The synergistic effect of poor motor coordination, gender and age on self-concept in children: A longitudinal analysis

Research in Developmental Disabilities 98 (2020) 103576

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The synergistic effect of poor motor coordination, gender and age on self-concept in children: A longitudinal analysis

T

Denver M.Y. Browna,*, John Cairneya,b a b

Faculty of Kinesiology & Physical Education, University of Toronto, 55 Harbord St., Toronto, Ontario, M5S 2W6, Canada Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, Ontario, L8P 1H6, Canada

ARTICLE INFO

ABSTRACT

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Background: Self-concept is a critical psychosocial outcome in childhood that is shaped by many factors. Gender, motor coordination and age have been identified as three important contributors. Aim: The present study examined whether poor motor coordination (i.e., being classified as at risk for Developmental Coordination Disorder [rDCD]), gender and age have a synergistic effect on domains of self-concept and self-worth in children. Methods: Data were derived from the Physical Health and Activity Study Team longitudinal open cohort project. Children enrolled in grade 4 (Mage = 9.88 ± 0.35) at baseline (n = 1978) completed the Self-Perception Profile for Children 7 times over 4 years to evaluate their competence across multiple domains. The Bruininks–Oseretsky Test of Motor Proficiency – Short Form was completed once to evaluate children’s motor coordination. Participants scoring ≤15th percentile were classified as rDCD. Results: A significant 3-way interaction between rDCD, gender and age was observed for athletic ability, physical appearance and academic competence, but not social competence, behavioural conduct or global self-worth. Findings revealed developmental trajectories for self-perceptions of athletic ability, physical appearance, and academic competence were lowest among rDCD girls. Boys classified as rDCD also demonstrated lower athletic, academic and physical self-perceptions in comparison to typically developing children. Conclusions: Age intensifies disparities in self held athletic, physical and academic perceptions attributable to differences in gender and rDCD status, however, differences in these domains appear to be independent of children’s overall views of themselves.

Keywords: Developmental coordination disorder (DCD) Motor proficiency Self-worth Developmental trajectories

1. Introduction Developmental coordination disorder (DCD) is a significant and prevalent neurodevelopmental disorder that affects between 2 and 5 percent of all school aged children (American Psychiatric Association, 2013; Gibbs, Appleton, & Appleton, 2007; Lingam, Hunt, Golding, Jongmans, & Emond, 2009) with a 2–7 times higher diagnosis in boys (American Psychiatric Association, 2013, p. 75). The hallmark features of the disorder are motor coordination problems as well as gross and/or fine motor deficits, which significantly interfere with activities of daily living and/or scholastic achievement (American Psychiatric Association, 2013). The exact cause of DCD is not known, and the diagnosis can only be made once other disorders (e.g., cerebral palsy, muscular dystrophy) are ruled out.

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Corresponding author. E-mail addresses: [email protected] (D.M.Y. Brown), [email protected] (J. Cairney).

https://doi.org/10.1016/j.ridd.2020.103576 Received 8 April 2019; Received in revised form 4 December 2019; Accepted 13 January 2020 0891-4222/ © 2020 Elsevier Ltd. All rights reserved.

