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Childhood clumsiness and peer victimization: a case–control study of psychiatric patients
© Bejerot and Humble; licensee BioMed Central Ltd. 2013
Received: 2 March 2012
Accepted: 19 February 2013
Published: 25 February 2013
Poor motor and social skills as well as peer victimization are commonly reported in both ADHD and autism spectrum disorder. Positive relationships between poor motor and poor social skills, and between poor social skills and peer victimization, are well documented, but the relationship between poor motor skills and peer victimization has not been studied in psychiatric populations.
277 patients (133 males, 144 females), mean age 31 years, investigated for ADHD or autism spectrum disorder in adulthood and with normal intelligence, were interviewed about childhood peer victimization and examined for gross motor skills. The parents completed a comprehensive questionnaire on childhood problems, the Five to Fifteen. The Five to Fifteen is a validated questionnaire with 181 statements that covers various symptoms in childhood across eight different domains, one of them targeting motor skills. Regression models were used to evaluate the relationship between motor skills and the risk and duration of peer victimization, adjusted for sex and diagnosis.
Victims were described as more clumsy in childhood than their non-victimized counterparts. A significant independent association was found between reportedly poor childhood gross motor skills and peer victimization (adjusted odds ratio: 2.97 [95% confidence interval: 1.46-6.07], n = 235, p = 0.003). In adulthood, the victimized group performed worse on vertical jumps, a gross motor task, and were lonelier. Other factors that were expected to be associated with peer victimization were not found in this highly selected group.
Poor gross motor skills constitute a strong and independent risk factor for peer victimization in childhood, regardless of sex, childhood psychiatric care and diagnosis.
Peer victimization  includes both confrontational behavior and relational forms of aggression (e.g., gossip and ostracism) and is a major problem in schools worldwide. At any given point, approximately 12% of children aged 8–13 are affected . Associated risk factors for being victimized are low socioeconomic status, belonging to a minority group, being overweight, being perceived as deviant (e.g. physical appearance), learning disabilities, poor social skills (e.g., p rovocative behaviors and behaviors that indicate vulnerability) [3, 4] and feeling lonely . Victims are at risk for future psychiatric disorders including anxiety disorders, depression, suicidality, and psychosis [5–8]. However, it is uncertain whether peer victimization is the sole cause of these disorders or whether early signs of the disorder cause social skills deficits and subsequent victimization . Undoubtedly, peer victimization increases the likelihood of becoming ill. A range of preventive methods has been used to reduce peer victimization, but most target the environment rather than focus on at-risk children .
Children with autism spectrum disorder (ASD) or attention-deficit hyperactivity disorder (ADHD) are at increased risk for being victimized by peers [11, 12], presumably explained by the poor social skills that are integrated in the clinical presentation. However, poor social skills often coincide with poor motor skills in neurodevelopmental disorders , despite no direct linkage between global cognitive functioning and motor behavior . Motor development status has gained little interest in psychiatric research but may provide a valuable link to understanding the underlying mechanisms or physiological components of mental states .
Children with emotional, behavioral, and pervasive developmental disorders often exhibit gross motor problems . Approximately 50% of children with ADHD [17, 18] and 60-80% of children with ASD have poor motor coordination [19, 20] compared with 6% in the general population . Conversely, poor motor skills have been shown to be a risk factor for anxiety [22, 23]. In ADHD, coexisting clumsiness determines a particularly poor psychosocial prognosis  and is associated with more autistic traits . Subtle motor signs in children tend to diminish before puberty. The persistence of motor signs into adulthood may indicate atypical neurological development .
In healthy subjects, an association between poor motor skills and peer victimization has been reported. However, these studies were based on retrospective reports from individuals at low risk for peer victimization and motor problems (i.e., healthcare workers across Sweden , Swedish university students , and Dutch youths . Based on clinical experience, we hypothesized that poor motor skills and social skills deficits may represent different aspects of shared neurodevelopmental dysfunction [30–32]. In such a case, either or both could serve as risk factors for peer victimization and thereby constitute targets for preventive measures [28, 29]. Possibly, assessments of motor skills problems are less stigmatizing and more reliable than those of poor social skills.
In the present study, psychiatric patients assessed for ASD or ADHD, disorders known to have a high prevalence of both motor and social skill problems in addition to peer victimization, were examined to explore the relationships between these factors. We hypothesized that there would be a positive association between peer victimization and poor motor skills, independent of psychiatric diagnosis and established risk factors for peer victimization.
All of the patients were assessed with a standardized research protocol to collect data on various aspects of adults with neurodevelopmental disorders. This included a diagnostic interview completed by a board-certified psychiatrist and psychologist. The assessment procedure took 12–18 h to complete over a period of 2–3 weeks. A parent, or in a few cases a significant other, was interviewed in person about early signs of ASD and ADHD based on the instrument Five to Fifteen (FTF) [33, 34]. This questionnaire includes neuropsychiatric symptoms noted by parents when the child was between 5 and 15 years of age. It was sent home to the parent prior to the first visit and the results were discussed with the parent and patient together at the consultation with the psychiatrist. The FTF comprises 181 statements that can be endorsed as “does not apply” (= 0), “applies sometimes or to some extent” (= 1), or “definitely applies” (= 2). The items are organized into 22 subdomains that compose eight general domains: motor skills, executive functioning, perception, memory, language, learning, social skills, and emotional/behavioral problems. The “motor skills” domain contains two subdomains: gross motor skills and fine motor skills. Individual items are shown in the Appendix. In this study the parents’ endorsement of gross motor problems in childhood is equated with “clumsiness”, and social skills problems are equated with “poor social skills.”
