Does dual tasking ability change with age across childhood and adolescence? A systematic scoping review

Accepted Manuscript Title: Does dual tasking ability change with age across childhood and adolescence? A systematic scoping review Author: Shikha Saxena Eda Cinar Annette Majnemer Isabelle Gagnon PII: DOI: Reference:

S0736-5748(16)30221-0 http://dx.doi.org/doi:10.1016/j.ijdevneu.2017.01.012 DN 2160

To appear in:

Int. J. Devl Neuroscience

Received date: Revised date: Accepted date:

11-8-2016 14-1-2017 24-1-2017

Please cite this article as: Saxena, S., Cinar, E.,Does dual tasking ability change with age across childhood and adolescence? A systematic scoping review, International Journal of Developmental Neuroscience (2017), http://dx.doi.org/10.1016/j.ijdevneu.2017.01.012 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Title of the paper: Does dual tasking ability change with age across childhood and adolescence? A systematic scoping review

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Authors: Shikha Saxenaa*, Eda Cinara, Annette Majnemera, Isabelle Gagnona Author affiliations: a School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, Québec H3G 1Y5

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Shikha Saxena – [email protected]

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Eda Cinar – [email protected] Annette Majnemer – [email protected]

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Isabelle Gagnon – [email protected]

*Corresponding author: Shikha Saxena; 207-6060 Chemin De La Cote Saint Luc Road,

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Highlights

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Montreal, H3X2G8, QC, Canada. Email id. Tel.: 5147075961

Cognitive and postural strategies while dual tasking change with age in children

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Older children perform better than younger ones when the single tasks are not equated

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Effect of age on dual tasking when both single tasks are equated is inconclusive

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Dual tasking is multidimensional and includes a subset of cognitive abilities

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Abstract

The aim of this literature search was to identify nature and extent of the evidence supporting the development of dual tasking skills in typically developing children. We systematically searched PsycINFO, Ovid and Pubmed for studies evaluating dual task performances of children and adolescents < 18 years of age. 31 studies published in English from 1990 to 2016 were included. 1

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A descriptive analysis was used for data extraction and charting. Study findings reported that age influenced dual task performances under difficult or complex task conditions but they were found to be inconclusive when the tasks were equated at everyone’s difficulty level. Therefore,

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greater attention should be paid to meet the methodological and interpretive challenges to investigate if task coordination in children is affected by the dual tasking skills or just by

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development of motor and cognitive systems in isolation.

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Keywords: dual task, coordination, children, adolescents, concurrent, simultaneous

1. Introduction

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Functional activities involving concurrent tasks are common in children’s everyday activities and can include, for example, walking while carrying a tray of food or writing while listening or answering questions. Coordinating two concurrent tasks, also termed dual tasking, might result

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in a change in performance of one or both tasks, relative to performance of each task separately. This occurs when the two tasks interfere with one another, and is known as dual task (DT)

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interference. The measure used to quantify DT interference is usually DT cost, defined as the

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difference in performance scores between single and dual tasks. During DT assessment, the two tasks performed simultaneously in a DT paradigm can be two cognitive (CC), two motor (MM),

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or a motor and a cognitive task (MC). Recent work suggests that dual tasking can be considered a distinct executive function, owing to the nature of processes underlying performance of two

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concurrent tasks (Miyake et al., 2000). However, assessment of dual tasking is mostly neglected during standard evaluation of cognitive functions or motor functions in children with brain

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pathologies, both in clinical and research settings. One of the main reasons is that the acquisition

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of task coordination skills in typically developing children (TDC) is still elusive. Therefore, to interpret the changes in DT performance scores across ages and to identify dual tasking deficits in children with neurological disorders, evidence related to maturation of dual tasking in TDC must first be examined.

DT studies have been conducted in children 2 years of age and above to assess their ability to coordinate two tasks. A seminal literature review investigated the effects of age on task interference in CC paradigm among TDC of different age groups (Guttentag, 1989). It was postulated that age differences might exist in cognitive resource capacity required to perform concurrent cognitive tasks (Guttentag, 1989). Since the publication of this initial review, a 3

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number of developmental studies compared DT performances between TDC of different age groups. Some studies showed that dual task costs (DTC) decrease as children grow older (Boonyong et al., 2012; Hung et al., 2013; Krampe et al., 2011) while others did not (Anderson

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et al., 2011; Otte et al., 2006). A recent systematic review was conducted to identify age-related changes in standing and walking performance under DT conditions across lifespan, which

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reported weak evidence to support age related changes in children (Jan Ruffieux et al., 2015).

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None of the reviews used a holistic approach to synthesize an exhaustive evidence supporting the changes in dual tasking ability with age in children and adolescents. To build a better

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understanding of how this ability is acquired or matures over time, we carried out a systematic scoping review of the literature to – a) explore breadth and nature of the evidence supporting the

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effects of age on dual tasking abilities in children and adolescents; b) to identify gaps, if any, in

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research.

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the existing literature that will generate areas for future policy making, clinical practice and

2. Method

Owing to the heterogeneity of DT studies, a systematic scoping review approach was adopted to capture all evidence and map a bigger picture of how does age affect dual tasking in children and adolescents. This approach is a combination of scoping review methodology (inclusion of broad areas of research and study designs) and a systematic review methodology (quantitative synthesis of data and quality assessment of studies) (Brien et al., 2010). Using the framework recommended by Arksey and O’Malley (2005), specific methodological steps have been described to complete scoping reviews and those will be presented in the following sections 4

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(Arksey et al., 2005): Step 1. Identifying the Research Question: The research questions that guided this review were a) What is the existing evidence about the effects of age on the development of dual tasking in

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TDC? b) What are the gaps between research, clinical practice and policy making?

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Step 2. Identifying Relevant Studies and Study Selection: The assessment of the ability to perform a DT in children has been a topic of research since 1960s. However, the earlier studies mainly

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dealt with cognitive functions and were summarized by Guttentag in 1989 (Guttentag, 1989). This review includes the studies from 1990 to re-evaluate the effect of age on dual tasking for all

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DT paradigms (MC, CC, MM). Searches were conducted in Ovid, PsycINFO, and Pubmed for studies published from 1990 to September, 2016 representing the population of interest, both

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children and adolescents (< 18 years), using a combination of search terms such as “dual task OR

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concurrent task OR multi task OR divided attention OR task coordination” AND “Age OR

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Development OR Maturation OR Evolution”. Language was restricted to English and the keywords were mapped to MeSH terms where appropriate. Step 3. Selecting inclusion and exclusion criteria: Original research studies that performed an age wise comparison of the ability to perform dual tasks in TDC were included. Studies that were not original research or where the source population included subjects > 18 years of age were excluded. Also, studies compared DTC with children with disabilities were not included. Titles and abstracts retrieved from the search were screened and included if they matched the selection criteria.

