ADAPTED PHYSICAL ACTIVITY QUARTERLY, 1994,11,203-213

O 1994 Human Kinetics PuMishers, Inc.

Tapping a Rhythm: A Probtem of Timing

for Children Who Are Clumsy and Dyslexic?

Reint H. Geuze and Alex F. Kalverboer

University of Groningen

This study is concerned with deficits in the ability to maintain an imposed rhythm
in a tapping task and the possible sources of these deficits. Three groups of children
between the ages of 7 and 12 with IQs above 75 participated: a group of children
who were clumsy, a group who were dyslexic, and a control group whose reading
and coordination were considered age appropriate. The children performed a series
of "continuation" tapping tasks in which hand, speed, and rhythm of tapping were
manipulated. The performance measure taken was the variability of tapping after
the pacing signal had ceased. When the three groups were compared, the children
who were clumsy showed a slightly increased variability across all tasks but no sign
of lateralized performance differences. In contrast, the children who were dyslexic
showed increased variability in only one task, involving the right hand. The results
are discussed in relation to three different models of brain dysfunction.
One of the defining features of good motor coordination is good timing. Precise
timing as is required, for example, in musical performance implies both a small constant
error and limited variability. During development, all aspects of timing ability improve
and children become better at catching moving objects, tapping out rhythms, skipping
to music, playing computer games involving coincident timing tasks, and so forth.
Perhaps not surprisingly, therefore, many have suggested that deficits in the mechanisms
that control the timing of action may be responsible for some of the difficulties experi-
enced by children with developmental coordination disorders (DCD) (e.g., Geuze &
Kalverboer, 1987; Henderson, Rose, & Henderson, 1992; Missiuna, this volume).
In the present study, the focus of concern is on one particular type of timing
difficulty, the inability to maintain consistency when tapping a predefined rhythm, a
problem that we have already studied to a limited extent (Geuze, 1990; Geuze &
Kalverboer, 1987). In order to learn more about this problem and its origins, we now
examine performance on a broader range of tasks involving both unimanual and bimanual
control. In addition, we compare children with DCD, not only with age-matched controls
but also with children with dyslexia who are known to have difficulties with the same
kinds of task.
Previous research has clearly shown that in a simple unimanual tapping task,
children who are clumsy are more variable than well-coordinated children of the same

Reint H. Geuze and Alex F. Kalverboer are with the Laboratory for Experimental Clinical
Psychology, University of Groningen, Grote Kruisstraat 211, NL 9712 TS Groningen, The
Netherlands.
 204 Geuze and Kalverboer