Assessment of peer victimization
Peer victimization was assessed using a specific question: “Have you ever been bullied?” If the answer was “Yes,” then the patient was asked whether the peer victimization was regarded as “a little” (i.e., notable to the patient but not necessarily known all over school) or “a lot” (i.e., clearly notable to people around) and during which time span it occurred (i.e., in nursery school, primary school [7–9 years old, 10–12 years old, 13–15 years old], or upper secondary school [16–19 years old]).
The psychiatrist conducted a physical examination that included motor function prior to determining the diagnosis of the patient. Gross motor coordination was observed during hopping with alternating vertical jumps and swinging the arms forward on the contralateral side. This was scored as “normal” (= 0; i.e., no difficulty accomplishing the task), “slightly abnormal” (= 1; i.e., difficulty coordinating the arms and legs), or “clearly abnormal” (= 2; i.e., great difficulty and only able to do at most three dis-coordinated hops). A score of 1 or 2 on this test was defined as “abnormal.”
Diagnose specific assessments
A number of assessments were used for assisting in the diagnostic procedures for ASD and ADHD. The Autism Spectrum Screening Questionnaire (ASSQ), a 27-items screening tool for detecting high functioning children with ASD, was completed by a parent . The Asperger Syndrome Diagnostic Interview (ASDI) , a highly structured diagnostic interview, comprising 20 different items including assessment of social impairment, narrow interests, repetitive routines, speech and language peculiarities, non-verbal communication problems, and motor clumsiness was used for almost all patients (n = 258). For a substantial group (n = 229) the self-rated Autism-Spectrum Quotient (AQ)  was also administered. All patients with a possible ADHD were assessed with a structured interview for ADHD, the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS), which covers attention difficulties, hyperactivity/restlessness, temper, affective liability, emotional over-reactivity, disorganization, and impulsivity in adulthood . The Wender Utah Rating Scale (WURS) was used in order to capture childhood symptoms of ADHD .
In addition, general functioning was assessed using the Global Assessment of Functioning (GAF) ranging from 0 to 100 , and depression was measured with the Montgomery-Åsberg Depression Rating Scale . Wechsler Adult Intelligence Scale, neuropsychological version, (WAIS III and WAIS III-NI) was used in order to identify intellectual disability. In those few cases where WAIS was not administrated, a high educational level excluded mental retardation. Personality traits were assessed using the screening version of Structured clinical interview for DSM-IV (SCID II Screen) and with the Swedish universities Scales of Personality .
Population characteristics in peer victimized and non-victimized patients
Victimized (n = 177)
Non- victimized (n = 100)
χ 2 ( d. f.)
Male, % (n)
Female, % (n)
Age, median (SD)
Autism spectrum disorder, % (n)
ADHD, % (n)
Other psychiatric disorder, % (n)
Poor gross motor skills in adulthood, % (n)†
Poor gross motor skills in childhood, % (n)††
Intelligence Quotient, total mean (SD) a
Body Mass Index, median (lower quartile; upper quartile) b
23.7 (21; 27)
22.6 (20; 26)
Single, % (n)
Highest educational level, % (n) c
Upper secondary school
Unfinished compulsory school
Working full day (i.e., ≥ 70%), % (n) d
Seeing friends, % (n)
Once weekly to once monthly
< Once monthly
Previous childhood psychiatric care, % (n) e
Previous psychiatric hospitalization, % (n) f
Previous treatment in psychiatric care, median months (lower quartile; upper quartile) g
24 (5; 72)
16 (1; 36)
Previous depression, % (n) h
Present antidepressant treatment, % (n) i
Data from this cohort on the outcome of central stimulant treatment in ADHD patients  and on psychiatric comorbidity in adults with ASD  have previously been reported. Approved written consent to use the information in research was obtained from the patients, and ethical approval was obtained from the Ethics Review Board, Karolinska hospital in Stockholm.
The peer victimized group consisted of all participants who reported having been bullied in nursery school or school, regardless of severity and duration of the peer victimization. Dichotomous variables were analyzed using the Pearson χ 2 test. Spearman’s rank correlation test was used to assess the correlations between motor skills and various domains on the FTF, with a significance level p < 0.001.
Five to Fifteen scores retrospectively reported by the parents of 235 adult psychiatric patients and odds ratios for peer victimization, bivariately unadjusted and adjusted ( n = 210) for sex, diagnosis (ASD, ADHD, or other), previous child psychiatric treatment, and educational level
n = 149
n = 86
(male, 79; female, 70)
(male, 38; female, 48)
(95% confidence intervals)
(95% confidence intervals)
Group means(± SD) of subdomain mean scores
Five to Fifteen subdomain
Gross motor skills
Fine motor skills
Planning and organizing
Relation in space
Expressive language skills
Coping in learning
Previous child psychiatric treatment
Peer victimization rates
Of the total sample, 64% (68% of the males and 60% of the females) reported that peers had victimized them in childhood. Most afflicted were individuals diagnosed with ASD, 83% of whom had been victimized. This rate was markedly higher than the rate among those with ADHD (53%) or those with other psychiatric diagnoses (57%). Of those who were victimized at any time period, 69% were also victimized during at least one additional period, confirming the repetitiveness of the experience.
In our sample, education, civil status, employment status, GAF, Body Mass Index in adulthood, Intelligence Quotient, current depressive symptoms, antidepressant treatment, and history of childhood psychiatric care did not differ between the victims and non-victims groups. However, those with a history of being victimized were lonelier compared with the non-victimized group (Table 1).