Step 4. Charting the data: A data extraction form was developed to record the information for each study. The methodological quality of the studies included in this review were evaluated by the Newcastle-Ottawa Scale (NOS), where the total scores range from one to nine. The total scores results are

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interpreted under three categories - high (8–9 stars), medium (6–7 stars) and low quality (≤5 stars) (Wells et al., 2000). In addition to the quality analysis using NOS, DT studies should also be analyzed for methodological rigor specific to DT procedures. Therefore, existing evidence on tenets and frameworks

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indexing DT procedures was used to develop a brief checklist entailing methodological issues relevant to DT assessments (Table 1) (Brown et al., 2002; Li et al., 2005; McIsaac et al., 2015; Plummer et al., 2015;

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Table 1: Methodological considerations for dual task assessments

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Plummer et al., 2013).

Each single task should comply with the definition of dual tasking which is the concurrent performance of two tasks that can be performed independently, measured separately and have distinct goals (McIsaac et al., 2015).

2-Equation of task

Equating the task refers to controlling individual differences for baseline single task performances. Equating eliminates the problems of differential performance related to developmental level on single tasks, making the task equally difficult for participants of different age groups, to reach a prefixed percent of accuracy (Anderson et al., 2011). Difficulty level of the each task should be equated across age groups in terms of complexity and familiarity (Li et al., 2005; McIsaac et al., 2015). In order to quantify dual task (DT) interference, the differences in performance scores between single and dual tasks should be measured: Absolute DTC: single task – dual task Proportional DTC: (single task – dual task)/single-task (McIsaac et al., 2015; Plummer et al., 2015; Somberg et al., 1982) DT effect(cost) is bidirectional, so it may result in any of the nine patterns of DT interference that span from no change in DT interference to mutual facilitation to mutual interference (Plummer et al., 2013). Therefore, the DT effect should be measured for both tasks (Li et al., 2005).

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3- Calculation of dual task costs (DTC)

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1-Appropriateness of single tasks

4-DTC for each single task

5-Randomization of task order 6- Practice effect

In order to avoid learning effect, task order should be randomized

7- Clear instructions

Instructions on presence or absence of task prioritization should be clear (Li et al., 2005)

Practice may be used to equate the tasks, but its effect should be assessed (Brown et al., 2002)

Step 5. Collating, Summarizing, and Reporting the Results: We analyzed and combined the study findings on the basis of similarities in task paradigms and age groups, to describe age and age x task interaction effects on DT interference. The study purpose, methodology and major findings

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were the primary units of analysis. Screening of literature, data extraction was performed by one

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and quality analysis was done by two reviewers.

3. Results

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The literature search yielded 1977 articles: 449 in Ovid, 1193 in Pubmed and 335 in PsycINFO.

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The study selection process is shown in Figure 1. The final number included in the review was 31.

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Figure 1. - Flow-diagram for included studies

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Articles identified through database searching (n = 1977)

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Articles after removal of duplicates (n = 884) Articles after initial screening of abstracts (n = 96) Full text articles assessed for eligibility (n = 43) Articles included in the review (n = 31)

Cytology/molecular basis/other contexts of dual tasking – 83 Dual tasking in adults/children with pathologies – 362 Dual task theories/ attention theories – 72 Assessment of other executive functions (working memory, inhibition) - 271 No comparison of age groups 53 Mean age group >18years, review articles - 12

All studies included in this review are presented in Table 2. All studies were cross-sectional, and compared age differences between children of different age groups, ranging from 2 to 17 years old. This review also included studies that compared DT performances between children and

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adults. Most of the studies used MC (52%), followed by CC (32%) and MM (16%) paradigms to investigate the dual tasking ability.

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3.1 Quality assessment As per NOS analysis, only one article was high quality(P. Hagmann-von Arx et al., 2016), all

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other being medium quality (for details see Appendix). Most studies did not have enough sample

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size and only two studies stated the psychometric properties of the measures used (P. Hagmannvon Arx et al., 2016; Palluel et al., 2010). Six articles had better comparability among

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participants by controlling for the selection bias (Getchell et al., 2003; P. Hagmann-von Arx et al., 2016; Otte et al., 2006; Reilly et al., 2008; Sabine Schaefer et al., 2015; Spronk et al., 2012).

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As per criteria proposed in Table 1, very few studies addressed most of the methodological issues (Anderson et al., 2011; Hinton et al., 2015; Reilly et al., 2008; S. Schaefer et al., 2008).

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Table 2 outlines these methodological criteria for each study. Almost all studies used appropriate

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tasks except two -holding a glass of water and carrying a tray while walking or reaching- that are classified as complex single rather than dual tasks in the literature (McIsaac et al., 2015). Single tasks were equated by only eleven studies (Anderson et al., 2011; Hinton et al., 2015; IrwinChase et al., 2000; Krampe et al., 2011; Rattat, 2010; Reilly et al., 2008; S. Schaefer et al., 2008; Sebastian et al., 2013; Spronk et al., 2012; Sun et al., 2013), two of which did not adjust or equate both single tasks (Krampe et al., 2011; Sebastian et al., 2013). Only eleven studies analyzed the DT effect using DTC (five: absolute DTC, six: proportional DTC) (Abbruzzese et al., 2014; Anderson et al., 2011; Boonyong et al., 2012; Gautier et al., 2002; Krampe et al., 2011; Miller et al., 1991; Otte et al., 2006; Palluel et al., 2010; Reilly et al., 2008; S. Schaefer et al., 2008; Sebastian et al., 2013) and rest of them only used statistical methods to estimate the age

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effect (ANOVA). Most studies measured the DT effect on both tasks, however, a few studies neglected the DT effect on the secondary tasks (Abbruzzese et al., 2014; Getchell et al., 2003; Roncesvalles et al., 2005). To eliminate learning effect, majority of the studies randomized the

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task order. Lastly, out of the studies providing practice to either equate the single tasks or to make the tasks more familiar, six studies controlled or checked for the practice effect (Dossett et

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al., 2000; Getchell et al., 2003; Hinton et al., 2015; Hung et al., 2013; Irwin-Chase et al., 2000; 1991).

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Whitall,

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cr Knowledge of attention and resource allocation

4y (24-26) 5y (21-40) 7y (29-22)

2.Irwin Chase H, 2000, USA(IrwinChase et al., 2000) 3.Gautier T, 2002, France(Gauti er et al., 2002)

Ability to divide and allocate attention

8y (22) 11y (24)

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Effect of a dualtask on time reproduction

5y (18) 8y (15)

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4.McKenzie B, 2003, UK(McKenzi e et al., 2003)

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1.Dossett D, 2000, USA(Dossett et al., 2000)

Measurement Results-effect of age on dual task Motor or cognitive components performances (C – cognitive; M – motor) Performance Analysis (PA) Cognitive – Cognitive

Tasks Analysis (C – only cognitive task was equated)

Quality Analysis

C1 & C2 –Attention Tasks Experiment 1- Both Tasks Were Visual Detection Experiment 2 – Visual and Auditory Detection Tasks

-Appropriate single tasks -Both tasks equated -Dual task cost measured -Results of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Results of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice

Medium level

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Population Age groups Years = y

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Outcome

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Author, year, location

Effect of phonological and visual spatial interference on children’s arithmetic performance

PA – ANOVA Both Tasks –Visual Attention Tasks (With Different Priority Levels) PA – ANOVA C1 - Information Processing (Temporal Reproduction Task) C2 - Attentional Control (Picture Naming Non-Temporal Task)

C1- No age related differences C2- Allocation of attention was better in 7y than other age groups.

