Research in Developmental Disabilities 74 (2018) 31–40

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Research in Developmental Disabilities

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Knowledge of performance feedback among boys with ADHD

T
a,⁎ b b
Jason C. Bishop , Luke E. Kelly , Michael Hull
a
Auburn University, Center for Disability Research and Policy Studies, 215 South Donahue Drive, Auburn, AL 36849, United States
b
University of Virginia, 405 Emmet St. S, Charlottesville, VA 22903, United States

AR TI CLE I NF O AB S T R A CT

Keywords: Background: Children with attention deficit-hyperactivity disorder (ADHD) often experience
Motor development delays in acquiring competence completing fundamental motor skills. The effects of augmented
Motor learning prescriptive knowledge of performance feedback (PKP) have not been explored as a possible
Performance feedback component solution.
Aims: The purpose of this study was to test the motor learning effects of KP among boys with
ADHD.
Methods and procedures: Thirty-one boys with ADHD, randomly selected into either a treatment
or a control group, completed a series of cornhole games. It was hypothesized that PKP feedback
administered to treatment group participants would increase motor learning. Dependent vari-
ables included cornhole scores and quality of performance measures.
Outcomes and results: Both groups improved in cornhole scores and improvement was not de-
pendent upon KP. Treatment group participants performed significantly better in quality of
performance of the underhand toss compared to the control group.
Conclusions and implications: PKP feedback improves motor skill performance learning among
children with ADHD above knowledge of results feedback only. Recreational program directors
should consider using KP feedback when teaching motor skills to boys with ADHD.

1. What this paper adds?

This study applied a motor learning factor hypothesized to partially explain motor deficits associated with children with ADHD.
The findings extend motor learning about PKP theory to boys with ADHD, a significant cognitive disability among children in
recreational and physical education settings. Results provide evidence that boys with ADHD can improve their motor performance
product through increased practice trials, similar to children without a diagnosed disability. In addition, it provides evidence that
PKP enhances qualitative performance among this population.

2. Effects of augmented feedback on motor performance of boys with ADHD

Recent increases of childhood sedentary behavior and obesity have resulted in several “calls to action” from public and private
organizations (Hagan, Shaw, & Duncan, 2008; Institutes of Medicine, 2013; National Conference of State Legislatures, 2011; National
Physical Activity Plan Alliance, 2014; USDHHS, 20011) that have identified these trends as significant public health issues (United
States Department of Health and Human Services, 2011; Physical Activity Guidelines Advisory Committee, 2008) in the United
States. A contributing issue is children’s unhealthy body mass tends to track into adulthood (Mamun, Hayatbakhsh, O’Callaghan,

⁎
Corresponding author.
E-mail addresses: jcbishop@auburn.edu (J.C. Bishop), lek@virginia.edu (L.E. Kelly), mfh4jz@virginia.edu (M. Hull).

