A Pilot Exploratory Study to Form Subgroups Using Cluster Analysis of Family Needs Survey Scores for Providing Tailored Support to Parents Caring for a Population-Based Sample of 5-Year-Old Children with Developmental Concerns.

In a population-based developmental screening program, healthcare providers face a practical problem with respect to the formation of groups to efficiently address the needs of the parents whose children are screened positive. This small-scale pilot study explored the usefulness of cluster analysis to form type-specific support groups based on the Family Needs Survey (FNS) scores. All parents (N = 68), who accompanied their 5-year-old children to appointments for formal assessment and diagnostic interviews in the second phase of screening, completed the FNS as part of a developmental questionnaire package. The FNS scores of a full dataset (N = 55) without missing values were subjected to hierarchical and K-means cluster analyses. As the final solution, hierarchical clustering with a three-cluster solution was selected over K-means clustering because the hierarchical clustering solution produced three clusters that were similar in size and meaningful in each profile pattern: Cluster 1-high need for information and professional support (N = 20); Cluster 2-moderate need for information support (N = 16); Cluster 3-high need for information and moderate need for other support (N = 19). The range of cluster sizes was appropriate for managing and providing tailored services and support for each group. Thus, this pilot study demonstrated the utility of cluster analysis to classify parents into support groups, according to their needs.

How does brief guided mindfulness meditation enhance empathic concern in novice meditators?: A pilot test of the suggestion hypothesis vs. the mindfulness hypothesis.

Despite the widespread popularity of mindfulness meditation for its various benefits, the mechanism underlying the meditation process has rarely been explored. Here, we present two preliminary studies designed to test alternative hypotheses: whether the effect of brief guided mindfulness meditation on empathic concern arises from verbal suggestion (suggestion hypothesis) or as a byproduct of an induced mindfulness state (mindfulness hypothesis). Study 1 was a pilot randomized control trial of sitting (breath-and-body) meditation vs. compassion meditation that provided preliminary support for the mindfulness hypothesis. Study 2 was set up to rule out the possibility that the meditation effects observed in Study 1 were the effects of repeated measures. An inactive control group of participants underwent the repeated measures of empathic concern with no meditation in between. The pre-post comparison demonstrated no significant changes in the measures. Thus, the results of two studies supported the mindfulness hypothesis. Limitations of the present study and future research directions are discussed.

Experiences of activity limitations and participation restrictions in individuals with developmental coordination disorder/dyspraxia, their families, and service providers: a qualitative systematic review protocol.

OBJECTIVE: This review aims to synthesize existing qualitative studies on the experiences of activity limitations and participation restrictions in individuals with developmental coordination disorder/dyspraxia, their families, and service providers. INTRODUCTION: Developmental coordination disorder features a significant delay in lifespan motor development, which limits daily activities and restricts participation at home, school, workplace, recreation, and in the community. To date, these activity limitations and participation restrictions have been sporadically characterized in quantitative and qualitative studies. However, the nature of the subjective experiences of activity limitations and participation restrictions has not been systematically reviewed or qualitatively synthesized from the first- and third-person perspectives. INCLUSION CRITERIA: The review will consider qualitative studies with participants who are 5 years of age and above, conducted anywhere in the world. We will exclude studies that are not identifiable through English titles or abstracts in English databases, and non-primary peer-reviewed evidence, such as biographies, newspapers, and magazines. METHODS: Key information sources include CINAHL, PsycINFO, MEDLINE, Embase, ERIC, SPORTDiscus, JSTOR, Soc Index, Project Muse, ProQuest Dissertations and Theses, and OpenGrey. No time or language limits will be placed. Two independent reviewers will screen and retrieve potentially relevant studies in full. The full-text of selected studies will be assessed against the inclusion criteria. All included studies will undergo the assessment of methodological quality, data extraction, and the generation of a single comprehensive set of synthesized findings. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019137616.

Physical Literacy as A Framework of Assessment and Intervention for Children and Youth with Developmental Coordination Disorder: A Narrative Critical Review of Conventional Practice and Proposal for Future Directions.

