LSHSS
Research Article
Associations Between Manual
Dexterity and Language Ability
in School-Age Children
Rita Obeida,b and Patricia J. Brooksa,b
Purpose: We aimed to determine whether individual
differences in manual dexterity are associated with specific
language skills (nonword repetition, receptive vocabulary,
and receptive grammar) after controlling for nonverbal
abilities (visual–spatial working memory and intelligence).
Method: We assessed manual dexterity using the pegboard
task and examined relationships with verbal and nonverbal
abilities in a diverse community sample of children (N = 63,
mean age = 8;2 [year;months], range: 6;0–10;8) varying in
language ability (Comprehensive Evaluation of Language
Fundamentals–Fourth Edition core language score M = 105,
range: 62–126; Semel, Wiig, & Secord, 2003).
Results: Correlational analyses indicated significant
relationships between manual dexterity and performance on
tests of nonword repetition, receptive vocabulary, receptive
C
linical research has shown that children with lan-
guage and social communicative impairments often
exhibit concomitant deficits in motor skills, which
encompass fine and gross motor control (see Hill, 2001;
Leonard & Hill, 2014, for reviews). Measures of fine motor
control typically require manual dexterity and visual–motor
integration, as in the pegboard task in which participants in-
sert grooved pegs into holes as fast as they can (Brookman,
McDonald, McDonald, & Bishop, 2013). In contrast, mea-
sures of gross motor control require coordination of whole-
body movements and include walking, hopping, and balance
tasks (Hill, 2001). In a meta-analysis of 16 studies utilizing
a
Psychology Department, The Graduate Center, City University of
New York, NY
b
The College of Staten Island and The Graduate Center, City
University of New York, NY
Correspondence to Rita Obeid, who is now at Case Western Reserve
University, Cleveland, OH: rita.obeid@case.edu
Editor-in-Chief: Shelley Gray
Editor: Kerry Ebert
Received November 14, 2017
Revision received April 28, 2018
Accepted June 3, 2018
https://doi.org/10.1044/2018_LSHSS-17-0124
982 Language, Speech, and Hearing Services in Schools • Vol. 49 • 982–994 • October 2018 • Copyright © 2018 American Speech-Language-Hearing Association
grammar, and nonverbal intelligence, after controlling for
multiple comparisons. In regression analyses, manual
dexterity remained a significant predictor of nonword
repetition after controlling for nonverbal abilities and age.
In contrast, manual dexterity was no longer significant in
predicting receptive vocabulary or grammar when nonverbal
intelligence was included as a factor in the model.
Conclusions: These findings build on prior work implicating
poor fine motor control in child language disorders by
identifying a robust relationship between manual dexterity
and nonword repetition. Relationships between manual
dexterity and receptive language abilities appear to be indirect
and mediated by nonword repetition. For clinicians, the results
underscore the importance of screening children with poor
fine motor control for concomitant language impairments.
a variety of motor tasks (Rechetnikov & Maitra, 2009),
children with speech-language impairments exhibited lower
scores (mean effect size d = –0.61), slower responses (mean
effect size d = 0.47), and higher error rates (mean effect
size d = 1.23) than typically developing children. Note that,
across the reported studies, the clinical samples appeared
to be heterogeneous and included children with speech
and/or language impairments (the latter called developmental
language disorder [DLD] or specific language impairment,
see D. V. M. Bishop, Snowling, Thompson, Greenhalgh,
& CATALISE consortium, 2016).
The pegboard task is perhaps the most widely used
measure in research evaluating the motor skills of children
with speech-language impairments. A number of studies
(e.g., D. V. Bishop, 2002; Powell & Bishop, 1992; Preis,
Schittler, & Lenard, 1997) have observed impaired perfor-
mance (i.e., slower response times in inserting the pegs) in
children with speech-language impairments relative to con-
trols, although some studies have failed to replicate this
finding (e.g., Archer, 1980). Preis et al. (1997) reported
impaired performance among 4- to 12-year-old children with
DLD on both a stylus tapping task and the pegboard task.
D. V. Bishop and Edmundson (1987) found performance on
Disclosure: The authors have declared that no competing interests existed at the time
of publication.
the pegboard task to predict language outcomes of children
with language impairment assessed longitudinally from ages 4
to 5.5 years. In a genetic linkage study, D. V. Bishop (2002)
found that twins (ages 7 to 13 years) with speech and language
difficulties showed worse performance on a thumb-tapping
task (Study 1) and a pegboard task (Study 2, conducted 2 to
3 years later) when compared with controls. Moreover, in an
analysis of shared genetic variance, performance on the peg-
board task was linked to accuracy in nonword repetition—
a measure of phonological short-term memory (Gathercole,
Willis, Baddeley, & Emslie, 1994) that is often viewed as a be-
havioral marker for DLD (D. V. Bishop, North, & Donlan,
1996; Conti-Ramsden, Botting, & Faragher, 2001).
Powell and Bishop (1992) extended these findings and
observed worse performance in a group of 6- to 12-year-olds
with language impairments on a range of fine motor (e.g.,
bead-threading, pegboard) and gross motor tasks (e.g.,
ball-rolling with stick, ball-rolling with foot) compared with
controls. Noterdaeme, Mildenberger, Minow, and Amorosa
(2002) observed difficulties in both fine motor skills (e.g.,
pegboard, drawing, cutting) and gross motor skills (e.g.,
stepping, stair climbing) in children (mean age = 8 years)
with either expressive language impairment or receptive lan-
guage impairment (two separate groups) as compared with
age and nonverbal IQ-matched controls. Owen and McKinlay
(1997) administered a battery of motor tasks (pegboard, fas-
tening buttons, threading beads, and drawing crosses) to
a group of 4- to 7-year-olds with speech and language im-
pairments and age-matched controls. They found worse
performance in the clinical sample on all tasks except for
the drawing crosses task, which may have required a lesser
degree of manual dexterity than the other tasks.
Theoretical Accounts Linking Motor Skills
and Language Development
From a neuropsychological perspective, researchers
have emphasized overlapping patterns of connectivity
across brain regions supporting motor control, speech, and
language abilities (e.g., Diamond, 2000; Lieberman, 2000).
In line with this view, Iverson and Fagan (2004) provided
evidence of synchronization in the production of gross
motor movements and vocalizations in infants as young as
6 to 9 months. They observed that the majority of infants
coordinated their babbling with ongoing rhythmic limb
activity, which suggested that the infants’ rhythmic move-
ments were serving to entrain their speech. To the extent
that speech and motor skills remain coupled, we would ex-
pect to find correlations across these two modalities over
the life span. A. M. Lieberman and Whalen (2000) have
argued that articulatory gestures are the primary represen-
tational objects underlying both the production and per-