age (Lundy-Ekman, Ivry, Keele, & Woollacott, 1991; Williams, Woollacott, & Ivry,
1992), especially when the rate of tapping is slow (Geuze & Kalverboer, 1987). Some
evidence suggests that such timing problems, at least in hand function, are related to
dysfunction of the ipsilateral regions of the cerebellum (Ivry, Keele, & Diener, 1988).
Two studies suggest that cerebellar dysfunction may be involved in enhanced timing
variability of tapping performance of children who are clumsy (Lundy-Ekman et al.,
1991; Williams et al., 1992). However, whether a cerebellar dysfunction will reveal
itself in lateralized problems of hand function or in bimanual coordination is as yet
unknown. Since bimanual coordination is also known to be impaired in children who
are clumsy (e.g., buttoning, cutting with scissors) (Henderson & Hall, 1982; Barnett &
Henderson, in press), the present study will investigate timing in children who are clumsy
in both unimanual and bimanual tapping tasks. For this purpose a continuation task was
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chosen to study both the accuracy of maintenance of tempo and timing variability.
Although the origins of their problems may be quite different, children who are
dyslexic are also known to have difficulty with tapping tasks. Children who are dyslexic
are generally described as having some kind of language impairment, concerning linguis-
tic processing deficits, speech production, or a combination of these functions. More
restrictively, dyslexia is defined as a failure to acquire normal reading skills despite
average IQ, neurological normality, and adequate education (Duffy & McAnulty, 1990).
In addition, a number of biological and nonlinguistic correlates have been noted (Denckla,
1979).
In an excellent review, Wolff, Michel, Ovrut, and Drake (1990) suggested that
the conjunction of these various impairments may not be fortuitous and that an underlying
common deficiency may be present. They further suggested that this deficit is concerned
with the process of temporal resolution and cite as evidence for this suggestion the fact
that children with dyslexia have problems in maintenance of tempo and rhythm in
speech, reading, writing, and other skilled manual actions (Corkin, 1974; Denckla,
1979). Later research has confirmed the overlap between temporal aspects of language
production and hand movements (Bellman & Walter, 1985; Franz, Zelaznik, & Smith,
1992). All of these findings support Lashley's (1951) notion that speech and skilled
movements share common neural mechanisms for timing precision and serial order
control.
However, the origin of such timing-related problems remains unclear. Since lin-
guistic ability is often thought to depend on the integrity of left hemisphere functioning,
one possible hypothesis is that deficits in temporal organization in people with dyslexia
should be restricted to right-hand performance (Hammond, 1982; Wolff et al., 1990).
However, to date no empirical support for this hypothesis exists. In fact, studies by
Wolff (Klipcera, Wolff, & Drake, 1981; Wolff, Cohen, & Drake, 1984; Wolff et al.,
1990) have shown that 11- to 13-year-olds with dyslexia do well in both unimanual
and bimanual synchronous tasks but have greater difficulty in bimanual asymmetrical
coordination tasks. Since Wolff et al. (1990) found no differences between left and right
hand they concluded that functional deficits in dyslexia are associated with impaired
interhemisphere communication.
From the preceding review, two points emerge. The first is that both children
who are clumsy and those who are dyslexic seem to have problems with continuous
tapping tasks that set them apart from age-matched controls. The second is that the
patterns of their impairment seem to be quite different. Whereas children who are clumsy
appear to have difficulty with unimanual tasks and do not show any difference between
their dominant and nondominant hands, children who are dyslexic seem to have more
difficulty when two hands are involved and the tapping requirements are more complex.
 Tapping a Rhythm 205

In the case of dyslexia, where there is much speculation about the specificity of the
neurological basis, there is correspondingly much theoretical speculation about the
origins of the timing deficits. In contrast, in the area of clumsiness, where very little is
known about the neurological origins, only Ivry and colleagues have ventured to speculate
on the locus of the timing problem in children who are clumsy (Lundy-Ekrnan et al.,
1991; Williams et al., 1992).
At present, however, the data available on both of these groups of children are
limited, and some studies contain methodological flaws that make them difficult to
interpret. Moreover, to the best of our knowledge a direct comparison between children
who are dyslexic and those who are clumsy has never been undertaken. In the present
study, therefore, we compare two groups of children whose difficulties are quite specific
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with children who perform well in both domains, using unimanual and bimanual continua-
tion tasks from the reviewed studies.

Method
Selection of Subjects
The children who participated in this study attended a school for children with specific
learning difficulties in the north of Holland. Pupils in the school are classified as having
a variety of problems such as learning disabilities, attentional problems, dyslexia, or
socio-emotional difficulties, but children who are mentally retarded and those with very
severe behavior problems are not admitted. Pupils follow the normal curriculum with
adaptations made to meet the tempo and special needs of the individual children.
Teachers were asked to provide three lists of children: with reading problems,
with motor problems, and without reading or motor problems. This resulted in a pool
of about 100 children between 7 and 12 years old, from which we selected our groups.
Informed consent by parents and children was given in all but two cases. Following
this initial selection procedure, three tests were administered:

To assess the delay in reading ability in months, a short test of reading ability
(word fluency) with age-related norms (Brus & Voeten, 1973) was administered.
To assess motor problems, teachers completed a questionnaire (Kalverboer, De
Vries, & Van Dellen, 1990), and the Test of Motor Impairment (TOMI; Stott,
Moyes, & Henderson, 1984) was administered.
To assess intelligence, we used the short form of the Wechsler Intelligence Scale
for Children-Revised (WISC-R).