A framework of literacy may have roles to play in the assessment and treatment of children and youth with developmental disorders. This review aims to evaluate the conventional practice of assessment and treatment for children and youth with a developmental disorder in the physical domain, called developmental coordination disorder (DCD), and explore how the framework of physical literacy could contribute to the advancement of the current practice. This study adopts a method of narrative critical review based on a non-systematic search for its broad coverage to provide insights into the trend and future alternative directions. Over recent decades, children and youth with DCD have been typically assessed with standardized norm-referenced tests, before and after task-oriented intervention, for aiding diagnosis and evaluating the treatment effect. However, a recent high-quality systematic review showed limited evidence for the treatment effect assessed by the tests. Here, a framework of physical literacy is proposed to be used as an alternative to the conventional practice by recalibrating treatment goals and modifying the assessment and intervention approaches; criterion-referenced real-life authentic assessment and activities are encouraged with an emphasis on the enjoyment of movement and value of physical activity towards the attainment of physically active and healthy lifestyle goals from a lifespan perspective. The application of the physical literacy framework to the assessment and treatment of DCD needs to be further examined conceptually and empirically, while exploring a potential contribution of the literacy framework to transform the conventional assessment and treatment of children and youth with other developmental disorders.

Intervention for children with developmental coordination disorder: How robust is our recent evidence?

BACKGROUND: The evaluation of methods of intervention for children with developmental coordination disorder (DCD) is an ongoing process. Systematic and meta-analytical reviews play an important role in this process. Before 2015, only four reviews of this type were published on this topic. By 2019, the number had tripled, raising the question of whether the increase in quantity is accompanied by a similar increase in quality. The aim of this meta-review was to evaluate eight new review studies published during this time period with particular focus on the consistency of the inclusion criteria, the coverage of primary studies and the quality of evidence on which the conclusions were based. METHOD: Methodological quality was evaluated using the Assessment of Multiple Systematic Reviews, Second Edition (AMSTAR 2). RESULTS: The eight reviews differed in the inclusion criteria employed, the sources of primary evidence cited and in the quality of evidence provided. Using AMSTAR 2 terminology, the overall methodology of the reviews was judged to be acceptably high for only one. All others contained serious flaws. The conclusions drawn were not consistent. CONCLUSIONS: In spite of the increase in the number of reviews on intervention for children with DCD, quality remains an issue. Persistent methodological problems mean that consumers still cannot be confident in any of the claims made for intervention effects.

Visual Body Part Representation in the Lateral Occipitotemporal Cortex in Children/Adolescents and Adults.

The lateral occipitotemporal cortex (LOTC) that responds to human bodies and body parts has been implicated in social development and neurodevelopmental disorders like autism spectrum disorder (ASD). Neuroimaging studies using a representational similarity analysis (RSA) revealed that body representation in the LOTC of typically developing (TD) adults is categorized into 3 clusters: action effector body parts, noneffector body parts, and face parts. However, its organization of younger people (i.e., children and adolescents) and its association with individual traits remain unclear. In this functional MRI study, TD adults and children/adolescents observed photographs of hands, feet, arms, legs, chests, waists, upper/lower faces, the whole body, and chairs. The univariate analysis showed that fewer child/adolescent participants showed left LOTC activation in response to whole-body images (relative to those of chairs) than adult participants. Contrastingly, the RSA on both age groups revealed a comparable body representation with 3 clusters of body parts in the bilateral LOTC. Hence, this result indicates that, although response to whole-body images can differ, LOTC body part representations for children/ adolescents and adults are highly similar. Furthermore, sensory atypicality is associated with spatial LOTC organization, suggesting the importance of this region for understanding individual difference, which is frequently observed in ASD.

Altered perspective-dependent brain activation while viewing hands and associated imitation difficulties in individuals with autism spectrum disorder.