ception of speech; hence, motor control, at a very basic level,
is foundational for phonological development.
Ullman’s work (2001, 2004) has highlighted the role
of neural circuits associated with the procedural memory
system (subsuming Broca’s area within the frontal cortex
and the caudate nucleus within the basal ganglia) in the
acquisition of motor skills and rule-based aspects of lan-
guage, especially phonology, morphology, and syntax.
Ullman’s procedural deficit hypothesis (Ullman & Pierpont,
2005) claims that the linguistic difficulties experienced by
children with DLD stem from underlying impairments in
procedural learning, which differentially impact learning
of sequences, probabilistic patterns, and higher order rules.
This hypothesis has gained support from recent meta-analyses
documenting impaired performance of individuals with
DLD, compared with age-matched controls, on assessments
of procedural learning, such as the serial reaction time task
and the artificial grammar learning task (Lum, Conti-Ramsden,
Morgan, & Ullman, 2014; Obeid, Brooks, Gillespie-Lynch,
Powers, & Lum, 2016). Ullman’s model (2001, 2004) leads
to the prediction that manual dexterity should be more
strongly associated with grammatical abilities than with
vocabulary knowledge, as the latter may rely to a greater
extent on the declarative memory system (Hamrick, Lum,
& Ullman, 2018).
Theoretical frameworks emphasizing embodied aspects
of cognition offer a different perspective on the relationship
of motor skills to language development. Under such a
framework, researchers have explored how children’s sen-
sorimotor activity, locomotion, and manual exploration
serve as a means of discovering the affordances of physical
and social environments with direct and indirect effects on
language and cognitive development (e.g., Bates & Dick,
2002; Iverson, 2010; Iverson & Thelen, 1999; Thelen &
Bates, 2003). The embodied cognition perspective views
semantic representations as multimodal in nature, with ac-
cess to concepts invoking mental reenactments of sensori-
motor experience (Barsalou, 2009; James & Swain, 2011).
Under this view, motor experience and skills directly im-
pact lexical representations. Evidence in support of the em-
bodied cognition perspective comes from neuroimaging
studies showing activation of motor areas in the frontal
cortex concurrent with activation of verb meanings, with
patterns of activity in the motor cortex varying as a function
of the type of action, such as whether it involves the hands
(e.g., grab) or the legs (e.g., walk; James & Maouene, 2009).
Bates and her colleagues (Bates, Dale, & Thal, 1995; Bates
& Goodman, 1997) argued that grammar and vocabulary
have inseparable developmental pathways, as evidenced by
high correlations between vocabulary diversity and gram-
matical complexity across childhood. Their “lexicalist” ap-
proach to grammar (Bates & Goodman, 1997) contrasts
with the dual-route model of Ullman et al. (1997; see also
Pinker 1999) and leads to the prediction that motor skills—
to the extent that they support language learning—should
impact both vocabulary and grammar acquisition.
Empirical Work Linking Manual Dexterity
With Specific Language Measures
To date, only a handful of studies have explored cor-
relations between fine motor control (manual dexterity)
and specific language measures. Corriveau and Goswami
(2009) found that 7- to 11-year-old children with DLD were
Obeid & Brooks: Manual Dexterity and Language Ability 983
slower than controls at rhythmic finger tapping and peg-
board tasks. However, across the sample as a whole, per-
formance on the pegboard task was significantly associated
with only one language measure (phoneme deletion). On
the other hand, performance on the rhythmic finger-tapping
task correlated significantly with multiple measures (recep-
tive vocabulary, reading, spelling, rapid color naming,
nonword repetition). DiDonato Brumbach and Goffman
(2014) documented delays in speech motor, gross motor,
and fine motor control in 4- to 6-year-olds with DLD in
comparison to an age-matched control group. Yet, after
merging the two samples, only fine motor skills (and not
gross motor skills) correlated with performance on a com-
posite measure of phonology and articulation (Bankson–
Bernthal Test of Phonology; Bankson & Bernthal, 1990).
In a twin study involving four hundred fifty-eight 9- and
10-year-olds, Brookman et al. (2013) found that children
with language impairments showed poorer performance on
the pegboard task when compared with controls; how-
ever, at the level of individual differences, they failed to
find any significant correlations between performance on
the pegboard task and core language abilities.
Moving beyond the clinical literature, which has
tended to focus on group-level comparisons of children
with language impairments and typically developing peers,
a handful of studies of neurotypical infants and children
have explored links between motor control and language
skills. In a large population-based longitudinal study (N =
62,944), Wang, Lekhal, Aarø, and Schjølberg (2012) had
mothers complete questionnaires about their children’s mo-
tor and communicative abilities at ages 1;6 (years;months)
and again at 3;0. Motor skills at 1;6 correlated concur-
rently with oral comprehension and word production at
1;6 and, longitudinally, with oral comprehension and pro-
duction of multiword utterances at age 3;0. Using data
from a large national cohort (N = 12,593 children), Son
and Meisels (2006) documented associations between
visual–motor skills, assessed via drawing and copying tasks
in kindergarten, and achievement in reading and mathe-
matics in first grade, after controlling for prior abilities.
Similarly, in a longitudinal study of 73 children, Doyen,
Lambert, Dumas, and Carlier (2017) found manual dex-
terity, assessed using the pegboard task in kindergarten, to
predict children’s reading abilities measured a year later
in first grade.
Taken together, these studies fail to provide a con-
sensus view of the relationship of fine motor control to
specific language skills. In light of the theoretical debates
about the interrelatedness of perceptual–motor function-
ing and language development, the current study was
conducted. We focused on children in the early elemen-
tary grades (ages 6 to 10 years) with the aim of exploring
the robustness of relationships between manual dexterity,
assessed via the pegboard task, and fundamental language
skills (receptive vocabulary, receptive grammar, and non-
word repetition) to shed light on mechanisms under-
lying putative relationships between motor and language
development.
984 Language, Speech, and Hearing Services in Schools • Vol. 49 • 982–994 • October 2018
Nonword Repetition as a Behavioral Marker
of Language Ability
As noted above, two previous studies (D. V. Bishop,
2002; Corriveau & Goswami, 2009) have linked individual
differences in motor skills with nonword repetition ability;
hence, the current study included nonword repetition as
part of a battery of language assessments. The nonword
repetition task is a commonly used measure of phonological
short-term memory in which participants are required to
repeat as accurately as possible a set of made-up words of
varying lengths. Nonword repetition is a challenging task
for many children with DLD (Dollaghan & Campbell,