Using these three tests we selected children for participation in the study as follows.
Fist, all children with a full-scale IQ score of less than 75 were eliminated. For admission
to one of the three groups we then applied the following criteria:

Dyslexic: reading ability more than 1.5 years below expected level; TOM1 score
less than 4 (normal range)
Clumsy: TOM1 score greater than 4.5 (i.e., below 15th percentile); less than 1
year behind in reading ability
Control: less than 1 year behind in reading ability; normal TOM1 score (<4)

Obviously, as they attend this type of school, the control children did have other problems
such as specific learning problems and attentional, emotional, and behavioral problems.
 206 Geuze and Kalverboer

Table 1 Characteristics of the Three Groups of Children Participating in the Study

Clumsy Dyslexic Control

Number 11
Age (months) 113
Sex mlf 912
IQ WISC-R 95
Motor score (TOMI) 7.4
Reading score (months) +1.3
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Table 1 presents the main characteristics of the three groups. As the table shows,
the children with dyslexia were older than the other children. This is mainly because it
is not possible for a child to meet the criterion for reading disability (1.5 years below
expected level) until he or she has been in school for at least 2 years. Using a Dutch
checklist as a measure of handedness, we found none of the children to be left-handed,
but 2 controls and 3 children who were clumsy were rated as ambidextrous.
Task and Instrumentation
A continuation tapping task similar to that used by Wolff et al. (1990) and Ivry and
Keele (1989) was employed in this study. A PC generated beeps at a fixed interval and
recorded responses from one or two buttons to the nearest millisecond. The subject was
seated with both arms resting on a table and the index fingers held over two buttons 5
cm apart. The subject was instructed to commence tapping the bunon(s) along with the
beep once he or she had internally established the required pace. After 12 taps the beeps
stopped and the subject had to continue tapping, such that the paced interval was produced
as regularly as possible until 31 complete continuation cycles had been recorded. There
were three conditions of coordination:
A unimanual condition, in which only one hand was involved, with one tap to
every beep
An alternating bimanual condition, in which one finger responded to the first beep,
the other finger to the next beep, and so on
A 2:l or 1:2 asymmetrical condition, in which the left or the right finger responded
to every beep while the other finger responded to every second beep

Subjects performed the unimanual tasks with the left and the right hands at two
speed levels: a fast condition with a 560-ms interval length and a slow condition with a
1,120-ms interval length. This setup enabled direct comparison with the bimanual coordina-
tion conditions in which the fingers also produced intervals of 560 ms or 1,120 ms.
The children practiced the coordination conditions up to a level that they could
produce a series of 31 cycles within a range of 50% of the paced interval. In the
unimanual condition one of the four tasks was randomly chosen for practice, and tasks
were counterbalanced over subjects in each group. Both bimanual tasks were also
practiced and the 2: 1 and 1:2 tasks were counterbalanced. In total, each child performed
four unimanual tasks, one alternating bimanual task, and two asymmetrical bimanual -
tasks.
 Tapping a Rhythm

Data Preparation and Analysis

Before the data were analyzed statistically three preparation steps were taken. To begin
with, the first cycle was deleted from all of the continuation sequences. Second, the
data were inspected to identify any cycles that were either shorter or longer than the
paced interval by 60%. In that case a shorter sequence length was chosen provided that
a minimum of 10 cycles within the predefined range were available. The average
sequence length was 29 for control children and 28 for children with DCD and dyslexia.
In rare cases the sequence length was too short, and the task was not further analyzed.
Finally, prior to analysis of variability the interval sequences were corrected for
linear drift. Linear drift was defined as the slope of the regression line through the interval
data. The basic measure of variability was calculated as standard deviation of the corrected
intervals (Keele, Pokomy, Corcos, & Ivry, 1985). To eliminate the effect of long intervals
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correlating with large variability, we calculated the coefficient of variation (CV) by dividing
the standard deviation by the mean interval length. This procedure enables a true comparison
of variability between the 560-ms and 1,120-ms conditions.
The statistical analysis was set up in two parts. First of all, MANOVA procedures
(with age and IQ as covariates) were used to test differences in the coefficient of variation
between the groups separately. Adjusted means (i.e., corrected for age and IQ) were
then calculated to determine the direction and size of the group differences. Second,
the effects of hand and speed and their interaction with group were determined by
MANOVA analyses using contrasts (again with age and IQ as covariates). These contrasts
were calculated from the same data set as used in the Fist procedure. This type of
analysis was performed for the unimanual and the bimanual conditions separately and
likewise for the comparison of unimanual versus bimanual 2: 1 tasks.

