Physical Therapy in Sport 14 (2013) 105e109

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Physical Therapy in Sport

journal homepage: www.elsevier.com/ptsp

Original research

Timing perception and motor coordination on rope jumping in children with

attention deficit hyperactivity disorder
Ying-Yi Chen a, Lih-Jiun Liaw b, Jing-Min Liang a, Wei-Tso Hung a, Lan-Yuen Guo a, Wen-Lan Wu a, *
a
Department of Sports Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Rd., Kaohsiung City, 80708, Taiwan
b
Department of Physical Therapy, Kaohsiung Medical University, Taiwan

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

Article history: Objectives: To evaluate timing perception ability and motor coordination in children with ADHD
Received 14 June 2011 (Attention Deficit Hyperactivity Disorder) while rope jumping at different rates.
Received in revised form Design and setting: Rope jumping at (1) a constant tempo of 100 for 15 s (RJ-C) and (2) two randomly
22 February 2012
permutated tempos (80, 100, or 120) for 15 s (RJ-V).
Accepted 6 March 2012
Main Outcome Measures: The “timing variation while jumping”, “timing variation while whirling”, and
“hand-foot deviation time” in each rope jumping cycle were recorded, to assess the time estimation
Keywords:
ability.
Attention-deficit/hyperactivity disorder
(ADHD)
Participants: 10 children with ADHD (9.65
1.27 years) and 10 children without ADHD (9.93
1.54
Timing years) were recruited.
Rope jumping Results: The ADHD group showed greater variation in time between the foot jumping and the rope
whirling tasks. Also, the median value of hand-foot deviation time was greater in the ADHD group
(3.34 ms) than in the control group (1.75 ms). In RJ-V, the control group was able to modify their pace
and respond to the target speed in the post-phase, while the ADHD group could not.
Conclusion: Impaired timing perception leads to less accurate performance during rope jumping for
ADHD children. The findings also reveal that poor hand-foot coordination results in poor control of
simultaneous movements of the upper and lower limbs during rope jumping.
Ó 2012 Elsevier Ltd. All rights reserved.

1. Introduction (Harrington, Haaland, & Hermanowicz, 1998). Previous studies have

Time perception is the ability to estimate periods of time of
coming events. Processing of timing in shorter intervals is based on
skilled movements and cerebellar mechanisms without cognitive
control, whereas, in longer intervals, it is associated with attention
and working memory (Lewis & Miall, 2003a,b; Rammsayer, 1999).
Previous studies have indicated that processing of precise timing
tasks and longer timing intervals are associated with the cere-
bellum and basal ganglia (Ivry & Keele, 1989; Ivry & Spencer, 2004;
Mangels, Ivry, & Shimizu, 1998). The network of right hemispheric
frontocerebellar time discrimination has also been shown to be
involved in timing tasks (Harrington, Haaland, & Knight, 1998;
Smith, Taylor, Lidzba, & Rubia, 2003).
The output of motor timing consists of two components: a clock
component, which reflects time keeper intervals, and a motor
delay component, which reflects motor implementation delay
* Corresponding author. Tel.: þ886 7 3121101x2646; fax: þ886 7 3138359.
E-mail address: wenlanwu@kmu.edu.tw (W.-L. Wu).
indicated that children with ADHD have perceptual deficits in the
clock component, such as in time production and reproduction,
which further influences their performance on motor timing tasks
(Barkley, Murphy, & Bush, 2001; Van Meel, Oosterlaan, Heslenfeld,
& Sergeant, 2005; Yang et al., 2007).
When rope jumping, it is necessary to coordinate the upper and
lower body to maintain balance and rhythm. Rope jumping can
enhance the precise coordination of multiple muscle groups, which
is why it is used widely in athletic training programs (Lee, 2010).
Rope jumping combines the angular momentum of the rope and
vertical displacement of the body (Pitreli & O’Shea, 1986). Also, rope
jumping involves upper and lower synchrony (hand-foot coordi-
nation) where positioning and timing is critical (Pitreli & O’Shea,
1986). The ability of time reproduction makes it possible to
reproduce specified time periods with great precision (Toplak,
Dockstader, & Tannock, 2006). Rope jumping skill involves good
perception of time reproduction. However, poor motor timing
performance has been found in children with ADHD. It seems that
timing abnormalities have been related to impulsiveness, a core