Risk for peer victimization in relation to childhood neuropsychiatric symptoms
Impaired visual perception was similarly associated with an increased risk for peer victimization (unadjusted odds ratio 2.00, 95% confidence interval: 1.10-3.63); however, none of the other domains of the FTF was associated with an increased odds ratio for peer victimization in the bivariate regression. In this particular cohort, externalizing and attention problems reported on the FTF, suggesting ADHD, seemingly decreased the risk of being victimized. In Table 2, the odds ratios for peer victimization associated with the various FTF domains (as continuous variables), sex, previous child psychiatric treatment, diagnosis, and educational level are presented, showing an almost three-fold increased risk of being victimized by peers among those with poor gross motor skills in childhood.
In an ordinal logistic regression model, with the number of time spans of peer victimization as the dependent variable, poor gross motor skills in childhood remained an independent risk factor when sex, diagnosis (i.e., ADHD, ASD, and other), and sex × diagnosis interactions (which turned out non-significant) were introduced in the model. The association between poor gross motor skills in childhood and number of peer victimization periods had an odds ratio of 1.78 (95% confidence interval: 1.13-2.79; n = 227, p = 0.013).
Correlations between motor problems, visual perception and other childhood symptoms, as measured with the Five to Fifteen
Strong correlations were found between gross motor skills in childhood and body perception (ρ (n = 232) = 0.57, p < 0.0001), fine motor skills (ρ (n = 235) = 0.55, p < 0.0001), and social skills in childhood (ρ (n = 233) = 0.51, p < 0.0001). Visual perception correlated strongly with fine motor skills (ρ (n = 230) = 0.55, p < 0.0001) and body perception (ρ (n = 228) = 0.53, p < 0.0001). Weaker correlations, but highly significant, were found between vertical jumps in adulthood and gross motor skills in childhood (ρ (n =168) = 0.26, p = 0.0008), body perception (ρ (n =166) = 0.29, p = 0.0002), and social skills in childhood (ρ (n =168) = 0.25, p = 0.0009).
Gross motor dysfunction in relation to peer victimization and diagnosis
Of those with impaired gross motor function (i.e., poor vertical jump performance), 75% had been victimized by peers in childhood compared with 59% of those with normal performance (χ 2 (df =1) = 6.01, p = 0.01, n = 206, unadjusted odds ratio 2.22 [95% confidence interval: 1.15-4.28]).
In this study, we showed that childhood motor clumsiness, reported by parents, and poor performance in a simple motor test, assessed in adulthood, are strongly associated with childhood peer victimization, as reported by adult psychiatric patients. This association remained when diagnosis was controlled for. The present study extends previous findings to psychiatric patients at substantial risk for social and motor skills problems and peer victimization. Additionally, the clumsiness retrospectively reported by the parents was often observable in adulthood as poor vertical jump performance, suggesting deviant cerebellar development. Moreover, impaired visual perception, but none of the other domains of the FTF, was similarly associated with increased odds for peer victimization. A strong link between motor and visuospatial deficits exists both in the general population and in clumsy children . Thus the fact that "gross motor skills" and "visual perception" were the only two domains from the FTF that showed an association with increased peer victimization strengthens our findings.
Cerebellar dysfunction in neurodevelopmental disorders
Motor deficits in children with ADHD and ASD are well documented [30, 45, 46], and comorbidity between ASD, ADHD, and developmental coordination disorder has long been recognized . Children with a combination of motor coordination deficits and ADHD have less favorable outcomes and more autistic traits , including perceptual problems, supporting the concepts of Deficits in Attention, Motor control, and Perception (“DAMP”) [25, 30] and Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (“ESSENCE”) . This also supports the idea that atypical brain development can explain the interrelatedness between these disorders .
Although motor abnormalities are common in ADHD and ASD and pivotal for the diagnosis of developmental coordination disorder, the underlying neurophysiologic impairments and type and persistence of motor problems appear to vary between the diagnostic groups and subgroups. Research in adults with ASD suggests a combination of cerebellar and basal ganglia deficits , and imaging studies of ASD and ADHD have consistently found cerebellar abnormalities [50–52]. The cerebellum controls sensorimotor coordination and is critical to timing computations in both motor and non-motor tasks . Working memory, the shifting of attention, implicit learning, emotional regulation, executive function and facial recognition all depend on cerebellar functioning [50, 54]. Moreover, symptoms of cerebellar lesions resemble the typical impairments of ASD .
In this study, the parents reported poor social skills in the majority of the cases (victims and non-victims), consistent with the social deficits related to ASD and to some extent to ADHD. However, poor gross motor skills in childhood but not poor social skills predicted peer victimization in the present study. Because poor social skills are frequent in both ADHD and ASD [56, 57], this by itself may explain the increased risk for peer victimization compared with normal controls [11, 12, 58]. Nevertheless, we propose that poor gross motor functioning constitutes an independent risk factor for peer victimization across various populations, regardless of provocative behaviors or anxiousness. Poor motor skills may manifest as impaired social skills, thereby contributing to peer victimization. Success in social interaction is largely a matter of timing and harmonious integration of verbal and non-verbal cues. In other words, cerebellar function may be critical for social success. Impairments in social functioning could be viewed as disintegrated motor skills, reflected by subtle aberrations in facial expressions, gaze, pitch, prosody, wording, posture, gestures, turn-taking, and sense of appropriate physical distance. Even slight signs of impairment, registered at a subliminal level, may affect others’ judgments and determine whether the person will be viewed as socially “normal” and attractive as a companion or considered “strange” and result in social exclusion or peer victimization. Preadolescents and adolescents are exceptionally sensitive to deviations , are easily embarrassed , and strive to conform to their peers [59, 61], possibly explaining why peer victimization peaks in the preteen years . We suggest that motor skills are associated with social likeability and that poor skills may contribute to the loneliness in adulthood reported by the victims in this study. Thus, the feeling of loneliness often reported by bullied children  seems to continue into adulthood.
