Coordination Difficulties Research Articles

The experiences of foundation doctors with dyspraxia: a phenomenological study

Dyspraxia, otherwise known as Developmental Coordination Disorder (DCD), is a specific learning difficulty (SpLD). Its main difficulties manifest as problems with motor coordination, organisation, academic and social difficulties. There are now more students arriving at university with SpLDs, and, therefore, a similar rise may be expected within medical education. There has been no previous research focusing on dyspraxia in doctors. An interpretive phenomenological approach was used. Six UK foundation schools disseminated the announcements. Three participants took part in loosely structured telephone interviews regarding their experiences of undertaking medical school and foundation school with dyspraxia. These were transcribed verbatim and then thematically analysed. The themes could be split into two main categories: “Weakness and Coping Strategies” and “Perspectives of Dyspraxia”. “Weakness” included: clumsiness, organisation and needing extra time. The participants focused on their “Coping Strategies” that included: Ensuring safety, adapted learning preferences and external support. “Perspectives of Dyspraxia” included: diagnosis, career choice, stigma, “normalisation” and the “difference view” or “medical deficit” view of dyspraxia. Doctors with dyspraxia often mask their difficulties through sophisticated coping strategies. These were determined and hardworking individuals who believe that their dyspraxia was a positive aspect of their identity, adopting a “difference view”. They felt further education is needed about dyspraxia to change the perceived stigma. There is now a need for further research in this area.

The effectiveness of gross motor interventions in improving motor function in childhood apraxia of speech

ABSTRACT Children with Childhood Apraxia of Speech (CAS) often present motor co-ordination difficulties accompanying their speech and sound delays. Therefore, the aim of this study was to investigate the effect of a paired versus a small group gross motor intervention on selected pre-school children, pre-identified with CAS. Children pre-identified with CAS (N = 20) were assessed with the Movement Assessment Battery for Children (MABC-2) and the Test of Gross Motor Development (TGMD-2) during the baseline-, pre- and post-tests. The participants were randomly divided into two groups and completed a 12-week gross motor intervention (two 45-minute sessions per week). There were significant improvements in the total motor proficiency of the MABC-2 as well as overall gross motor quotient (GMQ) of the TGMD-2 in both groups post-intervention. This study highlights the need for further research in gross motor interventions to improve the quality of movement of children, pre-identified with CAS.

Care Coordination Strategies and Barriers during Medication Safety Incidents: a Qualitative, Cognitive Task Analysis.

Medication errors are prevalent in healthcare institutions worldwide, often arising from difficulties in care coordination among primary care providers, specialists, and pharmacists. Greater knowledge about care coordination surrounding medication safety incidents can inform efforts to improve patient safety. To identify strategies that hospital and outpatient healthcare professionals (HCPs) use, and barriers encountered, when they coordinate care during a medication safety incident involving an adverse drug reaction, drug-drug interaction, or drug-renal concern. We asked HCPs to complete a form whenever they encountered these incidents and intervened to prevent or mitigate patient harm. We stratified incidents across HCP roles and incident categories to conduct follow-up cognitive task analysis interviews with HCPs. We invited all physicians and pharmacists working in inpatient or outpatient care at a tertiary Veterans Affairs Medical Center. We examined 24 incidents: 12 from physicians and 12 from pharmacists, with a total of 8 incidents per category. Interviews were transcribed and analyzed via a two-stage inductive, qualitative analysis. In stage 1, we analyzed each incident to identify decision requirements. In stage 2, we analyzed results across incidents to identify emergent themes. Most incidents (19, 79%) were from outpatient care. HCPs relied on four main strategies to coordinate care: cognitive decentering; collaborative decision-making; back-up behaviors; and contingency planning. HCPs encountered four main barriers: role ambiguity and constraints, breakdowns (e.g., delays) in care, challenges related to the electronic health record, and factors that increased coordination complexity. Each strategy and barrier occurred across all incident categories and HCP groups. Pharmacists went to extra effort to ensure safety plans were implemented. Similar strategies and barriers were evident across HCP groups and incident types. Strategies for enhancing patient safety may be strengthened by deliberate organizational support. Some barriers could be addressed by improving work systems.

The degree of stability in motor performance in preschool children and its association with child-related variables.