C-No differences in DT performance under equal priority condition; yet 8y showed lower DT performance under differential priority conditions C1- DTC was higher in 5y than 8y in the temporal task (more pronounced in longer duration 12s) C2- No age-related differences

PA – Absolute Dual Task Costs 6-7y (30) 8-9y (22)

Primary Task – Arithmetic Questions C1 – Phonological Interference (Digit Recall, Word List Recall) C2 – Visuospatial Interference (Block Recall, Visual Patterns Test)

C1- Older children had more phonological interference than younger one C1-Younger children more visuospatial interference than older.

PA – ANCOVA

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X

Medium level

X

Medium level

X X X

X X

High level

cr Top-down control over attention

6.Imbo I, 2007, Belgium(Imb o et al., 2007)

Working memory involvement

10y (15) Adults (21)

Measurement Motor or cognitive components (C – cognitive; M – motor) Performance Analysis (PA) C1 – Auditory Digit Span Task C2 – Visual Response Time Task

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PA - ANOVA

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10 y (21) 11 y (21) 12 y (21)

8y (61) 11y (45)

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Recruitment of executive resources

8.Rattat AC, 2010, France(Rattat , 2010)

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5.Karatekin C, 2004, USA(Karatek in, 2004)

7.Ang SY, 2010, Singapore (Ang et al., 2010)

Population Age groups Years = y

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Outcome

M

Author, year, location

Resources involved in duration processing

C1 - Arithmetic Problem (Different Strategies to Solve) C2 - Executive Working Memory Load (Distinguish Between High and Low Tones) PA – ANOVA C1 - Visual Short Term Memory (Visual Patterns Test) C2 - Visual Working Memory C3- Executive Suppression PA – ANOVA

5y (26) 8y (28)

C1 - Temporal Reproduction C2-Central Executive Task PA – ANOVA

Results-effect of age on dual task performances

Tasks Analysis (C – only cognitive task was equated)

Quality Analysis

C1- Adults performed better than children under dual task condition C2- The strategy of attention allocation in the children was similar to that of adults.

-Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice

Medium level

C1&C2-DT performance was better in 11y than 10y but no differences between 11y and 12y

C1&C2- 8y performed better than 11y in the visual tasks in dual task condition C3- No group differences were detected in the executive suppression under dual condition C1-Motor reproduction was greater in the younger children than older children in dual task condition C2-Differences in accuracy in the response single versus dual were higher in 5y than 8y.

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X X

X X X

Medium level

X X X X

Medium level

X X Medium level X

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cr 9.Anderson M, 2011, Australia(An derson et al., 2011)

Dual-task performance

10.Spronk M, 2012, Netherlands (Spronk et al., 2012)

Association of developmental interference control with developmental working memory

7y (55) 9y (49)

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Population Age groups Years = y

Measurement Motor or cognitive components (C – cognitive; M – motor) Performance Analysis (PA) C1 - Processing Speed C2 - Working Memory (Digit Recall Test)

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Outcome

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Author, year, location

Results-effect of age on dual task performances

Tasks Analysis (C – only cognitive task was equated)

Quality Analysis

C1&C2-No age -related differences in DTC.

-Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice

High level

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PA - Composite Proportional Dual Task Costs

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12y-16y (17) Adults (19)

Capacity required to execute the strategy

12.Whitall J, 1991, Madison, US(Whitall, 1991)

Attentional demands of locomotor skills

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11.Miller PH, 1991, Florida (US)(Miller et al., 1991)

6y-7 y (51) 10y-11y (28)

C1 - Visual Stroop C2 - Auditory N-Back PA – ANOVA

X Medium level X

X

Cognitive – Motor C - Selective Memory Task M - Motor Speed And Dexterity (Finger Tapping Task) PA - Proportional Dual Task Cost Or Motor Task

2.5y-3.5 y (8) 3.5y-4.5 y (8) 6y-7 y (8) 9y-10 y (8) Adults (8)

C1- Accuracy was lower in adolescent than adults in dual task condition C2-Adolescent had lower performance in working memory in dual condition than adults

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M1 – Run M2 – Gallop C1 – Vocal Task, Singing C2 – Non Vocal Task, Digit Recall

C- Younger children were less efficient in using strategy when attention demands are high. M- Interference in finger tapping was higher in younger than older group M1-2,5- 7y had higher cost than adults in initiating two motor tasks. C1-No differences among different age groups.

PA – ANOVA

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-Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice

X X

Medium level

X

X X X

Medium level

cr Execution of pointing movements

6y (12) 8y (12) 11y (12) Adults (6)

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13.Olivier I, 2003, France

Population Age groups Years = y

Measurement Motor or cognitive components (C – cognitive; M – motor) Performance Analysis (PA) C– Visuo-Manual Pointing M – Heel Lifting In Response To Auditory Stimuli

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Outcome

M

Author, year, location

15.Reilly DS, 2008, USA(Reilly et al., 2008)

Postural Control and Executive Function of Attention

7y (8) Adults (9)

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Cognitive and postural interference

M – Standing C - Visual Stroop Pa - ANOVA

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14.Olivier I, 2007, France(Olivi er et al., 2007)

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PA - ANOVA

4y-6y (6) 7y-12y (7) Adults (6)

M – Standing Task (Wide Stance And Romberg Stance) C – Visual Working Memory Task

Results-effect of age on dual task performances

Tasks Analysis (C – only cognitive task was equated)

C- DT performance was better in older age group (6y< 8y = 11 < Adults) M1- Reaction time decreased with age under dual task condition in programming phase

M- DT performance was lower in the children than adults under complex standing conditions. C-No differences in the accuracy, yet adults were better in processing speed

-Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice

M-DTC in Romberg stance was higher in the younger children than older children and adults. C-DTC in visual working memory was higher in the younger children than older children and adults

-Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice

PA – Absolute Dual Task Costs 16.Schaefer S, 2008, Germany(S. Schaefer et al., 2008)

Allocation of resources

9 y (9) 11y (9) Adults (9)

M - Ankle Disc Board Balance Task C1 - Short Term Memory (Memorize A List Of Words Using Auditory Cues) C2 - Working Memory (N-Back) PA - Proportional Dual Task Costs

-Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice

M- No differences in dual task costs between 9y and 11 y olds. Children (9y & 11y) had lower motor costs than adults, leading to differences in the motor-cognitive trade off pattern C- 9y had more DTC than 11y and adults.