Another possible explanation for our findings could be the close association between poor motor skills and visual perceptual dysfunction. Visual perceptual dysfunction has been shown to be associated with the number of co-occurring disorders in children with developmental coordination disorder  and contribute to poor outcome in preterm born babies  and in children with hyperopia . Poor motor skills without visual perception dysfunction may represent a dimension of normality whereas the combination of the two reflects a neurological dysfunction with increased risk for social exclusion, and/or cognitive, behavioral and emotional disability. In a study on adults with either social phobia or obsessive-compulsive disorder (OCD), childhood peer victimization was much more often reported in the OCD group . Although both disorders have similar ages of onset, chronicity, and relationships with avoidant personality, OCD differs from social phobia by being associated with motor problems and soft neurological signs [67–69], including deficits in visuospatial skills . Interestingly, poor visuospatial skills predicted persistence in pediatric-onset OCD .
Associated risk factors
None of the established factors previously shown to be associated with peer victimization (e.g., education level, civil status, employment, general functioning, overweight, intelligence, reported social skills, internalization, depression, and antidepressant treatment) were implicated in this study. Notably, however, childhood Body Mass Index data were not obtained. By studying a sample at high risk for peer victimization, risk factors beyond the expected may be revealed, such as poor gross motor skills. Hence, our lack of findings about the established risk factors cannot be generalized to normally developing children.
Psychiatric patients are often targets of peer victimization in childhood. Bullying amongst normally developing children peaks in the pre teens, but children with both poor gross motor skills and psychiatric problems have often been bullied for a prolonged period of time. Prolonged peer rejection tends to result in poor self-esteem and may decrease the ability to appeal to others. In adult psychiatric patients a history of poor gross motor skills and peer victimization in childhood may indicate a severe and pervasive neuropsychiatric disorder with social skills deficits. In such cases the clinician should be aware that a range of support and treatments often are indicated.
Simple assessments of motor skills in pre school children should be helpful for identifying children at risk. Furthermore, the possibility should be explored whether early intervention programs using specialized physical education adapted for ‘clumsy’ children (e.g. ) reduce the risk of loneliness and peer rejection.
The patient group studied here may be perceived as marginal; on the other hand ADHD is not by any means a rare disorder in adults. ADHD has a chronic course in approximately 4% of the adult population  and can be diagnosed in almost one of four adult psychiatric outpatients [74, 75]. Concerning ASD, the prevalence rate in the general population exceeds 1% , and ASD frequently co-occurs with other psychiatric disorders. In a recent study, 70% of adults with ASD had experienced at least one episode of major depression . Possibly, the co-occurring disorders draw the clinician’s attention, whereas ADHD and ASD often remain un-diagnosed.
Nevertheless, this study has several limitations, partially due to lack of relevant instruments and the naturalistic setting. First, our retrospective use of FTF could interfere with the results, as the FTF was designed to be filled out by parents, when evaluating their children. Consequently, since parents may forget earlier signs of problematic behavior, false-negative responses may constitute a problem. However, false positive results seem less likely. In our experience, the parents recalled signs of atypical development remarkably well and our results are consistent with a previous report on children with ASD and ADHD that used the FTF . Secondly, we did not use any specific definition of peer victimization, but the concept of bullying is well known , and the patients never questioned the meaning of the wording. They knew whether or not they were victimized by peers and remembered how long it lasted and who where the perpetrators. Being victimized by peers is such a traumatic experience that it may reside as a humiliating memory throughout one’s life. Although some children may deny being victimized by peers or belittle it as “teasing”, we question whether this bias prevails into adulthood. In fact, self-reports of peer victimization by adults may be more reliable than children’s self-reports because the shame that hindered them in childhood may eventually subside. In this study we did not inquire about type of bullying that the participants had experienced, which is another limitation. Most of the participants were in their preteens during the eighties and nineties, thus cyber bullying had not emerged on the scene yet. The three-point scale to determine severity used in this study is not a validated method for measuring severity. However, the question is straightforward and the responses were dichotomized in the analyses; thus the peer victim group consisted of all participants who reported being bullied, regardless of severity. Attrition was partially attributed to the fact that many patients were originally investigated at other clinics and only referred to us for medication, thus providing a smaller proportion of patients to examine. Of the total sample, 21% were not included in the study because of missing data. However, no significant demographic differences were found between these individuals and those included in the study.
Some children are persistently victimized during childhood, which is associated with poor mental health. Risk factors for peer victimization need to be identified to protect the most vulnerable children from feeling rejected, offended, and increasingly marginalized. In this study, poor gross motor skills in childhood predicted peer victimization among psychiatric patients assessed for ADHD or ASD in adulthood. We propose that poor motor functioning constitutes an independent and strong risk factor for peer victimization. Conceivably, subclinical cerebellar dysfunctions are perceived by others at a subliminal level. Subtle dys-coordinated behaviors may then give the impression of “awkwardness” and not fitting in, leading to peer rejection.
These findings may be useful for developing methods to protect and empower vulnerable children, which is a challenge for future research emphasizing the need for longitudinal intervention studies.