1998). As reported in a meta-analysis of 23 studies, chil-
dren with DLD exhibited impairments in repeating non-
words when compared with age-matched peers, with mean
effect sizes ranging from d = 0.52 to 1.05 for one- to four-
syllable nonwords (Estes, Evans, & Else-Quest, 2007). Re-
search has also confirmed associations between speech
motor abilities and performance on the nonword repetition
task. For example, when looking at the effects of speech
movement coordination in relation to nonword repetition,
researchers have shown that both children and adults show
improvements in repeating nonwords after speech motor
training (Sasisekaran, Smith, Sadagopan, & Weber-Fox,
2010). Children with DLD have been observed to have less
stable lip and jaw movements when compared with their
typically developing peers (Goffman, 1999) and are less
able to produce stable and organized rhythmic movements
when producing novel word sequences (Goffman, 2004).
A. Smith, Goffman, Sasisekaran, and Weber-Fox (2012)
examined nonword repetition in children who stutter: Chil-
dren who stutter but did not have a concomitant language
impairment performed as well as a typical control group,
whereas children who stutter and had a language impair-
ment performed poorly relative to both of the other groups.
These findings suggest that nonword repetition ability is
more closely related to language ability than to speech fluency.
The nonword repetition task has garnered much in-
terest due to its associations with word learning and vocab-
ulary development, which extend to typically developing
children and adolescents, foreign language learners, and
children and adults with language impairments (for re-
views, see Coady & Evans, 2008; Gathercole, 2006). In
an early study, Gathercole and Baddeley (1990) found that
5- to 6-year-old children who performed poorly at non-
word repetition also struggled in learning the unfamiliar
names of toy animals. Similarly, Michas and Henry (1994)
observed 5-year-old children’s nonword repetition accuracy
to correlate significantly with their success in a word-learning
task. Extending this to foreign language learning, Service
(1992) observed that Finnish 9- and 10-year-old children
who were better at nonword repetition were also better at
learning new English vocabulary. Using longitudinal designs,
researchers have demonstrated the robustness of the link
between nonword repetition and vocabulary development
while emphasizing its bidirectionality (e.g., Gathercole, Willis,
Emslie, & Baddeley, 1992; Melby-Lervåg et al., 2012).
Children with larger vocabularies show considerable advan-
tages in nonword repetition, perhaps due to their ability to
use their existing vocabularies to help them remember the
nonwords (Bowey, 2001; Metsala, 1999). Hence, in the cur-
rent study, we expected to find a strong correlation be-
tween receptive vocabulary and nonword repetition ability.
Impact of Nonverbal Abilities
Diamond (2000) has linked cognitive and motor func-
tioning to the protracted development of brain regions,
including the prefrontal cortex and cerebellum, that sub-
serve coordination, cognitive control, and working mem-
ory (see also Rosenbaum, Carlson, & Gilmore, 2001).
Under this view, motor skills are expected to show rela-
tionships with a broad set of cognitive abilities, including
nonverbal intelligence and visual–spatial working memory,
as well as language. Clinical research has supported this
conjecture by suggesting comorbid motor impairments in
children with intellectual disabilities (Howe, 1959; Rintala
& Loovis, 2013; Vuijk, Hartman, Scherder, & Visscher,
2010; Wuang, Wang, Huang, & Su, 2008).
In addition to group-level comparisons of motor
skills in children with and without intellectual disabilities,
researchers have documented interrelationships between
motor control and cognitive functioning in samples of
typically developing children (e.g., Davis, Pitchford, &
Limback, 2011; Jenni, Chaouch, Caflisch, & Rousson,
2013; Martin, Tigera, Denckla, & Mahone, 2010; Pangelinan
et al., 2011; Roebers & Kauer, 2009). In a longitudinal study
of over 200 children from ages 7 to 18 years, Jenni et al.
(2013) documented relationships between various measures
of gross and fine motor control and general intelligence
(assessed via a German version of the Wechsler Intelli-
gence Scale for Children [Tewes, 1983] with subscores re-
ported for performance, visuomotor, and verbal IQ). In this
study, individual differences in manual dexterity assessed
via the pegboard task correlated with both performance and
visuomotor IQ (measured using tasks of block design and
object assembly) but not with verbal IQ. Roebers and Kauer
(2009) examined relationships between performance on mea-
sures of gross and fine motor control, including the pegboard
task, and executive functioning in 7-year-old children. Per-
formance on the pegboard task showed significant associ-
ations with both the Simon task (a measure of inhibitory
control) and the measure of cognitive flexibility/working mem-
ory. Pangelinan et al. (2011) used magnetic resonance
imaging to explore linkages between manual dexterity and
intelligence in a sample of typically developing children.
The researchers documented correlations between full-scale
IQ and performance on the pegboard task and between IQ
and measures of brain volume in the cerebellum and cau-
date nucleus (i.e., brain regions subserving motor control).
These studies suggest that motor control plays a role
in the development of nonverbal and verbal abilities and
indicate the need to control for nonverbal abilities when
assessing the role of motor control in language development.
In the current study, we included a standardized assessment
of nonverbal intelligence (Brown, Sherbenou, & Johnsen,
1997) and an assessment of visual–spatial working memory
intended for school-aged children, that is, the one-shape
array memory task (Cowan, AuBuchon, Gilchrist, Ricker,
& Saults, 2011) as control variables in analyses.
Research Aims
The current study sought to examine whether manual
dexterity, assessed via the pegboard task, was associated
with individual differences in specific language skills in
a community sample of school-age children with a broad
range of language ability. We included nonword repetition
as prior work documents its significance in distinguishing
children with language impairments from age-matched peers
(D. V. Bishop et al., 1996; Conti-Ramsden et al., 2001)
and receptive measures of vocabulary and grammar to eval-
uate claims of competing theoretical accounts that impli-
cate motor skills in language development. Our research
questions were as follows:
1. Is manual dexterity associated with individual differ-
ences in nonword repetition, receptive vocabulary, and
receptive grammar?
2. Do these relationships remain significant after control-
ling for individual differences in nonverbal abilities?
3. Is the relationship of manual dexterity to language skills
direct or indirect?
Method
Participants
Sixty-three children took part in the study (33 girls;
30 boys, mean age = 8;2, SD = 1;3, range: 6;0–10;8); all
children were native speakers of American English living
in the New York metropolitan area. Children were re-
cruited either through a child subject pool at an urban
public university or using flyers posted at the university
and local convenience stores. Families were compensated