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X X

Quality Analysis

Medium level

X X X

Medium level

X Medium level

X Medium level

X

cr Attentional cost of postural control

20.Krampe RT, 2011, Germany(Kr ampe et al., 2011)

12y-17 y (38) Adults (13)

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Cognitve and sensorimotor coupling under dual task conditions

Dual-task performance

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18.Palluel E, 2010, France(Pallu el et al., 2010)

7y (8) 8y (8) 9y (7) 10y (6) 11y (8) Adults (9)

Results-effect of age on dual task performances

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Cognitive and postural dual task performance

Measurement Motor or cognitive components (C – cognitive; M – motor) Performance Analysis (PA) M – Standing (Semi-Tandem) C – Stroop Task (Congruent And Non-Congruent)

9y (32) Adults (32)

PA - ANOVA

M - Postural Control (Quiet Stance Task) C- Stroop Task PA – Absolute Dual Task Costs

M - Treadmill Walking At Different Speeds(Fixed Speed and Preferred Speed) C - Auditory N-Back PA – ANOVA

9y (30) 11y (30) Young adults (30) Old Adults (30)

Tasks Analysis (C – only cognitive task was equated)

M- DT performance in standing increased with age. (7y<8y=11y< Adults) C- DT performance in cognitive task increased with age. (7<8<9<10<11
M

17.Olivier I, 2010, France(Olivi er et al., 2010)

19.Schaefer S, 2010, Germany

Population Age groups Years = y

ed

Outcome

pt

Author, year, location

M -Dynamic Balance (Walking Task) C -Semantic Fluency (Word Fluency Task) PA -Proportional Dual Task Costs

M-Postural cost is greater in the younger children (12-15) than adults. Complex cognitive tasks lead to higher postural cost in the children than adults C- No difference in the single vs dual task condition in between the groups M- Dual task performance was lower in children under complex cognitive task condition C-DT performance increased in children more than adults under preferred speed (easy) walking condition. M- 9 y had a higher cost than 11y and young adults, but equal the older adults (9y > 11y = young adult, 9y=older adults) C-9y had higher cost than all other age groups.

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-Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice

X X

Quality Analysis

Medium level

X X

Medium level

X

X X

Medium level

X C

X

Medium level

cr Postural control during gait

5y-6y (20) 7y-16y (20) Young adults19y-26y (12)

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21.Boonyong S, 2012, USA(Boonyo ng et al., 2012)

Population Age groups Years = y

Measurement Motor or cognitive components (C – cognitive; M – motor) Performance Analysis (PA) M - Dynamic balance ( Motion Analysis System ) C - Inhibition (Auditory Stroop Task)

Results-effect of age on dual task performances

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Outcome

C1 – Digit Span Task M – Paper and Pencil Tracking Task

23.Hinton DC, 2015, Canada(Hint on et al., 2015)

Development of attention strategies and segmental coordination during motor-cognitive tasks

7y (12) Adults (11)

M - Sitting and Reaching C - Auditory Stroop

24.Lejeune C, 2015, Belgium(Lej eune et al., 2015)

Dual task effect on procedural learning

7y (38) 10y (37)

pt

5y (46) 6y-8y (127) 9y-11y (120) 12y-14y (128) 15y-17y (149)

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Dual-Task Coordination

ed

PA - Proportional Dual Task Costs

22.Sebastian MV, 2013, Spain(Sebasti an et al., 2013)

M&C-DTC was higher in 5y than other age groups

PA - Proportional Dual Task Costs, Dual Tasking Ability Index

PA – ANOVA

M - Mirror Tracing Task C - Auditory Attention Task PA - ANOVA

Tasks Analysis (C – only cognitive task was equated)

M-Younger children (YC) (5-6y) had greater motor costs than older children (OC) and adults. C-Both YC and OC had greater cognitive costs than adults (YC= OC)

M

Author, year, location

M-Children had greater variability than adults. C- Reaction time was longer in 7y than adults.

M-DT performance was better in younger children than older in the first stages of learning task. C- No difference in age groups.

-Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice

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X

Quality Analysis

Medium level

X

C

Medium level

X X X Medium level X

X X

X

Medium level

cr 25.Schaefer S, 2015, Berlin, Germany(Sa bine Schaefer et al., 2015)

Influence of cognitive load and walking speed on walking patterns

26.Hagmannvon Arx P, 2016, UK(Priska Hagmannvon Arx et al., 2015)

Gait characteristics under single and dual task conditions

27.Getchell N, 2003, Baltimore, USA(Getchel l et al., 2003)

Dual motor coordination

28.Roncesval les MN, 2005, US(Roncesva lles et al., 2005)

Postural control under bimanual tasks

7y (18) 9y (18) Adults (18)

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Population Age groups Years = y

Measurement Motor or cognitive components (C – cognitive; M – motor) Performance Analysis (PA) M - Walking with Different Speeds C - N Back Task

Results-effect of age on dual task performances

an

Outcome

ed

PA - ANOVA

Ac

ce

pt

6y-13y (138)

4y (11) 6y (11) 8y (11) 10 (11)

2y-3y (7) 4y-6y (9) 7y-9y (8) Adults (29)

M1-Walking M2 -Unfasten and Fasten a Button C1 -Digit Recall Task PA - MANOVA

M1 - Walk/ Gallop M2 – Clap

Tasks Analysis (C – only cognitive task was equated)

M1- DT performance was better in 9y and adults than 7y under complex task condition. C1- DT performance was better in 9y and adults than 7y; no differences between 9y and adults

M

Author, year, location

M1- DT performance in gait increased with age. M2- No significant difference with age. C1- Children performance in DT condition increased with age.

Motor – Motor M1- Variability in movement decreased with age M2-Not presented separately

PA - ANOVA

M1 – Blow Bubble with One Hand + Hold Bottle in Other M2 – Reach and Touch An Object With One Hand + Hold Bottle in Other

M1&M2-Perforamance was not measured, posture is measured. -The strategies to control posture are different in 2-6 y than other age groups. 7-9y have similar postural references as adults

PA – ANOVA

16 Page 16 of 33

-Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice

X X

Quality Analysis

Medium level

X X X

Medium level

X

X X

Medium level

X

X X X X X X

Medium level

cr Bimanual interference

4y (10) 5-6y (10) 7-8y (10) 9-11y (10)

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29.Otte E, 2006, Germany(Ott e et al., 2006)

Population Age groups Years = y

Measurement Motor or cognitive components (C – cognitive; M – motor) Performance Analysis (PA) M1 - Motor Speed & Dexterity, Finger Tapping Task M2 - Figure Tracing Task

an

Outcome

M

Author, year, location

Dual task cost

Ac

31.Abbruzze se LD,2014,US A(Abbruzzes e et al., 2014)

4-6y (8) 7-9y (8) 10-13y (8)

pt

Bimanual coordination and gait

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30.Hung YC, 2013, USA(Hung et al., 2013)

ed

PA - Proportional Dual Task Costs

7-10y (10) 21-37y (10)

M1 - Dynamic Balance (Walking) M2 - Bimanual Coordination (Carrying A Box) PA - ANOVA

M1-Gait Function-(Gaitrite) M2-Bimanual Coordination (Carrying A Tray-Easy and Difficult) M3-Bimanual Coordination (Carrying A Pitcher - Easy and Difficult) PA - Absolute Dual Task Cost

Results-effect of age on dual task performances

Tasks Analysis (C – only cognitive task was equated)

M1- DTC in tapping task was higher in 9-11y than other age groups and 7-8y than 4y. M2- DTC was lower in the oldest group than the others and 7-8y had lower DTC than 4y.