https://doi.org/10.1016/j.ridd.2017.12.003
Received 14 February 2017; Received in revised form 1 November 2017; Accepted 1 December 2017
Available online 19 January 2018
0891-4222/ Published by Elsevier Ltd.
 Table 1
Motor Skill Studies of Children with ADHD.
Study Purpose
Intergroup Comparison
Beyer (1999) Compared movement skills of boys 112 boys: ADHD = 56, taking Ritalin; LD = 56, no
with ADHD and boys with LD meds: 7–12 years; DSM-IV
Doyle, Wallen, and Examined movement skills and
Whitmont (1995) parental perceptions about their
children’s skills
Wade (1976) Described differences on
stabiolmeter task between children
with and without ADHD and
examined effects of Ritalin when
performing a stabiometer task
Harvey & Reid (1997) Described fundamental movement
skills and fitness conditions
Harvey et al. (2009) Explored physical activity
experiences of children with and
without ADHD
32
Harvey et al. (2007) Compared the fundamental
movement skills of children with
and without ADHD and assessed
the effects of stimulant medication
on the movement skill performance
of children with ADHD
Intragroup Comparison
Piek, Pitcher, and Hay Investigated movement skills and
(1999) kinaesthetic processes of boys with matched on age & verbal IQ; 8.7–11.7 years DSM-IV: 8
and without ADHD
Miyahara, Möbs, and Identified movement and
Doll-Tepper behavioral subtypes of HKS while
(1995) estimating the comorbidity of HKS
with DCD
Kaplan, Wilson, Described comorbidity between
Dewey, and DCD, ADHD, and RD.
Crawford (1998)
Sample
38 children; 33 boys; 7–12; DSM-III-R; stimulant
medication use was variable
24 children; 12 = ND, 12 = hyperactive; 7.7–11.8
years; genders not reported; diagnostic framework not
reported; stimulant medication taken
19 children; 17 boys; 5–12 years; DSM-III-R; 89% of
sample on stimulant medication
24 boys; 12 with ADHD, 12 without ADHD; DSMV-IV;
Stimulant medication not reported
44 children; 22 in ADHD group, 22 comparison peers
matched by gender and age; 20 boys in each group;
Subtype of ADHD group = ADHD-PI (2), ADHD −pH
(2), ADHD − C (18); Comparison group = oppositional
defiant disorder (8), separation anxiety disorder (1), and
depression (1), DSMV-IV-R; 13 in children in ADHD
group were stimulant naïve before the study
48 boys: ADHD-PI (16), ADHD-C (16), ADHD-ND (16),
children form ADHD-C received stimulant medication
12 Children: 21 boys, 4–12 years; German psychiatric
textbook; stimulant medication taken
162 children; age & gender not reported 169 boys, 55
Girls = ADHD +LD:; 105 boys, 50 girls = ND; 8–18
years; DSM-III-R; Medication not reported
Statistical Analysis Findings
J.C. Bishop et al.
MANOVA; ANOVA Significant multivatriate age (p < 0.001) and condition (p < 0.001)
main effects were found on the VOTMP-LP. ANOVAs revealed boys with
ADHD performed bilateral coordination (p < ,001), strength
(p < 0.001), visual motor coordination (p < 0.001), and upper limb
speed and dexterity (p < 0.001) significantly worse than their peers
with LD.
Multiple independent t 82% of children with ADHD performed gross motor skills above the
tests norms of the VOTMP-SF. Parents underrated the movement skill
performance of their children using a 5-point Likert scale.
Descriptive statistics Non-diagnosed children spent, on average, more time on the static
balancing task and performed more consistently than children with
ADHD
Descriptive statistics, Children with ADHD performed locomotor skills (22.3 percentile) and
graphs object control skills (33.4 percentile) below the 35th percentile when
compared to the age-matched norms of the TGMD.
Descriptive statistics; Children without ADHD scored significantly higher in locomotor and
Interviews object control skills. Boys with ADHD reported playing with friends, paid
little attention to details, possessed superficial knowledge about
movement skills, and expressed negative feelings about physical activity.
Split-plot ANVOA; Children without ADHD were significantly more skilled than children
Repeated measures with ADHD (p < 0.001). No medication interaction effects on the
MANOVA movement skill patterns of children with ADHD.
MANOVA; ANOVA Boys with ADHD performed significantly poorer (p < 0.002) on the
MABC than boys without disabilities. In comparison with the other
groups, boys with ADHD-PI demonstrated significantly worse manual
dexterity skills (p < 0.01) while boys with ADHD-C demonstrated
significantly worse balance skills (p < 0.01).
Cluster analysis; ANOVA Significant univariate results were found between the free-from-severe
motor impairment and manual incoordination motor clusters on manual
dexterity (p < 0.01) and balance (p < 0.01) subtests of the MABC. 52%
of the sample, 12 out of 23 participants, fell in the manual
incoordination subtype and were thus considered as having DCD.
Descriptive statistics; Assessment instruments were the VOTMP, MABC, and an initial version
Pearson correlation of the DCDQ. Of the 162 participants with comorbidity, 47 children and
coefficients; x2; ANOVA no disabilities. There were pure cases of ADHD (N = 8), DCD (N = 26),
and RD (N = 19). Comorbidity was identified for ADHD/RD (N = 7),
ADHD/DCD (N = 10), DCD/RD (N = 22), and ADHD/DCD/RD
(N = 23).
(continued on next page)
Research in Developmental Disabilities 74 (2018) 31–40
 Table 1 (continued)

Study Purpose Sample Statistical Analysis Findings

Miyahara et al. Examined the severity of HKS 47 children: 38 boys, 9 girls: Mage = 8.4 years; German ANOVA Children with HKS, attending a school, were rated with significantly
J.C. Bishop et al.

behaviors and comorbidity
between HKS and DCD from school, reported
support group, and hospital sample
sources
Verret et al. (2010) Assessed fitness and gross motor
performance of children with
ADHD and effects of
methylphenidate medication
Intervention Effectiveness
Hodge, Murata, and Examined the effects of warm-up
Porretta (1999) activities on fundamental
movement skill performance of
children with LD +ADHD
Wade (1996) Described differences on
stabiometer task between children
with and without ADHD and
psychiatric textbook; stimulant medications were not
70 boys: ND (27), ADHD-PI (4), ADHD-C (39); DSM-IV- MANOVA; univariate
TR; 24 were receiving methylphenidate
46 children: 36 boys; 9–11 years; diagnostic framework Two-way factorial
not reported; medications were not reported
24 children: ND (12), ADHD −pH A (12);
7.7–11.8 years; genders not reported; diagnostic
framework not reported; stimulant medication taken
greater conduct problems (p < 0.02) than their hospitalized peers with
HKS and greater hyperactive behaviors (p,.01)when compared to other
peers with HKS from a support group. No significant difference were
found between groups on the MANC. Substantial amounts of overlap
between HKS and DCD were found at the school (35%), support group
(54%), and hospital (55%).
No statistical differences between the 3 groups on body composition,
ANOVA’s; Paired samples flexibility, muscular endurance, and aerobic capacity measured via a
t-tests treadmill test. Each group performed lower than average on a field
shuttle run. BMI was lower in the methylphenidate group. Both ADHD
groups scored significantly lower in locomotion skills. No
methylphenidate interaction was observed.
Children with AHD (visual imagery warm-up condition) demonstrated
ANOVAs (group skill x significantly better throwing accuracy (p < 0.001) than their peers who
gender) participated in task-specific warm-up or no warm-up conditions. No
performance differences were found between groups on a timed 40 yd-
dash and a ball catching task. No main effects for gender or interactions
effects were observed.
ANOVA The static balance of children with ADHD on the stabiometer improved
significantly (p < 0.01) when methylphenidate was used.

33
examined the effects of Ritalin on
children with ADHD performing a
stabiometer task
Pelham et al. (1990) Examined the effects of 17 boys; 7.8–9.9 years; DSM-III-R; stimulant medication MANOVA The attention of boys with ADHD, when medicated with
methylphenidate on attention and taken methylphenidate, improved significantly during baseball games
baseball skills of boys with ADHD (p < 0.001). However, baseball skills did not improve.