with $20 gift cards for each session. Informed consent was
obtained from parents and verbal assent from children.
Parental report of race/ethnicity was as follows: 63.5%
White, 12.7% Black/African American, 6.3% Middle Eastern,
4.8% Latino/a, 1.6% Asian, 11.1% mixed. Parental and child
self-report indicated that 58 children were right-handed
and five were left-handed. All families reported English as
the child’s primary language, although 10 families reported
that an additional language was in use at home.1
All children were given the Clinical Evaluation of
Language Fundamentals–Fourth Edition (CELF-4; Semel,
Wiig, & Secord, 2003) test, which provides a global as-
sessment of expressive and receptive language abilities. As
children at different ages were required to complete different
subtests of the CELF-4, we did not include this measure in
1
All results reported in this article still held when excluding the 10 bilingual
children.
Obeid & Brooks: Manual Dexterity and Language Ability 985
any analyses but used the standardized scores to provide
descriptive information about the sample. Note that stan-
dardized scores on the CELF-4 follow a normal distribu-
tion with μ = 100 and σ = 15. The current sample scored
slightly above these expected values: M = 106 (SD = 13)
for expressive language, M = 105 (SD = 15) for receptive
language, M = 105 (SD = 14) for total (core language) scores.
Materials and Measures
Assessment of Manual Dexterity
The Grooved Pegboard (Lafayette Evaluation,
Lafayette Instruments # 32025) was used to assess manual
dexterity (i.e., fine motor control). The pegboard has 25 key-
shaped holes arranged in a 5 × 5 matrix. Below the grid of
holes is a circular receptacle where the key-shaped pegs are
placed. Participants were instructed to place a peg in each
of the holes by rotating the peg to match the shape of the
hole. Participants completed this task using their dominant
and nondominant hand in a counterbalanced order. In ac-
cordance with instructions in the manual, trained research
assistants used a stopwatch to manually time how long it took
the child to insert all of the pegs, with completion time in
seconds used as a measure of fine motor control. To obtain
a measure of manual dexterity, we averaged completion
times for the two hands. Note that there was a strong cor-
relation between the dominant and nondominant hand per-
formance on the pegboard task, r(63) = .72, p < .001.2
Assessments of Verbal Abilities
Children were given standardized assessments of re-
ceptive vocabulary and grammar. Trained research assistants
calculated raw and standardized scores for each test, with
all scores double-checked for accuracy. The Peabody Picture
Vocabulary Test–Fourth Edition (PPVT-4; Dunn & Dunn,
2007) served as a standardized measure of receptive vocab-
ulary. In this test, the participant is provided with sets of
four pictures and instructed to point to the picture that best
illustrates the meaning of a word spoken aloud. The test
terminates after the participant makes a specified number
of errors at a given level. The Test for the Reception of
Grammar–Second Edition (TROG-2; D. V. M. Bishop, 2003)
served as a standardized measure of receptive grammar.
In this test, the participant is provided with sets of four
pictures and instructed to point to the picture that best il-
lustrates the meaning of a sentence spoken aloud. Each
participant is tested on 20 grammatical contrasts (80 trials
total). For both of these standardized tests, we used raw
scores as the outcome measure and controlled for age in
the statistical analyses. Use of raw scores on standardized
assessments avoids interpretative problems associated with
including scores from tests lacking age norms in the same
set of statistical analyses as standardized (age-adjusted)
scores.
2
Analyses with the pegboard task remain the same when using only
the dominant hand or when including only right-handed children.
986 Language, Speech, and Hearing Services in Schools • Vol. 49 • 982–994 • October 2018
In addition to these standardized tests, children were
given a computerized version of the nonword repetition
task adapted from Edwards, Beckman, and Munson (2004)
and Munson, Kurtz, and Windsor (2005) and run on an
Acer laptop computer using E-Prime 2.0 software (Schneider,
Eschman, & Zuccolotto, 2002). Thirty 3- and 4-syllable non-
words (e.g., /hesɚlәm/, /mæsɚtɑlәn/), recorded by a female
native speaker of English, were presented in a random or-
der in two blocks of 15 trials. At each syllable length, there
were equal numbers of nonwords with high versus low
phonotactic probability. On each trial, a nonword was pre-
sented auditorily over speakers, and the child was instructed
to repeat it as soon as a blue cross fixation symbol ap-
peared on the computer screen (100 ms after the offset of
the nonword). All responses were audio-recorded and scored
as correct or incorrect. To establish coding reliability, two
trained research assistants independently scored 20% of
the data (i.e., 390 trials from 13 participants). Interrater
agreement was 94%. The proportion of correct responses
served as the outcome variable. Because of violations of
normality, we arcsine transformed the proportions prior
to statistical analyses based on recommendations from
Cohen and Cohen (1983).
Assessments of Nonverbal Abilities
Children were given the Test of Nonverbal Intelligence–
Third Edition (TONI-3; Brown et al., 1997), which pro-
vides a language-free measure of intelligence, aptitude, ab-
stract reasoning, and problem-solving. The test consists
of 60 items arranged in order of increasing difficulty. Par-
ticipants were presented with a series of shapes that are set
in a specific pattern. Participants were then required to
choose from a series of four to six shapes the shape that best
completes the pattern. We calculated raw and standardized
scores for the test but used raw scores in all analyses.
The one-shape array memory task (Cowan et al., 2011)
was used to assess visual–spatial working memory. The
task was run on an Acer laptop computer using E-Prime
2.0 software (Schneider et al., 2002). Participants were
instructed to attend to a set of two, three, four, or six col-
ored circles that appeared in a grid of 12 squares (see
Figure 1). To keep the children interested, they were told
that the grid represented a classroom with each colored cir-
cle representing an individual student. On each trial, the
grid appeared for 500 ms with several circles in it; after
500 ms, it reappeared with only a single-colored circle pres-
ent and a door icon to the right of the grid.
If the colored circle was in the correct place (no change
trial), the child was instructed to click on the colored circle
(the “student”). If the colored circle was in the wrong place
(location change trial), the child was instructed to click
on the box (the “seat”) in which the colored circle (“stu-
dent”) belonged (i.e., its original location). If the colored
circle (“student”) did not belong anywhere in the class-
room (a new color trial), the child was instructed to click
on a door to “send the student to the principal.” Partici-
pants were given 10 practice trials and 32 test trials (16 no
change, eight location change, eight new color) in a random
Figure 1. Examples of trials in the one-shape array memory task (Cowan et al., 2011).