M1-Higher variability in posture in the youngest age group than older children M2- Youngest age group had largest deviation and joint excursion than others. M1-Younger age group showed more dual task cost than older children in walking speed and step length while carrying out difficult concurrent tasks M2- Not measured

-Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks -Both tasks equated -Dual task cost measured -Result of each single task -Task order randomized -Clear instructions -Effect of practice -Appropriate single tasks

X

X X

X X

-Result of each single task

X

-Task order randomized -Clear instructions

17 Page 17 of 33

Medium level

X

-Both tasks equated -Dual task cost measured

-Effect of practice

Quality Analysis

X

Medium level

Medium level

3.2 Variation of dual task costs with age in children The age effect was rarely estimated per age group in the literature. So, we pooled the age groups

3.2.1 Dual task performances in cognitive-cognitive task paradigm

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Age effect

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into age ranges to provide a conclusive evidence of maturation effect.

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Three studies reported improved DT performances from 4 years to 7-8 years (Dossett et al., 2000; Gautier et al., 2002; McKenzie et al., 2003). However, the age differences were absent

an

when the tasks were equated and performed under equal priority conditions (Anderson et al., 2011; Irwin-Chase et al., 2000). The DTC were comparable between 7 and 9 year olds

M

(Anderson et al., 2011); and between 10, 11 and 12 year olds (Imbo et al., 2007). The results for

2011; Karatekin, 2004).

Ac ce pt e

Age x Task effect

d

comparison of DT performances between children and adults were inconsistent (Anderson et al.,

The cognitive tasks used in CC task paradigm were mainly - working memory, temporal (reaction time and temporal reproduction), discrimination, and detection tasks. The effect of age was more pronounced in the temporal reproduction and working memory tasks. Temporal reproducibility increased from 5 to 8 years under dual task conditions (Gautier et al., 2002; Rattat, 2010); other age groups were not examined. The age effect on working memory costs depended on the types of stimuli and cognitive strategies used (Imbo et al., 2007; Irwin-Chase et al., 2000). Younger children (4-7 years) were affected more by visual-spatial interference in comparison to older children (8-11 years), who were affected more by phonological interference (Ang et al., 2010; Karatekin, 2004; McKenzie et al., 2003). No age effect was found on reaction

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Page 18 of 33

time costs (7years ≈ 9years,10years ≈ Adults) (Anderson et al., 2011; Karatekin, 2004). Similarly, no change with age was present for detection task costs between 4-7years (Dossett et al., 2000) and 8-11years (Irwin-Chase et al., 2000) under equal priority condition. Although, the

ip t

cost was higher in 8year olds in comparison to 11year olds under differential priority conditions

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3.2.2 Dual task performances in motor-cognitive task paradigm

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(Irwin-Chase et al., 2000).

The DT effect has been analyzed separately on motor and cognitive tasks.

an

3.2.2.1 Effects on motor performance Age effect

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A decline in motor task costs was observed between 2-6 years and 7-8 years (Boonyong et al., 2012; Hinton et al., 2015; Miller et al., 1991; Olivier et al., 2007, 2010; Olivier et al., 2003;

d

Reilly et al., 2008; Sebastian et al., 2013; Whitall, 1991). The task costs remained stable between

Ac ce pt e

the age of 8 and 11 years (Olivier et al., 2010). On equating the cognitive tasks, the motor costs were comparable between younger children (6-8years) and older children (9-11 years) (Sebastian et al., 2013). However, children and adolescents demonstrated higher motor costs than adults, even when the cognitive task was equated, mostly under difficult task conditions (Hinton et al., 2015; Reilly et al., 2008; S. Schaefer et al., 2008). Age x task effect

The performance costs associated with standing were evaluated by four studies with different difficulty levels of motor and cognitive tasks (Olivier et al., 2007, 2010; Palluel et al., 2010; Reilly et al., 2008). No age effect on postural tasks was present when the dual tasks were performed under simple task conditions (no proprioceptive perturbation, wide stance, low

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Page 19 of 33

cognitive load); but postural costs were higher for children only under complex task conditions (semi-tandem stance, perturbed proprioception, non-congruent cognitive stimuli), with the sequence of decreasing DTC: 4-6 years > 7-12years > 13-17 years > adults (Olivier et al., 2007,

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2010; Palluel et al., 2010; Reilly et al., 2008). Similar results were obtained for walking under dual task conditions. Three studies investigated the DTC of walking with or without change in

cr

speeds, under different cognitive loads (easy, difficult), where the order of DTC followed a

us

similar order – 7years > 9years > 11 years (Krampe et al., 2011; Sabine Schaefer et al., 2015; S. Schaefer et al., 2008). The performance costs of 11 year olds were comparable to that of adults.

an

The DT effect on dexterity tasks was examined by four studies, which included finger tapping (Miller et al., 1991; Sun et al., 2013) and trail making (Lejeune et al., 2015; Sebastian et al.,

M

2013) performed together with auditory or memory cognitive tasks. Two studies reported an age effect of dual tasking on both motor and cognitive tasks, where the order of DTC was 5years >

d

7years and 8 years > 11 years olds (Miller et al., 1991; Sebastian et al., 2013). On the contrary,

Ac ce pt e

another study reported higher motor costs for 10 year olds than 7 year olds, only during the initial stages of task performance (Lejeune et al., 2015). The higher motor costs in older children were attributed to the differences in the use of learning processes during different phases of tasks between children of different age groups (Lejeune et al., 2015).

3.2.2.2 Effects on cognitive performance Age effect

DTC for cognitive tasks did not vary across children of different age groups (Olivier et al., 2007; Palluel et al., 2010; Reilly et al., 2008; S. Schaefer et al., 2008; Whitall, 1991). On comparison

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Page 20 of 33

with adults, three studies reported higher cognitive costs in the 5y (Sebastian et al., 2013), 7y (Hinton et al., 2015) and 9y (Krampe et al., 2011). Age x Task effect

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The cognitive tasks used in MC paradigm included working memory(Miller et al., 1991; Reilly et al., 2008; S. Schaefer et al., 2008), discrimination (Olivier et al., 2007, 2010; Palluel et al.,

cr

2010), detection (Olivier et al., 2003) and verbal fluency (Krampe et al., 2011; Whitall, 1991).

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No age x task effect was reported for cognitive tasks even under difficult standing conditions between children aged 7-12years, adolescents and adults (Olivier et al., 2007, 2010; Palluel et al.,

an

2010). However, younger children (4y-6y olds) had higher cognitive costs in discrimination tasks than older children (7y-12y) and adults in semi-tandem stance (Reilly et al., 2008). The trend

M

was quite different for the DTC in the detection task where children reached a plateau at the age of 8years (Olivier et al., 2003). Verbal fluency costs did not differ across age groups (2.5years to

d

adulthood) in an easy dual task situation (Whitall, 1991); but the costs were higher in 9y than

Ac ce pt e

11y in a difficult condition (Krampe et al., 2011).