Results
Maintenance of Tempo
In most cases (64%) the children's speed of tapping drifted to a faster rate. Drift toward
a slower rate occurred in only 36% of cases, and in neither case did we find differences
between the groups. In 80% of trials, drift over 30 sequential intervals was within a
range of 18% of the paced interval length (this equals a range of 100 ms for the 560-
ms condition and 200 ms for the 1,120-ms condition). Control children drifted to a
faster rate outside this range in 4% of cases compared to 12% for the children who
were clumsy (chi-square = 4.99, p < .05) and 17% for children with dyslexia (chi-
square = 9.69, p < .01). Drift to a slower rate did not differ between the three groups
and amounted to 8%, 11%, and 6%, respectively.
Effects of Speed, Hand, and Condition
Before we could compare the three groups of children in the study it was first necessary
to take account of a number of factors that might influence our interpretation of the
outcome. Since the children were much more variable when the tapping tempo was
slow than when it was fast, the use of the coefficient of variation, suggested by Peters
(1989), proved to be essential as a means of comparing performance in the two speed
conditions. Inspection of the individual data showed Iarge variability (outside the range
of the control group), for about half of the children who were clumsy or dyslexic. Also,
since there were minor differences in age and IQ between the groups it was necessary
to correct for these before performing the appropriate statistical analyses. These corrected
 208 Geuze and Kalverboer

Groups

BO -
+ dyslexic

50 - 17 dumsy
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40-
0 control
SO-
20 -
10 -
01 , I I ,
580L580R1120L1120R 1120LllpR 560L1120R1120L580R
Unirnanual Alternating 2:l Birnanual 1:2
Figure 1-MANOVA-adjusted means with age and IQ as covariates of the coefficient of
variation (CV). The effect of the covariate "age" is that differences between the children
who were clumsy and the controls become smaller, whereas differences between the children
who were dyslexic and the controls become larger. IQ did not have such a consistent effect.

Table 2 Levels of Significance @ values) for MANOVA Group Comparisons in

Drift-Corrected Variability per Task Condition, With Age and IQ as Covariates.

Unimanual Alternating Asynchronous

Task condition fL fR sL sR sL sR fL fR sL sR

Three groups .583 .052 .005 .449 .536 .363 .531 .072 .633 .018
Clumsy vs. control .453 .098 .I10 .631 .612 .266 .312 .902 .625 .486
Dyslexic vs. control .499 .223 .007 .218 .451 .883 .963 .025 .504 .002
Clumsy vs. dyslexic .675 363 .081 .765 .601 .716 .403 .096 .824 .I39

Note. L = left; R = right; s = slow; f = fast.

scores are presented graphically in Figure 1 accompanied by an overview of the statistical

tests performed in Table 2.
The analysis with three groups shows a significant effect for slow unimanual left-
hand performance, F(2, 30) = 6.23, p < .005, and slow right-hand performance in the
2:l task, F(2, 28) = 4.63, p < .02. These differences are now explored in more depth
in separate comparisons between the groups.
Children Who Were Clumsy Versus Controls
In the unimanual conditions, children who were clumsy were slightly more variable
than control children for fast right-hand performance, F ( l , 19) = 3.04, p < .lo, and for
slow left-hand performance, F(1, 19) = 2.81, p = .11, but these differences were not
 Tapping a Rhythm 209

maintained when the four unimanual tasks were combined, F(1, 19) = 2.1, p = .16. An
interaction of Group x Speed x Hand was found in the unimanual condition, mainly
because of the differential effect of hand in the fast condition for the two groups, F(l,
19) = 3.43, p = .08 (see Figure 1). Bimanual task performance did not differ between
these groups.
Children Who Were Dyslexic Versus Controls
In the unimanual conditions generally, the children who were dyslexic proved to be
more variable than the control children, F(1, 20) = 7.56, p < .02, but there were no
interactions with hand or speed. In the bimanual conditions only the 2:l variant differenti-
ated the groups, F ( l , 18) = 5.07, p < .05, but this time there was a Group x Hand
interaction indicating enhanced variability in right-hand performance in the children
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who were dyslexic, F(l, 18) = 6.12, p < .05.