1466-853X/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ptsp.2012.03.012
106 Y.-Y. Chen et al. / Physical Therapy in Sport 14 (2013) 105e109
clinical symptom of ADHD (Rubia, 2002; Rubia, Halari, Christakou,
& Taylor, 2009). It has been found that children with ADHD
show less activity in regions including the prefrontal and precentral
gyri, basal ganglia, cerebellum, inferior parietal lobule, superior
temporal gyri, and insula, which are associated with sensorimotor
timing (Valera et al., 2010). Thus, they have demonstrated deficits
in time perception including shorter reproductions and greater
reproduction errors than healthy children (Barkley et al., 2001).
ADHD children have been shown to be impaired at maintaining
a chosen tapping rhythm synchronously and in responding to
organize their motor output (Rubia, Taylor, Taylor, & Sergeant,
1999). Children with ADHD showed poor ability to plan events
which are separated by time (Barkley, 1997). Also, children with
ADHD have problems executing motor output (Pennington &
Ozonoff, 1996) and they exhibit slow output on automatic pro-
cessing tasks (Carte, Nigg, & Hinshaw, 1996). It has been suggested
that children with ADHD have difficulty adjusting their speed to
motor tasks with external cues (Carte et al., 1996).
Much evidence exists to suggest that children with ADHD have
impairments in fine motor timing when executing finger tapping
tasks. However, few studies have focussed on gross motor timing.
Through clinical observation, it was found that children with ADHD
showed poor performance when rope jumping. It has been sug-
gested that problems with timing perception and motor coordi-
nation might be the reason. Thus, in this study, a series of rope
jumping tasks involving different rope jumping rates was designed
to evaluate the timing perception ability and motor coordination of
ADHD children.
2. Methods
2.1. Subjects
Five boys and five girls, with a mean age of 9.65
1.27 years,
diagnosed as ADHD by a local hospital and without other combined
syndromes, were recruited in this study. Ten age-matched non-
ADHD children (4 boys, mean age 9.93
1.54 years), without ADHD
symptoms or other neuromuscular symptoms, were recruited from
local schools as the control group. Rope jumping was already a part
of the physical education curriculum at the time of data collection.
Informed consent, approved by the university ethical review
committee, was obtained from parents prior to involvement in the
study.
2.2. Material
A force plate (Kistler Instrument Corp, Winterhur, Switzerland)
with the sample rate of 1000 Hz was used to record the flight
timing of rope jumping. A six-camera motion capture system
(Qualisys Motion capture Systems, Qualisys AB, Sweden), with
a sample rate of 100 Hz, was used to capture rope movement using
a reflective label attached to the distal end of the rope. Further-
more, the rhythm, as controlled by a metronome, was recorded by
a CD player for use as our target signal before the test.
2.3. Procedure
A reflective label was stuck to the distal end and on the middle
of the rope in order to record the trajectory of the rope. Two
reflective markers were stuck on each side of the third metatarsal
head to help judge the flight phase and landing phase during rope
jumping. Subsequently, participants were asked to warm up by
doing rope jumping for at least 15 s before the formal rope jumping
test; they then practiced three cycles at each tempo; 80, 100 and
120. The sounds at the various tempi were played during the task
by CD player. Each participant was allowed to take a rest during this
study. Muscle fatigue was not an issue.
Firstly, subjects were required to jump the rope at a constant
tempo of 100 for 15 s (RJ-C). After 10 min rest, they were asked to
jump at variable speeds, consisting of the tempos of 80e100,
80e120, 100e80, 100e120, 120e80, and 120e100, for 15 s (RJ-V),
respectively, in a random order. Each participant was allowed to
take a 3 min rest between these 6 trials. Under RJ-V, the tempo was
changed at around the 6the7th second during each trial. The tempo
of sound for each trial had been recorded before the experiment
and was played continuously by CD player. Participants were
instructed to do their best to follow the tempo and were required to
jump inside the edges of the force platform. Each subject was
instructed to finish 2 trials on RJ-C and only 1 trial on each RJ-V task
to achieve a total of three acceleration trials and three deceleration
trials. If a subject tripped on the rope and failed on the task, then
they were asked to do more trials. The number of failures was
recorded.
2.4. Data analysis
The recurrent period of jumping (foot jumping cycle) was defined
as the time span from when the ground reaction force first excee-
ded 10 N until the next time the ground reaction force exceeded
10 N, and so on. Similarly, the period of the rope cycle (rope whirling
cycle) was defined by the rope marker reaching the lowest point
and contacting ground. The “timing variation in jumping” and
“timing variation in whirling” were calculated as the absolute value
of the difference between 60 and the foot jumping cycle or rope
whirling cycle, respectively; multiplied by the reciprocal of the
tempo. The timing variation is the inconsistency between the
manipulation of time by the performer and the expected manipu-
lation of time for the task, the symptom of which is either an
extended performance time or a shortened one compared with the
expected time. Moreover, we subtracted the timing variation in
whirling from the timing variation in jumping and found the
absolute value to define the “hand-foot deviation time”.
In the RJ-C task, two trials were analyzed. Each trial of the RJ-C
task was analyzed from 4 to 9 s. In the RJ-V task, 6 different tasks
were analyzed. Moreover, each trial of the RJ-V tasks was separated
into three phases, which were selected as pre-phase (4e5 s), mid-
phase (6e7 s), and post-phase (8e9 s). Finally, the mean values for
hand-foot deviation time, timing variation in foot jumping, and
timing variation in rope whirling from all the available rope
jumping cycles of the RJ-C and RJ-V tasks were recorded.
2.5. Statistical analysis
A non-parametric test (Mann Whitney U test) was used to assess
the time difference between the ADHD group and the control group
for RJ-C and RJ-V from 4 to 9 s. Also, a Mann Whitney U test was
used to assess the difference between successful trials and failed
trials for RJ-C. The statistical significance for paired comparisons
between each phase was calculated using Wilcoxon Signed-Rank
test method. All analyses were performed using SPSS 17.0 soft-
ware (SPSS Inc., USA). Results were considered statistically signifi-
cant when the p-value was less than 0.05.
3. Results
Fig. 1(a) displays the median value of hand-foot deviation time
from 4 to 9 s across the groups for the RJ-C task. The median value
of hand-foot deviation time was greater in the ADHD group
(3.34 ms), compared to the control group (1.75 ms) (p<.01, Table 1).
Moreover, no falls were found in the control group, but some
 Y.-Y. Chen et al. / Physical Therapy in Sport 14 (2013) 105e109 107