order. Responses on test trials were scored as correct/
incorrect by the E-Prime program. Proportions of correct
responses were tabulated; arcsine-transformed proportions
were used in all statistical analyses (Cohen & Cohen, 1983).
Procedure
Participation took place over two sessions conducted
in a laboratory at a large urban public university, with
each session lasting up to 2 hr. Children completed the lan-
guage and nonverbal tasks in a counterbalanced order.
Trained research assistants supervised by the first author
assisted with data collection.
correlated significantly with both measures of receptive
language (PPVT-4 and TROG-2) but not with nonword rep-
etition. Performance on the pegboard task showed signifi-
cant negative correlations with all of the variables, except
for the array memory task, with faster response times as-
sociated with higher scores on language and nonverbal
intelligence tests. All of the tasks except TROG-2 and non-
word repetition showed significant associations with age
(in months) after controlling for multiple comparisons; note
that the nonsignificant correlations between age and TROG-2,
r(61) = .27, p = .031, and between age and nonword repeti-
tion, r(61) = .29, p = .020, were in the predicted direction.

Regression Analyses Exploring Individual

Results
Table 1 provides descriptive statistics for each of the
language and nonverbal tasks. Table 2 presents zero-order
correlations between assessments and age (Bonferroni-
adjusted α = .0024). As expected, all of the language mea-
sures (PPVT-4, TROG-2, nonword repetition) were highly
correlated with one another. Performance on the TONI-3
Differences in Language Abilities
To examine relationships between manual dexterity
and specific language abilities, we ran a series of regression
models with receptive vocabulary (PPVT-4 raw scores),
receptive grammar (TROG-2 raw scores), and nonword
repetition (% correct) as outcome measures, see Table 3.
When creating the regression models, we entered variables

Table 1. Mean scores for verbal and nonverbal assessments and standard deviations in parentheses, N = 63.

Task Domain Raw scores Raw score range Standardized scores Standardized range

Pegboard Manual dexterity 98.2 s (24.3) 60.6–166.0 s — —

PPVT–4 Receptive vocabulary 146.4 (22.0) 90–183 112.7 (15.5) 72–146
TROG–2 Receptive grammar 14.9 (3.5) 5–20 102.4 (16.0) 62–130
Nonword repetition Phonological working memory 70.8% (14.2%) 36.7%–96.7% — —
Array memory Visual–spatial working memory 64.5% (14.2%) 28.1%–87.5% — —
TONI-3 Nonverbal intelligence 113.8 (14.2) 4–34 20.9 (6.6) 81–144

Note. Em dashes indicate data not [obtained/reported/available]. PPVT-4 = Peabody Picture Vocabulary Test–Fourth Edition; TROG-2 =
Test for the Reception of Grammar–Second Edition; TONI-3 = Test of Nonverbal Intelligence–Third Edition.

Obeid & Brooks: Manual Dexterity and Language Ability 987

Table 2. Zero-order correlations between all outcome and predictor variables, N = 63.