Research in Developmental Disabilities 98 (2020) 103576

D.M.Y. Brown and J. Cairney

While DCD has been consistently shown to be associated with poor physical fitness (Cairney, Hay, Faught, Flouris, & Klentrou, 2007; Hands & Larkin, 2006; Schott, Alof, Hultsch, & Meermann, 2007), which increases this population’s risk for a range of negative physical health outcomes including all-cause mortality (Kodama et al., 2009), there has also been considerable interest in the negative impact of motor coordination problems on self-concept (Piek, Baynam, & Barrett, 2006; Poulsen, Ziviani, & Cuskelly, 2006; Yu et al., 2016). In its own right, self-concept is a critical psychosocial outcome in childhood and adolescence and has been referred to as the “cornerstone” of emotional and social development (Kagan, Moore, & Bredekamp, 1995). While a multitude of terms (e.g., selfesteem, self-concept, self-confidence and self-worth) have been used to describe perceptions of self, in this paper, we use the term selfconcept to refer to the totality of perceived competence in specific domains (e.g., athletic ability) and overall or global sense of selfworth. An especially useful model for examining the impact of motor coordination on self-concept, and one that has been applied in relation to DCD before (Piek et al., 2006; Skinner & Piek, 2001; Watson & Knott, 2006), is Harter’s (1978), 1981 competence motivation theory. One of the key propositions of the theory is that children form global perceptions of their selves (sense of selfworth) by evaluating their competences/abilities in specific domains (e.g., physical appearance, athletic ability, popularity with peers). Repeated failures lead to feelings of inadequacy and ineffectualness, which influence the perception of incompetence in a given domain (Harter, 1987). Together, perceived competence across a number of core domains, shape a child’s overall assessment of his/her self-worth. In the context of DCD, Harter’s (1978, 1981) competence motivation model is particularly useful because children with the disorder are at much greater risk for feelings of incompetence, the result of a history of unsuccessful attempts to succeed across a number of different domains. Poor motor coordination, for example, makes participation in sports and active games extremely difficult, and exposes the child to potential embarrassment and ridicule (Fitzpatrick & Watkinson, 2003). Research has shown children with DCD frequently perceive their athletic and physical abilities as low compared to typically developing children (e.g., Cairney, Hay, Faught, Mandigo, & Flouris, 2005, Cairney, Hay, Faught, Wade, Corna, & Flouris, 2005b; Cocks, Barton, & Donelly, 2009; Poulsen, Ziviani, & Cuskelly, 2008; Rose, Larkin, & Berger, 1997; Skinner & Piek, 2001; Yu et al., 2016). Many children with DCD also struggle with fine motor tasks such as printing and writing, which affects their ability to succeed at school, especially in junior and middle school (Cantell, Smyth, & Ahonen, 1994). Specifically, evidence demonstrates children with DCD tend to report lower perceived competence in relation to academic pursuits than children unaffected by the condition (Rose et al., 1997; Skinner & Piek, 2001). Children with DCD have also been shown to be socially isolated (Jarus, Lourie-Gelberg, Engel-Yeger, & Bart, 2011) and more likely to victimized by bullying (Campbell, Missiuna, & Vaillancourt, 2012) than typically developing children. Such experiences may explain why perceptions of social competence (or acceptance) in terms of interactions with peers are significantly lower in children with DCD in some studies (Poulsen et al., 2006; Rose et al., 1997), although others have failed to uncover any differences which suggests a more complex relationship exists (Piek, Dworcan, Barrett, & Coleman, 2000; Watson & Knott, 2006). Finally, there is evidence that children with DCD also hold negative perceptions of their physical appearance (Piek et al., 2000; Rose et al., 1997). Although the reasons for this are not well understood, it may be due, at least in part, to the high prevalence of overweight/obesity in children with motor coordination problems (Hendrix, Prins, & Dekkers, 2014). Although evidence indicates children with motor coordination problems are likely to hold more negative appraisals of their selfcompetence across multiple domains, these domain-specific negative feelings do not always extend to overall self-worth. For instance, several studies have reported no significant differences for self-worth between children with DCD and typically developing children (Cantell et al., 1994; Mæland, 1992; Piek et al., 2000; Van Rossum & Vermeer, 1990), while others have (Rose et al., 1997; Schoemaker & Kalverboer, 1994; Skinner & Piek, 2001). Given the complexity of interacting factors that contribute to self-worth, it is not surprising that this literature has produced equivocal results. While sampling (e.g., small sample sizes) and measurement (e.g., different tests of motor coordination/ability) differences cannot be ruled out as potential causes of this variability across these studies, there are equally compelling conceptual issues that may help us to better understand the discrepancies. The focus of study in this paper is on the potential role that gender and age play in influencing the association between DCD and self-concept. 1.1. Motor coordination, gender and self-concept There is evidence that movement difficulties may affect self-perceptions differently for boys and girls (Cratty, Ikeda, Martin, Jennet, & Morris, 1970; Cratty, 1994; Rose et al., 1997). Using Harter’s model, Rose et al. (1997) examined the combined influence of gender and motor coordination on perceptions of competence and global self-worth in children. While overall, children with low levels of motor coordination reported lower perceived competence across all domains, and lower levels of self-worth when compared to typically developing children, gender was found to influence the association of motor coordination on specific aspects of selfconcept. Girls with DCD, for example, reported the lowest levels of scholastic competence of all children in the study. Similar findings were obtained for behavioural conduct and global self-worth, although, interestingly, girls who were well-coordinated reported the highest levels of behavioural conduct and perceived self-worth. On the basis of this evidence, gender should be taken into account when considering the impact of motor coordination problems on perceptions of self. 1.2. Age, motor coordination and self-concept Age may further influence the effect of both gender and motor coordination on perceived competence and self-worth. There is evidence that adolescents may be more aware of differences in abilities than younger children (Harter & Robinson, 1988). Greater 2

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awareness of differences makes it likely that the association between motor competence and self-concept may be stronger in older children. As well, peer acceptance becomes increasingly important as children age especially in the transition to high school (Harter, 1987). The impact of motor coordination, therefore, may be greater on perceived social acceptance in older children. The effect of motor coordination on specific domains of competence becomes more pronounced with age among children and youth with DCD. For example, Skinner and Piek (2001) explored the effect of motor coordination on competence and self-worth in a sample of children (ages 8–10) and adolescents (ages 12–14). Children with DCD reported lower perceived competence on scholastic ability than their peers, whereas no such differences were found among adolescents. The opposite effect was found for social acceptance in that lower social acceptance was reported by adolescents with DCD and no differences were observed between groups in younger children. Perceived athletic competence, physical appearance and self-worth were lower in both children and adolescents with DCD when compared to their peers. Notably, effects of DCD on physical appearance and self-worth increased with age. Piek et al. (2006) have shown that gender also plays a moderating role. For example, among boys with DCD, the impact of perceived incompetence in athletic ability may be a stronger determinant of self-worth as they develop from childhood into adolescence. While such things may be of minimal consequence in early childhood, they become increasingly important through middle childhood and adolescence as people try to conform to widely held social norms (Hendry, Shucksmith, Love, & Glendinning, 1993). 1.3. Age, gender, motor coordination and self-concept While there are compelling theoretical reasons for expecting the association between motor coordination, perceived competence and self-worth to be contingent on both gender and age, the vast majority of research has focused on differences between children with and without DCD without specific regard to either gender or age. The exception, as we have seen, has been the work of Piek et al. (2006). However, even this work is not without its limitations. Most notably, the influence of age and gender on the association between motor coordination, competence and self-worth was tested indirectly, using cross-sectional data that sampled both children (ages 7.5–11) and adolescents (ages 12–15.5) and tested for age differences. Analytically, in order to assess the synergistic effect of motor coordination, gender and age on the association between DCD and self-concept, longitudinal data, with repeated assessments on core variables over time is required. Thus, the purpose of the present study was to examine the relationship between rDCD status, gender and age on domains of self-concept and self-worth among a large cohort of children from ages 9 to 13. 2. Methods 2.1. Study sample and data collection Data for the present study were derived from the Physical Health and Activity Study Team (PHAST) project. The PHAST project was a longitudinal open cohort study that examined developmental trajectories of health and physical activity among school-aged children. Data collection occurred over 7 time points across 4 years beginning in Spring 2005, with follow-ups in Fall 2005, Spring 2006, Fall 2006, Spring 2007, Fall 2007 and Fall 2008. Thus, we have data for a cohort of children from the end of grade 4 to the beginning of grade 8. Children with previously identified learning disorders (n = 8) were included in the study but excluded from the analysis. Children with pre-existing physical limitations that restricted their participation in physical education class were excluded from the study (n = 18). Data was collected by teams of trained research assistants during regular school hours. Self-reported questionnaires were administered within the classroom, whereas, anthropometric measurements (i.e., height, weight) and motor skills were assessed in the gymnasium. Sample sizes and descriptive statistics for measures of interest for each wave are presented in Table 1. The protocol for the PHAST project was approved by two Institutional Research Ethics Boards. 2.2. Measures 2.2.1. Demographics At each participant’s first visit, a demographic questionnaire assessing date of birth (age) and gender was completed. Table 1 Participant demographics over time. Time