Note: ADHD = attention-deficit/hyperactivity disorder, ADHD-PI = attention-deficit/hyperactivity disorder-predominately inattentive subtype, ADHD-C = attention-deficit/hyperactivity disorder-combined subtype,
DCD = developmental coordination disorder, DCDQ ‘ Developmental Coordination Disorder Questionnaire (Wilson, Kaplan, Crawford, Campbell, & Dewey, 2000), HKS = Hyperkinetic disorder, RD = reading disability,
LD = learning disability, ND = no disability, MABC = Movement Assessment Battery for Children (Henderson & Sugden, 1992), BOTMP = Bruininks-Oseretsky Test of Motor Proficiency (Bruininks, 1978), TGMD = Test of Gross
Motor Development (Ulrich, 1985).
Research in Developmental Disabilities 74 (2018) 31–40
J.C. Bishop et al. Research in Developmental Disabilities 74 (2018) 31–40

Williams, & Najman, 2009). Thus, it is believed that early childhood interventions are needed to effectively address obesity. Proper
nutrition and adequate amounts of physical activity are protective factors against sedentary behaviors and childhood obesity
(PAGAC, 2008). One determinate of physical activity participation is children’s ability to perform fundamental motor skills (FMS)
such as running, throwing, and kicking a ball (Weiss & Williams, 2004). For example, Lloyd, Saunders, Bremer, & Tremblay (2014)
found a positive relationship between children’s FMS proficiency in youth and their engagement in physical activity participation 20
years later. Other studies indicated positive associations between FMS proficiency and health-related fitness (Fisher et al., 2005) and
physical activity outside of regular school hours (PAGAC, 2008).
These findings are particularly pertinent to public health professionals who work with children with attention-deficit/hyper-
activity disorder (ADHD) as this population not only comprises up to 15% of school age children in some parts of the United States
(Visser et al., 2014) but also experience significant delays in FMS development (Beyer, 1999); Harvey & Reid, 1997, 2003; Harvey
et al., 2009, 2007; Verret, Gardiner, & Belivveaur, 2010 (see Table 1). Excessive activity, inattention, or both continue to be the
hallmark behaviors of children with ADHD (American Psychological Association, 2013) often requiring medication to increase daily
function (e.g., maintaining sustained focus to complete a task). Due to the high use of medication use to address ADHD symptoms,
Harvey et al. (2007) tested the effects of stimulant medication on FMS performance among children with ADHD. Using the Test of
Gross Motor Development − 2 (TGMD-2) (Ulrich, 2000), no significant differences were observed between children with ADHD
taking vs. not taking stimulant medication (i.e., methylphenidate (Ritalin)). Using a motor-control theoretical frame, Yan and Thomas
(2012) investigated arm-movement differences requiring speed and accuracy between children with ADHD and a control group not
diagnosed with ADHD. As the task increased in complexity, the control group performed the movements more quickly and accurately
than the children with ADHD. The two groups used different motor control mechanisms to inform their arm movements. Children
without ADHD used more cognitive processes or motor-programming control while children with ADHD utilized visual feedback and
relied less upon motor-programming control to make corrections during the execution of the movement. The authors hypothesized
that the variance in the use of cognitive resources (e.g., attention span, concentration, and motor planning; fewer for the ADHD
group) was responsible for the group differences. The underutilization of cognitive resources to solve a problem in a decisive moment
is consistent with symptomology typical of children with ADHD (Barkley, 2006).
In their analysis of ADHD research challenges, Harvey and Reid (2005) recommended exploring and identifying key independent
variables responsible for the poor movement behavior of children with ADHD. Augmented skill-specific feedback may be an influ-
ential factor to help children with ADHD increase motor skill learning. A study testing the effects of augmented skill-specific feedback
on motor performance of children with ADHD was not found in the literature; and may be a factor influencing motor skill devel-
opment of children with ADHD. Augmented feedback is performance outcome information or motor performance information and is
segmented into either knowledge of results (KR) feedback or knowledge of performance (KP) feedback. The natural environment
often provides KR. For example, a golfer’s putt on the putting green falls short of reaching the hole. The distance traveled, curvature
of the ball path, speed of the ball, changes in velocity, and distance of the ball from the pin are examples of KR. On contrast, KP is
provided by an external source, usually by an instructor, auditory, or video display. Knowledge of performance informs the performer
of the qualitative movement patterns produced during the execution of a motor performance. Using the same scenario as the KR
example, the golfer’s playing group is often in great position to provide auditory KP to the performer. For example, during the
backstroke phase of the golf putt, the performer may have failed to bring the club back far enough to strike the ball with the optimal
force on the downswing for the ball to drop in the hole. Mentioning this performance-related segment (i.e., failure to bring the club
head far enough) of the qualitative performance to the golfing performer is an example of KP.
Knowledge of performance often enhances learning when the performer is completing a complex skill requiring an optimum
multilimb pattern of coordination (Magill, 2011). For example, Kernodle and Carlton (1992) tested performance effect differences
between KR and KP among participants throwing a softball throw. A softball throw is a discrete and closed multilimb motor skill,
usually mastered by 5th grade (SHAPE America, 2013). Participants receiving KP feedback of their quality of completing the critical
elements of the overhand throw displayed better throwing technique and threw farther than those who only received KR. In a
volleyball setting, players receiving KP about their striking error while hitting a volleyed ball performed better than players receiving
KR about the ball’s rotation, flight, and spatial precision (Zubiaur, Ona, & Delgado, 1999). Hinder, Riek, Tresilian, de Rugy, & Carson
(2010), suggest that when performers learn with KP as opposed to KR, they are able to constantly cognitively map the visual
information with the added motor information and then transform visual information into motor commands. Those receiving only KR
are not able to map the visual information and then performers must learn an explicitly cognitive strategy to compensate for error and
error correction of their performances.
Two types of KP that an instructor can provide include descriptive KP and prescriptive KP (PKP). Descriptive KP describes the
error the performer made. A PKP statement identifies the error of the critical element, but also provides a corrective statement.
Descriptive KP is more helpful in guiding advanced performers, while PKP is more helpful when guiding beginners (Magill, 2011).
The purpose of this study therefore, was to test the effects of a PKP feedback intervention to enhance the motor performance of a
discrete and closed multilimb skill among boys with ADHD. It was hypothesized that a treatment group composed of children with
ADHD receiving prescriptive KP feedback would increase motor skill learning compared to a control group of boyos with ADHD who
did not receive KP feedback.

