Assessing motor proficiency in young adults: The Bruininks Oseretsky Test-2 Short Form and the McCarron Assessment of Neuromuscular Development.

Currently, only two motor tests have norms extending into young adulthood - the McCarron Assessment of Neuromuscular Development (MAND, McCarron 1997) and the Bruininks Oseretsky Test of Motor Proficiency-2 (BOT-2, Bruininks & Bruininks, 2005). Research into the motor difficulties in early adulthood and health outcomes has been impeded because there is no agreed gold standard motor test for this group. The purposes of this study were to compare the discrimination accuracy, classification agreement, and predictive values, and gender distribution and prevalence of each test in identifying motor impairment (MI) in relation to DSM-V diagnostic criteria for DCD. Ninety-one young, healthy adults (M=21.4years, SD=3.3) were recruited. Those classified as MI by each test scored at one standard deviation or more below the overall mean standard score. Small, statistically significant correlations were found between the MAND and BOT-2 SF tests for score rank (r=0.370, p=0.01) and standard score values (r=0.404; p=0.01). The overall decision agreement for non-MI cases was relatively high at 85% but very low for MI cases (4.4%). Unexpectedly, gender was balanced in MI cases. BOT-2 SF identified twice as many MI cases than MAND (13.2% vs 6.6%), yet overall comparative test specificity was high (89%). Predictive values for MAND, compared against BOT-2 SF as the standard, indicated broad independence between these tests and overall, the decision statistics indicated that the two tests identified different adult cohorts with MI. Objective classification of adult motor proficiency using a gold standard assessment tool including complex and ecologically valid tasks is still elusive.

The relationship between motor proficiency and mental health outcomes in young adults: A test of the Environmental Stress Hypothesis.

Growing evidence has highlighted the importance of motor proficiency in relation to psychosocial outcomes including self-perceived competence in various domains, perceived social support, and emotional areas such as anxiety and depression. The Environmental Stress Hypothesis-elaborated (Cairney, Rigoli, & Piek, 2013) is a proposed theoretical framework for understanding these relationships and recent studies have begun examining parts of this model using child and adolescent populations. However, the extent to which the relationships between these areas exist, persist or change during early adulthood is currently unclear. The current study aimed to investigate the Environmental Stress Hypothesis in a sample of 95 young adults aged 18-30years and examined the mediating role of physical self-worth and perceived social support in the relationship between motor proficiency and internalising symptoms. The McCarron Assessment of Neuromuscular Development (McCarron, 1997) was used to assess motor proficiency, the Depression Anxiety Stress Scale (Lovibond & Lovibond, 1995) provided a measure of internalising symptoms, and the Physical Self Perceptions Profile (Fox & Corbin, 1989) and the Multidimensional Scale of Perceived Social Support (Zimet, Dahlem, Zimet, & Farley, 1988) were used to investigate the possible mediating role of physical self-worth and perceived social support respectively. Potential confounding variables such as age, gender and BMI were also considered in the analysis. Structural Equation Modelling revealed that perceived social support mediated the relationship between motor proficiency and internalising symptoms, whereas, the mediating role of physical self-worth was non-significant. The current results provide support for part of the model pathways as described in the Environmental Stress Hypothesis and suggest an important relationship between motor proficiency and psychosocial outcomes in young adults. Specifically, the results support previous literature regarding the significant role of perceived social support for mental well-being and suggest that an intervention that considers social support may also indirectly influence mental health outcomes in young adults who experience movement difficulties.

Gender and motor competence affects perceived likelihood and importance of physical activity outcomes among 14 year olds.

BACKGROUND: Perceptions of the effects of physical activity could facilitate or deter future participation. This study explored the differences between gender and motor competence at 14 years of age in the perceptions of likelihood and importance of physical activity outcomes. METHOD: The sample comprised 1582 14-year-old adolescents (769 girls) from the Western Australian Pregnancy Cohort (Raine) Study. Four motor competence groups were formed from a standardized Neuromuscular Developmental Index score (McCarron 1997). Perceptions of the likelihood and the importance of 15 physical activity outcomes were measured by a questionnaire developed for the NSW Schools Fitness and Physical Activity Survey (Booth et al. 1997). Gender (two) × motor competence (four) analyses of variance and Tukey post hoc were conducted on outcome scores (P < 0.02) using SPSS version 17. RESULTS: Gender differences were found in the perceived likelihood and importance of physical activity outcomes within competition, social friendships and injury domains. Motor competence was significant in the perceived likelihood of physical health (P < 0.001), psychosocial (P < 0.009) and competition (P < 0.002) outcomes, with lower perceptions by the least competent groups. Significantly lower importance was perceived for academic outcomes for 14 year olds categorized with low compared with high motor competence (P < 0.005). Regardless of motor competence and gender, the same health and fun outcomes were ranked the highest in likelihood and the highest in importance. CONCLUSION: Although level of motor competence at 14 years affected the perceived likelihood of health, social and fun outcomes from future participation in physical activity, adolescents highly valued these outcomes, whereas gender affected competition and winning, outcomes that were less valued. Physical activity that promotes these key and valued outcomes may encourage young people's ongoing involvement in physical activity, especially for those at risk of low participation.