Sample Size Females (%) rDCD (%) Females Classified as rDCD (%) Body Mass Index [# missing] Age (years)

Spring 05’

Fall 05’

Spring 06’

Fall 06’

Spring 07’

Fall 07’

Fall 08’

1978 975 (49.3) 179 (9.0) 110 (5.6) 18.59 (3.53) [6] 9.88 (.35)

1917 949 (49.5) 168 (8.8) 104 (5.4) 18.97 (3.74) [6] 10.33 (.35)

2028 999 (49.3) 179 (8.8) 110 (5.4) 19.20 (3.75) [8] 10.76 (.49)

1955 970 (49.6) 171 (8.7) 109 (5.6) 19.65 (3.97) [6] 11.33 (.35)

1956 972 (49.7) 167 (8.5) 105 (5.3) 20.05 (4.02) [7] 11.88 (.38)

1415 684 (48.3) 102 (7.2) 64 (4.5) 20.30 (4.09) [15] 12.40 (.33)

1323 646 (48.8) 108 (8.2) 67 (5.1) 21.14 (4.16) [30] 13.40 (.33)

Note: M (SD) displayed for Body Mass Index and Age. 3

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2.2.2. Anthropometric measures Anthropometric data (height and weight) were obtained using a calibrated weigh scale and stadiometer to calculate body mass index (mass(kg)/height(m)2) at each visit. 2.2.3. Self-concept Harter’s (1985) Self-Perception Profile for Children (SPPC) was used to measure children’s evaluations of their competence across multiple domains including Academic Competence, Athletic Competence, Social Competence, Physical Appearance, Behavioural Conduct and Global Self-Worth at each time point. The SPPC is a validated measure that has shown strong reliability for measuring various domains of self-concept (Harter, 1985, 2012). Participants responded to 36 questions structured in an alternative choice format containing one positive and one negative sentence (e.g., “some kids wish they could be a lot better at sports “and “other kids feel they are good enough at sports“), for which they selected the statement that better describes them and whether that statement is “really true for me” or “sort of true for me.” Responses were coded so that higher scores reflected greater perceptions of self-concept. Internal consistencies were acceptable for each scale at each administration (Cronbach’s α = 0.76–0.90). 2.2.4. Motor coordination The Bruininks–Oseretsky Test of Motor Proficiency – Short Form (BOTMP-SF; Bruininks, 1978) was used to evaluate participants’ motor skills and identify motor impairments (Cairney, Hay, Veldhuizen, Missiuna, & Faught, 2010; Crawford, Wilson, & Dewey, 2001). The BOTMP-SF has been validated against the full version of the BOTMP (r = .90–.91; Bruininks, 1978) as well as the Movement Assessment Battery for Children (M-ABC; Cairney, Hay, Veldhuizen, Missiuna, & Faught, 2009; Henderson & Sugden, 1992) as a tool for classifying children with a diagnosis of DCD. The BOTMP-SF has also shown good interrater reliability (r = .77–.79) and test-retest reliability (ICCs ≥ .77; Bruininks, 1978). Participants were required to complete 14 items across 4 subdomains of motor proficiency (fine motor control, manual coordination, body coordination and strength/agility). Raw scores for each item were converted into an overall score and corresponding percentile based on the child’s age and sex. Participants scoring ≤15th percentile were considered to be at risk of DCD (rDCD). The 15th percentile was used as a threshold for classifying children as rDCD due to the low sensitivity of the BOTMP for diagnosing DCD relative to the M-ABC (Blank et al., 2019). The BOTMP-SF was only completed once (1 % of the sample at time 1, 30 % at time 2, 36 % at time 3, 33 % at time 4) for most participants in the current study and was therefore used as a fixed classification for rDCD status across each time point given the relative stability of motor development among children (r = 0.70, p < 0.001; Cairney et al., 2009). 2.3. Statistical analysis To test our research question, separate mixed-effects models were computed to measure change over time across each domain of self-concept and global self-worth. Time (age) was included as a random slope and participant ID (subject) was included as a random intercept. An unstructured covariance matrix was used with full information maximum likelihood. Each model produced main effects for rDCD, age and gender as well as interaction effects for rDCD by age, rDCD by gender, age by gender and rDCD by age by gender. Global pseudo-R2 effect size statistics were computed for each dependent variable to explain the amount of variance accounted for by the main and interactive effects (Peugh, 2010). This procedure involved computing the correlation between the observed and predicted values for each dependent variable and squaring this value to provide a global pseudo-R2 effect size. All statistical analyses were performed using IBM SPSS version 25. 3. Results Table 1 outlines the samples sizes as well as participant demographics at each time point. Due to the nature of using a longitudinal open cohort design, sample sizes varied across the course of the study period. 3.1. Primary outcomes Coefficients and standard errors for rDCD, age and gender as well as the interaction effects for rDCD by age, rDCD by gender, age by gender and rDCD by age by gender for each of the primary outcome variables are displayed in Table 2. 3.1.1. Physical appearance Results of the mixed effects model for physical appearance (see Fig. 1a) showed significant main effects of age (p < .001, R2 < 1 %), gender (p < .001, R2 = 1.1 %) and rDCD (p = .008, R2 = 1.9 %) as well as significant interaction effects for gender by age (p < .001, R2 = 1.9 %), gender by rDCD (p = .031, R2 = 2.9 %) and gender by age by rDCD (p = .04, R2 = 3.6 %). Results failed to show a significant interaction effect for rDCD by age (p = .12, R2 = 2.3 %). Collectively, results suggest females report lower perceptions of their physical appearance as they age and that meeting the diagnostic criteria for rDCD may further exacerbate this effect. 3.1.2. Social competence Results of the mixed effects model for social competence (see Fig. 1b) revealed a significant main effect of age (p < .001, R2 < 1 %), however, the main effects of rDCD and gender as well as the interaction effects for gender by age, rDCD by age, rDCD by gender and rDCD by gender by age did not reach statistical significance (all ps > .05, all R2s < 3 %). 4