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Table 2
Participant Height, Weight, BMI, and BMI Percentile.

Participants Age (SD) Height (SD) Weight (SD) BMI (SD) BMI Percentile

Control Group (16) 9.48 (1.2) 143.43 (13.51) 33.34 (3.86) 16.2 (3.28) 46.7
Treatment Group (15) 9.93 (.92) 140.41 (13.74) 34.85 (4.40) 17.7 (3.42) 69.2
Total 9.74 (1.03) 141.86 (13.69) 34.12 (4.15) 17.0 (3.38) 59.0

Note: aCentemeters, bKilograms.

3. Method

3.1. Participants

Thirty-one male children, ages 8–11, diagnosed with ADHD by a family physician using DSM-V criteria (APA, 2013), were
purposely recruited for the intervention. Sixty-four percent of the sample identified as White/Caucasian, 19% as Latino/Mexican,
10% as African American/Black, and 6% Asian. Each participant was enrolled in a private school for children with learning dis-
abilities or emotional regulation impairment. The school was located in the Southwest United States. Table 2 provides participant
demographics. Each participant was prescribed stimulant medication by their family physician to alleviate ADHD symptoms. A
record of medication compliance indicated that participants received their medication on each testing day. Participants were ran-
domly assigned into either a treatment (n = 16) or a control (n = 15) group. Randomization was conducted by flipping a coin
(Suresh, 2011) just prior to initially meeting the participant. Participants were assigned into the treatment group if the coin landed on
heads.
Approval to conduct the investigation was obtained from a University Institutional Review Board. Permission to conduct the study
was attained from the private school Board of Directors that provided a list of students who met the research criteria: males between
the ages of 8 and 11 and diagnosed ADHD within 6-months by a family physician. Notification letters informing parents of the study
and withdrawal procedures were sent home to 35 potential participants. In addition, the headmaster e-mailed the notification letter
to potential participant parents. Parents and children were given 3 days to opt-out of the study before data collection began. Four
parents withdrew their child from the study prior to the start of the intervention. No participant withdrew from the study after the
study began.

3.2. Study design and intervention

The study was conducted over 5-weeks. Data were collected three times per week (i.e., Monday, Thursday, and Friday) resulting
in 15 total sessions. Make-up sessions were provided on Wednesdays for two participants who each missed a previous session. Each
session was completed in the presence of the first author and each participant was tested at the same time of the day in each session.
Sessions lasted approximately 10 min and occurred during the participant’s physical education or another academic class. The in-
tervention was conducted at the cornhole station located adjacent to the school’s gymnasium in the outside environment between the
gymnasium and recreation areas (park, basketball court, football field). The station included a wooden cornhole board, 10 6-oz bean
bags, a chair to place the bean-bags onto for easy participant access, and a tripod-mounted video recording camera. The cornhole
board was a 2′ x 4′, 30° inclined board with a 6” diameter cut-out bull’s eye. Circumventing the bull’s eye was a 4” diameter blue ring.
Adjacent to the blue ring was a second 4” diameter white ring. The remainder of the board was unpainted. The first author ac-
companied each participant to the cornhole station.
Once at the station, participants were reminded that they were going to play a series of cornhole games. The first author explained
the rules of the game which included the participant standing 12′ from the cornhole board. Points were scored by performing an
underhand toss – other methods of getting the beanbag to the cornhole board were not permitted. Each participant performed 10
tosses per game with a maximum score of 100 points per game. 10 points were earned if the beanbag landed in the cornhole; 5 points
if the beanbag landed in the 1st ring; 3 points if the bag landed in the 2nd ring; and 1 point was earned if the bag landed on the board,
but not on a ring. No points were given if the beanbag fell off the board. Points were allotted to the higher ring if the beanbag landed
between rings. After it was clear that the participant understood the rules, the first author explained the critical components of the
underhand toss then provided a skill demonstration. Each group performed 30 warm-up tosses prior to completing the 1st session, 15
warm-up tosses for the 2nd session, and warm-up session for the remaining sessions. Game 1 was played next followed by Game 2.
The treatment group protocol was identical except that immediately prior to Game 2, treatment group participants received one
prescriptive augmented skill specific feedback (PKP) statement from the investigator on how to improve their underhand toss per-
formance.
Protocol of PKP feedback was modeled after Kelly and Melograno’s (2004) approach. The Everyone Can! Underhand Throw
Assessment Item (Kelly, Wessel, Dummer, & Sampson, 2010). (see Table 3) was used to evaluate the underhand toss performances.
This instrument presents seven critical elements of the underhand toss. The first author qualitatively assessed each toss of Game 1 (10

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J.C. Bishop et al. Research in Developmental Disabilities 74 (2018) 31–40

Table 3
Critical Elements of the Underhand Toss.