Background: Individuals with autism spectrum disorder (ASD) appear to have a unique awareness of their own body, which may be associated with difficulties of gestural interaction. In typically developing (TD) individuals, the perception of body parts is processed in various brain regions. For instance, activation of the lateral occipito-temporal cortex (LOTC) is known to depend on perspective (i.e., first- or third-person perspective) and identity (i.e., own vs. another person's body). In the present study, we examined how perspective and identity affect brain activation in individuals with ASD, and how perspective- and identity-dependent brain activation is associated with gestural imitation abilities. Methods: Eighteen young adults with ASD and 18 TD individuals participated in an fMRI study in which the participants observed their own or another person's hands from the first- and third-person perspectives. We examined whether the brain activation associated with perspective and identity was altered in individuals with ASD. Furthermore, we identified the brain regions the activity of which correlated with gestural imitation difficulties in individuals with ASD. Results: In the TD group, the left LOTC was more strongly activated by viewing a hand from the third-person perspective compared with the first-person perspective. This perspective effect in the left LOTC was significantly attenuated in the ASD group. We also observed significant group differences in the perspective effect in the medial prefrontal cortex (mPFC). Correlation analysis revealed that the perspective effect in the inferior parietal lobule (IPL) and cerebellum was associated with the gestural imitation ability in individuals with ASD. Conclusions: Our study suggests that atypical visual self-body recognition in individuals with ASD is associated with an altered perspective effect in the LOTC and mPFC, which are thought to be involved in the physical and core selves, respectively. Furthermore, the gestural imitation difficulty in individuals with ASD might be associated with the altered activation in the IPL and cerebellum, but not in the LOTC. These findings shed light on common and divergent neural mechanisms underlying atypical visual self-body awareness and gestural interaction in ASD.

Emotions surrounding friendships of adolescents with autism spectrum disorder in Japan: A qualitative interview study.

Emotions are embedded in culture and play a pivotal role in making friends and interacting with peers. To support the social participation of students with autism spectrum disorders (ASD) it is essential to understand their emotional life in the context of ethnic and school cultures. We are particularly interested in how anxiety and loneliness are experienced in developing and maintaining friendships in the daily encounters of adolescents with ASD in the specific context of Japanese schools, because these emotions could serve either as facilitators or barriers to social interaction, depending on how individuals manage them. The present qualitative study investigated perceptions of emotions related to friendship in the everyday school life of 11 adolescents with ASD in Japan. Data were collected by means of semi-structured individual interviews, which revealed a wide range of motivations for socialization, limited future prospects to deepen friendships, robust self-awareness of one's own social challenges, and conscious efforts to cope with these challenges. An inductive approach to data analysis resulted in four themes: social motivation, loneliness, anxiety, and distress. To our knowledge this is the first study to uncover the rich emotional life of adolescents with ASD in the context of their friendships in an Asian culture.

Task-oriented interventions for children with developmental co-ordination disorder.

BACKGROUND: Developmental co-ordination disorder (DCD) is a common childhood disorder, which can persist into adolescence and adulthood. Children with DCD have difficulties in performing the essential motor tasks required for self-care, academic, social and recreational activities. OBJECTIVES: To assess the effectiveness of task-oriented interventions on movement performance, psychosocial functions, activity, and participation for children with DCD and to examine differential intervention effects as a factor of age, sex, severity of DCD, intervention intensity, and type of intervention. SEARCH METHODS: In March 2017, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, 13 other databases, and five trials registers. We also searched reference lists, and contacted members of the mailing list of the International Conference on DCD to identify additional studies. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) and quasi-RCTs that compared the task-oriented intervention with either an inactive control intervention or an active control intervention in children and adolescents aged four to 18 years with a diagnosis of DCD.Types of outcome measures included changes in motor function, as assessed by standardised performance outcome tests and questionnaires; adverse events; and measures of participation. DATA COLLECTION AND ANALYSIS: All review authors participated in study selection, data extraction, and assessments of risk of bias and quality, and two review authors independently performed all tasks. Specifically, two review authors independently screened titles and abstracts to eliminate irrelevant studies, extracted data from the included studies, assessed risk of bias, and rated the quality of the evidence using the GRADE approach. In cases of ambiguity or information missing from the paper, one review author contacted trial authors. MAIN RESULTS: This review included 15 studies (eight RCTs and seven quasi-RCTs). Study characteristicsThe trials included 649 participants of both sexes, ranging in age from five to 12 years.The participants were from Australia, Canada, China, Sweden, Taiwan, and the UK.Trials were conducted in hospital settings; at a university-based clinic, laboratory, or centre; in community centres; at home or school, or both at home and school.The durations of task-oriented interventions were mostly short term (less than six months), with the total number of sessions ranging from five to 50. The length of each session ranged from 30 to 90 minutes, and the frequencies ranged from once to seven times per week.We judged the risk of bias as moderate to high across the studies. Some elements were impossible to achieve (such as blinding of administering personnel or participants). KEY RESULTS: primary outcomesA meta-analysis of two RCTs and four quasi-RCTs found in favour of task-oriented interventions for improved motor performance compared to no intervention (mean difference (MD) -3.63, 95% confidence interval (CI) -5.88 to -1.39; P = 0.002; I2 = 43%; 6 trials, 169 children; very low-quality evidence).A meta-analysis of two RCTs found no effect of task-oriented interventions for improved motor performance compared to no intervention (MD -2.34, 95% CI -7.50 to 2.83; P = 0.38; I2 = 42%; 2 trials, 51 children; low-quality evidence).Two studies reported no adverse effects or events. Through personal correspondence, the authors of nine studies indicated that no injuries had occurred. KEY RESULTS: secondary outcomesDue to the limited number of studies with complete and consistent data, we were unable to perform any meta-analyses on our secondary measures or any subgroup analysis on age, sex, severity of DCD, and intervention intensity. AUTHORS' CONCLUSIONS: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. The conclusions drawn from previous reviews, which unanimously reported beneficial effects of intervention, are inconsistent with our conclusions. This review highlights the need for carefully designed and executed RCTs to investigate the effect of interventions for children with DCD.