5

−.91 (.34)* [−1.58, −.23] −.03 (.01)** [−.04, −.01] .46 (.13)** [.22, .71] .05 (.03) [−.01, .10] −.06 (.01)** [−.08, −.03] .95 (.44)* [.09, 1.82] −.08 (.04)* [−.15, −.00] 3.59 (.09)** [3.42, 3.77]

rDCD Time (age) Gender rDCD by Time Time by Gender rDCD by Gender rDCD by Time by Gender Intercept

Note: ** p < .001; * p < .05.

Physical Appearance Estimate (SE) [95 % CI]

Main and Interaction Effects

Self-Perception Profile Subscales

−.45 (.32) [−1.07, .18] .05 (.01)** [.03, .06] −.01 (.12) [−.24, .22] .01 (.03) [-.04, .06] .00 (.01) [−.02, .02] .48 (.41) [−33, 1.28] .01 (.03) [−.12, .02] 2.69 (.08)** [2.53, 2.85]

Social Competence Estimate (SE) [95 % CI] .07 (.31) [−.54, .68] −.02 (.01)** [−.04, −.01] .20 (.11) [−.02, .43] .01 (.03) [−.05, .06] .01 (.01) [−.01, .03] −.54 (.40) [−1.33, .24] .02 (.03) [−.04, .09] 3.32 (.08)** [3.17, 3.48]

Behavioural Conduct Estimate (SE) [95 % CI]

Table 2 Mixed effects models for domains of self-concept and global self-worth over time by gender and rDCD status.

−.35 (.31) [−.95, .26] −.01 (.01) [−.02, .01] .08 (.11) [−.14, .30] .02 (.03) [−.04, .07] −.00 (.01) [−.02, .02] .61 (.39) [−.16, 1.38] −.07 (.03)* [−.14, −.00] 3.12 (.08)** [2.97, 3.27]

Academic Competence Estimate (SE) [95 % CI]

−.48 (.29) [−1.05, .08] .02 (.01)* [.00, .03] −.08 (.11) [−.28, .13] −.00 (.02) [−.05, .05] −.01 (.01) [−.03, .01] .94 (.37)* [.21, 1.66] −.08 (.03)* [−.14, −.02] 3.09 (.07)** [2.94, 3.22]

Athletic Ability Estimate (SE) [95 % CI]

−.44 (.30) [−1.02, .14] −.01 (.01) [−.02, .00] −.00 (.11) [−.22, .21] .02 (.03) [−.03, .07] .00 (.01) [−.02, .02] .41 (.38) [−.33, 1.16] −.04 (.03) [−.11, .02] 3.54 (.08)** [3.39, 3.68]

Global Self-worth Estimate (SE) [95 % CI]

D.M.Y. Brown and J. Cairney

Research in Developmental Disabilities 98 (2020) 103576

Research in Developmental Disabilities 98 (2020) 103576

D.M.Y. Brown and J. Cairney

Fig. 1. Model predicted scores for domains of self-concept and global self-worth over time by gender and rDCD status. Note: TD = typically developing children; rDCD = children at risk for DCD.

3.1.3. Behavioural conduct Results of the mixed effects model for behavioural conduct (see Fig. 1c) revealed a significant main effect of age (p < .001, R2 < 1 %), however, the main of effects of rDCD and gender as well as the interaction effects of rDCD by age, rDCD by gender, age by gender and rDCD by age by gender were not significant (all ps > .05, all R2s ≤ 4 %). 3.1.4. Academic competence Results of the mixed effects model for academic competence (see Fig. 1d) revealed a significant interaction effect of age by gender by rDCD (p = .038, R2 = 1.3 %), however, the main effects for rDCD, age and gender as well as interaction effects for rDCD by age, rDCD by gender and age by gender were not significant(all ps > .05, all R2s < 1.2 %). 3.1.5. Athletic ability Results of the mixed effects model for athletic ability (see Fig. 1e) revealed a significant main effect of age (p = .008, R2 < 1 %) as well as significant interaction effects for rDCD by gender (p = .011, R2 = 7.2 %) and rDCD by age by gender (p = .01, R2 = 7.4 %). The main effects of gender and rDCD as well as the interaction effects for gender by age and rDCD by age were not significant (all ps > .05, all R2s < 4.8 %). Findings suggest children with rDCD have lower perceptions of their athletic abilities as they age and this effect is most pronounced among females. 3.1.6. Global self-worth Results of the mixed effects model for global self-worth (see Fig. 1f) failed to demonstrate significant main effects of rDCD, age, and gender as well as the interaction effects for rDCD by age, rDCD by gender, age by gender and rDCD by age by gender (all ps > .05, all R2s < 1.4 %). 4. Discussion The aim of the present study was to examine the potential synergistic effects of poor motor coordination (i.e., diagnosis of rDCD), gender and age on self-perceptions and global self-worth. Using data from a large cohort of children (nearly 2000 at baseline) tracked from ages 9–13, findings demonstrated a significant interaction effect for rDCD, gender and age on self-perceptions of academic competence, athletic competence and physical appearance, but not social competence, behavioural conduct or global self-worth. Results suggest rDCD girls are affected more in terms of psychosocial outcomes. That is, females with poor motor skills displayed the lowest trajectories for academic, athletic and physical self-perceptions and these differences became more pronounced as they aged from childhood into adolescence. It should be acknowledged that the effects observed for academic competence and physical appearance were weaker than that observed for athletic abilities. Given the established link between actual and perceived physical abilities with physical activity behaviour (cf. Stodden et al., 2008), becoming older may trigger a cascade of events resulting in disengagement from sport and physical activity throughout the lifetime among rDCD girls. Interestingly, no differences were 6