3.2.3 Dual task performances in motor-motor task paradigm Age effect

A gradual increase in the dual motor task coordination was found by two studies between children 4-11year olds (Getchell et al., 2003; Otte et al., 2006). But another study reported that children 7-9 year olds performed as well as adults (Hung et al., 2013; Roncesvalles et al., 2005).

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Age*Task effect Three studies assessed the DT effect on gross motor functions (walking, running), and other two on manual dexterity. The DT effect on gait gradually decreased from 4-6years to 7-9years, and

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remained stable until the age of 10-13y (Abbruzzese et al., 2014; Hung et al., 2013). The DT effect on bimanual coordination was measured as per elbow- shoulder excursion where the

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children aged 7-10 years demonstrated similar joint variability as adults (Hung et al., 2013).

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However, DTC were higher in 9-10year olds than 11-13year olds, when complexity of the manual task increased (Getchell et al., 2003; P. Hagmann-von Arx et al., 2016). Another study

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reported that the DT performances got better with age from 4 years to 11 years but the task costs remained same (Otte et al., 2006). Only two out of the five studies measured the concurrent task

Ac ce pt e

d

Roncesvalles et al., 2005).

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performance under dual task condition (Abbruzzese et al., 2014; Getchell et al., 2003;

4. Discussion

This review identified 31 articles that summarized the current evidence of literature assessing the development of dual tasking in TDC. The purpose of this review was to improve our understanding of developmental changes in children’s ability to perform concurrent tasks, which would allow a more detailed analysis of age differences in single- and DT performances. 4.1 Overall effects of age on dual tasking ability The evidence supporting the effects of age on the ability to coordinate two concurrent tasks showed inconsistent results, where the DTC ranged from either being lower or comparable or higher in younger children (4-6years) than in older children (7-12 years), adolescents and adults. 22

Page 22 of 33

A recent review reported similar findings supporting the presence of a feeble evidence towards a definite trend in the development of DT performances in postural tasks (J. Ruffieux et al., 2015). This is the first review to investigate the effects of age on the dual tasking ability of children

ip t

including all DT paradigms. Despite the heterogeneity in the methods and age groups, few findings were common to all paradigms. For example, the effect of DT interference on both

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motor and cognitive tasks was significantly higher for younger children than older children and

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adults under complex/difficult task conditions in all DT paradigms (Abbruzzese et al., 2014; Irwin-Chase et al., 2000; Miller et al., 1991; Olivier et al., 2007; Palluel et al., 2010; Reilly et al.,

an

2008; Sabine Schaefer et al., 2010). Complex task conditions refer to DT situations where the difficulty level of the single tasks was increased. For instance, non-congruent cognitive vs

M

congruent cognitive tasks, semi-tandem stance vs normal stance, and perturbed proprioception vs

Ac ce pt e

al., 2008).

d

non-perturbed proprioception and so on (Olivier et al., 2007, 2010; Palluel et al., 2010; Reilly et

Another similar pattern between studies was observed for age differences in the motor-cognitive tradeoff under DT conditions. Under high cognitive loads and simple postural tasks, younger children had higher motor costs, increased body sway and gait variability than adults (Lejeune et al., 2015; Olivier et al., 2010; Palluel et al., 2010; Sabine Schaefer et al., 2010). On the contrary, under low cognitive loads and simple postural tasks, children had better postural control and lower walking costs than adults (S. Schaefer et al., 2008; Sabine Schaefer et al., 2010). However, under postural tasks with a risk of fall, younger children had higher motor and cognitive costs than older children and adults, irrespective of the cognitive load (Olivier et al., 2007; Sabine Schaefer et al., 2010; Whitall, 1991). The hypotheses supporting these differences are: a) task 23

Page 23 of 33

prioritization hypothesis: postural control is prioritized over cognitive activity under specific conditions (e.g., postural threat conditions) (Lacour et al., 2008); and b) U-shaped non-linear interaction hypothesis: an easy cognitive task can shift the focus of attention away from postural

ip t

control, leading to a better postural control relative to a single-task with no cognitive load. However, a difficult cognitive task can result in a degradation of postural sway (Huxhold et al.,

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2006). Overall, the results suggest that there are no differences in the dual task performances

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between children, adolescents and adults under easy or simple task conditions. Additionally, no differences in the performance costs were found when the single tasks were either equated or

an

performed at equalized priority level (Anderson et al., 2011; Imbo et al., 2007; Irwin-Chase et al., 2000). As soon as the complexity of the single tasks is raised or when the single tasks are not

M

equated, the age effect of DTC appears. Whether this age effect can be attributed to changes in

Ac ce pt e

d

children’s dual tasking ability or to the difficulty of individual tasks needs to be confirmed.

4.2 Methodological challenges in measuring age-differences in dual task costs among children The methodological issues associated with DT studies have been outlined by many reviews over decades to ensure minimal measurement bias and better comparability of different participant groups at baseline (Al-Yahya et al., 2011; Beurskens et al., 2015; Lee et al., 2013; McIsaac et al., 2015; J. Ruffieux et al., 2015). Unfortunately, these issues are still not frequently addressed by studies investigating differences in dual tasking between two different populations. For this review, we proposed a list of points indexing use of DT procedures (Table 1) and used these criteria to assess each study (Table 2). In this review, 22 studies did not equate one or both single tasks. Figure 4 shows the distribution of studies based on whether – a) effects of age on dual tasking were present; b) tasks were equated; and c) proportional DTC were calculated. Most 24

Page 24 of 33

studies observed an age effect on dual task performances, but without equating tasks and calculating proportional DTC.

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Figure 4- Distribution of studies based on age effect and task equation

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The continued presence of methodologically weak studies even after decades of DT research is unusual as the measurement challenges posed in the DT literature are compounded with a list of

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possible solutions. For example, the difficulty level of cognitive tasks can be equated by changing the congruence between stimuli (stroop task), load factor (Nback task), or manipulating

an

other parameters. To equate the difficulty level of motor tasks, age appropriate tasks can be used for children of different age groups by manipulating the externally controlled variables (eg.

M

shapes of drawing figures/trails, walking patterns, height of obstacles while walking), until an

d

accuracy percentage is reached on the single task performance. The other not so reliable

Ac ce pt e

alternative is to provide extra task practice to younger children (Palluel et al., 2010; Rattat, 2010; S. Schaefer et al., 2008). If practice is used to equate the task performance on single tasks, it is suggested to examine the effect of practice trials as practice might result in plateauing of dual task performance (Guttentag, 1989). In this review, few studies that provided practice trials verified the effects of practice by comparing the task performances before and after the practice trials (Hinton et al., 2015; Irwin-Chase et al., 2000; Miller et al., 1991; Whitall, 1991). Another solution to overcome learning effect after undergoing practice trials can be to design the trial task in a way that it is a little different from the experiment task in terms of difficulty level, order of presentation of stimuli etc., but emphasize the same domain of motor or cognitive function as is present in the actual experiment. For example, Krampe et al, 2011 included a sequence of

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Page 25 of 33

medium level difficulty of word fluency task that was later not assigned to subjects (Krampe et al., 2011).