1. Stand with body square to target, weight evenly distributed on both feet, feet shoulder-width apart, eyes on target, ball held in palm of dominant hand at
waist level in front of body
2. Arm swings back, elbow extended, until dominant hand is behind the thigh, with trunk rotation back.
3. Arm swings forward below the shoulder until dominant hand is in front of the thigh, with trunk rotation forward.
4. Weight shift to the foot on the arm swing side of the body during the arm swing back, and stride forward with weight shift to the foot on the opposite side of the
body during the arm swing forward.
5. Ball release in direction of target, knees and hips slightly flexed, trunk near vertical, pam facing upward.
6. Arm follows through well beyond ball release toward the target.
7. Smooth integration (not mechanical or jerky) of the previous critical elements

Adapted from the EVERYONE CAN! Assessment Item: UNDERHAND THROW found in Kelly et al., 2010.

underhand tosses) and identified which critical element the participant completed incorrectly in ascending order, starting with
critical element 1 (Stand with body square to target) and ending with critical element 7 (Smooth integration). After completion of
Game 1 the first author provided a positive statement of performance, followed by a DKP statement, then a reiteration of the previous
positive statement. For example, if a participant completed the first critical element (i.e., stand with body square to target) but then
did not complete the second critical element (i.e., arm swings back), the participant was judged to have correctly completed the first
critical element but not the second. A positive statement of the correct performance of the first critical element was delivered, such as
“good job of keeping your eyes on the target.” Next, a PKP statement was provided “but, bring your tossing hand further back so you
will have better control of the toss.” Finally, a second positive performance statement was presented, such as “nice job of facing the
target.” If the treatment group participant completed the 1st and 2nd critical elements but incorrectly performed the 3rd, a PKP
statement about the 3rd critical element was given in a similar approach (e.g., positive statement, PKP statement, positive statement).
This method of identifying which critical element, starting with the 1st and ending with the 7th, was used to deliver PKP feedback. If
each critical element of the underhand toss was completed successfully, a positive generic feedback statement was given.

3.3. Measures

Dependent measures included participants’ cornhole scores (range = 0–100) and quality of performance (range = 0–7). A video
camera mounted on a tri-pod was used to record participants’ quality of performance scores. Using the Underhand Throw Assessment
Item, participants could correctly demonstrate 0–7 critical elements of the underhand toss. Quality of performance of the last two
tosses of Game 2 were averaged and then recorded for each session for 15 quality of performance measures. To increase validity of the
rated performances, a doctoral student with a physical education background provided a validity rating of the video clips. Interrater
reliability was assessed for the quality of performance on the last two tosses of Game 2. Twenty-five percent of tests were analyzed for
internal reliability. A checking system was developed to maintain a 0.80 rater agreement or higher to control for potential errors
related to investigator drift (Haynes, 2001). The second rater was unaware of the experimental design, testing order, group as-
signment (experimental vs. control), or the children’s ADHD diagnosis.

3.4. Data analysis

Data were organized by group (control and treatment) and trial (15 sessions) and consisted of repeated measures of cornhole
scores and quality of performance. Group membership was the independent variable in each analysis. Two two-factor split-plot
analysis of variances (ANOVA) were conducted to test for interaction effects and between- and within-group differences of the
dependent measures. The separate ANOVA’s were deemed more appropriate than a multivariate analysis of variance (MANOVA) as
the dependent variables were highly correlated and violated MANOVA assumptions (Stevens, 2009). Data were reported in means
and standard deviations. Statistical significance for each test was set at p < 0.05, and omega-squared (ω2) was used to determine
effect size (Fig. 1).

4. Results

4.1. Actual scores

Interaction effects were not significant (see Table 4 and Fig. 2) but between-groups effects were significant, F(1.29) = 6.98,
p .01 < 0.01, ω2 = 0.04. The means of the control group (M = 35.16, SD = 1.75) were lower than the means of the treatment group
(M = 41.6, SD = 1.70) with a mean difference of 6.44. Effect size, was medium (Fan and Konold, 2010) and indicated that 4% of the
observed variance can be attributed to group membership. Tests of within-subjects effects of actual scores of Game 2 were significant
F(1.29) = 3.83, p = < 0.001, ω2 = 0.06. The control group means increased from to 29.33 (SD = 13.47) to 41.20 (SD = 12.03) and
treatment group means increased from 32.25 (SD = 14.35) to 50.06 (SD = 6.55). Effect size was medium.

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J.C. Bishop et al. Research in Developmental Disabilities 74 (2018) 31–40

Table 4
Means and Standard Deviations for Scores of Game 2.