Understanding the stability of individual differences in motor performance during the early years of life, despite normative age-related growth in motor performance, has important implications for identification of motor coordination difficulties and subsequently, early remediation. Therefore, the aims of the present study were to examine the degree of rank-order and individual-level stability in motor performance in young children with different levels of motor skill proficiency. Subsequently, we explored the influence of child variables (i.e., age, gender, and behavioural self-regulation) on different aspects of stability. In this longitudinal study, a community sample of 68 participants (49% girls) with a mean age of 3years and 11months (SD=7months) were assesses in three six-monthly waves. The total standard score of the Movement Assessment Battery for Children-2 (MABC-2) was used as the measure of motor performance. Rank-order stability was examined with zero-order Pearson correlations. Individual-level stability was examined by means of stability in classifications (at risk for motor coordination difficulties versus typically developing). In addition to examining stability in group classification, the Reliable Change Index (RCI) was calculated to examine if the difference in a child's scores over time exceeded (increased or decreased relative to) the expected change. The results showed moderate to high rank-order stability between time points. No significant differences in degree of rank-order stability were found between boys and girls and between 3-year old and 4-year old children. In terms of stability of classification, it was shown that for ~50% of the children with motor coordination difficulties and~90% of typically developing the classification based on the cut-off score on the MABC-2 was stable. Based on the RCI, over 90% showed individual-level stability. The level of behavioural self-regulation at T1 (as measured with the Head-Toes-Knees-Shoulders task) was not significantly related to individual-level stability in motor performance. In conclusion, our findings highlight the importance of a careful choice of stability measures and a reflection on the implications of their results. More research is needed to understand which child and environmental variables impact on stability.

Scaling up Business Plans in Tajikistan: a qualitative study of the history, barriers, facilitators and lessons learnt

ABSTRACT Background To improve health planning at primary health care (PHC) level, Business Plans were introduced in Tajikistan by the Enhancing Primary Health Care (EPHC) Services Project. Objective To describe the history and process of implementation of Business Plans and to identify barriers, facilitators and lessons learnt from scaling up Business Plans. Methods Set in a qualitative research design, we conducted a desk review of project and official documents and seventeen semi-structured interviews with key stakeholders at national and sub-national levels between May and July 2020. We used an interview guide informed by the ExpandNet/WHO framework and analyzed the data following a content analysis approach facilitated by MAXQDA. Results With the participation of various user organizations and resource teams and through a variety of strategic scale-up choices, Business Plans have been scaled up from a vertical pilot project to institutionalized health management tools covering 45% of Tajikistan’s PHC facilities. The most prominent facilitators for scaling up Business Plans were the institutionalization and integration of the tool into the Tajik health system, the close collaboration with Community Health Teams (CHTs), the high acceptance of the tool among the users, the advocacy through champions and policy-makers and the large dissemination network. The most outstanding barriers to scaling up Business Plans were insufficient financial or human resources, general weaknesses in health governance, the lack of a strategic scale-up plan and strategic decisions, the lack of motivation or overall vision to implement Business Plans at a large scale and difficulties in donor coordination. Conclusion To ensure the continuity of scaling up Business Plans, developing a scale-up strategy, strengthening cross-sectoral collaboration and participation during scaling up, and capacitating the user organizations of Business Plans are important next steps to ensure the sustainability and effectiveness of Business Plans in the future.

Pedagogical performance in the preschool teaching of students with Autism Spectrum Disorder

ABSTRACT Purpose: to describe the panorama of the pedagogical context in the preschool teaching of students with Autism Spectrum Disorder (ASD), in a municipality in the state of São Paulo, Brazil. Methods: 32 teachers, including early childhood education (ECE), special education (SE), and specialized educational assistance (SEA), participated answering a questionnaire about their performance with autistic students. A descriptive qualitative analysis of the data was performed. Results: the average age of the teachers was 40.6 years old, with an undergraduate degree in Teaching, Pedagogy, Special Education, and/or Visual Arts, of which 84.4% were postgraduate. 87.4% knew ASD characteristics; 80%, SEA, 66.7%, SE, 57.1% of ECE teachers had receive the medical report. 78.1% reported difficulties in socialization, communication, behavior, learning; 15.6%, aggressive behavior / irritation; 12.5%, difficulties in attention / concentration; 6.2%, motor coordination difficulties in their autistic students. 62.5% considered that their autistic students had the potential to follow mainstream education; 68.8% received guidance from team professionals; 78.1% participated in courses/lectures on the theme; 28.1% considered they were able to teach autistic children; 78.1% stated that adjustments in the teaching structure were necessary. Conclusion: the scenario of the pedagogical context in the preschool teaching of students with ASD, in the studied municipality, needs reflections. Information on ASD characteristics, training courses, knowledge on individual follow-ups, so that teachers are prepared to promote effective teaching and learning, are needed.