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4.3 Theoretical underpinnings in interpreting age-differences in dual task costs among children The theoretical frameworks encompassing DT procedures lay the substructure for interpreting

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the differential DTC across age groups. The framework of attentional resource utilization, used

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often in articles (Gautier et al., 2002; Hung et al., 2013; Imbo et al., 2007; Palluel et al., 2010; Rattat, 2010; S. Schaefer et al., 2008), refers to the total attentional resource capacity available to

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perform dual tasks. This estimation of capacities, however, necessitates a somewhat narrow view of the specific processes that lead to more efficient DT performance in children. In other words,

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the differential DTC between children of various age groups does not solely rest upon the assumption that younger children have lesser resource capacity than older ones (Krampe et al.,

d

2011). Ability to perform concurrent tasks is multidimensional and embodies a few individual

Ac ce pt e

cognitive abilities. In this review, differences in DT performances across age groups were interpreted under the context of different cognitive processes -– use of attentional resources (Gautier et al., 2002; Hung et al., 2013; Imbo et al., 2007; Palluel et al., 2010; Rattat, 2010; S. Schaefer et al., 2008); divide attentional capacities and allocating resources (Imbo et al., 2007; Sebastian et al., 2013); share time from a dynamic perspective (Whitall, 1991); use task strategies (Ang et al., 2010; Gautier et al., 2002; Krampe et al., 2011), prioritize one task over other (Sabine Schaefer et al., 2015; S. Schaefer et al., 2008); knowledge of person and task variables affecting dual tasking (Dossett et al., 2000). Few other studies emphasize the use of dynamic systems perspective to assess and interpret DT data findings. For example, children have different postural strategies when confronted with a concurrent cognitive task and they

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might limit their degrees of freedom while standing or walking (Blanchard et al., 2005). Another study proposed that the leg muscle quality might be a predictor for better gait stability under dual task conditions for children 7-9 years old (Beurskens et al., 2015). A dynamic perspective on the

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dual motor cognitive behavior accounts for the peripheral constraints and factors affecting dual tasking (Whitall, 1991). Although, these findings are supported by a limited number of studies,

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they propose a dynamic perspective in addition to the attentional models, attentional processing

an

us

capacities and cerebral organization.

4.4 Existing gaps and future directions

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Task coordination during childhood and adolescence can't be reduced to a standardized DT paradigm, as it is a complex skill that demands an understanding on the associations between

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development of executive functions and motor control. There are some major gaps in the

Ac ce pt e

literature that should be addressed to advance the knowledge on dual tasking in children. First, a need to develop a validated conceptual framework that can guide both researchers and clinicians to use and interpret DT procedures. The checklist proposed in this review is an example of how a set of criteria can standardize the DT research. Second, the development of functions is best captured by prospective longitudinal study designs, however, there are none in this area. Therefore, the effects of age on dual tasking in children and adolescents should further be confirmed by conducting longitudinal studies per age group. Third, there is a major gap between the existing evidence and its uptake by researchers while conducting DT experiments. If the DT paradigm is to remain a valuable tool in the future developmental research, then greater attention must be paid towards the assumptions that underlie the procedures and to validate the dual task measures. This review had few limitations – a) the heterogeneity of the studies limited the 27

Page 27 of 33

analysis broadly to DT performances, and the impact on each outcome measure could not be

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discussed; b) language limit to English might have resulted in some loss of information.

5. Conclusion

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This is the first review to map the available literature on development of dual tasking in TDC

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including all DT paradigms. Children as young as 2 years old can perform two tasks together, and as they mature, they acquire new cognitive and postural strategies to coordinate their

an

performance on concurrent tasks. Moreover, the development is not linear, thus the question of coordinating two concurrent tasks, including a subset of cognitive skills such as - mastering

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prioritization and inhibitory control - is particularly relevant during critical period of development, such as infancy; 6-7 years and adolescence. This review provides a weak evidence

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for a trend towards higher effects of DT interference in younger children (2-6 years) than older

Ac ce pt e

children and adults when the task conditions are difficult or complex. The evidence supporting the effects of age on dual tasking under similar dual task demands is still inconclusive.

References

Abbruzzese, L. D., Rao, A. K., Bellows, R., Figueroa, K., Levy, J., Lim, E., & Puccio, L. (2014). Effects of manual task complexity on gait parameters in school-aged children and adults. Gait & Posture, 40, 658-663. Al-Yahya, E., Dawes, H., Smith, L., Dennis, A., Howells, K., & Cockburn, J. (2011). Cognitive motor interference while walking: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 35, 715-728. Anderson, M., Bucks, R. S., Bayliss, D. M., & Della Sala, S. (2011). Effect of age on dual-task performance in children and adults. Mem Cognit, 39, 1241-1252. Ang, S. Y., & Lee, K. (2010). Exploring developmental differences in visual short-term memory and working memory. Dev Psychol, 46, 279-285. 28

Page 28 of 33

Ac ce pt e

d

M

an

us

cr

ip t

Arksey, H., & O'Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8, 19-32. Beurskens, R., Muehlbauer, T., & Granacher, U. (2015). Association of dual-task walking performance and leg muscle quality in healthy children. BMC Pediatrics, 15, 2. Blanchard, Y., Carey, S., Coffey, J., Cohen, A., Harris, T., Michlik, S., & Pellecchia, G. L. (2005). The influence of concurrent cognitive tasks on postural sway in children. Pediatr Phys Ther, 17, 189-193. Boonyong, S., Siu, K. C., van Donkelaar, P., Chou, L. S., & Woollacott, M. H. (2012). Development of postural control during gait in typically developing children: the effects of dual-task conditions. Gait Posture, 35, 428-434. Brien, S. E., Lorenzetti, D. L., Lewis, S., Kennedy, J., & Ghali, W. A. (2010). Overview of a formal scoping review on health system report cards. Implementation Science, 5, 1-12. Brown, S., & Bennett, E. (2002). The role of practice and automaticity in temporal and nontemporal dual-task performance. Psychological Research, 66, 80-89. Dossett, D., & Burns, B. (2000). The development of children's knowledge of attention and resource allocation in single and dual tasks. J Genet Psychol, 161, 216-234. Gautier, T., & Droit-Volet, S. (2002). Attention and time estimation in 5- and 8-year-old children: a dual-task procedure. Behav Processes, 58, 57-66. Getchell, N., & Whitall, J. (2003). How do children coordinate simultaneous upper and lower extremity tasks? The development of dual motor task coordination. J Exp Child Psychol, 85, 120-140. Guttentag, R. E. (1989). Age differences in dual-task performance: Procedures, assumptions, and results. Developmental Review, 9, 146-170. Hagmann-von Arx, P., Manicolo, O., Lemola, S., & Grob, A. (2016). Walking in School-Aged Children in a Dual-Task Paradigm Is Related to Age But Not to Cognition, Motor Behavior, Injuries, or Psychosocial Functioning. Front Psychol, 7, 352. Hagmann-von Arx, P., Manicolo, O., Perkinson-Gloor, N., Weber, P., Grob, A., & Lemola, S. (2015). Gait in Very Preterm School-Aged Children in Dual-Task Paradigms. PLoS One, 10, e0144363. Hinton, D. C., & Vallis, L. A. (2015). How do children complete a seated combined cognitive and motor multi-tasking paradigm? Human Movement Science, 41, 179-192. Hung, Y. C., Meredith, G. S., & Gill, S. V. (2013). Influence of dual task constraints during walking for children. Gait Posture. Huxhold, O., Li, S.-C., Schmiedek, F., & Lindenberger, U. (2006). Dual-tasking postural control: aging and the effects of cognitive demand in conjunction with focus of attention. Brain Research Bulletin, 69, 294-305. Imbo, I., & Vandierendonck, A. (2007). The development of strategy use in elementary school children: working memory and individual differences. J Exp Child Psychol, 96, 284-309. Irwin-Chase, H., & Burns, B. (2000). Developmental changes in children's abilities to share and allocate attention in a dual task. J Exp Child Psychol, 77, 61-85. Karatekin, C. (2004). Development of attentional allocation in the dual task paradigm. Int J Psychophysiol, 52, 7-21. Krampe, R. T., Schaefer, S., Lindenberger, U., & Baltes, P. B. (2011). Lifespan changes in multi-tasking: concurrent walking and memory search in children, young, and older adults. Gait Posture, 33, 401-405.