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observed for global self-worth which suggests psychosocial difficulties experienced in specific domains may be independent from children’s overall views of themselves. Previous research has established associations between motor competence (i.e., DCD), gender and age (e.g., Piek et al., 2006; Poulsen et al., 2008; Rose et al., 1997; Rose, Larkin, Parker, & Hands, 2015; Skinner & Piek, 2001; Yu et al., 2016), however, a threeway interaction among these variables had not been examined within a large cohort of children over time. Using arguably the most comprehensive dataset available, current findings support general trends of lower self-perceptions among females compared to males beginning in childhood and extending across different periods of the life span (Harter, 1999; Kling, Hyde, Showers, & Buswell, 1999; Labbrozzi, Robazza, Bertollo, Bucci, & Bortoli, 2013; Wigfield, Eccles, Mac Iver, Reuman, & Midgley, 1991). Findings further demonstrate the instrumental role motor skills play in shaping children and adolescent’s self-perceptions (Skinner & Piek, 2001) and mental health (Hill et al., 2016), and the differences observed between males and females (Rose et al., 2015). Results also revealed a similar proportion of girls classified as rDCD than boys, which contradicts the ratio of boys to girls that receive a clinical diagnosis of DCD (2:1 to 7:1; Blank et al., 2019). Thus, evidence indicates DCD is less likely to be recognized and diagnosed in girls given that comparable levels of poor motor coordination (i.e., rDCD) were observed between the genders. This finding is problematic considering rDCD girls were found to be at the greatest risk of having poor perceptions of their athletic abilities and to a lesser degree, their physical appearance and academic competence. Therefore, the current results address a major gap in the current literature by showing that age intensifies disparities in select self-held perceptions attributable to differences in gender and rDCD status. This study provided the first evidence for an interactive effect of rDCD status, gender and age on perceptions of athletic abilities. Rose et al. (1997) have shown low motor coordination, but not gender, is associated with lower athletic competence in children. However, gender effects, in addition to motor coordination, become more evident in adolescence (Rose et al., 2015). Indeed, among a large sample (N = 1568) of adolescents, Rose et al. (2015) demonstrated that girls with very low motor competence reported the lowest scores for athletic competence. The current results extend our previous understanding by establishing the temporal nature of this relationship between motor coordination and gender using a well-powered, repeated measures longitudinal design. In the context of our findings, rDCD boys have lower perceptions of their athletic competence than typically developing children, although these feelings are relatively stable as they age. Conversely, rDCD girls not only have lower self-held perceptions about their athletic abilities to begin with, but these perceptions get worse with age. Such patterns of self-perceptions may stem from feelings of shame and embarrassment due to struggling in sports or being excluded. This potential cascade of events may partially explain why rDCD girls participate in lower levels of physical activity than rDCD boys and typically developing children (Kwan, King-Dowling, Hay, Faught, & Cairney, 2016). Girls with poor motor coordination (i.e., rDCD status) also reported the lowest scores for perceptions of physical appearance as they matured. One potential reason for this pattern of findings may be the importance boys and girls both place on appearance for female popularity (Chase & Machida, 2011). Unrealistic media portrayals of women may partly drive these views. Research using the same cohort as the present study has shown children with DCD have higher body composition scores (i.e., BMI, waist circumference) than typically developing children and these differences increase with age (Joshi et al., 2015). Although these effects are more pronounced among boys, appearance is not as central to popularity for boys as it is for girls (Chase & Machida, 2011). Another factor contributing to these results relates to the well-established impact that DCD has on fine motor skills. For instance, poor motor skills may negatively impact girls’ personal grooming abilities such as applying make-up. Given the interrelatedness between physical attractiveness and popularity, it is not surprising that rDCD girls also reported the lowest scores for physical appearance. Findings from the present study also extend previous literature that has documented differences in self-held views of academic competence attributable to poor motor coordination and gender. For instance, research has shown that girls with poor motor coordination report the lowest scores for academic competence in childhood (Rose et al., 1997) and adolescence (Rose et al., 2015). Our findings align with these studies and reveal that age further exacerbates this effect, although evidence indicates this effect is relatively weak and explains a very small portion of the variance. Considering that DCD affects key skills associated with academic success (i.e., printing, writing) and children with DCD have been found to struggle in school, particularly in language and mathematics (Cantell et al., 1994; Gomez et al., 2015; Pieters, Desoete, Van Waelvelde, Vanderswalmen, & Roeyers, 2012), it makes sense that this population has lower self-perceptions of academic competence. Gender stereotypes surrounding academic performance also help explain why rDCD girls report slightly lower academic competence. A meta-analysis of 17 studies including over 10,000 participants demonstrated that boys in elementary school report significantly higher academic competence than girls (d = .27; Wilgenbusch & Merrell, 1999), although recent evidence indicates girls achieve higher grades than boys during these school years (d = .37; Voyer & Voyer, 2014). Therefore, even though rDCD girls may outperform rDCD boys in school, gender-based stereotypes in our culture likely contribute to why they do not perceive themselves as highly as others. The lack of evidence for differences in perceptions of social competence, behavioural conduct and global self-worth is promising in that negative self-appraisals may be much more siloed to specific domains as children age than previously thought (Mancini, Rigoli, Roberts, & Piek, 2019). One plausible explanation is that rDCD girls may begin to focus more on other pursuits such as the performing arts in which less emphasis is placed on motor abilities. Higher participation rates in music and performing arts among girls provide some support for this line of theorizing (Rose-Krasnor, Busseri, Willoughby, & Chalmers, 2006; Voyer & Voyer, 2014). Moreover, children may not place as much importance on athletic success for social status today as they did three decades ago (Chase & Machida, 2011), which makes other social contexts beyond athletic pursuits rich environments for cultivating social acceptance through interacting with their peers. Thus, as children mature and naturally allocate more of their time to activities they feel competent at and enjoy, their overall sense of self-worth may be largely informed by these pursuits as they become more central to one’s self-identity. Moving forward, research that extends the work of Piek et al. (2006) to further differentiate between areas of achievement that rDCD girls derive a sense of self-worth from would help answer this question. For instance, it is plausible that rDCD 7