Within the unimanual tasks, children who were dyslexic differed from control
children on the slow left-hand variant, F(1, 20) = 9.13, p < .01. In contrast, the right-
hand test showed most variability in the asymmetric tasks, and this was true for both
speeds, F(1, 19) = 5.97, p < .05, and F(1, 19) = 12.18, p < .O1 (Table 2). Whereas it
is possible that the finding for unimanual performance is due to chance, as quite a
number of statistical tests have been performed, the possibility of the right hand being
affected in both variants of the 2:l condition by chance seems much less likely.
Children Who Were Clumsy Versus Dyslexic
Marginal statistical differences between children who were clumsy and those who were
dyslexic suggested that the latter were more variable in the unimanual slow left-hand
performance, F(1, 19) = 3.4, p < .lo, and on fast right-hand performance in the 2:l
tasks, F(1, 18) = 3.08, p < .10 (Table 2). Moreover, in the bimanual 2:l condition the
Group x Hand interaction again emphasized the right-hand disadvantage of children
who were dyslexic, F(1, 17) = 5.68, p < .05.

Discussion
In this study, we have compared three groups of children who differed in both their
motor competence and their reading ability. Since it was not possible to match the
children perfectly on age and IQ during the process of selection, we were obliged to
control for these differences in our statistical analysis. When this was done, the overall
comparisons between the two groups of children with difficulties and their controls
produced a pattern that was largely but not completely in line with our prediction.
Whereas we had expected the control children to be less variable than the other children
on all variants of the tapping task, on some components the performances of the controls
and of the children who were clumsy were similar, and on others the performances of
children who were dyslexic and those of the controls were similar. Since it is these
individual comparisons that concern us most in this study, we will summarize them
briefly before turning to their interpretation.
We found no clear-cut laterality effects or group differences between the children
who were clumsy and the controls. Although the children who were clumsy seemed to
be more variable in 7 out of the 10 comparisons (Figure I), in not a single case did
this difference reach statistical significance. This outcome seems to be at odds with that
of Lundy-Ekman et al. (1991) and Williams et al. (1992), who reported a significant
difference in unimanual task performance between children who were clumsy and control
 210 Geuze and Kalverboer

children. Although it should be noted that the control children in this study had some
developmental problems, we do not think these affected their proficiency in tapping'.
The fact that there was a Group x Speed x Hand interaction in the unimanual task is
more or less consistent with the earlier reported finding of increased variability in the
slow unimanual task performance of children who were clumsy (Geuze & Kalverboer,
1987). As some might have predicted we found no evidence of laterality effects in the
children who were clumsy.
When children with dyslexia were compared to control children the pattern of
results obtained was rather different. On a11 four unimanual tasks, the children with
dyslexia were more variable than controls but this was especially true when the children
were required to tap at a slow pace with the left hand. However, the most striking
finding revealed in the present study was the difficulty experienced by the children who
were dyslexic in the bimanual task involving the right hand in the 2:l condition. This
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result runs counter to the common finding that right-handed adults are much less variable
with the right than the left hand in 2:l tapping tasks (Peters, 1987), an advantage that
disappears in people who stutter (Webster, 1990) and those who are left-handed (Peters,
1987). In our study, the control children appeared to show no right-hand advantage but
this may have been because they were too young.
As noted earlier, three possible theoretical models have been proposed that might
be considered in relation to the present findings. Two of these were developed within
the context of work on dyslexia, the other emerged from work on adults with cerebellar
impairment. We will begin by considering our findings in relation to the work of Wolff
and colleagues.
The study by Wolff et al. (1990) involved adolescents with dyslexia in bimanual
tapping. Their alternating and asymmetric tasks at the slower rate (500 and 660 ms)
were comparable to those used in our study. Their main finding was that subjects who
were dyslexic performed with larger variability in both aIternating and asymmetric tasks,
but not when tapping with both hands in unison. In contrast, our study did not yield
differences between the groups in the alternating task, and we found specifically the
right-hand being affected in the asymmetrical tasks. From their results, Wolff et al.
(1990) concluded that the discriminating tasks required integration of asynchronous
responses that they associated with impaired interhemispheric communication. They did
not find evidence for the competing hypothesis of a left hemisphere dysfunction expressed
in poor right-hand performance.
It should be noted, however, that the analysis of the data by Wolff et al. (1990)
has two problems. One is that the data have not been corrected for drift (i.e., the subject
systematically sIows down or speeds up during the continuation sequence). The variability
measure, then, may be determined by drift rather than by interval-to-interval variability.
The other problem is that the mean interval length was not controlled for. The study
by Peters (1989) shows that the standard deviation as a measure of variability depends
linearly on mean interval length, and therefore a relative measure of variability such as
the coefficient of variation should be used.
In the light of these two problems, it is rather difficult for us to compare our
resuIts with those of Wolff et al., since their results may hold under conditions where