Pegboard PPVT-4 TROG-2 Nonword repetition Array memory TONI-3

Age –.50* .49* .27 .29 .41* .45*

Pegboard — –.48* –.42* –.42* –.32 –.46*
PPVT-4 — .70* .55* .39* .52*
TROG-2 — .49* .36** .59*
Nonword repetition — .21 .23
Array memory — .36**

Note. PPVT-4 = Peabody Picture Vocabulary Test—Fourth Edition; TROG-2 = Test for the Reception of Grammar—Second Edition.
*p < .0024 Bonferroni-adjusted alpha. **p < .0036.

in two separate blocks. In Block 1, we entered age (months) and accounted for 18.2% of the variance. Note that per-
and pegboard as predictors; this is presented as Model 1 in formance on the pegboard task, t(60) = −2.82, p = .007,
Table 3. In Block 2, we added nonverbal cognitive abilities, but not age, t(60) = 0.61, p = .54, predicted receptive gram-
that is, the array memory task and nonverbal intelligence mar scores. Model fit improved substantially with nonver-
(TONI-3 raw scores), as additional factors; this is presented bal abilities included as predictors, ΔF(2, 58) = 10.85, p <
as Model 2 in Table 3. Collinearity diagnostics indicated .001, ΔR2 = 22.3%. In the expanded model, the effect of
that all variance inflation factors were below 1.4, and toler- manual dexterity was no longer significant, t(58) = −1.63,
ance values were above 0.2; observation of probability- p = .11, and nonverbal intelligence was the only signifi-
probability plots showed that the assumption of normality cant factor, t(58) = 4.06, p < .001.
was met (Field, 2009). With nonword repetition as the outcome variable,
With PPVT-4 raw scores as the outcome variable, Model 1 was significant, F(2, 60) = 6.84, p = .002, and
Model 1 was significant, F(2, 60) = 13.48, p < .001. Both accounted for 18.6% of the variation. Response times on
age, t(60) = 2.65, p = .01, and the pegboard task, t(60) = the pegboard task, t(60) = −2.72, p = .008, but not age,
−1.54, p = .01, predicted receptive vocabulary scores and, t(60) = 0.81, p = .42, predicted accuracy in nonword repe-
together, accounted for 28.7% of the variance. Model fit tition. Model fit did not improve when nonverbal abilities
improved significantly when nonverbal abilities (array mem- were included as predictors, ΔF(2, 58) = 0.11, p = .90,
ory task and TONI-3) were included as factors in Model 2, ΔR2 = 0.3%. As shown in Table 3, performance on the
ΔF(2, 58) = 4.18, p = .02, ΔR2 = 8.7%. In the expanded pegboard task remained significant in predicting nonword
model, the effect of manual dexterity was no longer sig- repetition after accounting for nonverbal abilities, t(58) =
nificant, t(58) = –1.65, p = .10, and nonverbal intelligence −2.46, p = .02.
(TONI-3) was the only significant factor, t(58) = 2.34, p = .02.
With TROG-2 raw scores as the outcome variable,
Model 1 was again significant, F(2, 60) = 6.66, p = .002, Indirect Effects of Manual Dexterity
on Receptive Language
Having established a link between manual dexterity
Table 3. Standardized regression coefficients with language measures
as the outcome variables. and nonword repetition and robust intercorrelations be-
tween nonword repetition with receptive language abilities
Nonword (see Table 2), we explored possible indirect effects of
Predictors PPVT-4 TROG-2 repetition manual dexterity on receptive vocabulary and grammar.
Using the PROCESS macro in SPSS (Hayes & Preacher,
Model 1: 2014), we conducted mediation analyses with receptive vo-
Age (months) .33* .08 .11
Pegboard –.31* –.38** –.37**
cabulary (PPVT-4 raw scores) and grammar (TROG-2
R2 total .31 .18 .19 raw scores) as outcome measures, nonword repetition as
F (2, 60) 13.48*** 6.66** 6.84** the mediator variable, and manual dexterity as the inde-
Model 2: pendent variable. Nonverbal intelligence and age were
Age (months) .20 –.12 .09
treated as covariates as both of these variables had been
Pegboard –.20 –.20 –.35*
TONI-3 .28* .49*** .01 significant in prior regression models. The mediation analy-
Array memory .14 .17 .56 ses used a bootstrap estimation approach with 1,000 samples
R2 total .40 .40 .13 and 95% confidence intervals.
F (2, 58) 9.55*** 9.85*** 3.37* With PPVT-4 scores as the outcome variable, the
Note. PPVT-4 = Peabody Picture Vocabulary Test–Fourth Edition; mediation analysis confirmed a significant indirect effect of
TROG-2 = Test for the Reception of Grammar–Second Edition. manual dexterity on receptive vocabulary that was medi-
*p < .05. **p < .01. ***p < .001. ated by nonword repetition, Z = –2.06, p = .039; β = –.14,
CI [–0.31, –0.03]. With regard to direct effects, both nonword