ADHD-participants fell during the RJ-C task. The median value of

a hand-foot deviation time was greater in falling trials (7.77 ms) than
successful trials (3.34 ms) in the ADHD group (p<.05, Table 1).
Fig. 1(b) displays the median of hand-foot deviation time from 4 to
9 s across the groups in the RJ-V task. Also, we found a significant
difference in hand-foot deviation time between groups on the RJ-V
task (p<.01, Table 1). The median value of hand-foot deviation time
was greater in the ADHD group (4.89 ms) than in the control group
(2.93 ms, p<.01, Table 1). Furthermore, each trial of RJ-V tasks was
separated into three phases, including pre-phase (4e5 s), mid-
phase (6e7 s), and post-phase (8e9 s), to examine their timing
variation in foot jumping and timing variation in rope whirling in
different phases. Fig. 2 shows performance in foot jumping and
rope whirling across the groups in the three phases. It was found
that the ADHD group presented greater variation time in both the
foot jumping and rope whirling cycle than did the control group.
Further, Wilcoxon Signed-Rank test for paired comparisons
between the timing variations in each phase were performed
(Table 2). In the control group, the timing variation in foot jumping in
the mid-phase was 12.99 ms (Table 1) greater than it was in the pre-
b phase (4.39 ms, Table 1) (p<.05, Table 2). Also, in the ADHD group,
significantly greater timing variations in foot jumping were found in
the mid-phase (15.13 ms) and post-phase (15.35 ms) than in the pre-
phase (4.15 ms) (p<.05 in mid-phase; p<.05 in post-phase, respec-
tively, Table 2). In the control group, the timing variation in rope
whirling in the mid-phase was higher than in the pre-phase (p<.05,
Table 2). In the ADHD group, the timing variations in rope whirling in
the mid-phase (18.21 ms) and post-phase (12.78 ms) were signifi-
cantly greater than in the pre-phase (6.00 ms) (p<.05 in mid-phase;
p<.01 in post-phase, respectively, Table 2).

