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Table 1 Summary of Included Sources

From: How effective is fine motor training in children with ADHD? A scoping review

Source Study design Population Intervention Outcomes (incl. outcome measures)
Bartscherer & Dole (2005) [78] Case report Boy with attention and motor coordination difficulties (n = 1; no formal ADHD diagnosis)
Age: 9
Medication: no
Interactive Metronome training: Variety of upper and lower limb tasks performed with metronome beat
7-week program
Sessions 3x/week (60–90 min each)
4 pre-sessions, 15 sessions
Bruininks-Oseretsky Test of Motor Proficiency (BOTMP): Improvements in gross and fine motor skills:
∙ Largest improvements in balance, response speed, visual-motor control, upper limb speed, dexterity
∙ Smaller changes in bilateral coordination, strength
∙ No change in running speed, agility
∙ Decline in upper limb coordination
Interactive Metronome long-form test (IM LFT): Improvements in timing accuracy
Parent reports:
Behavior changes
More cooperative, less resistance & fighting, self-confidence (willingness to take risks), faster at solving math problems, improvements in handwriting
Dahan et al. (2018) [20] Review ADHD subjects Neurofeedback (NF) interventions: Theta/beta frequency training and SCP neurofeedback
EMG-Biofeedback (EMG-BF) interventions: Feedback on motor activity
Physical activity and motor interventions: Several weeks training program or single intervention (e.g. running on treadmill, ball handling and balance exercises, general exercise)
NF: Improvements in behavioral self-regulation; reduction of ADHD symptoms (mixed findings); increase in response speed; no differences between the different NF approaches
EMG-BF: Improvements in motor coordination and regulation, visuo-motor precision, flexibility, fine motor control, muscle relaxation; reduction of ADHD symptoms
Physical activity and motor interventions: Improvements in executive functioning, social behavior, response preparation, working memory, motor performance; reduction of ADHD symptoms; regardless of type of physical activity
Follow-up: Evidence for persisting changes
Duda et al. (2019) [79] Case-control study Children and adolescents with ADHD (n = 16)
Control group: Children and adolescents without ADHD (n = 16)
Age: 9–15
Medication: no
Graphomotor learning task: Practicing a novel grapheme on a digitizing tablet 30 x
Schedule: One single session
Note: Not a training for fine motor skills but to investigate graphomotor procedural learning
WACOM Cintiq 21UX digitizing tablet & MovAlyzeR software
ADHD group: No improvements in graphomotor fluency and automaticity
Control group: Improvement in graphomotor fluency and automaticity
Gharebaghy et al. (2015) [80] Single case experimental design (multiple baselines) Children with ADHD (n = 6)
Age: 7–12
Medication: yes
Cognitive Orientation to daily Occupational Performance (CO-OP): Use of cognitive strategies to reach self-selected goals regarding motor performance in daily living activities (e.g. handwriting, dressing)
12-week program
12 sessions (45–60 min each)
Bruininks-Oseretsky Test of Motor Proficiency and Performance (BOTMP): Improvements in motor performance
Canadian Occupational Performance Measure (COPM): Perceived improvements in chosen goals (satisfaction and performance) reported by all children and parents
Goal Attainment Scaling: 17/18 goals attained or exceeded
Halperin et al. (2013) [81] Proof-of-concept study Preschool children with ADHD (n = 29; all subtypes)
Age: 4–5
Medication: no
TEAMS Intervention (Training Executive, Attention, and Motor Skills): Games designed to enhance inhibitory control, working memory, attention, visuo-spatial abilities, planning, and motor skills (e.g. games with balls, puzzles, jump rope) + additional aerobic exercises (e.g. jumping jacks)
Therapist sessions for children (90 min each)
Parent sessions (20 min each): Psychoeducation & support
Group A: 5 weeks, 1x/week
Group B: 8 weeks, 1x/week
Group C: 5 weeks, 2x/week
A, B, C: Additional daily training sessions at home (30–45 min each)
ADHD-RS-IV (parent & teacher ratings):
Improvement in ADHD symptoms; reductions in impairment
No differences on outcomes among groups
Parent Satisfaction Questionnaire (PSQ): Satisfaction with program and treatment compliance
Follow-up (1 month & 3 months): Improvements in ADHD symptoms maintained
Molsberger et al. (2014) [82] Case report Boy with ADHD (n = 1)
Age: 9
Medication: yes
Complementary medical intervention: Applied kinesiology (AK), acupuncture, respiratory exercises
10 months
18 sessions
Week 1: 2 sessions
Week 2 to end: sessions every 2–4+ weeks
First 3 sessions: respiratory exercises (10–15 min each) + acupuncture (permanent needles for 2 days each time)
Respiratory exercises at home (2 min/day)
Coachman’s test: Normalized muscle function
Parent reports: Improvements in sleep behavior and handwriting; increased effectiveness of medication after acupuncture
Follow-up (15 months): Improvements maintained
Palsbo & Hood-Szivek (2012) [83] Non-randomized uncontrolled pretest-posttest design Children with learning impairments, neuromotor and/or handwriting deficits (n = 18): ASD (n = 5), ADD or ADHD (n = 2), Pervasive developmental delay (n = 1), Intellectual disability (n = 2), Auditory processing disorder or deafness (n = 2), no disability (n = 6)
Age: 5–11
Robotic-assisted three-dimensional repetitive motion training: Use of a haptic computer-user interface to improve handwriting through a program of active therapy (e.g. proprioception exercises, robot-assisted glyph formation) with multisensory feedback
4–6/8 weeks
15–20 sessions
3-5x/week or daily sessions (25–30 min each)
Beery-Buktenica Developmental Test of Visual-Motor Integration (Motor Coordination Subtest):
Improvements in fine motor skills & motor control (children with learning disabilities and ≥ 9 years)