The Effects of Joint Audits on Audit Quality and Audit Costs: A Game-theoretical Explanation for Contradictory Empirical Results

We analyze how auditor expertise and the auditors’ (dis)similarity affect audit quality and audit costs in a joint audit (JA) setting. We model both harmful free-riding incentives and a beneficial synergy effect between auditors. We find that audit quality is high and audit costs are low if both auditors have similarly high expertise. Free riding of one auditor occurs most likely if the auditors are dissimilar. In such a JA situation, allocating more of the audit work to the auditor with high expertise can increase audit quality and decrease audit costs. However, an imbalance in the allocation of the audit work can be harmful if both auditors have similar expertise. We show that JAs can lead to higher audit quality and lower audit costs than single audits (SAs) when synergy effects are sufficiently high. In contrast, low synergy effects (i.e., due to rivalry) can lead to coordination difficulties in JAs and result in lower audit quality and higher costs than SAs. Our game-theoretical analysis provides insights into the effects of institutional parameters like a mandated allocation of the audit work and a proportional litigation rule on the JA outcomes. Our findings thus can help to prevent unintended consequences from a mandatory JA regulation.

Prevalence estimations of comorbid attention deficit hyperactivity disorder and developmental co-ordination disorder in children aged 8 - 9 in KwaZulu-Natal, South Africa

Background. Children diagnosed with attention deficit hyperactivity disorder (ADHD) often encounter motor co-ordination difficulties. Little has been documented about the prevalence of comorbid ADHD and developmental co-ordination disorder (DCD), both in South Africa (SA) and globally. Objective. The purpose of the study was to establish the prevalence and demographics of comorbid ADHD and DCD at 5 sites located within 3 districts of KwaZulu-Natal Province, SA. Methods. A descriptive observational study was undertaken of 151 children aged 8 - 9 years, both male and female, from 4 population groups. The children were clinically diagnosed with ADHD and were receiving remedial education. Children with any other conditions and/or receiving occupational therapy, physiotherapy and/or psychotherapy were excluded. The Conners’ Teacher Rating Scale, the DCD Questionnaire and the Movement Assessment Battery for Children were administered to confirm comorbid ADHD and DCD. Results. A 74% prevalence of comorbid ADHD and DCD was identified, with a male-to-female ratio of 2:1. The combined subtype of ADHD was most commonly associated with comorbid DCD. Conclusion. From the relatively high prevalence figures, it appears that an association between ADHD and DCD exists. Children with ADHD should therefore be assessed for motor skills deficiency and offered appropriate interventions.

A-093 Neuropsychological Functioning in an 8-year-old female with Friedreich’s Ataxia

Abstract Objective An 8-year old female in the 3rd grade was referred for an evaluation due to concerns surrounding attention, academics, and motor skills in the context of Friedreich’s Ataxia (FA). FA is the most common genetically inherited ataxia (Delatycki et al., 2000). Neurocognitively, deficits in processing and motor speed, visuospatial reasoning, and executive function have been documented in FA (Nieto et al., 2012; Mantovan et al., 2006; Schmahmann et al., 1998). This case study expands on the limited literature on the neuropsychological profile of children with FA. Methods Patient was diagnosed with FA in 2014 following genetic testing significant for over 1,000 repeats of the Frataxin gene. She has experienced a steady decline in her gross-, fine-, and oral-motor skills. Patient requires a personal aide at school to ensure safety ambulating and manage her attention and learning challenges. Results Intellectual ability was estimated as average (WISC-V: GAI = 92). She exhibited significant deficits in reading, writing, and mathematics, clustering around an early 1st grade level (WIAT-III). She presented with attention and executive function impairments (CPT-3, TEA-Ch, NEPSY-II). Motor coordination difficulties were characteristic of FA (WRAVMA, Finger Tapper). Conclusion Patient demonstrated deficits in motor coordination, processing speed, attention, and executive function typical of FA, given its cerebellar pathology and impacted corticocerebellar pathways. The etiology of her learning challenges is unknown, as these domains are not typically impacted in FA. Future investigation of the relationship between FA and other neurocognitive domains is warranted.