4. Discussion

In this study, the ADHD group demonstrated greater timing

Fig. 1. (a) The interquartile range and median of hand-foot deviation time measured
for each group in the task of RJ-C. (b) The interquartile range and median of hand-foot
deviation time measured for each group in the task of RJ-V.
Table 1
Descriptive statistics for hand-foot deviation time (ms), timing variation in foot
jumping (ms), and timing variation in rope whirling (ms) across group, and the
statistical significance of the hand-foot deviation time (ms) between groups and
between success trials and falling trials (median with interquartile range in
parentheses).
variation in both RJ-C and RJ-V tasks (Table 1). Moreover, it is
interesting to note that the ADHD group showed greater variation
time in the RJ-V task than in the RJ-C task. This suggests that control
group subjects could follow the given rate with less timing vari-
ability when processing rope jumping; while the ADHD group
could not. It also suggests that when conditions changed, the
symptoms of ADHD interfered with motor timing performance.
Previous studies have shown that greater variability in motor
timing is obvious in children with ADHD (Pitcher, Piek, & Barrett,
2002; Rommelse et al., 2008; Rubia et al., 1999). Through func-
tional magnetic resonance imaging, individuals with ADHD have

ADHD Control p-value

Hand-foot coordination
Hand-foot deviation time (ms)
RJ-C (40 e90 ) Success trails 3.34 (4.33/1.33) 1.75 (2.78/1.13) .005**
Failing trails 7.77 (12.13/5.86) N/A
p-value .028* e
RJ-V (40 e90 ) 4.89 (8.63/3.73) 2.93 (3.33/2.51) .003**

Foot jumping cycle

Timing variation in foot jumping (ms)
Pre-phase (40 e50 ) 4.15 (21.33/2.75) 4.39 (17.00/2.33)
Mid-phase (60 e70 ) 15.13 (32.75/11.11) 12.99 (17.64/7.00)
Post-phase (80 e90 ) 15.35 (25.43/6.11) 9.22 (11.56/4.38)

Rope whirling cycle

Timing variation in rope whirling (ms)
Pre-phase (40 e50 ) 6.00 (22.17/4.47) 6.30 (15.78/4.04)
Mid-phase (60 e70 ) 18.21 (27.58/12.11) 13.77 (17.89/6.75)
Post-phase (80 e90 ) 12.78 (24.71/8.11) 9.74 (11.17/3.94)