Session Control Group Scores (SD) Treatment Group Scores (SD) Session Total

1 29.33 (13.47) 32.25 (14.35) 30.84 (13.77)

2 35.80 (13.13) 42.63 (15.99) 39.32 (14.85)
3 34.33 (16.60) 41.56 (15.24) 38.06 (16.07)
4 38.13 (12.74) 37.50 (14.54) 37.81 (13.47)
5 34.20 (8.30) 38.37 (13.79) 36.35 (11.48)
6 34.13 (15.11) 39.19 (12.78) 36.74 (13.96)
7 33.27 (14.30) 41.75 (13.91) 37.65 (14.51)
8 31.27 (10.97) 33.81 (16.97) 32.59 (14.20)
9 33.33 (13.88) 40.81 (15.49) 37.19 (14.97)
10 29.93 (13.47) 43.06 (15.04)* 36.71 (15.57)
11 35.60 (12.61) 40.69 (14.93) 38.23 (38.23)
12 45.87 (13.39) 48.44 (13.22) 47.19 (13.14)
13 39.13 (11.88) 46.75 (16.57) 43.06 (14.77)
14 31.80 (9.13) 47.12 (10.98)* 39.71 (12.64)
15 41.20 (12.03) 50.06 (6.55)* 45.77 (10.45)
Total 35.16 (1.75) 41.60a,b (1.70)

Note: *p < 0.05, ap < .05 within-subjects effects, bp < .05 between group main effects.

48

43

38

33

28

Fig. 1. Group (Control and Treatment) x Session Means of Actual Scores of Game 2.

4.2. Quality of performance

Interaction effects were significant, F (1.29) = 1.88. p = 0.03, ω2 = 0.02. Visual inspection of Table 5 and Fig. 2 reveals that
group differences in quality of performance were dependent upon receiving the PKP feedback.

Table 5
Means and Standard Deviations for Quality of Performance of Game 2.

Session Control Group Scores (SD) Treatment Group Scores(SD) Session Total

1 2.27 (1.58) 3.19 (1.87) 2.74 (1.77)

2 1.93 (1.44) 3.81 (1.78)** 2.90 (1.87)
3 2.33 (1.34) 4.31 (1.58)** 3.35 (1.76)
4 2.20 (1.27) 4.31 (1.15)*** 3.35 (1.54)
5 2.20 (1.57) 4.13 (2.03)** 3.19 (1.98)
6 2.33 (1.88) 3.94 (1.95)* 3.16 (2.05)
7 2.47 (1.60) 4.44 (1.26)** 3.48 (1.73)
8 2.67 (1.68) 4.69 (1.70)** 3.71 (1.95)
9 3.07 (1.75) 4.94 (1.69)** 4.03 (1.94)
10 3.07 (1.71) 4.94 (1.61)** 4.03 (1.89)
11 2.73 (1.79) 4.81 (1.80)** 3.81 (2.06)
12 2.80 (1.66) 5.25 (1.73)*** 4.06 (2.08)
13 3.00 (1.81) 5.50 (1.41)*** 4.29 (2.04)
14 2.60 (1.40) 5.88 (1.71)*** 4.29 (2.27)
15 2.93 (1.75) 5.56 (1.50)*** 4.29 (2.09)
Total 2.57 (1.71) 4.62 (1.82)a,b,c

Note: *p < .05, **p < .01, ***p < .001 ap < 0.05 within-subjects effects, bp < .05 between group main effects, cp < .05 interaction effects.

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4
Control

3 Treatment

Fig. 2. Means of Quality of Performance of Game 2 by Group (Control vs. Treatment).

