AIM To study the value and reliability of an examination of neurological soft-signs, often used in Sweden, in the assessment of children with attention-deficit-hyperactivity disorder (ADHD), by examining children with and without ADHD, as diagnosed by an experienced clinician using the DSM-III-R.
METHODWe have examined interrater reliability (26 males, nine females; age range 5y 6mo-11y), internal consistency (94 males, 43 females; age range 5y 6mo-11y), test-retest reliability (12 males, eight females; age range 6-9y), and validity (79 males, 33 females; age range 5y 6mo-9y).
RESULTSThe sum of the scores for the items on the examination had good interrater reliability (intraclass correlation [ICC] 0.95) and acceptable internal consistency (Cronbach's alpha 0.76). The test-retest study also showed good reliability (ICC 0.91). There were modest associations between the examination and the assessment of motor function made by the physical education teacher (ICC 0.37) as well as from the parents' description (ICC 0.39). The examination of neurological softsigns had a sensitivity of 0.80 and a specificity of 0.76 in predicting motor problems as evaluated by the physical education teacher.
INTERPRETATIONThe reliability and validity of this examination seem to be good and can be recommended for clinical practice and research.Subtle motor problems, often called neurological soft-signs (e.g. mild dysfunction in muscle tone regulation, choreiform dyskinesia, dysdiadochokinesis, difficulties with balance, fine manipulative disability, and difficulties in coordination between right and left arm or leg) have been considered to reflect brain dysfunction. [1][2][3] The assessment of soft-signs has been met with criticism concerning reliability and validity. 4 In their classic work, Touwen and Kalverboer have described detailed methods for examining children of different ages. 5 Uslu et al. 6 used the Neurological Examination for Subtle Signs to differentiate clinical groups with attention-deficithyperactivity disorder (ADHD), specific learning disorders, and ADHD combined with learning disorders, from comparison groups and from each other. The term of developmental coordination disorder (DCD) 1 is applied if the patient has difficulties with motor coordination that interfere significantly with academic achievement or activities of daily living. Different assessment methods for the evaluation of DCD have been developed, 1,7-11 of which some (like the so-called Motor Development as a Basis for Learning [MUGI] examination used in the present study) have been used by physical education teachers in school settings. 12 In the Nordic countries, the concept of deficits in attention, motor control, and perception 13 has been used and is defined as a condition in which ADHD and DCD are both present.1 Hadders-Algra 14 has described two types of minor neurological dysfunction: simple (children with fewer symptoms at an early age, mild hypotonia and choreiform dyskinesia just before puberty, with mild or low level learning and behavio...