988 Language, Speech, and Hearing Services in Schools • Vol. 49 • 982–994 • October 2018
repetition, t(58) = 3.86, p < .001, and nonverbal intelligence,
t(58) = 2.80, p = .007, were significant in predicting PPVT-4
scores, and manual dexterity was significant in predicting
nonword repetition, t(59) = –2.52, p = .014. Age was
not significant in the analysis. Likewise, with TROG-2
scores as the outcome variable, the mediation analysis indi-
cated a significant indirect effect of manual dexterity on recep-
tive grammar mediated by nonword repetition, Z = –2.00,
p = .046; β = –.13, CI [–0.29, –0.02]. With regard to direct
effects, both nonword repetition, t(58) = 3.54, p < .001, and
nonverbal intelligence, t(58) = 4.71, p < .001, predicted
TROG-2 scores, and manual dexterity predicted nonword
repetition, t(59) = –2.52, p = .014. Age was not significant in
the analysis.
Discussion
Difficulties in motor control have been documented in
children with speech-language disorders (Leonard & Hill,
2014; Rechetnikov & Maitra, 2009), yet few studies have
demonstrated links between motor skills and specific lan-
guage abilities. The current study explored relationships
between manual dexterity (grooved pegboard task), re-
ceptive language (vocabulary and grammar), and nonword
repetition in a community sample of school-age children
with a broad range of language abilities. In addition to ex-
amining relationships between motor and language skills,
we included assessments of nonverbal intelligence and visual–
spatial working memory, as existing research suggests broad
linkages between cognitive and perceptual–motor skills
(Davis et al., 2011; Roebers & Kauer, 2009), as well as be-
tween nonverbal cognitive abilities and language (Gallinat
& Spaulding, 2014; Vugs, Cuperus, Hendriks, & Verhoeven,
2013). In discussing our findings, we start by examining
the overall pattern of correlations across motor, language,
and nonverbal assessments and, then, focus the remaining
discussion on relating manual dexterity to specific lan-
guage subskills and theoretical models.
Intercorrelations Across Disparate Tasks
In the current study, manual dexterity was signifi-
cantly associated with all three language assessments after
controlling for multiple comparisons, and it also showed a
significant relationship with nonverbal intelligence (TONI-3
scores). These findings are largely consistent with those
of an early study (D. V. Bishop & Edmundson, 1987),
which examined performance on the pegboard task at ages
4, 4.5, and 5.5 years in relation to a battery of language
assessments that included tests of receptive vocabulary
(British Picture Vocabulary Scale; Dunn, Dunn, Whetton,
& Pintillie, 1982) and grammar (Test for the Reception of
Grammar; Bishop, 1983). At ages 4.5 and 5.5 years, manual
dexterity correlated significantly with all of the standard-
ized language tests and with the mean length of children’s
utterances. At age 4 years, manual dexterity correlated
significantly with two expressive language tests (Action
Picture Test, Bus Story Test; Renfrew, 1997, 2010), the
Verbal Comprehension subtest of the British Ability Scales,
and nonverbal intelligence (Leiter International Performance
Scale; Leiter, 1948). Although Bishop and Edmundson’s
sample was younger than the children in our study, the
overall pattern of their results appears to be similar to
ours in demonstrating broad associations between motor
control, language, and nonverbal skills.
Taken as a whole, the full set of correlations shown
in Table 2 provide evidence of a positive manifold in abili-
ties, where individual differences in performance across
disparate tasks exhibit positive linkages suggestive of
bidirectional influences and interactions across modalities
(cf. Kievit et al., 2017; van der Maas et al., 2006). Al-
though not all of the correlations were significant after
Bonferroni corrections for multiple comparisons, the over-
all pattern was consistent: Response times on the pegboard
task exhibited negative relationships with scores on lan-
guage and nonverbal tests (i.e., greater manual dexterity
was associated with higher test scores), whereas other tasks
(verbal and nonverbal) showed positive associations. After
noting a wide range of associations in performance across
cognitive and motor tasks, Diamond (2000) proposed that
maturation of neural circuits connecting brain regions,
such as the striatum, the neocerebellum, and dorsolateral
prefrontal cortex, might underlie correlated developments
in motor and cognitive control, executive functioning, and
working memory. Evidence of such interdependencies also
aligns well with dynamic systems models of development
(e.g., Iverson, 2010; Rosenbaum et al., 2001; L. B. Smith,
2013), as will be discussed further below.
Direct and Indirect Influences of Manual
Dexterity on Language Subskills
In an effort to disentangle direct and indirect effects
of manual dexterity on nonword repetition, receptive vocab-
ulary, and receptive grammar, we conducted a series of
regression analyses controlling for age and nonverbal abili-
ties. In the models for receptive vocabulary and grammar,
the effect of manual dexterity became nonsignificant when
nonverbal intelligence was added as a factor. In contrast,
for nonword repetition, the effect of manual dexterity
remained significant. The observed relationship between
performance on the pegboard task and nonword repeti-
tion confirms D. V. Bishop’s (2002) research, which doc-
umented similar findings in a genetic linkage study. Note
also that the lack of an association between nonword repe-
tition and both measures of nonverbal ability aligns with
other studies (e.g., Engel de Abreu, Conway, & Gathercole,
2010) indicating the absence of a significant relationship
between measures of fluid intelligence and phonological
short-term memory.
Given that a strong association between accuracy in
nonword repetition and receptive grammar and vocabulary
was evident in our data (see also Bowey, 2001; Metsala,
1999), we conducted a series of mediation analyses, with
nonverbal intelligence and age as covariates, to deter-
mine whether manual dexterity had a significant indirect
Obeid & Brooks: Manual Dexterity and Language Ability 989
relationship on receptive language measures (vocabulary
and grammar). The mediation analyses provided evidence
of direct effects of nonverbal intelligence and nonword
repetition on receptive language, as well as a significant in-
direct effect of manual dexterity mediated by nonword
repetition skill. In other words, manual dexterity explained
residual variance in receptive language abilities via its
relationship with nonword repetition (phonological short-
term memory).
As outlined in the Introduction section, various theo-
retical accounts have proposed connections between motor
skills and language development with somewhat different
implications for phonological, lexical, and grammatical
development. The robust relationship between manual dex-
terity and nonword repetition seems to fit the predictions
of speech motor theorists emphasizing connections between
phonological abilities, motor control, and articulatory ges-
tures (P. Lieberman, 2000; A. M. Lieberman & Whalen,
2000), as well as more domain-general theories emphasizing
a common neural substrate underlying the procedural learn-
ing of cognitive and motor skills (Diamond, 2000; Ullman,
2001, 2004).
In line with a domain-general approach to DLD,
Ullman and Pierpont (2005) proposed the procedural def-
icit hypothesis, suggesting that DLD is associated with
an underlying impairment involving the neural substrates
of cognitive–motor skills acquisition. Such impairments
would impede learning of sequential and rule-based aspects
of language (phonology and grammar) more so than vo-
cabulary, which is supported to a greater extent by de-