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girls’ self-worth is influenced more through academic performance in music and art courses than it is through science and math courses. Given that self-worth has a strong negative association with psychological distress (Sowislo & Orth, 2013), similarities observed for global self-worth trajectories among our groups have positive implications for mental health. Among the domains that did show significant synergistic interactions, findings observed for athletic competence may have negative ramifications for lifelong physical activity behaviour among rDCD girls. Perceptions of one’s physical abilities (or athletic competence) are a central determinant of physical activity behaviour as evidenced by a medium sized effect (r = .30) observed in a recent meta-analysis of 59 studies (Babic et al., 2014). It is well established that children with low motor competence, or DCD, engage in less physical activity than typically developing peers (Cairney, Hay, Faught, Wade et al., 2005; Cairney, Veldhuizen, King-Dowling, Faught, & Hay, 2017) and this gap increases with age (Kwan et al., 2016). Thus, our findings fit within Stodden et al.’s (2008) developmental perspective of motor competence in that low actual and perceived physical competence among girls may contribute to a negative spiral of disengagement in physical activity, increasing their relative risk of becoming overweight or obese (Hendrix et al., 2014). From this perspective, our findings highlight the importance of creating targeted interventions aiming to improve not only motor skills, but also perceptions of physical abilities among girls with poor motor coordination in early childhood. Creating environments that foster a sense of self-efficacy may be instrumental for altering developmental trajectories to increase physical activity participation. Despite several strengths (e.g., longitudinal design, large representative sample) and providing novel evidence related to the synergistic interaction between gender, rDCD status and age on self-perceptions and global self-worth, the current study is not without its limitations. First, this study did not look at the relation between each domain-specific subscale and how each subscale contributed to global self-worth. Establishing how associations between each domain are altered in relation to gender, age and rDCD status may help understand different factors that contribute to stable views of global self-worth. Nevertheless, children’s domainspecific evaluations do not necessarily influence their overall sense of self-worth (Harter, 2012), therefore it is important to understand how age, gender and motor coordination affect children’s global self-worth and competence or adequacy in each facet of their lives independently. Second, motor coordination was only measured at one time point. Although motor coordination has been shown to be relatively stable during development (Cairney et al., 2009), it is plausible that some children classified as rDCD may have experienced improvements in motor coordination with age which could ultimately affect their self-perceptions. Another limitation pertains to how motor coordination scores were used to classify participants into two discrete groups (i.e., rDCD or typically developing children). The analysis was performed in this manner to extend previous literature that has examined differences between children meeting diagnostic criteria for rDCD and typically developing children, however, motor coordination scores could be used as a continuous variable. Future research should move beyond testing threshold models based on cut-point criterions to investigate whether dose-response effects may exist. A fourth limitation involves the magnitude of the effects observed between the groups in the present study. While there was evidence of significant three-way interactions for academic competence, athletic competence and physical appearance, these results are largely driven by the differences between rDCD girls and typically developing children. The growing disparity between rDCD girls and typically developing children for athletic, academic and physical self-perceptions appears genuinely meaningful and potentially warrants intervention, however, differences between typically developing children and rDCD boys are small and may not be as concerning. Lastly, our analysis focused on individual-level factors and failed to consider environmental factors which could provide additional insight. Future research should consider evaluating the impact of sport participation and interventions that may have occurred within select populations included in this broad sample. In summary, results from this large cohort demonstrate a synergistic effect of gender, rDCD and age across a cluster of interrelated self-perceptions (i.e., academic competence, athletic competence, physical appearance) in which girls with poor motor coordination are affected most. Lower self-held views of athletic competence may have a negative influence on lifelong physical activity engagement. Conversely, no differences were observed for social competence, behavioural conduct and global self-worth. These results suggest motor deficiencies among girls may only influence specific domains and global self-worth may be formed through a variety of different mechanisms as they become older. CRediT authorship contribution statement Denver M.Y. Brown: Formal analysis, Writing - original draft. John Cairney: Conceptualization, Funding acquisition, Methodology, Supervision, Writing - review & editing. Acknowledgement This study was supported by the Canadian Institutes of Health Research (Grant #: 66959). References American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Babic, M. J., Morgan, P. J., Plotnikoff, R. C., Lonsdale, C., White, R. L., & Lubans, D. R. (2014). Physical activity and physical self-concept in youth: Systematic review and meta-analysis. Sports Medicine, 44, 1589–1601. Blank, R., Barnett, A. L., Cairney, J., Green, D., Kirby, A., Polatajko, H., ... Vinçon, S. (2019). International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. Developmental Medicine and Child Neurology, 61, 242–285. Bruininks, R. H. (1978). Bruininks-oseretsky test of motor proficiency: Examiner’s manual. Circle Pines, MN: American Guidance Service. Cairney, J., Hay, J. A., Faught, B. E., Flouris, A., & Klentrou, P. (2007). Developmental coordination disorder and cardiorespiratory fitness in children. Pediatric Exercise