Peripheral quantitative computed tomography (pQCT) reveals low bone mineral density in adolescents with motor difficulties.

UNLABELLED: This is the first reported study to describe local bone mineral density, assess parameters of fracture risk and report history of fractures in adolescents with motor difficulties. Motor difficulties evidenced by poor coordination in adolescence should be considered a new risk factor for below-average bone strength and structure and fracture risk. INTRODUCTION: Adolescents with motor difficulties are characterised by poor coordination and low levels of physical activity and fitness. It is possible these deficits translate into below-average bone strength and structure. The objectives of this study were to describe local bone mineral density (BMD), assess parameters of fracture risk (stress-strain index, SSI) and report history of fractures in this group. METHODS: Thirty-three adolescents (13 females), mean age of 14.3 (SD = 1.5) years, with motor difficulties underwent peripheral quantitative computed tomography (pQCT) measurements at proximal (66 %) and distal (4 %) sites of the non-dominant radius (R4 and R66) and tibia (T4 and T66). One sample t test was used to compare Z-scores for total BMD, trabecular density, cortical density and stress strain index (SSI) against standardized norms. RESULTS: Significant differences were present at R4 total density mean Z-score = -0.85 (SD = 0.7, p < 0.001), R66 cortical density mean Z-score = -0.74 (SD = 1.97, p = 0.038), R66 SSI mean Z-score = -1.00 (SD = 1.08, p < 0.001) and T66 SSI mean Z-score = -0.70 (SD = 1.15, p < 0.001). There was a higher incidence of fractures (26.9 %) compared to the normal population (3-9 %). CONCLUSIONS: Motor difficulties in adolescence should be considered a risk factor for below-average bone strength and structure and fracture risk. Strategies are needed to improve bone health in this high-risk-group.

Associations between aggressive behaviour scores and cardiovascular risk factors in childhood.

OBJECTIVE: To examine the influence of aggressive behaviour scores on cardiovascular disease (CVD) risk factors throughout childhood. METHODS: This study utilized cross-sectional and longitudinal data from the Western Australian Pregnancy Cohort (Raine) Study (n = 2900). Aggressive behaviour scores were derived from the Child Behavior Checklist/4-18(CBCL), Youth Self-Report/11-18 (YSR) and Teacher Report Form/6-18 (TRF). CVD risk factors included body mass index (BMI), blood pressure, fasting lipids and homeostasis model of insulin resistance (HOMA-IR). RESULTS: Girls with higher aggressive behaviour scores had higher BMI from 10 years of age (P ≤ 0.001), higher BMI trajectories throughout childhood (P = 0.0003) and at 14 years higher HOMA-IR (P = 0.008). At the 14-year survey, this equated to a difference of 1.7 kg/m2 in the predicted BMI between the extreme CBCL scores in girls (top 5% (CBCL ≥ 17) vs. CBCL score = 0). Boys with higher aggressive behaviour scores had higher BMI at 5 years (P = 0.002), lower diastolic pressure at 14 years (P = 0.002) and lower systolic blood pressure trajectories throughout childhood (P = 0.016). CONCLUSION: Aggressive behaviour influences BMI from early childhood in girls but not boys. If this association is causal, childhood offers the opportunity for early behavioural intervention for obesity prevention.

Body mass index, adiposity rebound and early feeding in a longitudinal cohort (Raine Study).

OBJECTIVE: This study examined the influence of type and duration of infant feeding on adiposity rebound and the tracking of body mass index (BMI) from birth to 14 years of age. METHODS: A sample of 1330 individuals over eight follows-ups was drawn from the Western Australian Pregnancy Cohort (Raine) Study. Trajectories of BMI from birth to adolescence using linear mixed model analysis investigated the influence of age at which breastfeeding was stopped and the age at which other milk was introduced (binomial 4-month cutoff point). A subsample of linear mixed model-predicted BMI was used to determine BMI and age at nadir for early infant feeding groups. RESULTS: Chi-square analysis between early feeding and weight status (normal weight, overweight and obese) groups found a significant difference between thee age at which breastfeeding was stopped (P<0.001) and the age at which other milk was introduced (P=0.011), with a higher proportion of overweight and obese in the < or = 4-month group, even after controlling for maternal education. Using the linear mixed model, the BMI determined was higher over time for the group that was breastfed for < or = 4 months (P=0.015), with a significant interaction effect with the group in which other milk was introduced at < or = 4 months (P=0.011). Using predicted BMI from the linear mixed model, significant differences for nadirs of adiposity rebound between early feeding groups were found (P<0.005). CONCLUSIONS: Early infant feeding was important in the timing of, and BMI at, adiposity rebound. The relationship between infant feeding and BMI remained up to the age of 14 years. Although confounding factors cannot be excluded, these findings support the importance of exclusive breastfeeding for longer than 4 months as a protective behaviour against the development of adolescent obesity.