Five to Fifteen (FTF)
Gross motor skills
Difficulty acquiring new motor skills
Difficulty throwing and catching a ball
Difficulty running fast and smoothly
Difficulty/does not like to participate in game sports
Has balance problems
Often trips and falls
Has clumsy movements
Fine motor skills
Has difficulty drawing
Difficulty manipulating small objects
Difficulty pouring water into a glass
Often spills food onto clothes when eating
Difficulty using knife and fork
Difficulty buttoning buttons/tying shoe-laces
Difficulty using a pen
Has not developed clear hand-dominance
Writing is slow and awkward
Has immature pen-grip
This study was founded through the regional agreement for support for research between Stockholm County Council (ALF) and Karolinska Institutet, Stockholm, Sweden and The Swedish Medical Research Council (Grant No 523-2011-3646). The funders did not interfere with the study design, the data collection, data analysis or manuscript preparation or decisions on the manuscript. We thank the staff at the former neuropsychiatric unit at the St. Göran hospital, Jan Kowalski for statistical support and Eva Hesselmark and Christina Arlinde for technical support. We also want to express our gratitude towards all patients who agreed to sign up for the study.
- Hawker DS, Boulton MJ: Twenty years' research on peer victimization and psychosocial maladjustment: a meta-analytic review of cross-sectional studies. J Child Psychol Psychiatry. 2000, 41: 441-455. 10.1111/1469-7610.00629.View ArticlePubMedGoogle Scholar
- Hunter SC, Boyle JM, Warden D: Perceptions and correlates of peer-victimization and bullying. Br J Educ Psychol. 2007, 77 (Pt 4): 797-810.View ArticlePubMedGoogle Scholar
- Salmon G, West A: Physical and mental health issues related to bullying in school. Curr Opin Psychiatry. 2000, 13: 375-380. 10.1097/00001504-200007000-00003.View ArticleGoogle Scholar
- Lumeng JC, Forrest P, Appugliese DP, Kaciroti N, Corwyn RF, Bradley RH: Weight status as a predictor of being bullied in third through sixth grades. Pediatrics. 2010, 125: e1301-e1307. 10.1542/peds.2009-0774.View ArticlePubMedPubMed CentralGoogle Scholar
- Arseneault L, Bowes L, Shakoor S: Bullying victimization in youths and mental health problems: 'much ado about nothing'?. Psychol Med. 2010, 40: 717-729. 10.1017/S0033291709991383.View ArticlePubMedGoogle Scholar
- Fekkes M, Pijpers FI, Fredriks AM, Vogels T, Verloove-Vanhorick SP: Do bullied children get ill, or do ill children get bullied? a prospective cohort study on the relationship between bullying and health-related symptoms. Pediatrics. 2006, 117: 1568-1574. 10.1542/peds.2005-0187.View ArticlePubMedGoogle Scholar
- Mackie CJ, O'Leary-Barrett M, Al-Khudhairy N, Castellanos-Ryan N, Struve M, Topper L, Conrod P: Adolescent bullying, cannabis use and emerging psychotic experiences: a longitudinal general population study. Psychol Med. 2012, 7: 1-12.Google Scholar
- Copeland WE, Wolke D, Angold A, Costello EJ: Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry. 2013, 20: 1-8.Google Scholar
- Fox CL, Boulton MJ: The social skills problems of victims of bullying: self, peer and teacher perceptions. Br J Educ Psychol. 2005, 75: 313-328. 10.1348/000709905X25517.View ArticlePubMedGoogle Scholar
- Rigby K, Slee P: Interventions to reduce bullying. Int J Adolesc Med Health. 2008, 20: 165-183.View ArticlePubMedGoogle Scholar
- Cappadocia MC, Weiss JA, Pepler D: Bullying experiences among children and youth with autism spectrum disorders. J Autism Dev Disord. 2012, 42: 266-277. 10.1007/s10803-011-1241-x.View ArticlePubMedGoogle Scholar
- Sofronoff K, Dark E, Stone V: Social vulnerability and bullying in children with Asperger syndrome. Autism. 2011, 15: 355-372. 10.1177/1362361310365070.View ArticlePubMedGoogle Scholar
- Gillberg C, Kadesjö B: Why bother about clumsiness? the implications of having developmental coordination disorder (DCD). Neural Plast. 2003, 10: 59-68. 10.1155/NP.2003.59.View ArticlePubMedPubMed CentralGoogle Scholar
- Wassenberg R, Feron FJ, Kessels AG, Hendriksen JG, Kalff AC, Kroes M, Hurks PP, Beeren M, Jolles J, Vles JS: Relation between cognitive and motor performance in 5- to 6-year-old children: results from a large-scale cross-sectional study. Child Dev. 2005, 76: 1092-1103. 10.1111/j.1467-8624.2005.00899.x.View ArticlePubMedGoogle Scholar
- Denckla MB: Revised neurological examination for subtle signs. Psychopharmacol Bull. 1985, 21: 773-800.PubMedGoogle Scholar
- Emck C, Bosscher R, Beek P, Doreleijers T: Gross motor performance and self-perceived motor competence in children with emotional, behavioral, and pervasive developmental disorders: a review. Dev Med Child Neurol. 2009, 51: 501-517. 10.1111/j.1469-8749.2009.03337.x.View ArticlePubMedGoogle Scholar
- Kadesjö B, Gillberg C: Attention deficits and clumsiness in Swedish 7-year-old children. Dev Med Child Neurol. 1998, 40: 796-804.View ArticlePubMedGoogle Scholar