An Instrumented Assessment of a Rhythmic Finger Task among Children with Motor Coordination Difficulties.

Background: Coordination is crucial for motor function, yet objective clinical evaluations are limited. We therefore developed and tested the reliability and validity of a low-cost sensorized evaluation of a rhythmic finger task. Methods: Children with coordination difficulties (n = 24) and typically developing children (n = 24) aged from 5 to 7 years performed the Sensorized Finger Sequencing Test (SFST), a finger sequencing test that records the correct sequence, total time, and the standard deviation (SD) of touch time. Additionally, motor performance tests and parents’ reports were applied in order to test the reliability and validity of the SFST. Results: The study group had significantly greater thumb-finger test scores—total time in the dominant hand (p = 0.035) and the SD of the touch time in both dominant (p = 0.036) and non-dominant (p = 0.032) hands. Motor performance tests were not correlated with the SFST. Test–retest reliability in 10 healthy children was found for the SD of touch time in the dominant hand (r = 0.87, p = 0.003). Conclusions: The SFST was successful in assessing the movement pattern variability reported in children with motor difficulties. This exploratory study indicates that the low-cost SFST could be utilized as an objective measure for the assessment of proprioception components, which currently are overlooked by standardized motor performance assessments.

Case Report: Obsessive compulsive disorder in posterior cerebellar infarction - illustrating clinical and functional connectivity modulation using MRI-informed transcranial magnetic stimulation

Objectives: We describe atypical and resistant neuropsychiatric clinical manifestations in a young male with posterior cerebellar gliosis. We also attempt to test the mediating role of the cerebellum in the clinical presentation by manipulating the frontal-cerebellar network using MRI-informed transcranial magnetic stimulation (TMS). Methods: A case report of a young adult male describing obsessive-compulsive symptoms, probably secondary to an infarct in the cerebellar right crus II, combined with an examination of behavioral and functional connectivity changes following TMS treatment. Results: Obsessions, compulsions, and pathological slowing were observed in the background of a posterior cerebellar infarct, along with impairments in vigilance, working memory, verbal fluency, visuospatial ability, and executive functions, in the absence of any motor coordination difficulties. These symptoms did not respond to escitalopram. MRI-informed intermittent theta-burst stimulation delivered to the pre-supplementary motor area identified based on its connectivity with the cerebellar lesion in the crus II resulted in partial improvement of symptoms with enhanced within and between-network modularity of the cerebellar network connectivity. Conclusion: We illustrate a case of OCD possibly secondary to a posterior cerebellar infarct, supporting the role of the cerebellum in the pathophysiology of OCD. Functional connectivity informed non-invasive neuromodulation demonstrated partial treatment response. A seriation technique showed extended connectivity of the cerebellar lesion regions following the neuromodulatory treatment.

Co-location of R&D and production in fashion industry

PurposeThe purpose of this paper is to analyze how important is co-location of R&D and production for firms originated from high-cost countries and to provide evidence of the relationship between the different strategies of location choices and co-location.Design/methodology/approachIn order to investigate the relationship between R&D/design-production co-location and strategies of location choices for production, this paper uses a cluster analysis of 37 Italian firms that operate in fashion industry.FindingsThis article finds that co-location results in a dominant strategy for firms under the following conditions: high level of product customization, coordination difficulties between R&D and production, rapid change in production process technologies and product complexity difficult to be coded.Research limitations/implicationsThis paper presents some limitations in that it focuses only on fashion industry without considering other sectors.Practical implicationsThis paper has some managerial implication in that offers some insight on decision making in organization. In particular offers some insights of how important is having an internal R&D/design function rather than collaborating with external designers in order to achieve competitive advantage in terms of product quality, product design and also brand name reputation.Originality/valueThis paper suggests that the co-location of R&D and production may improve the firms' performance considering the need for constant interaction between the two units. Moreover, it suggests that the co-location of R&D and production both within and external (within the firms' region and/or within the country) to the firms might be important. Furthermore, larger firms in terms of turnover have a greater preference to locate the R&D function close to the production function.