Perceptions of a cognitive rehabilitation group by older people living with cognitive impairment and their caregivers: A qualitative interview study.

Cognitive rehabilitation has been developed to improve quality of life, activities of daily living and mood for people with cognitive impairment, but the voice of people with cognitive impairment has been underrepresented. This study aimed to understand the experience of people living with cognitive impairment, as well as their caregivers who took part in a cognitive rehabilitation intervention programme. Twelve individuals with cognitive impairment and 15 caregivers participated in individual qualitative interviews. The interview data were analysed in three steps: 1) familiarisation of the transcripts; 2) identification of themes; 3) re-interpretation, refinement and integration of themes with methodological auditors. Both participants living with cognitive impairment and caregivers valued the comfortable environment with friendly, caring and supportive group leaders who taught practical tips and strategies. The participants living with cognitive impairment enjoyed socialising with like others. Caregivers benefited from learning about memory problems and sharing their challenges with other caregivers. The participants living with cognitive impairment emphasised the benefits of relational and practical aspects, whereas the caregivers valued the informational and emotional support. In conclusion, both participants living with cognitive impairment and caregivers found the cognitive rehabilitation group useful.

Maternal health in pregnancy and associations with adverse birth outcomes: Evidence from Growing Up in New Zealand.

OBJECTIVE: To examine prospectively multiple indicators of pregnancy health and associations with adverse birth outcomes within a large, diverse sample of contemporary women. DESIGN: A cohort of pregnant women who gave birth during 2009-10. POPULATION: We enrolled a sample of 6822 pregnant New Zealand (NZ) women: 11% of all births in NZ during the recruitment period. METHODS: We analysed a number of maternal health indicators and behaviours during pregnancy in relation to birth outcomes using multivariable logistic regression. Associations were described using adjusted odds ratios and 95% confidence intervals. MAIN OUTCOME MEASURES: Three birth outcomes, low birth weight (LBW), pre-term birth (PTB) and delivery type, were measured via linkage with maternity hospital perinatal databases. Small for gestational age (SGA) was then defined as below the 10th percentile by week of gestation. RESULTS: Modelling of birth outcomes after adjusting for confounders indicated patterns of increased risk of LBW and PTB for women who smoke, have elevated pre-pregnancy body mass index (BMI), or with insufficient pregnancy weight gain. SGA was associated with maternal smoking, alcohol use, insufficient weight gain and nausea and vomiting during pregnancy. Risk of caesarean section was associated with having a diagnosed illness before pregnancy, elevated BMI, greater pregnancy weight gain and less pregnancy exercise. Number of risk factor variables were then used to model birth outcomes. Women with multiple risk factors were at increased risk compared with those who had no risk factors. CONCLUSIONS: Women with multiple health risks are at particular risk of adverse birth outcomes.

One-week temporal stability of hyperactivity in preschoolers with ADHD during psychometric assessment.