- Kopp S, Beckung E, Gillberg C: Developmental coordination disorder and other motor control problems in girls with autism spectrum disorder and/or attention-deficit/hyperactivity disorder. Res Dev Disabil. 2010, 31: 350-361. 10.1016/j.ridd.2009.09.017.View ArticlePubMedGoogle Scholar
- Dewey D, Cantell M, Crawford SG: Motor and gestural performance in children with autism spectrum disorders, developmental coordination disorder, and/or attention deficit hyperactivity disorder. J Int Neuropsychol Soc. 2007, 13: 246-256.View ArticlePubMedGoogle Scholar
- Ghaziuddin M, Butler E, Tsai L, Ghaziuddin N: Is clumsiness a marker for Asperger syndrome?. J Intellect Disabil Res. 1994, 38: 519-527.View ArticlePubMedGoogle Scholar
- APA: Diagnostic and statistical manual of mental disorders. 1994, Washington (DC): American Psychiatric Press, 4Google Scholar
- Sigurdsson E, Van Os J, Fombonne E: Are impaired childhood motor skills a risk factor for adolescent anxiety? results from the 1958 U.K. Birth cohort and the national child development study. Am J Psychiatry. 2002, 159: 1044-1046. 10.1176/appi.ajp.159.6.1044.View ArticlePubMedGoogle Scholar
- Shaffer D, Schonfeld I, O'Connor PA, Stokman C, Trautman P, Shafer S, Ng S: Neurological soft signs. Their relationship to psychiatric disorder and intelligence in childhood and adolescence. Arch Gen Psychiatry. 1985, 42: 342-351. 10.1001/archpsyc.1985.01790270028003.View ArticlePubMedGoogle Scholar
- Rasmussen P, Gillberg C: Natural outcome of ADHD with developmental coordination disorder at age 22 years: a controlled, longitudinal, community-based study. J Am Acad Child Adolesc Psychiatry. 2000, 39: 1424-1431. 10.1097/00004583-200011000-00017.View ArticlePubMedGoogle Scholar
- Reiersen AM, Constantino JN, Todd RD: Co-occurrence of motor problems and autistic symptoms in attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2008, 47: 662-672. 10.1097/CHI.0b013e31816bff88.View ArticlePubMedGoogle Scholar
- Cole WR, Mostofsky SH, Larson JC, Denckla MB, Mahone EM: Age-related changes in motor subtle signs among girls and boys with ADHD. Neurology. 2008, 71: 1514-1520. 10.1212/01.wnl.0000334275.57734.5f.View ArticlePubMedPubMed CentralGoogle Scholar
- Bejerot S, Humble M: Relevance of motor skill problems in victims of bullying. Pediatrics. 2007, 120: 1226-1227. 10.1542/peds.2007-2187.View ArticlePubMedGoogle Scholar
- Bejerot S, Edgar J, Humble MB: Poor performance in physical education - a risk factor for bully victimization. A case–control study. Acta Paediatr. 2011, 100: 413-419. 10.1111/j.1651-2227.2010.02016.x.View ArticlePubMedGoogle Scholar
- Jansen DE, Veenstra R, Ormel J, Verhulst FC, Reijneveld SA: Early risk factors for being a bully, victim, or bully/victim in late elementary and early secondary education. The longitudinal TRAILS study. BMC Public Health. 2011, 11: 440-10.1186/1471-2458-11-440.View ArticlePubMedPubMed CentralGoogle Scholar
- Gillberg C: Deficits in attention, motor control, and perception: a brief review. Arch Dis Child. 2003, 88: 904-910. 10.1136/adc.88.10.904.View ArticlePubMedPubMed CentralGoogle Scholar
- Cummins A, Piek JP, Dyck MJ: Motor coordination, empathy, and social behaviour in school-aged children. Dev Med Child Neurol. 2005, 47: 437-442. 10.1017/S001216220500085X.View ArticlePubMedGoogle Scholar
- Wagner MO, Bös K, Jascenoka J, Jekauc D, Petermann F: Peer problems mediate the relationship between developmental coordination disorder and behavioral problems in school-aged children. Res Dev Disabil. 2012, 33: 2072-2079. 10.1016/j.ridd.2012.05.012.View ArticlePubMedGoogle Scholar
- Kadesjö B, Janols LO, Korkman M, Mickelsson K, Strand G, Trillingsgaard A, Gillberg C: The FTF (five to fifteen): the development of a parent questionnaire for the assessment of ADHD and comorbid conditions. Eur Child Adolesc Psychiatry. 2004, 13 (Suppl 3): 3-13.PubMedGoogle Scholar
- Korkman M, Jaakkola M, Ahlroth A, Pesonen AE, Turunen MM: Screening of developmental disorders in five-year-olds using the FTF (five to fifteen) questionnaire: a validation study. Eur Child Adolesc Psychiatry. 2004, 13 (Suppl 3): 31-38.PubMedGoogle Scholar
- Ehlers S, Gillberg C, Wing L: A screening questionnaire for Asperger syndrome and other high-functioning autism spectrum disorders in school age children. J Autism Dev Disord. 1999, 29: 129-141. 10.1023/A:1023040610384.View ArticlePubMedGoogle Scholar
- Gillberg C, Råstam M, Wentz E: The Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI): a preliminary study of a new structured clinical interview. Autism. 2001, 5: 57-66. 10.1177/1362361301005001006.View ArticlePubMedGoogle Scholar
- Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E: The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord. 2001, 31: 5-17. 10.1023/A:1005653411471.View ArticlePubMedGoogle Scholar