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D.M.Y. Brown and J. Cairney

Science, 19, 20–28. Cairney, J., Hay, J. A., Faught, B. E., Mandigo, J., & Flouris, A. (2005). Developmental coordination disorder, self-efficacy toward physical activity and participation in free play and organized activities: Does gender matter? Adapted Physical Activity Quarterly, 22, 67–82. Cairney, J., Hay, J. A., Faught, B. E., Wade, T. J., Corna, L., & Flouris, A. (2005). Developmental coordination disorder, generalized self-efficacy toward physical activity and participation in organized and free play activities. Journal of Pediatrics, 147, 515–520. Cairney, J., Hay, J., Veldhuizen, S., Missiuna, C., & Faught, B. E. (2009). Comparing probable case identification of developmental coordination disorder using the short form of the Bruininks‐Oseretsky Test of Motor Proficiency and the Movement ABC. Child: Care, Health and Development, 35, 402–408. Cairney, J., Hay, J. A., Veldhuizen, S., Missiuna, C., & Faught, B. E. (2010). Developmental coordination disorder, sex, and activity deficit over time: A longitudinal analysis of participation trajectories in children with and without coordination difficulties. Developmental Medicine and Child Neurology, 52, e67–e72. Cairney, J., Veldhuizen, S., King-Dowling, S., Faught, B. E., & Hay, J. (2017). Tracking cardiorespiratory fitness and physical activity in children with and without motor coordination problems. Journal of Science and Medicine in Sport, 20, 380–385. Campbell, W. N., Missiuna, C., & Vaillancourt, T. (2012). Peer victimization and depression in children with and without motor coordination difficulties. Psychology in the Schools, 49, 328–341. Cantell, M. H., Smyth, M. M., & Ahonen, T. P. (1994). Clumsiness in adolescence: Educational, motor, and social outcomes of motor delay detected at 5 years. Adapted Physical Activity Quarterly, 11, 115–129. Chase, M. A., & Machida, M. (2011). The role of sport as a social status determinant for children: Thirty years later. Research Quarterly for Exercise and Sport, 82, 731–739. Cocks, N., Barton, B., & Donelly, M. (2009). Self-concept of boys with developmental coordination disorder. Physical & Occupational Therapy in Pediatrics, 29, 6–22. Cratty, B. J. (1994). Clumsy child syndrome: Descriptions, evaluation and remediation. Chur, Switzerland: Harwood Academic Publishers. Cratty, B. J., Ikeda, N., Martin, M. M., Jennet, C., & Morris, M. (1970). Movement activities, motor ability, and the education of children. Springfield, IL: Charles C. Thomas. Crawford, S. G., Wilson, B. N., & Dewey, D. (2001). Identifying developmental coordination disorder: Consistency between tests. Physical & Occupational Therapy in Pediatrics, 20, 29–50. Fitzpatrick, D., & Watkinson, E. J. (2003). The lived experience of physical awkwardness: Adults’ retrospective views. Adapted Physical Activity Quarterly, 20, 279–297. Gibbs, J., Appleton, J., & Appleton, R. (2007). Dyspraxia or developmental coordination disorder? Unravelling the enigma. Archives of Disease in Childhood, 92, 534–539. Gomez, A., Piazza, M., Jobert, A., Dehaene-Lambertz, G., Dehaene, S., & Huron, C. (2015). Mathematical difficulties in developmental coordination disorder: Symbolic and nonsymbolic number processing. Research in Developmental Disabilities, 43, 167–178. Hands, B., & Larkin, D. (2006). Physical fitness differences in children with and without motor learning difficulties. European Journal of Special Needs Education, 21, 447–456. Harter, S. (1978). Effectance motivation reconsidered. Toward a developmental model. Human Development, 21, 34–64. Harter, S. (1981). A model of mastery motivation in children: Individual differences and developmental change. Aspects of the development of competence: The Minnesota symposia on child psychology, Vol. 14, Hillsdale, NJ: Erlbaum215–255. Harter, S. (1985). The self-perception profile for children: Revision of the perceived competence scale for children. Denver, CO: University of Denver. Harter, S. (1987). The determinants and mediational role of global self-worth in children. In N. Eisenberg (Ed.). Contemporary topics in developmental psychology (pp. 219–242). New York, NY: John Wiley. Harter, S. (1999). The construction of the self. New York, NY: Wiley. Harter, S., & Robinson, N. (1988). The function and source of different types of social support and their impact on global self-worth. Unpublished manuscriptDenver, CO: University of Denver. Harter, S. (2012). Self-perception profile for children: Manual and questionnaires (grades 3–8). Denver, CO: University of Denver. Henderson, S. E., & Sugden, D. A. (1992). Movement assessment battery for children. London, England: The Psychological Corporation. Hendrix, C. G., Prins, M. R., & Dekkers, H. (2014). Developmental coordination disorder and overweight and obesity in children: A systematic review. Obesity Reviews, 15, 408–423. Hendry, L. B., Shucksmith, J., Love, J. G., & Glendinning, A. (1993). Young people’s leisure and lifestyles. New York, NY: Routledge. Hill, L. J., Mushtaq, F., O’Neill, L., Flatters, I., Williams, J. H., & Mon-Williams, M. (2016). The relationship between manual coordination and mental health. European Child & Adolescent Psychiatry, 25, 283–295. Jarus, T., Lourie-Gelberg, Y., Engel-Yeger, B., & Bart, O. (2011). Participation patterns of school-aged children with and without DCD. Research in Developmental Disabilities, 32, 1323–1331. Joshi, D., Missiuna, C., Hanna, S., Hay, J., Faught, B. E., & Cairney, J. (2015). Reprint of “Relationship between BMI, waist circumference, physical activity and probable developmental coordination disorder over time”. Human Movement Science, 42, 307–317. Kagan, S. L., Moore, E., & Bredekamp, S. (1995). Reconsidering children’s early development and learning toward common views and vocabulary. Washington, D.C: U.S. Government Printing Office. Kling, K. C., Hyde, J. S., Showers, C. J., & Buswell, B. N. (1999). Gender differences in self-esteem: A meta-analysis. Psychological Bulletin, 125, 470–500. Kodama, S., Saito, K., Tanaka, S., Maki, M., Yachi, Y., Asumi, M., ... Yamada, N. (2009). Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: A meta-analysis. JAMA, 301, 2024–2035. Kwan, M. Y., King-Dowling, S., Hay, J. A., Faught, B. E., & Cairney, J. (2016). Longitudinal examination of objectively-measured physical activity and sedentary time among children with and without significant movement impairments. Human Movement Science, 47, 159–165. Labbrozzi, D., Robazza, C., Bertollo, M., Bucci, I., & Bortoli, L. (2013). Pubertal development, physical self-perception, and motivation toward physical activity in girls. Journal of Adolescence, 36, 759–765. Lingam, R., Hunt, L., Golding, J., Jongmans, M., & Emond, A. (2009). Prevalence of developmental coordination disorder using the DSM-IV at 7 years of age: A UK population–based study. Pediatrics, 123, e693–e700. Mæland, A. F. (1992). Self‐esteem in children with and without motor co‐ordination problems. Scandinavian Journal of Educational Research, 36, 313–321. Mancini, V., Rigoli, D., Roberts, L., & Piek, J. (2019). Motor skills and internalizing problems throughout development: An integrative research review and update of the environmental stress hypothesis research. Research in Developmental Disabilities, 84, 96–111. Peugh, J. L. (2010). A practical guide to multilevel modeling. Journal of School Psychology, 48, 85–112. Piek, J. P., Baynam, G. B., & Barrett, N. C. (2006). The relationship between fine and gross motor ability, self-perceptions and self-worth in children and adolescents. Human Movement Science, 25, 65–75. Piek, J. P., Dworcan, M., Barrett, N. C., & Coleman, R. (2000). Determinants of self-worth in children with and without developmental coordination disorder. International Journal of Disability, Development and Education, 47, 259–272. Pieters, S., Desoete, A., Van Waelvelde, H., Vanderswalmen, R., & Roeyers, H. (2012). Mathematical problems in children with developmental coordination disorder. Research in Developmental Disabilities, 33, 1128–1135. Poulsen, A. A., Ziviani, J. M., & Cuskelly, M. (2006). General self-concept and life satisfaction for boys with differing levels of physical coordination: The role of goal orientations and leisure participation. Human Movement Science, 25, 839–860. Poulsen, A. A., Ziviani, J. M., & Cuskelly, M. (2008). Leisure time physical activity energy expenditure in boys with developmental coordination disorder: The role of peer relations self-concept perceptions. OTJR: Occupation, Participation and Health, 28, 30–39. Rose, B., Larkin, D., & Berger, B. G. (1997). Coordination and gender influences on the perceived competence of children. Adapted Physical Activity Quarterly, 14, 210–221. Rose, E., Larkin, D., Parker, H., & Hands, B. (2015). Does motor competence affect self-perceptions differently for adolescent males and females? SAGE Open, 5, 2158244015615922. Rose-Krasnor, L., Busseri, M. A., Willoughby, T., & Chalmers, H. (2006). Breadth and intensity of youth activity involvement as contexts for positive development.