AIM: To examine the usefulness of temporal measures of motor activity during psychometric assessment on two different assessment days, 1 week apart with a scope to help the early identification of hyperactivity. METHODS: Actigraph measures at the ankle and the waist were compared on the first and the second days of psychometric assessment in a total of 169 children (93 children in ADHD group; 76 children in Non-ADHD group) aged 3 years and 4 years. RESULTS: There was a significant interaction effect between group and time on the activity level at the waist. Although the activity level of the waist in the children with ADHD did not significantly differ between Day 1 and Day 2, the activity level of the children without ADHD declined significantly from Day 1 to 2. A total of 70% of children were correctly classified into ADHD or Non-ADHD groups based only on Day 2 waist activity data. CONCLUSION: The temporal consistency of hyperactivity in young children with ADHD during psychometric assessment is confirmed, indicating that objective measures of motor activity at the waist over different days of psychometric assessment can provide additional information for the stability of hyperactivity.

Meta review of systematic and meta analytic reviews on movement differences, effect of movement based interventions, and the underlying neural mechanisms in autism spectrum disorder.

PURPOSES: To identify and appraise evidence from published systematic and meta analytic reviews on (1) movement differences of individuals with autism spectrum disorders (ASD); (2) the effects of movement based interventions for ASD; (3) hypothesized underlying neural mechanisms for the movement characteristics. METHODS: A meta review of published systematic and meta analytic reviews on movement differences, structural, and functional brain anomalies in ASD and the effects of movement based interventions for individuals with ASD between 1806 and October 2012. The methodological quality of the identified systematic and meta analytic reviews was independently assessed by two assessors with the assessment of multiple systematic reviews (AMSTAR). RESULTS: The search yielded a total of 12 reviews that met the inclusion/exclusion criteria. The methodological quality of the reviews varied, but the review conclusions were similar. Although individuals with ASD generally perform less well than age-matched controls in developmental movement tasks, there are few exceptions whose movement abilities are intact. Most movement based interventions report their efficacies. However, all existing studies employ the research design that is inherently incapable of providing strong evidence, and they often fail to report the extent of psychosocial interactions within the movement interventions. The hypothesized neural mechanisms are still under development and speculative in nature. CONCLUSIONS: It is premature to designate movement disturbance as a core symptom of ASD. The effects of movement based interventions on the present ASD core symptoms need to be further validated by stronger evidence and verified theoretical mechanisms linking ASD with movement disorders.

Early visual experience and the recognition of basic facial expressions: involvement of the middle temporal and inferior frontal gyri during haptic identification by the early blind.

Face perception is critical for social communication. Given its fundamental importance in the course of evolution, the innate neural mechanisms can anticipate the computations necessary for representing faces. However, the effect of visual deprivation on the formation of neural mechanisms that underlie face perception is largely unknown. We previously showed that sighted individuals can recognize basic facial expressions by haptics surprisingly well. Moreover, the inferior frontal gyrus (IFG) and posterior superior temporal sulcus (pSTS) in the sighted subjects are involved in haptic and visual recognition of facial expressions. Here, we conducted both psychophysical and functional magnetic-resonance imaging (fMRI) experiments to determine the nature of the neural representation that subserves the recognition of basic facial expressions in early blind individuals. In a psychophysical experiment, both early blind and sighted subjects haptically identified basic facial expressions at levels well above chance. In the subsequent fMRI experiment, both groups haptically identified facial expressions and shoe types (control). The sighted subjects then completed the same task visually. Within brain regions activated by the visual and haptic identification of facial expressions (relative to that of shoes) in the sighted group, corresponding haptic identification in the early blind activated regions in the inferior frontal and middle temporal gyri. These results suggest that the neural system that underlies the recognition of basic facial expressions develops supramodally even in the absence of early visual experience.

From gestures to words: spontaneous verbal labeling of complex sequential hand movements reduces fMRI activation of the imitation-related regions.

The association of verbal labels with visuo-spatial patterns and sequences detectably alters neuronal activity in the brain in ways that have yet to be fully characterized. This study investigated the neural substrates involved in the effect of spontaneous verbal labeling on memorizing increasingly complex sequences of hand movements. We used functional magnetic resonance imaging (fMRI) to test our hypothesis that when verbal labels were employed, neuronal activity in imitation-related regions, such as the left inferior frontal gyrus (IFG), would be reduced, whereas without verbal labels, neuronal activation would increase. Sixteen healthy adults satisfactorily performed an immediate imitation task involving six levels of increasing complexity. After the fMRI experiment, participants reported at which complexity level they had formed verbal labels. Based on the self-report, we categorized the task blocks at each complexity level as either with verbal labeling (VL+) or without (VL-). Compared with VL+, the VL- condition activated the left IFG, bilateral middle frontal gyri, left precentral gyrus, and the right angular gyrus, whereas the opposite contrast revealed no significant brain activation. Verbal labeling seems to serve as an efficient heuristic that reduces the cost of cortical activation in the imitation-related regions.