- Reimherr FW, Marchant BK, Strong RE, Hedges DW, Adler L, Spencer TJ, West SA, Soni P: Emotional dysregulation in adult ADHD and response to atomoxetine. Biol Psychiatry. 2005, 58: 125-131. 10.1016/j.biopsych.2005.04.040.View ArticlePubMedGoogle Scholar
- Ward MF, Wender PH, Reimherr FW: The Wender Utah rating scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry. 1993, 150: 885-890.View ArticlePubMedGoogle Scholar
- Montgomery SA, Åsberg M: A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979, 134: 382-389. 10.1192/bjp.134.4.382.View ArticlePubMedGoogle Scholar
- Gustavsson JP, Bergman H, Edman G, Ekselius L, von Knorring L, Linder J: Swedish universities Scales of Personality (SSP): construction, internal consistency and normative data. Acta Psychiatr Scand. 2000, 102: 217-225. 10.1034/j.1600-0447.2000.102003217.x.View ArticlePubMedGoogle Scholar
- Bejerot S, Rydén EM, Arlinde CM: Two-year outcome of treatment with central stimulant medication in adult attention-deficit/hyperactivity disorder: a prospective study. J Clin Psychiatry. 2010, 71: 1590-1597. 10.4088/JCP.09m05168pur.View ArticlePubMedGoogle Scholar
- Rydén E, Bejerot S: Autism spectrum disorder in an adult psychiatric population. A naturalistic cross sectional controlled study. Clin Neuropsychiatry. 2008, 5: 13-21.Google Scholar
- Wilson PH, McKenzie BE: Information processing deficits associated with developmental coordination disorder: a meta-analysis of research findings. J Child Psychol Psychiatry. 1998, 39: 829-840. 10.1017/S0021963098002765.View ArticlePubMedGoogle Scholar
- Barkley RA, DuPaul GJ, McMurray MB: Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. J Consult Clin Psychol. 1990, 58: 775-789.View ArticlePubMedGoogle Scholar
- Piek JP, Dyck MJ, Nieman A, Anderson M, Hay D, Smith LM, McCoy M, Hallmayer J: The relationship between motor coordination, executive functioning and attention in school aged children. Arch Clin Neuropsychol. 2004, 19: 1063-1076. 10.1016/j.acn.2003.12.007.View ArticlePubMedGoogle Scholar
- Gillberg C: The ESSENCE in child psychiatry: early symptomatic syndromes eliciting neurodevelopmental clinical examinations. Res Dev Disabil. 2010, 31: 1543-1551. 10.1016/j.ridd.2010.06.002.View ArticlePubMedGoogle Scholar
- Kaplan B, Crawford S, Cantell M, Kooistra L, Dewey D: Comorbidity, co-occurrence, continuum: What's in a name?. Child Care Health Dev. 2006, 32: 723-731. 10.1111/j.1365-2214.2006.00689.x.View ArticlePubMedGoogle Scholar
- Rinehart NJ, Bellgrove MA, Tonge BJ, Brereton AV, Howells-Rankin D, Bradshaw JL: An examination of movement kinematics in young people with high-functioning autism and Asperger's disorder: further evidence for a motor planning deficit. J Autism Dev Disord. 2006, 36: 757-767. 10.1007/s10803-006-0118-x.View ArticlePubMedPubMed CentralGoogle Scholar
- Cherkasova MV, Hechtman L: Neuroimaging in attention-deficit hyperactivity disorder: beyond the frontostriatal circuitry. Can J Psychiatry. 2009, 54: 651-664.PubMedGoogle Scholar
- Enticott PG, Bradshaw JL, Iansek R, Tonge BJ, Rinehart NJ: Electrophysiological signs of supplementary-motor-area deficits in high-functioning autism but not Asperger syndrome: an examination of internally cued movement-related potentials. Dev Med Child Neurol. 2009, 51: 787-791. 10.1111/j.1469-8749.2009.03270.x.View ArticlePubMedGoogle Scholar
- Pagani M, Manouilenko I, Stone-Elander S, Odh R, Salmaso D, Hatherly R, Brolin F, Jacobsson H, Larsson SA, Bejerot S: Brief report: alterations in cerebral blood flow as assessed by PET/CT in adults with autism spectrum disorder with normal IQ. J Autism Dev Disord. 2012, 42: 313-318. 10.1007/s10803-011-1240-y.View ArticlePubMedGoogle Scholar
- Keele SW, Ivry R: Does the cerebellum provide a common computation for diverse tasks? a timing hypothesis. Ann N Y Acad Sci. 1990, 608: 179-207. 10.1111/j.1749-6632.1990.tb48897.x.View ArticlePubMedGoogle Scholar
- D'Agata F, Caroppo P, Baudino B, Caglio M, Croce M, Bergui M, Tamietto M, Mortara P, Orsi L: The recognition of facial emotions in spinocerebellar ataxia patients. Cerebellum. 2011, 10 (3): 600-610. 10.1007/s12311-011-0276-z.View ArticlePubMedGoogle Scholar
- Stoodley CJ, Schmahmann JD: Evidence for topographic organization in the cerebellum of motor control versus cognitive and affective processing. Cortex. 2010, 46: 831-844. 10.1016/j.cortex.2009.11.008.View ArticlePubMedPubMed CentralGoogle Scholar
- Murray-Close D, Hoza B, Hinshaw SP, Arnold LE, Swanson J, Jensen PS, Hechtman L, Wells K: Developmental processes in peer problems of children with attention-deficit/hyperactivity disorder in the multimodal treatment study of children with ADHD: developmental cascades and vicious cycles. Dev Psychopathol. 2010, 22: 785-802. 10.1017/S0954579410000465.View ArticlePubMedPubMed CentralGoogle Scholar
- Szatmari P, Bartolucci G, Bremner R: Asperger's syndrome and autism: comparison of early history and outcome. Dev Med Child Neurol. 1989, 31: 709-720.View ArticlePubMedGoogle Scholar