5. Discussion

The purpose was to evaluate the motor performance effects of PKP feedback among a sample of boys with ADHD completing a
motor skill. Both groups improved in actual cornhole scores and the treatment group significantly improved their qualitative of
performance of the underhand toss compared to the control group. It was hypothesized that the treatment group scores in Game 2
would improve more than the control group as a result of the PKP feedback provided after Game 1. The findings indicated that both
groups improved in actual scores across the 15 sessions and this improvement was not dependent upon PKP feedback. Both groups
experienced tremendous variability in mean day-to-day performances. Several possible explanations account for the lack of sig-
nificant improvement in the treatment group. First, the treatment group’s baseline scores non-significantly higher than the control
group. An interaction effect may have been present if the two group’s baseline scores were more similar. Next, the underhand toss is a
simple motor task. It is a discrete and closed multilimb motor skill normally expected to be mastered by the 5th grade (SHAPE, 2013).
It is conceivable that the task itself may not have evoked high internal motivation due to its simplicity. However, a case may also be
made that no participant scored exceptionally well, and that an opportunity for improvement throughout the intervention may have
provided adequate challenge. Most participants from both groups appeared to engage in the task and looked forward to participating
in each session. Next, a non-significant group difference was observed in actual scores in 14 of the 15 sessions with larger differences
observed over the last 5 sessions. The control group averaged 37.26 and the treatment group averaged 46 points among these. The
increase of actual scores among both groups, indicates that children with ADHD can improve their FMS competence through practice
alone (Silverman, Woods, & Subrahaniam, 1998).
These results reinforce the importance of maximizing practice attempts among children with ADHD when learning motor skills.
As a result of these findings it is recommended for recreational services directors and coordinators as well as physical and adapted
physical educators to maximize the availability of practice attempts in their physical activity programs especially during activities
involving motor skills. Future research investigating the effects of specific versus specific plus variable practice scenarios of this
population is warranted to explore the unique practice effects on motor learning traits of boys with ADHD.
Significant interaction effects on quality of performance indicated the treatment group improved above and beyond that of the
control group. These findings support the effects of the PKP feedback provided before Game 2 of each session. The effects of PKP
feedback are well documented among children without disabilities to enhance motor learning of skills beyond what could be
achieved without it (Magill, 2011; Silverman et al., 1998). The results partially support the results of Kernodle and Carlton (1992).
Participants in their study increased the quality of performance and distance thrown when completing the overhand throw. While the
treatment group participants in the present study increased their quality of performance, their actual scores while playing cornhole
was not significantly better than control participants. A possible explanation for the different results is that participants were par-
ticipating in a recreational activity not associated with a competitive individual or team sport while Kernodle, and Carlton’s (1992)
participants were on a competitive baseball team. This study’s findings are significant in that they provide initial evidence that best
instructional practices, when teaching boys with ADHD, should include PKP feedback. The results demonstrates the importance of
practice and appropriate, real-time PKP feedback provided by a skilled educator or coach.
The study is not without limitations, which limits its generalizability. First, a true control group without ADHD was not included
in the study, therefore we do not know if the findings are novel to only boys with ADHD. The sample size is small and convenience-
sampling methods were used. Participant ADHD sub-type (i.e., inattentive, hyperactive, combined type) was not available. The
intervention was not administered in a natural environment such as a physical education class or community recreational program.
As often the case in adapted physical activity research, the first author and initial evaluator of the quality of performance trials was
not blinded to the participants (Hutzler, 2011). It was of interest to note that the treatment group’s actual scores at baseline (Session
1) were non-significantly higher than those of the control group. As random assignment of participants was employed, this difference
is speculated to be attributed to chance (e.g., sampling distribution, sampling error) and not measurement error or uncontrolled
variability in the administration of the treatment. Future research recommendations include investigating the effects of specific
versus specific plus variable practice settings of a similar closed and discrete multilimb motor skill. Research investigating the
learning effects of KR, descriptive KP, and PKP are also warranted. Motor learning differences between ADHD subtypes are also
largely unexplored.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Barkley, R. A. (2006). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed.). New York, NY: Guilford Press.
Beyer, R. (1999). Motor proficiency of boys with attention deficit hyperactivity disorder and boys with learning disabilities. Adapted Physical Activity Quarterly, 16(4),
403–414.
Bruininks, R. H. (1978). The Bruininks-Oseretsky test of motor proficiency. Circle Pines, MN: American Guidance Service.
Doyle, S., Wallen, M., & Whitmont, S. (1995). Motor skills in Australian children with attention deficit hyperactivity disorder. Occupational Therapy International, 2,
229–240.
Fan, X., & Konold, T. R. (2010). Statistical significance versus effect size. In P. Penelope Peterson, E. Backer, & B. McGaw (Vol. Eds.), International encyclopedia of
education: 7, (pp. 444–450). Oxford: Elsevier.
Fisher, A., Reilly, J. J., Kelly, L. A., Montgomery, C., Williamson, A., Paton, J. Y., et al. (2005). Fundamental movement skills and habitual physical activity in young
children. Medicine & Science in Sports & Exercise, 37(4), 684–688 [ISSN 0195-9131].
Bright futures. In J. F. Hagan, J. S. Saw, & P. M. Duncan (Eds.). Guidelines for health supervision of infants, children, and adolescents(3rd ed.). Elk Grove Village, IL:
American Academy of Pediatrics.
Harvey, W. J., & Reid, G. (1997). Motor performance of children with attention-deficit hyperactivity disorder: A preliminary investigation. Adapted Physical Activity
Quarterly, 14(3), 189–202.
Harvey, W. J., & Reid, G. (2003). Attention-deficit/hyperactivity disorder: A review of research on movement skill performance and physical fitness. Adapted Physical
