A number of recent studies have found a relationship between poor motor coordination and mental health problems within
community-based samples (Lingam et al., 2012; Rigoli et al., 2017; Wagner, Jekauc, Worth, & Woll, 2016). Specifically, children with
motor coordination problems, such as Developmental Coordination Disorder (DCD), have been found to be at greater risk for internalizing
problems, such as depression and/or anxiety, compared to their typically developing peers (Missiuna et al., 2014; Piek,
Bradbury, Elsley, & Tate, 2008; Skinner & Piek, 2001). This may be due to the fact that their motor difficulties interfere with tasks or
activities of daily living both at home and school (APA, 2013) and further result in a number of other adverse outcomes, such as
negative self-perceptions (Skinner & Piek, 2001), reduced physical activity participation and poor health- related physical fitness
(Cairney & Veldhuizen, 2013). As motor coordination problems early in life are likely to track into adolescence and adulthood, they
have also been linked to symptoms of psychological distress later in life (Piek, Barrett, Smith, Rigoli, & Gasson, 2010; Sigurdsson, Van
Os, & Fombonne, 2002). However, little work has examined the specific reasons or mechanisms behind why children with motor
coordination problems are at risk for mental health issues.
The Environmental Stress Hypothesis (ESH) was developed based on Pearlin’s Stress Process model, which provided a flexible,
generic framework to understand the mediating and/or moderating variables that connect stress to emotional consequences (Pearlin,
1989; Pearlin, Menaghan, Lieberman, & Mullan, 1981). Cairney and colleagues subsequently modified the general model to include
pathways hypothesized to be salient factors that could explain the complex inter-relationships between motor coordination problems
and internalizing problems, such as depression and anxiety (Cairney, Rigoli, & Piek, 2013). In the ESH, internalizing problems are
considered to be mediated and/or moderated by other physical (i.e. physical activity and overweight/obesity) and psychosocial (i.e.
interpersonal conflicts, perceived social support, and self-concept) factors (Cairney et al., 2013). According to this model, DCD is
considered a primary stressor that initiates a cascade of other stressors (i.e., interpersonal conflicts), which negatively impacts other
psychosocial and behavioral risk factors known to be associated with increased symptoms of internalizing problems (Cairney et al.,
2013). For example, it is hypothesized that interpersonal conflicts or poor social relationships may result in lower perceived social
support and negative self-concept, which in turn lead to increased risk for anxiety or depression (Cairney et al., 2013). Physical
inactivity and obesity, both of which are considered to be consequences of DCD (Cairney & Veldhuizen, 2013), may further deteriorate
peer relationships, perceived social support and self-concept, and lead to greater risk for internalizing problems in children
with DCD (Cairney et al., 2013).
Despite evidence from a recent review supporting some of the underlying pathways in the ESH (Mancini, Rigoli, Heritage,
Roberts, & Piek, 2016), there are still significant knowledge gaps with regard to empirically testing the pathways identified in the
model. To date, a limited number of studies have directly examined the relationship between motor coordination problems and
internalizing problems based on the ESH (Li et al., in press; Mancini et al., 2016; Mancini, Rigoli, Roberts, Heritage, & Piek, 2017;
Rigoli, Piek, & Kane, 2012; Wilson, Piek, & Kane, 2013). For example, in a recent study using a community-based sample of children
and youth, Li et al. (in press) found that the relationship between children at risk for DCD and internalizing problems could be
sequentially mediated by physical activity, BMI or global self-worth. Rigoli et al. (2012) and Mancini et al. (2016, 2017) have also
identified the mediating effects of self-perceptions and perceived social support on the relationship between poor motor coordination
and internalizing problems in Australian preschool and school-aged children.
Although prior longitudinal research has also indicated that in both clinical and community populations, motor coordination
difficulties at early ages would have direct effects on emotional or mood problems in adolescence (Wagner et al., 2016), or indirect
effects through social communication skills (Harrowell, Hollen, Lingam, & Emond, 2017), our understanding of the impact of poor
motor coordination on internalizing issues in other populations, specifically young adults, is limited (Rigoli et al., 2017). Moreover,
all potential mediators identified in the ESH (e.g. stress, perceived social support, or self-competence) have yet to be comprehensively
tested in any age group. This includes the direct effects of physical activity and Body Mass Index (BMI) on internalizing problems
(Biddle & Asare, 2011; Hoare, Skouteris, Fuller-Tyszkiewicz, Millar, & Allender, 2014). There is evidence that physical activity may
have both a direct effect on internalizing problems and may also mediate the relationship between DCD and internalizing problems,
in part through its influence on other risk and protective factors. For example, a recent study by McIntyre, Chivers, Larkin, Rose &
Hands, 2015 showed that exercise improved self-perceptions in adolescents with poor motor competence. Li et al. (in press) also
found that physical activity mediated the association between DCD and internalizing problems, but only in school-aged girls (Li et al.,
in press). To our knowledge, no research has investigated the impact of both physical activity and BMI simultaneously on mental
health problems.
Both motor difficulties and internalizing problems (symptoms of depression and anxiety) have been found to track from childhood
through adolescence into adulthood (Rasmussen & Gillberg, 2000). Findings from a 10-year longitudinal study found that the 16-
year-old adolescents who were originally diagnosed as “clumsy” at the age of 6 still experienced difficulties with motor coordination
and reported lower participation in physical education classes while in high school. This same group was also found to have lower
physical self-concept and more emotional and behavioral problems when compared to their typically developing peers (Losse et al.,
1991; Rasmussen & Gillberg, 2000). Despite motor coordination problems likely persisting beyond the transition out of high school,
little research has focused specifically on young adults with these problems (Hill & Brown, 2013; Kirby, Sugden, Beveridge, &
Edwards, 2008). More research investigating the relationship between motor coordination problems and internalizing problems
during the early adulthood period is needed, and the ESH may be a useful framework to begin to understand the predictors of mental
health problems during this developmental period.
The purpose of the present study is to examine the relationship between motor coordination problems and psychological distress
among emerging adults and to explore underlying mechanisms identified in the ESH (i.e., the mediating pathways through physical
Y.-C. Li et al. Research in Developmental Disabilities 84 (2019) 112–121
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activity, BMI, and psychosocial factors). Based on the ESH, we hypothesized that lower levels of motor coordination would be
associated with physical inactivity and higher BMI in young adults, all of which further increase their general stress and poor social
relationships. These primary and secondary stressors would further erode social and personal resources, and consequently, be associated
with increased psychological distress.
2. Material and methods
2.1. Participants and design
This was a cross-sectional study of undergraduate students at a mid-size Canadian university who were recruited for the current
study between January and April 2016. A total of 241 students agreed to participate and responded to the online survey. Participants
with intellectual disability, neurological/musculoskeletal disease, or physical impairments contributing to significant motor difficulties
were excluded from the study (n=1, 0.4%). Data with evidence of potential response bias (e.g., answers were all the same) or
incomplete data (> 50% missing values) were also excluded (n=15, 6.2%). After applying the exclusion criteria, the final study
sample included 225 participants (93.4%). The mean age of the final sample was 19.5 years (SD=1.0, range=17 to 23), and the
majority were female (75.1%), in their first year of study (53.8%), and recruited from the School of Science (53.0%). Ethical approval
was obtained from the Institutional Research Ethics Board.