- Holmberg K, Hjern A: Bullying and attention-deficit- hyperactivity disorder in 10-year-olds in a Swedish community. Dev Med Child Neurol. 2008, 50: 134-138. 10.1111/j.1469-8749.2007.02019.x.View ArticlePubMedGoogle Scholar
- Rich Harris J: The nurture assumption. Why children turn out the way they do. 1999, New York, NY: Simon & Schuster IncGoogle Scholar
- Wolman BB: Adolescence: biological and psychosocial perspectives. 1998, Westport, CT: Greenwood Publishing group, Inc., 35Google Scholar
- Schave D, Schave B: Early adolescence and the search for self: a developmental perspective. 1989, New York, NY: Praeger PublishersGoogle Scholar
- Nansel TR, Overpeck M, Pilla RS, Ruan WJ, Simons-Morton B, Scheidt P: Bullying behaviors among US youth: prevalence and association with psychosocial adjustment. JAMA. 2001, 285: 2094-2100. 10.1001/jama.285.16.2094.View ArticlePubMedPubMed CentralGoogle Scholar
- Crawford SG, Dewey D: Co-occurring disorders: a possible key to visual perceptual deficits in children with developmental coordination disorder?. Hum Mov Sci. 2008, 27: 154-169. 10.1016/j.humov.2007.09.002.View ArticlePubMedGoogle Scholar
- Marlow N, Hennessy EM, Bracewell MA, Wolke D: Motor and executive function at 6 years of age after extremely preterm birth. Pediatrics. 2007, 120: 793-804. 10.1542/peds.2007-0440.View ArticlePubMedGoogle Scholar
- Atkinson J, Anker S, Nardini M, Braddick O, Hughes C, Rae S, Wattam-Bell J, Atkinson S: Infant vision screening predicts failures on motor and cognitive tests up to school age. Strabismus. 2002, 10: 187-198. 10.1076/stra.10.3.187.8125.View ArticlePubMedGoogle Scholar
- Bejerot S, Mörtberg E: Do autistic traits play a role in the bullying of obsessive-compulsive disorder and social phobia sufferers?. Psychopathology. 2009, 42: 170-176. 10.1159/000207459.View ArticlePubMedGoogle Scholar
- Conde Lopez V, de la Gandara Martin JJ, Blanco Lozano ML, Cerezo Rodriguez P, Martinez Roig M, de Dios FA: Minor neurological signs in obsessive-compulsive disorders. Actas Luso Esp Neurol Psiquiatr Cienc Afines. 1990, 18: 143-164.PubMedGoogle Scholar
- Purcell R, Maruff P, Kyrios M, Pantelis C: Neuropsychological deficits in obsessive-compulsive disorder: a comparison with unipolar depression, panic disorder, and normal controls. Arch Gen Psychiatry. 1998, 55: 415-423. 10.1001/archpsyc.55.5.415.View ArticlePubMedGoogle Scholar
- Kuelz AK, Hohagen F, Voderholzer U: Neuropsychological performance in obsessive-compulsive disorder: a critical review. Biol Psychol. 2004, 65: 185-236. 10.1016/j.biopsycho.2003.07.007.View ArticlePubMedGoogle Scholar
- Savage CR, Rauch SL: Cognitive deficits in obsessive-compulsive disorder. Am J Psychiatry. 2000, 157: 1182-1183. 10.1176/appi.ajp.157.7.1182.View ArticlePubMedGoogle Scholar
- Bloch MH, Sukhodolsky DG, Dombrowski PA, Panza KE, Craiglow BG, Landeros-Weisenberger A, Leckman JF, Peterson BS, Schultz RT: Poor fine-motor and visuospatial skills predict persistence of pediatric-onset obsessive-compulsive disorder into adulthood. J Child Psychol Psychiatry. 2011, 52: 974-983. 10.1111/j.1469-7610.2010.02366.x.View ArticlePubMedPubMed CentralGoogle Scholar
- Piek JP, McLaren S, Kane R, Jensen L, Dender A, Roberts C, Rooney R, Packer T, Straker L: Does the animal Fun program improve motor performance in children aged 4–6 years?. Hum Mov Sci. 2012, doi:pii: S0167-9457(12)00118-2Google Scholar
- Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenaere K, De Girolamo G, Haro JM, Karam EG, Lara C, Lépine JP, Ormel J, Posada-Villa J, Zaslavsky AM, Jin R: Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry. 2007, 190: 402-409. 10.1192/bjp.bp.106.034389.View ArticlePubMedGoogle Scholar
- Nylander L, Holmqvist M, Gustafson L, Gillberg C: ADHD in adult psychiatry. Minimum rates and clinical presentation in general psychiatry outpatients. Nord J Psychiatry. 2009, 63: 64-71. 10.1080/08039480802416323.View ArticlePubMedGoogle Scholar
- van Emmerik-van OK, van de Glind G, van den Brink W, Smit F, Crunelle CL, Swets M, Schoevers RA: Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug Alcohol Depend. 2012, 22: 11-19.View ArticleGoogle Scholar
- Kim YS, Leventhal BL, Koh YJ, Fombonne E, Laska E, Lim EC, Cheon KA, Kim SJ, Kim YK, Lee H, Song DH, Grinker RR: Prevalence of autism spectrum disorders in a total population sample. Am J Psychiatry. 2011, 168: 904-912. 10.1176/appi.ajp.2011.10101532.View ArticlePubMedGoogle Scholar
- Lugnegård T, Hallerbäck MU, Gillberg C: Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Res Dev Disabil. 2011, 32: 1910-1917. 10.1016/j.ridd.2011.03.025.View ArticlePubMedGoogle Scholar
- Olweus D: Bullying at school: what we know and what we can do. 1993, Oxford: Blackwell PublishersGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/13/68/prepub
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