9

Research in Developmental Disabilities 98 (2020) 103576

D.M.Y. Brown and J. Cairney

Journal of Youth and Adolescence, 35, 365–379. Schott, N., Alof, V., Hultsch, D., & Meermann, D. (2007). Physical fitness in children with developmental coordination disorder. Research Quarterly for Exercise and Sport, 78, 438–450. Schoemaker, M. M., & Kalverboer, A. F. (1994). Social and affective problems of children who are clumsy: How early do they begin? Adapted Physical Activity Quarterly, 11, 130–140. Skinner, R. A., & Piek, J. P. (2001). Psychosocial implications of poor motor coordination in children and adolescents. Human Movement Science, 20, 73–94. Stodden, D. F., Goodway, J. D., Langendorfer, S. J., Roberton, M. A., Rudisill, M. E., Garcia, C., & Garcia, L. E. (2008). A developmental perspective on the role of motor skill competence in physical activity: An emergent relationship. Quest, 60, 290–306. Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological Bulletin, 139, 213. Van Rossum, J. V., & Vermeer, A. (1990). Perceived competence: A validation study in the field of motoric remedial teaching. International Journal of Disability, Development and Education, 37, 71–81. Voyer, D., & Voyer, S. D. (2014). Gender differences in scholastic achievement: A meta-analysis. Psychological Bulletin, 140, 1174. Watson, L., & Knott, F. (2006). Self-esteem and coping in children with developmental coordination disorder. British Journal of Occupational Therapy, 69, 450–456. Wigfield, A., Eccles, J. S., Mac Iver, D., Reuman, D. A., & Midgley, C. (1991). Transitions during early adolescence: Changes in children’s domain-specific selfperceptions and general self-esteem across the transition to junior high school. Developmental Psychology, 27, 552–565. Wilgenbusch, T., & Merrell, K. W. (1999). Gender differences in self-concept among children and adolescents: A meta-analysis of multidimensional studies. School Psychology Quarterly, 14, 101–120. Yu, J., Sit, C. H., Capio, C. M., Burnett, A., Ha, A. S., & Huang, W. Y. (2016). Fundamental movement skills proficiency in children with developmental coordination disorder: Does physical self-concept matter? Disability and Rehabilitation, 38, 45–51.

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