N/A denotes no falling trial; e denotes no p-value. Fig. 2. The median value of timing variation in foot jumping and rope whirling across
*Denotes p-value < 0.05; **denotes p-value < 0.01. groups in the pre, mid and post-phase in the task of RJ-V.
108 Y.-Y. Chen et al. / Physical Therapy in Sport 14 (2013) 105e109
Table 2
The pairwise comparison across the median value on timing variation in foot
jumping and timing variation in rope whirling, respectively.
p-value
ADHD (n ¼ 10) Control (n ¼ 10)
Timing variation in Pre-phase Mid-phase .015* .017*
foot jumping Post-phase .015* .074
Timing variation in Pre-phase Mid-phase .015* .009**
rope whirling Post-phase .008** .203
*Denotes p-value < 0.05; **denotes p-value < 0.01.
been shown to have less activity in the prefrontal region, basal
ganglia, and cerebellum, which are associated with sensorimotor
timing, resulting in wild variability in timing mechanisms (Valera
et al., 2010). Previous studies have used tapping tasks to measure
the variability of motor output in response to an external cue (Kalff
et al., 2005; Rommelse et al., 2008). Children with ADHD displayed
impairments in duration discrimination on timing tasks (Toplak,
Rucklidge, Hetherington, John, & Tannock, 2003; Yang et al., 2007);
therefore, poor timing performance causes them to show slower
responses and more variability in processing sequential tapping
tasks (Kalff et al., 2005; Pitcher et al., 2002; Rommelse et al., 2008).
The findings of this study reveal that the ADHD group showed
greater timing variation on the RJ-C and RJ-V than did the control
group, which means less accurate performance when emulating the
target signal. The impaired timing perception in ADHD children
indeed causes less accurate performance during rope jumping.
The RJ-V task was separated into three phases: pre- (4e5 s), mid
(6e7 s), and post- (8e9 s), to observe subjects’ adaptations in each
phase. After the rate changed, timing variation in foot jumping and
timing variation in rope whirling in the post-phase did not differ
from those in the pre-phase in the control group (p ¼ .07 in foot
jumping; p ¼ .20 in rope whirling, Table 2). This indicates that the
foot jumping and rope whirling performances were the same in
pre-phase and post-phase. This suggests that control group
subjects had the ability to adapt quickly to a given rate and dis-
played decreased timing variability in the post-phase. However, in
the ADHD group, the performance in foot jumping and rope
whirling in the post-phase still showed significant difference
compared to the pre-phase (p ¼ .02 in foot jumping; p ¼ .01 in rope
whirling, respectively, Table 2). This indicates that performance in
the pre-phase differs from that in the post-phase, without showing
significant decline in timing variation in the post-phase, either in
foot jumping or in rope whirling. This finding indicates that chil-
dren with ADHD were impaired in time perception and reproduc-
tion, compared to children without ADHD.
In the task with longer time intervals (over 1 s); subjects relied
on attention and cognitive process (Nenadic et al., 2003). However,
handling of short intervals (milliseconds) may be more related to
an internal timing mechanism (Ivry, 1996). A previous study has
demonstrated that participants anticipated the following tone
when the interval was less than 3-sec, and then tapped synchro-
nously with or before the tone, rather than hearing it (Mates,
Müller, Radil, & Pöppel, 1994). In this study, jumping intervals of
less than 1 s decreased the confounding influence from cognitive
process. Excluding inferences from cognitive process, external cues
likes rope swing in a school yard jump rope, were not considered
relevant in this study. Thus, the poor performance on rope jumping
in this study was more related to ADHD children’s abilities with
regard to time perception.
Previous research has also suggested that children with ADHD
have motor coordination deficiency in postural adjustment (Jucaite,
Fernell, Forssberg, & Hadders-Algra, 2003), which also has a nega-
tive impact on daily life (Fliers et al., 2008). In this study, rope jumpers
needed more skill for coordination of upper and lower limb
movements. ADHD-participants showed a big drop in overall
performance on the RJ-C task and on the RJ-V task with a higher hand-
foot deviation time. Simultaneously, the ADHD individuals tripped up
more than the others. No control group subject failed on any of the
tasks. The experimental results showed that there was greater hand-
foot deviation time (7.77 ms, Table 1) in falling trials. This may suggest
that values of hand-foot deviation time closer to zero represent
jumpers who manifest synchronous activation of upper and lower
extremities during rope jumping. Better performance in rope jump-
ing leads to good ability in motor coordination. Therefore, this
suggests that ADHD individuals were poor in controlling simulta-
neous movements of the upper and lower limbs when facing high
quality motor coordination tasks. Further study, testing other coor-
dination tasks is suggested to understand with greater confidence the
overall breakdown in hand-foot coordination in ADHD.
There were some limitations to this study. Rope jumping is
a gross motor performance task, combining upper and lower limbs.
A child’s ability to perform this motor skill depends on a number of
factors, including muscle strength, coordination, flexibility, range of
motion, cardiopulmonary endurance, and so on. Muscle strength
variations in different school-age children may be an issue that
influences their performance. Therefore, further studies are sug-
gested to investigate each participant’s muscle strength and then
observe their performance in coordination tests. In this study, this
factor was excluded by asking each participant to do rope jumping
15 s before this study in order to observe their ability on rope
jumping. If they could not complete it, they were considered to
have weak muscle strength and endurance and were excluded from
this study. Leaving aside the muscle strength problem, and taking
all other experiential elements to be the same, the performance
criterion set up in this study may serve as a reliable diagnostic
marker for this complex challenge of observing the precision of
internal timing perception in conjunction with motor coordination
ability. Moreover, cordless jump rope may be useful to construct
a simple task to compare rope jumping with and without rope to
observe gross motor coordination skill.
5. Conclusion
The findings suggest that abnormalities in motor coordination
and motor timing perception are present in ADHD children during
rope jumping. Longer hand-foot deviation time indicated poor rope
jumping performance. The findings reveal that the ADHD group
had greater hand-foot deviation time in both RJ-C and RJ-V tasks.
Due to the poor timing perception and motor coordination, most
children with ADHD could not carry out tasks as well as children
without ADHD. Further studies could focus on specific training of
time perception skill as well as motor coordination for children
with ADHD to improve their rope jumping skill.
Conflict of interest
None declared.
Ethical approval
Informed consent, approved by the university ethical review
committee, was obtained from parents prior to involvement in the
study.
Funding
None declared.
Acknowledgments
This work was supported by the National Science Council,
Taiwan (NSC 97-2320-B-037-004-MY3). We are grateful to Mi-Chia
 Y.-Y. Chen et al. / Physical Therapy in Sport 14 (2013) 105e109
Ma for providing the statistical consulting services from the
Statistics Consulting Center, National Cheng Kung University.
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