clarative memory (Hamrick et al., 2018). Although the
demonstrated link between manual dexterity and nonword
repetition fits with Ullman’s views, we failed to find any
evidence for a heightened relationship between motor con-
trol and children’s grammatical abilities. That is, the ob-
served indirect relationship of motor control to receptive
language, mediated by nonword repetition, was identical
for vocabulary and grammar. Thus, this aspect of our re-
sults appears to be more consistent with the lexicalist
framework of Bates and Goodman (1997) than with the
words versus rules framework of Pinker and Ullman (cf.
Pinker, 1999; Ullman et al., 1997), which proposes a
common mechanism, as opposed to distinct mechanisms,
for acquisition of vocabulary and grammar.
Broader Implications of Motor
Development for Language
Moving beyond manual dexterity, the literature
points to relationships between motor skills and language
ability that may be fruitful to pursue in future research.
It is now widely recognized that children learn words at
around the same time that they learn to express themselves
via gesture, with expressions in either modality used for
similar communicative purposes in a mutually supportive
fashion (Volterra, Caselli, Caprici, & Pizzuto, 2005). In a
longitudinal study, Iverson and Goldin-Meadow (2005) ex-
amined toddlers’ speech and gestures as they transitioned
990 Language, Speech, and Hearing Services in Schools • Vol. 49 • 982–994 • October 2018
from producing single-word to multiword speech (ages 10–
20 months). They found that toddlers often used gestures
to refer to objects prior to learning their names; in other
words, lexicalized concepts were often expressed first in the
manual modality and only later in speech. Moreover, the
occurrence of gesture-plus-word combinations in which the
gesture added information not expressed by the word (e.g.,
pointing at a cookie and saying “eat”), predicted the subse-
quent occurrence of two-word utterances (e.g., “eat cookie”;
see also Özçalışkan and Goldin-Meadow [2009]). Argu-
ably, the use of a deictic gesture (e.g., show or point) func-
tioned similarly to a pronoun (e.g., it or that) in allowing
the toddlers to adapt their limited communicative reperto-
ries to ever-changing communicative contexts.
Other research suggests that attainment of motor
milestones correlates with advances in children’s language
development. Oudgenoeg-Paz, Volman, and Leseman
(2012) assessed infants longitudinally from ages 16 to
28 months and found earlier development of sitting and
walking to predict expressive vocabulary size and a steeper
rate of vocabulary growth. In a subsequent longitudinal
study of infants from 12 to 23 months, Longobardi,
Spataro, and Rossi-Arnaud (2014) confirmed the positive
association between motor skills (e.g., crawling, walk-
ing, climbing) and acquisition of expressive vocabulary,
while demonstrating that this relationship was mediated
by individual differences in infants’ production of gestures.
Dynamic systems theorists, emphasizing mutual inter-
dependencies across disparate aspects of development,
have suggested ways that achievement of motor milestones
might have cascading effects on language and cognitive
development (Rosenbaum et al., 2001; L. B. Smith, 2013).
As shown by Kretch, Franchak, and Adolph (2014), changes
in posture that accompany locomotor development dra-
matically alter infants’ views of the world. That is, by walk-
ing upright, as opposed to crawling, infants transition from
looking mostly at the floor to being able to see their care-
givers and other interesting sites that are in front of them.
These disparate experiences impact how infants engage
with and explore objects, which, in turn, alter their social
interactions with caregivers (Clearfield, 2011; L. B. Smith,
2013). For example, Karasik, Tamis-LeMonda, and
Adolph (2014) documented how infants’ locomotor devel-
opment impacts the quality of child-directed (maternal)
speech by comparing 14-month-olds who were crawlers
with age-matched peers who were already walking. Both
crawling and walking infants often showed interesting
objects to their mothers, yet differed in the extent to which
they made such communicative bids while in motion. Crawl-
ing infants typically showed objects from a stationary posi-
tion (e.g., while seated), whereas walkers more often made
bids while in transit to their mother. This, in turn, im-
pacted how the mothers responded. When infants showed
objects to their mother while in transit, the mother often
replied with an action directive (e.g., Bring it here), which
encouraged further interaction. In contrast, when infants
held up objects from stationary positions, the mother was
more likely to respond with general affirmation or ignore
them. It remains to be determined whether such variation
in the quality of the maternal speech directed to infants
with more versus less advanced motor skills has measur-
able effects on children’s language trajectories.
Conclusions
The current study aimed to link manual dexterity with
specific language abilities (nonword repetition, receptive vo-
cabulary, and receptive grammar) in a community sample of
school-age children. The observed correlations between fine
motor control, language, and nonverbal abilities indicated a
positive manifold across tasks and skills (Kievit et al., 2017;
van der Maas et al., 2006). Regression models indicated a
direct link between manual dexterity and children’s perfor-
mance on a task of nonword repetition and an indirect
link between motor control and receptive vocabulary and
grammar, mediated by nonword repetition. These direct and
indirect relationships were significant after controlling
for nonverbal abilities and age. Taken together, the findings
can be interpreted as providing support for theoretical frame-
works emphasizing a direct link between phonological
development and motor control, as well as frameworks
emphasizing commonalities, as opposed to distinct
mechanisms, underlying acquisition of vocabulary and
grammar.
Given the correlational nature of the dataset and
the likelihood that the observed relationships may be bi-
directional, longitudinal studies are needed to identify the
mechanisms by which motor control impacts language
development. Research is also needed to examine whether
the observed relationships of manual dexterity, nonword
repetition, and nonverbal intelligence extend to expressive,
as opposed to receptive, measures of vocabulary and gram-
mar. Furthermore, given concerns about task impurity, it
would be beneficial for future work to use multiple mea-
sures of manual dexterity and fine motor control, as per-
formance on the grooved pegboard task may be influenced
by decision-making and planning of moves. Identifying
relationships between cognitive, verbal, and motor skills
has theoretical significance and clinical implications. At
a minimum, children with poor motor control should be
screened for possible language difficulties, which can inform
targets for intervention and remediation.
Acknowledgments
The work was conducted with support from a dissertation
grant from Language Learning: A Journal in Language Sciences
(awarded to R. Obeid). Preliminary analyses were presented at
the 2017 Biennial Conference of the Society for Research in Child
Development, Austin, TX. We thank the families for their par-
ticipation and Danielle DeNigris, Alexandria Garzone, Fabienne
Geara, and Jocelyn Philip for their assistance. We thank Anna
Stetsenko, David Rindskopf, Kristen Gillespie-Lynch, Lana Karasik,
and Jarrad Lum for their advice and support during the develop-
ment of this project as a dissertation. We also thank Benjamin
Munson for sharing recordings of nonwords for our adapted non-
word repetition task.
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