Activity Quarterly, 20(1), 189–202.
Harvey, J. W., & Reid, G. (2005). Attention-deficit/hyperactivity disorder: APA research challenges. Adapted Physical Activity Quarterly, 22(1), 1–20.
Harvey, W. J., Reid, G., Grizenko, N., Mbekou, V., Ter-Stepanian, M., & Joober, R. (2007). Fundamental movement skills and children with ADHD: Peer comparisons
and stimulant effects. Journal of Abnormal Child Psychology, 35(5), 871–882. http://dx.doi.org/10.1007/s10802-007-9140-5.
Harvey, W. J., Reid, G., Bloom, G. A., Staples, K., Grizenko, N., Mbekou Ter-Stepanian, M., et al. (2009). Physical activity experiences of boys with and without ADHD.
Adapted Physical Activity Quarterly, 26(2), 131–150.
Haynes, S. N. (2001). Clinical applications of analogue behavioral observation: Dimensions of psychometric evaluation. Psychological Assessments, 13(1), 73–85. http://
dx.doi.org/10.1037//1040-3590.13.1.73.
Henderson, S. E., & Sugden, D. A. (1992). Movement assessment battery for children. London: Psychological Corporation.
Hinder, M. R., Riek, S., Tresilian, J. R., de Rugy, A., & Carson, R. G. (2010). Real-time error detection but not error correction drives autmoatci viuamotor adaptation.
Experimental Brain Research, 201, 191–207. http://dx.doi.org/10.1007/s00221-009-2025-9.
Hodge, S. R., Murata, N. M., & Porretta, D. L. (1999). Enhancing motor performance through various preparatory activities involving children with learning dis-
abilities. Clinical Kinesiology, 53(4), 76–82.
Hutzler, Y. S. (2011). Evidence-based practice and research: A challenge to the development of adapted physical activity. Adapted Physical Activity Quarterly, 28(2),
189–208.
Institutes of Medicine (2013). Educating the student body. Taking physical activity and physical education to school. Washington, DC: The National Academies Press.
Kaplan, B. J., Wilson, B. N., Dewey, D., & Crawford, S. G. (1998). DCD may not be a discrete disorder. Human Movement Science, 17, 471–490 (MS).
Kelly, L. E., & Melograno, V. J. (2004). Developing the physical education curriculum. Champaign, IL: Human Kinetics Publishers.
Kelly, L. E., Wessel, J. A., Dummer, G. M., & Sampson, T. (2010). Everyone can. Skill development and assessment in elementary physical education. Champaign, IL: Human
Kinetics Publishers.
Kernodle, M. W., & Carlton, L. G. (1992). Information feedback and the learning of multiple-degree-of-freedom activities. Journal of Motor Behavior, 24(2), 187–195.
Lloyd, M., Saunders, T. J., Bremer, E., & Tremblay, M. S. (2014). Long-term importance of fundamental motor skills: A 20-year follow up study. Adapted Physical
Activity Quarterly, 31(1), 67–78 [https://doi.org/10.1123/apaq.2013-0048].
Magill, R. A. (2011). Motor learning and control: concepts and applications. New York: NY: McGraw-Hill Publishers.
Mamun, A. A., Hayatbakhsh, M. R., O’Callaghan, M., Williams, G., & Najman, J. (2009). Early overweight and pubertal maturation −pathways of association with
young adults’ overweight: a longitudinal study. International Journal of Obesity, 33, 14–20. http://dx.doi.org/10.1038/ijo.2008.220.
Miyahara, M., Möbs, I., & Doll-Tepper, G. (1995). Subtypes of clinically identified children with hyperkinetic syndrome based upon perceptual motor function and
classroom behaviors. In I. Morisbak, & P. E. Jorgensen (Eds.). 10th International Symposium on Adapted Physical Activity: Quality of life through adapted physical
activity, A lifespan concept (pp. 278–286).
National Conference of State Legislatures (2011). Reversing the trend in childhood obesity: Policies to promote healthy kids and communities. Washington, DC: Government
Printing Office.
National Physical Activity Plan Alliance (2014). United States report card on physical activity for children and youthColumbia, SC: National Physical Activity Plan Alliance.
Pelham, W. E., McBurnett, K., Harper, G. W., Milich, R., Murphy, D. A., Clinton, J., & Thiele, C. (1990). Methylphenidate and baseball playing in ADHD children: Who’s
on first? Journal of Consulting and Clinical Psychology, 58, 130–133.
Physical Activity Guidelines Advisory Committee (2008). Physical activity guidelines advisory committee report, 2008Washington, D.C: U.S. Department of Health and
Human Services.
Piek, J. P., Pitcher, T. M., & Hay, D. A. (1999). Motor coordination and kinaesthesis in boys with attention deficit-hyperactivity disorder. Developmental Medicine and
Child Neurology, 41, 159–165.
SHAPE America (2013). Grade-level outcomes for K-12 physical education. Reston, VA: SHAPE America [Author].
Silverman, S., Woods, A. M., & Subramaniam, P. R. (1998). Task structures, feedback to individual students, and student skill level in physical education. Research
Quarterly for Exercise and Sport, 69(4), 420–424. http://dx.doi.org/10.1080/02701367.1998.10607718.
Stevens, J. P. (2009). Applied multivariate statistics for the social sciences. New York, NY: Routledge.
Suresh, K. P. (2011). An overview of randomization techniques: An unbiased assessment of outcome in clinical research. Journal of Human Reproductive Sciences, 4(1),
8–11. http://dx.doi.org/10.4103/0974-1208.82352.
Ulrich, D. A. (1985). Test of gross motor development. Austin, TX: Pro-ed Publishers.
Ulrich, D. A. (2000). TGMD 2–Test of gross motor development examiner’s manual (2nd ed.). Austin, TX: PRO-ED.
U.S. Department of Health and Human Services (2011). The Surgeon General's call to action to support breastfeeding.
Verret, C., Gardiner, P., & Beliveau, L. (2010). Fitness level and gross motor performance of children with attention-deficit hyperactivity disorder. Adapted Physical
Activity Quarterly, 27, 337–351.
Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., et al. (2014). Trends in the parent-report of health care provider diagnosed
and medicated ADHD: United States, 2003–2011. Journal of American Academy of Child & Adolescent Psychiatry, 53(1), 34–46. http://dx.doi.org/10.1016/j.jaac.
2013.09.001.
Wade, M. G. (1976). Effects of methylphenidate on motor skill acquisition of hyperactive children. Journal of Learning Disabilities, 9, 443–447.
Weiss, M. R., & Williams, L. (2004). The why of youth sport involvement: A developmental perspective on motivational processes: A lifespan perspective. Developmental sport
and exercise psychology: A lifespan perspective. Fitness Information Technology.

39
J.C. Bishop et al. Research in Developmental Disabilities 74 (2018) 31–40

Wilson, B. N., Kaplan, B. J., Crawford, S. G., Campbell, A., & Dewey, D. (2000). Reliability and validity of a parent questionnaire. American Journal of Occupational
Therapy, 54, 484–493.
Yan, J. H., & Thomas, J. R. (2012). Arm movement control: Differences between children with and without attention deficit hyperactivity disorder. Research Quarterly
for Exercise and Sport, 73(1), 10–18. http://dx.doi.org/10.1080/02701367.2002.10608987.
Zubiaur, M., Ona, A., & Delgado, J. (1999). Learning volleyball serves: A preliminary study of the effects of knowledge of performance and of results. Perceptual and
Motor Skills, 89(1), 223.

40