No improvements (children with CP or < 9 years)
Test of Handwriting Skills-Revised (THS-R; random number and uppercase letter order subtests) & Print Tool (random lowercase letter order subtest): Improvements in consistency of glyph formation (10/14 children) and writing size (all children with ASD)
Evaluation Tool of Children’s Handwriting (ETCH; copy subtest): Improvements in handwriting fluidity (writing speed) while maintaining legibility (all children with ASD or ADHD/ADD)
Ruiz-Manrique et al. (2014) [84] Case report Boy with ADHD and comorbid video game addiction (n = 1)
Age: 10
Medication: yes
“ADHD Trainer”: Mobile/tablet application designed to treat ADHD using a cognitive training method to enhance cognitive skills (attention, working memory, processing speed, calculation ability, reasoning, visuo-motor coordination)
2 months (within study), 6 months (total training reported by parents)
1st month: 10 min-4 h/day (average: 1 h/day)
2nd month: min. 10 min/day
Conners’ Parent and Teacher Rating Scales & Barkley School Situations Questionnaire:
∙ Behavioral improvements
∙ Academic improvements
∙ Improvement of cognitive areas: visuo-spatial working memory, fine motor skills
Parent report: Reduction of videogame abuse (playing time)
Shaffer et al. (2001) [85] Randomized controlled pretest-posttest design (blinded) Boys with ADHD (n = 56)
Age: 6–12
Interactive Metronome training: Variety of upper and lower limb tasks performed with metronome beat
Treatment group:
3–5 weeks Interactive Metronome training
15 sessions (60 min each)
Control group A: No intervention
Control group B:
3–5 weeks video game training (incl. eye-hand coordination, advanced mental planning, multiple task sequencing)
15 sessions (60 min each)
Treatment group: Improvements in attention:
Tests of Variables of Attention (TOVA): Reduction of errors and distractibility, consistency of reaction time, improved overall attention
Conners’ Rating Scales-Revised (CRS-R) Teacher & Parent versions: Improvements in aggression control
Wechsler Intelligence Test for Children-Third Edition
Achenbach Child Behavior Checklist
Improvements in motor control:
Conners’ Rating Scales-Revised (CRS-R) Teacher & Parent versions
Achenbach Child Behavior Checklist
The Sensory Profile
Bruininks-Oseretsky Test for Motor Proficiency (selected subtests)
Improvements in academic achievements:
Wide Range Achievement Test (WRAT 3; reading & writing): Improvements in reading
Language Processing Test: Improvements in language processing
Differences between groups: Improved performance in treatment group; decreased performance in control group and video game group
Tucha & Lange (2005) [86] Study 1: Experimental design (randomized)
Study 2: Experimental design (randomized)
Study 3: Case report
Study1: Neurotypical students (n = 26)
Age: 20–35
Study 2: Children with ADHD/combined type (n = 12; no fine motor problems)
Age: 9–12
Medication: Depending on experimental condition
Study 3: Boy with ADHD/combined type (n = 1)
Age: 10
Medication: yes
Study 1: Examination of handwriting movements of neurotypical students under different conditions (normal/neat/blind writing, visually/mentally tracking the pen)
Schedule: 1 single session
Note: Not included in review (not ADHD)
Study 2: Examination of handwriting movements of children with ADHD under medication vs. placebo condition
Medication condition: different instructions (repetitive hand movements, fluent circle drawing, blind/fast writing)
Schedule: 2 sessions in 5–7 days
Note: Not included in review (no training)
Study 3: Training of automated handwriting movements (copying short texts) aided by simple instructions to direct attention away from accuracy and legibility of handwriting
~ 3 weeks
6 sessions
WACOM IV Digitizing Tablet & specific pen:
Study 1 (Tablet): Automated handwriting movements under different conditions
Study 2 (Tablet): Reduced handwriting fluency on medication; automated handwriting movements on medication through instructions
Study 3:
Tablet: Automated and perfectly smooth handwriting movements (on tablet and homework) through instructions and feedback; reduced number of false starts
Parent and teacher reports: Increased writing speed; legible handwriting but irregular alignment; better grades; higher motivation
Follow-up (4 weeks): Improvements of handwriting movements maintained
Weerdmeester et al. (2016) [87] Feasibility study (randomized controlled pretest-posttest design) Children with ADHD (n = 47) or elevated ADHD symptoms (n = 26)
Age: 6–13
“Dragon”: Full-body videogame intervention with ADHD-focused training components
Intervention condition: “Dragon”
Control condition: “Angry Birds Trilogy” (comparable full-body videogame not targeting ADHD symptoms)
Schedule: 6 sessions (15 min each)
ADHD VragenLijst (AVL; teacher-ratings): Greater improvement of ADHD symptoms in intervention vs. control group
Go/no-go task: Reduction in number of hits (sustained attention) in both groups; greater increase in false alarms (impulsivity) in intervention vs. control group
Movement Assessment Battery for Children (MABC-2-NL): Improvements in fine motor skills (both groups); no improvement in gross motor skills
Evaluative questions about “Dragon”: Satisfaction with game
Yazd et al. (2015) [88] Experimental design (randomized) Children with ADHD (n = 36)
Age: 6–12
Medication: Depending on experimental condition
Group A: Perceptual-motor training (incl. spatial/temporal/directional/body awareness, balance, coordination)
Group B: Combination of perceptual-motor training and drug therapy
Group C: Drug therapy (Methylphenidate, Risperidone)
Schedule: 6-week treatment/training
Group B & C: 18 training sessions
Bruininks-Oseretsky Test of Motor Proficiency:
Group A: Improvements in gross and fine motor skills
Group B: Improvement in gross and fine motor skills
Group C: No improvement in motor performance