Functional connectivity between amygdala and facial regions involved in recognition of facial threat.

The recognition of threatening faces is important for making social judgments. For example, threatening facial features of defendants could affect the decisions of jurors during a trial. Previous neuroimaging studies using faces of members of the general public have identified a pivotal role of the amygdala in perceiving threat. This functional magnetic resonance imaging study used face photographs of male prisoners who had been convicted of first-degree murder (MUR) as threatening facial stimuli. We compared the subjective ratings of MUR faces with those of control (CON) faces and examined how they were related to brain activation, particularly, the modulation of the functional connectivity between the amygdala and other brain regions. The MUR faces were perceived to be more threatening than the CON faces. The bilateral amygdala was shown to respond to both MUR and CON faces, but subtraction analysis revealed no significant difference between the two. Functional connectivity analysis indicated that the extent of connectivity between the left amygdala and the face-related regions (i.e. the superior temporal sulcus, inferior temporal gyrus and fusiform gyrus) was correlated with the subjective threat rating for the faces. We have demonstrated that the functional connectivity is modulated by vigilance for threatening facial features.

A pilot study of family-focused tele-intervention for children with developmental coordination disorder: development and lessons learned.

Developmental coordination disorder (DCD) is characterized by substantial delay in motor development, despite intact neuromuscular, intellectual, and social functions. Although it is estimated there is one child with DCD in every elementary school classroom, sufficient remedial treatment has not yet been provided in medical or educational systems. This article reports on the development of a family-focused tele-intervention program for children with DCD. Unlike conventional direct service delivery, the tele-intervention program offers parents a workbook, DVDs, telephone support, and a blog to teach children at home. This pilot work involved the development of prototype materials (Phase 1), trialing and process evaluation with 3 children and their families (Phase 2), refinement of the program, and a further trial with two other groups of 4 children and their families (Phases 3-4). The outcome of the pilot intervention was satisfactory, but more work is needed to resolve some outstanding issues regarding assessment, diagnosis, telephone consultation, Internet support systems, and discrepant intervention outcomes before tele-intervention is offered to a wider community.

Effect of postural instability on drawing errors in children: a synchronized kinematic analysis of hand drawing and body motion.

To investigate the role that postural stability plays in fine motor control, we assessed kinematics of the head, shoulder, elbow, and the pen during an accuracy drawing task in 24 children. Twelve children were classified into an accurate drawing (AD) group and 12 children into an inaccurate drawing (ID) group based on a manual dexterity task from the movement assessment battery for children [Henderson, S. E., & Sugden, D. A. (1992). Movement assessment battery for children. London: Psychological Corporation.]. Their parents completed a questionnaire to assess children's inattention, hyperactivity, and impulsivity. An electromagnetic tracking system was used to monitor 3-D kinematic data of the body parts, while 2-D kinematic data of pen movement was simultaneously collected from a computer digitizer tablet. If a sudden body motion (1cm/s) occurred within a time window from one second prior to the onset of the drawing error to the end of the error, we considered that the error coincided with the extraneous body movement. For each drawing trial, the coincidence rate was computed as (number of coincidences)/(number of errors). The ID group had a significantly higher coincidence rate of head and shoulder movements compared with elbow movements, whereas coincidence rates did not differ between the three body parts in the AD group. Parental ratings of children's behavioral ratings of inattention, hyperactivity, and impulsivity were not correlated with the coincidence rates. The results indicated that inaccurate drawing was a result of postural instability rather than fidgeting caused by inattention or hyperactivity/impulsivity.

Aging influences on working memory for hand movements: a test of the metamemory deficit hypothesis.

This study examined the role verbal labels play in working memory for hand movements between young and older adults. All young adults formed verbal labels spontaneously to remember hand movements, whereas only 20% of the older adults did so. After instructed to use verbal labels, the older adults performed at a level close to the level of the young adults. These results indicated an age-related decline of the ability to spontaneously recruit a verbal labeling strategy that can be learned and retained. However, there was no significant interaction between age group and instruction, suggesting the need for further investigation into factors other than verbal labels, including the capacity of the visuospatial memory, interference from earlier items, and fatigue.