Dietary patterns and markers for the metabolic syndrome in Australian adolescents.

BACKGROUND AND AIMS: Overweight and other risk factors for cardiovascular disease (CVD) as well as their clustering, are increasingly prevalent among adolescents. We examined dietary patterns, CVD risk factors, and the clustering of these risk factors in 1139 14-year-olds living in Western Australia. METHODS AND RESULTS: Usual dietary intake was assessed using a food frequency questionnaire. Two dietary patterns, 'Western' and 'Healthy', were identified using factor analysis. Associations between these dietary patterns and BMI, waist circumference, systolic blood pressure, fasting levels of serum glucose, insulin, total cholesterol, HDL-C, LDL-C, triglycerides and insulin resistance were assessed using ANOVA. Cluster analysis identified a high risk group (the 'high risk metabolic cluster') with features akin to adult metabolic syndrome. Belonging to the 'high risk metabolic cluster' was examined in relation to dietary patterns using logistic regression, adjusting for aerobic fitness and socio-demographic factors. Higher 'Western' dietary pattern scores were associated with greater odds for the 'high risk metabolic cluster' (p for trend=0.02) and greater mean values for total cholesterol (p for trend=0.03), waist circumference (p for trend=0.03) and BMI (p for trend=0.02) in girls, but not boys. Scores for the 'Healthy' dietary pattern were not related to the 'high risk metabolic cluster' but were inversely associated with serum glucose in boys and girls (p for trend=0.01 and 0.04, respectively) and were positively associated with HDL-C in boys (p for trend=0.02). CONCLUSIONS: Dietary patterns are associated with CVD risk factors and the clustering of these risk factors in adolescence.

The relationship among physical activity, motor competence and health-related fitness in 14-year-old adolescents.

Physical activity, physical fitness and motor competence are important health-related constructs. However, the relationship among them, particularly for children and adolescents, is still unclear. In this study, motor competence (measured by the McCarron Assessment of Neuromuscular Development), pedometer-determined physical activity and physical fitness (aerobic fitness, muscle strength, muscle endurance, flexibility and body composition) were examined in a cohort of 1585 adolescents (771 girls, 814 boys) of mean age 14.06 years. Significant gender differences were observed for all measures except motor competence. Apart from hip and shoulder flexibility, males outperformed females. For both males and females, motor competence was associated with all fitness measures, physical activity was associated only with aerobic fitness and aerobic fitness was associated with physical activity, motor competence, BMI and chest pass. Among males, aerobic fitness was also associated with all other fitness tests. The correlations were, in general, moderate to weak. The results challenge the current focus on physical activity rather than physical fitness as the preferred intervention.

Using the Rasch measurement model to investigate the construct of motor ability in young children.

This paper reports the use of a Rasch measurement model, the Extended Logistic Model of Rasch (Andrich, 1988), to explore the construct of a general motor ability in young children. Data were collected from 332 five and six year old children performing 24 motor skills, including run, hop, balance and ball skills. The data were categorised based on threshold estimates provided by the measurement model. Gender differences in performances on items were hypothesised to contribute to initial item and person misfit for the total sample. The data for boys and for girls were separated and independently analysed resulting in improved item and person fit. Two different, unidimensional scales for boys and for girls were created.

Creating performance categories from continuous motor skill data using a Rasch measurement model.

This paper reports the use of the Extended Logistic Model (ELM) of Rasch (Andrich, 1988), based on Item Response Theory, to validate the reduction of continuous motor skill data to categories of performance. The data were gathered from the performances of 5 and 6 year old children on 24 fundamental movement skills and involved different measurement units such as seconds, centimetres, scores and counts. In order to compare results across all skills the data were collapsed into discrete sets of categories. Several alternative cut-off locations based on normative data were considered. A feature of the ELM is that it can account for correct scoring of the response categories, but only if the threshold estimates derived from the data by the measurement model are correctly ordered in a hierarchical fashion, from lowest to highest. Should this be the case, a valid scoring function has been established. In this study, the data were successfully reduced to three categories based on the 15th and 85th percentile allowing further analysis to proceed.

Letter: Abnormal patency of eustachian tube from oral contraceptives.

PIP: A case report of abnormal patency of the eustachian tube associated with oral contraception use is discussed. The symptoms (autophony) appeared 3 weeks after the patient began using oral contraceptives (OCs) and grew progressively worse to the point where she was afflicted during almost all of her working hours. The treatment results were either unsatisfactory, transient, or resulted in serious complications. Pregnancy caused a dramatic increase in the frequency and duration of the symptoms. It is believed that abnormal eustachian tube patency induced by OC use is more prevalent than reported in the literature.^ieng