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Lacour, M., Bernard-Demanze, L., & Dumitrescu, M. (2008). Posture control, aging, and attention resources: models and posture-analysis methods. Neurophysiologie Clinique/Clinical Neurophysiology, 38, 411-421. Lee, H., Sullivan, S. J., & Schneiders, A. G. (2013). The use of the dual-task paradigm in detecting gait performance deficits following a sports-related concussion: A systematic review and meta-analysis. Journal of Science and Medicine in Sport, 16, 2-7. Lejeune, C., Desmottes, L., Catale, C., & Meulemans, T. (2015). Age difference in dual-task interference effects on procedural learning in children. Journal of Experimental Child Psychology, 129, 165-172. Li, K. Z., Krampe, R. T., & Bondar, A. (2005). An ecological approach to studying aging and dual-task performance. Cognitive limitations in aging and psychopathology, 190-218. McIsaac, T. L., Lamberg, E. M., & Muratori, L. M. (2015). Building a Framework for a Dual Task Taxonomy. BioMed Research International, 2015, 10. McKenzie, B., Bull, R., & Gray, C. (2003). The effects of phonological and visual-spatial interference on children’s arithmetical performance. Educational and Child Psychology, 20, 93-108. Miller, P. H., Seier, W. L., Probert, J. S., & Aloise, P. A. (1991). Age differences in the capacity demands of a strategy among spontaneously strategic children. J Exp Child Psychol, 52, 149-165. Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to complex "Frontal Lobe" tasks: a latent variable analysis. Cogn Psychol, 41, 49-100. Olivier, I., Cuisinier, R., Vaugoyeau, M., Nougier, V., & Assaiante, C. (2007). Dual-task study of cognitive and postural interference in 7-year-olds and adults. Neuroreport, 18, 817821. Olivier, I., Cuisinier, R., Vaugoyeau, M., Nougier, V., & Assaiante, C. (2010). Age-related differences in cognitive and postural dual-task performance. Gait Posture, 32, 494-499. Olivier, I., Rival, C., Bard, C., & Fleury, M. (2003). Aged-related differences in the attentional cost of pointing movements. Neurosci Lett, 338, 169-173. Otte, E., & van Mier, H. I. (2006). Bimanual interference in children performing a dual motor task. Hum Mov Sci, 25, 678-693. Palluel, E., Nougier, V., & Olivier, I. (2010). Postural control and attentional demand during adolescence. Brain Res, 1358, 151-159. Plummer, P., & Eskes, G. (2015). Measuring treatment effects on dual-task performance: a framework for research and clinical practice. Frontiers in Human Neuroscience, 9. Plummer, P., Eskes, G., Wallace, S., Giuffrida, C., Fraas, M., Campbell, G., . . . Skidmore, E. R. (2013). Cognitive-Motor Interference During Functional Mobility After Stroke: State of the Science and Implications for Future Research. Archives of Physical Medicine & Rehabilitation, 94, 2565-2574.e2566. Rattat, A. C. (2010). Bidirectional interference between timing and concurrent memory processing in children. Journal of Experimental Child Psychology, 106, 145-162. Reilly, D. S., van Donkelaar, P., Saavedra, S., & Woollacott, M. H. (2008). Interaction between the development of postural control and the executive function of attention. J Mot Behav, 40, 90-102.

30

Page 30 of 33

Ac ce pt e

d

M

an

us

cr

ip t

Roncesvalles, M. N., Schmitz, C., Zedka, M., Assaiante, C., & Woollacott, M. (2005). From egocentric to exocentric spatial orientation: development of posture control in bimanual and trunk inclination tasks. J Mot Behav, 37, 404-416. Ruffieux, J., Keller, M., Lauber, B., & Taube, W. (2015). Changes in Standing and Walking Performance Under Dual-Task Conditions Across the Lifespan. Sports Medicine, 45, 1739-1758. Ruffieux, J., Keller, M., Lauber, B., & Taube, W. (2015). Changes in Standing and Walking Performance Under Dual-Task Conditions Across the Lifespan. Sports Medicine, 45, 1739-1758. Schaefer, S., Jagenow, D., Verrel, J., & Lindenberger, U. (2015). The influence of cognitive load and walking speed on gait regularity in children and young adults. Gait & Posture, 41, 258-262. Schaefer, S., Krampe, R. T., Lindenberger, U., & Baltes, P. B. (2008). Age differences between children and young adults in the dynamics of dual-task prioritization: body (balance) versus mind (memory). Dev Psychol, 44, 747-757. Schaefer, S., Lövdén, M., Wieckhorst, B., & Lindenberger, U. (2010). Cognitive performance is improved while walking: Differences in cognitive–sensorimotor couplings between children and young adults. European Journal of Developmental Psychology, 7, 371-389. Sebastian, M. V., & Hernandez-Gil, L. (2013). Do 5-Year-Old Children Perform Dual-Task Coordination Better Than AD Patients? J Atten Disord. Somberg, B. L., & Salthouse, T. A. (1982). Divided attention abilities in young and old adults. Journal of Experimental Psychology: human perception and performance, 8, 651. Spronk, M., & Jonkman, L. M. (2012). Electrophysiological evidence for different effects of working memory load on interference control in adolescents than adults. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 83, 24-35. Sun, B., Berl, M. M., Burns, T. G., Gaillard, W. D., Hayes, L., Adjouadi, M., & Jones, R. A. (2013). Age association of language task induced deactivation induced in a pediatric population. Neuroimage, 65, 23-33. Wells, G., Shea, B., O’connell, D., Peterson, J., Welch, V., Losos, M., & Tugwell, P. (2000). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Whitall, J. (1991). The developmental effect of concurrent cognitive and locomotor skills: Timesharing from a dynamical perspective. Journal of Experimental Child Psychology, 51, 245-266.

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