'We compared the performance of our control group with the performance of a control
group from a regular school on one task (the fast unimanual condition). There were no statistical
differences in variability measures between
up is sufficientIy representativefa this ms
 Tapping a Rhythm 21 1

drift is negligible and mean interval length stays close to the paced value. Among our
children a considerable amount of drift occurred in about 11% of bids. Also the fact
that the mean interval length differed by more than 10% of the paced interval in 32%
of cases (21% in controls, 28% in children who were dyslexic, and 47% in children
who were clumsy) hampers the comparison of variability uniess the coefficient of
variation is used.
Although we may not be able to make direct comparisons between our data sets,
what we can do at present is consider our own findings in relation to the theoretical
proposals made by Wolff and colleagues. Beginning with the children who were dyslexic,
we could find little evidence to support either of the two hypotheses proposed. Variability
in the altemating task was found to be equal to variability in the unimanual task, which
goes against the interhemispheric communication hypothesis, and leftlright differences
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were found in the asymmetric task only (i.e., not in the altemating or unimanual tasks),
which provides little support for the laterality hypothesis. Apparently, timing variability
in dyslexia is not simply a problem of laterality or interhemisphere communication.
What does this mean for our understanding of DCD in children? Children who
were clumsy did not show coherent lefvright differences in any of the conditions,
although they were slightly more variable. If we follow Wolff s reasoning, the children
who were clumsy seem to be characterized by more variable left and right hemispheric
control, while the communication between the hemispheres seems to be intact. Whether
equal variability of the children who were clumsy and the controls in the bimanual tasks
really can be interpreted as intact interhemisphere communication remains unsolved
because interlimb coordination in these simple rhythmic tasks may well be left to a
lower level of control in the nervous system, for example, the spinal level, with higher
levels only supervising more general aspects of the task such as maintenance of a
constant tempo.
The other theoretical model that we considered in relation to timing difficulties
in children with DCD was that proposed by Ivry and Keele (1989). Their model predicts
ipsilateral cerebellar involvement for lateralized unimanual timing problems, as exempli-
fied by a study of patients with cerebellar lesions. Using the model proposed by Wing
and Kristofferson (1973), Ivry and Keele separated the total variability into a central
(cerebellar) component and a motor delay component. In two studies that pursued this
idea, Lundy-Ekman et al. (1991) and Williams et al. (1992) divided children with DCD
in two groups: those showing minor signs of cerebellar dysfunction and those showing
minor signs of basal ganglia dysfunction. They found that the cerebellar group showed
a central timing deficit, whereas the basal ganglia group showed enhanced motor delay
variability.
We have also tried to apply Wing and Kristofferson's model to our data and found
that 30% of the analyzed interval sequences yielded negative variances, which implies
violation of the basic assumptions of the model. Although Keele and colleagues appar-
ently encountered the same problem in some 10 to 20% of the analyzed sequences in
the previous studies, and dealt with it by either setting the variance to zero or omitting
the sequence (S.W. Keele, personal communication, August 7, 1991; September 21,
1993), we were reluctant to do this. Consequently, we were unable to inspect our data
for evidence in support of their line of reasoning. In view of the fact that we found, as
they did, considerable individual variation within our group of children with DCD,
however, we do think this is a promising approach and we intend to pursue it in the
future.
In summary, we have evaluated the problems that children with DCD have with
continuation tapping tasks in relation to three different theories of what might underlie
 212 Geuze and Kalverboer

the problem. As our data could not support any of these, this leaves unanswered the
question of why children with movement difficulties have timing problems. However,
in the present paper we have only investigated measures of single-hand performance,
both in the unimanual and in the bimanual tasks. Specific measures concerned with the
coordination between the hands, such as the relative phase, were reported in a separate
article (Geuze & Kalverboer, 1993). Such an approach may carry us further forward.

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