be related to the prefrontal cortex
tion, which is in line with a previous study by Poeta et al.9 abnormalities found in ADHD, which causes deficits in
The spatial organization tasks involve processes of organization, working memory, and planning and attention.
localization, orientation, visual-spatial recognition, per- In addition, a dysfunction in the cerebellum – thalamus –
ception of distance, and speed.8 ADHD is associated with prefrontal circuit may cause deficits in executive function,
anomalous laterality and these individuals are not only inhibition, and motor control.19
characterized by a shift in handedness, but may be better A strength of this study is the use of a test of motor
described as exhibiting a more general condition of ability that has been standardized in Brazil. The motor
lateralization.25 Hale et al.26 concluded that ADHD tests most commonly used around the world, such
individuals demonstrated greater right hemisphere as Bruininks-Oseretsky Test of Motor Proficiency
and reduced left hemisphere contribution, and these (second edition)32 and the McCarron Assessment of

Rev Bras Psiquiatr. 2015;37(3)

 Motor development of children with ADHD 233

Neuromuscular Development,33 have not been translated Also, careful observation across different contexts
and culturally adapted to Brazilian Portuguese. The MDS is required to ascertain if a lack of motor competence
is a useful tool for the systematic assessment of global is attributable to distractibility and impulsiveness rather
and specific domains of motor development. Never- than to DCD.2 Therefore, this study highlights the
theless, future research is needed for the translation, need for a multidisciplinary team in the assessment
cultural adaptation, and validation of the MDS in other and treatment of these individuals, including physical
countries because cross-cultural studies not only identify and occupational therapists. All health specialists
differences between individuals and cultures, but also treating children with ADHD should be attentive to the
help us understand their common characteristics. high frequency of co-occurring motor problems,3 as
The traditional subtypes of ADHD (predominantly children who have both ADHD and motor impairment
inattentive, predominantly hyperactive-impulsive, and are particularly at heightened risk of psychological
combined)15 were not analyzed in this paper because distress.36
they have been downgraded to presentations, according Our results provide support for an overlap between
to the new DSM-5 classification.2 Previous studies have motor difficulties and ADHD, which has important
reported a general decline in hyperactivity-impulsivity practical implications. Furthermore, the current study also
symptoms across development and a general increase in points to the possibility of executive function as a
inattentive symptoms,34 which indicates that the presen- mechanism underlying the relationship between motor
tation of ADHD differs according to age of diagnosis. development and ADHD and suggests possible brain
A developmental change in the presentation of motor deficits related to the motor difficulties of these children.
functioning may also occur in ADHD. The findings also suggest that, when investigating the
The current study has some limitations, including the relationship between ADHD and motor development, it is
non-exclusion and identification of comorbidities that important to consider the different processes that are
commonly occur with ADHD, such as DCD, learning required when performing specific motor tasks, including
disorders, mood disorders, oppositional defiant disorder, motor and cognitive aspects. This may clarify the
and conduct disorder. However, although ADHD is a conflicting findings from previous studies and lead to a
heterogeneous condition, this study revealed that only 6% better understanding of the nature of the relationship
of the sample were classified with normal medium motor between ADHD and motor problems.
development. This study highlights an important relation-
ship between ADHD and motor development. Future
Acknowledgements
studies should be designed to control for comorbidities
when investigating the motor problems related to ADHD. JBG has received grant/research support from Coorde-
It is also important to note, however, that controlling for nac¸ão de Aperfeic¸oamento de Pessoal de Nı́vel Superior
comorbidity in clinical samples is difficult, as 60% of (CAPES).
ADHD cases have shown to have comorbid psychiatric
diagnoses. Comparing the pattern of comorbidities might Disclosure
also provide useful information regarding differential
responses to treatment. The authors report no conflicts of interest.
The current findings support previous studies by Fliers
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