PENATAAN ADMINISTRASI KELEMBAGAAN RT 14 DESA BRAJAN, TAMANTIRTO KASIHAN BANTUL

This community service program is based on the fact that RT 14, Brajan, mostly consists of housing areas whose residents rent the houses. This situation creates difficulties in coordination and participants among the residents in various activities. That condition affects the comfort, discipline, cleanliness, and harmony among them. The method applied in this community service program is in the forms of coordination and deliberation towards the residents of RT 14. There are four activities conducted in this program: 1) strengthening organization by formulating job description to the boards of RT; 2) formulating rules and regulations in RT to motivate the residents’ active participations; 3) formulating resident database of RT 14; 4) creating empowering program for the residents. Hopefully, this community service program affects positive feedback to RT. 14 to be actively included in the development of Brajan, Tamantirto, Kasihan, Bantul.

Atypical Sensory Processing Profiles and Their Associations With Motor Problems In Preschoolers With Developmental Coordination Disorder

The aims of this study were to identify sensory processing profiles specific to preschoolers with DCD in a community sample and examine the association of sensory processing problems with motor coordination difficulties in these children. Sixty-three 5-year-old children with DCD and without other neurodevelopmental disorders and 106 age-matched typically developing children participated in this study. Sensory processing problems were assessed using the Sensory Profile. Our results demonstrated problems in wide sensory processing patterns (low registration, sensitivity and avoiding) and areas (auditory, vestibular, touch and oral) in children with DCD compared with typically developing children. Additionally, the association of problems in sensory processing patterns (sensitivity and avoiding) and areas (touch and auditory) with motor coordination difficulties were identified in children with DCD alone. Our findings indicate that sensory processing abnormalities may contribute to the pathophysiology of DCD, suggesting the importance of assessing sensory processing functions in children with DCD.

Cross-Cultural Adaptation and Preliminary Validation of the European Spanish Version of the Developmental Coordination Disorder Questionnaire (DCDQ-ES).

The Developmental Coordination Disorder Questionnaire (DCDQ) is the most widely used measure of difficulties with activities of daily living and academic performance in children with developmental coordination disorder, but this tool has not been adapted for use in Spain. To translate and cross-culturally adapt the DCDQ into European Spanish (DCDQ-ES) for use in assessing motor coordination in Spanish children. Cross-cultural adaptation and preliminary validation study. Community and mainstream schools in Spain. A committee of five experts oversaw the cross-cultural adaptation process. A community-based convenience sample of 31 parents of children ages 5-14 yr was used to test the comprehensibility of the DCDQ-ES. Preliminary reliability was tested with 35 randomly selected parents of children ages 6-12 yr. The DCDQ was translated into European Spanish and cross-culturally adapted following international guidelines. Comprehensibility was assessed using cognitive debriefing interviews. The final version of the DCDQ-ES was used for the reliability analysis. Cultural relevance and equivalence and idiomatic differences between the DCDQ and DCDQ-ES were evaluated. Comprehensibility analysis led to minor modifications that facilitated comprehension and interpretation. Internal consistency and homogeneity of the DCDQ-ES were good (Cronbach's α = .857, corrected item-total correlations = .268-.692). The DCDQ-ES is conceptually and semantically equivalent to DCDQ and was successfully cross-culturally adapted for the European Spanish context. Preliminary data suggest that the DCDQ-ES is a reliable measure of motor coordination in Spanish children. This study provides evidence of the cultural equivalence of the DCDQ-ES for use with Spanish children. Occupational therapists in Spain can use the DCDQ-ES to evaluate children's motor coordination difficulties in everyday activities.

Coordination difficulties and self-esteem: The views of children, adolescents, and their parents.

This study aimed to examine the views of children and adolescents with significant coordination difficulties, and their parents, regarding factors they considered had most supported and hindered the development of their self-esteem (SE). A survey was sent to members of the Dyspraxia Support Group of New Zealand asking participants to prioritise the three factors that had most positively and negatively influenced the development of the young person's SE. Quantitative content analysis was utilised to summarise responses in order to describe main influences. Both groups rated love and support from family as an important factor that had promoted SE. Young people placed more emphasis than parents on friendship and rewarding activities. Parents emphasised the importance of a supportive school environment and the benefits of "diagnosis." Both groups frequently rated aspects directly related to coordination difficulties and bullying as negative influences on SE. The results provide information for young people with coordination difficulties, their parents, and occupational therapists regarding useful strategies for developing healthy SE. Occupational therapists have a critical role in the assessment of children and adolescents with coordination difficulties which leads to better understanding of the young person by others. Additionally, task-oriented treatment approaches are indicated and are likely to lead to increased rates of participation of young people in rewarding activities, including with friends. Further research is required to determine whether these occupational therapy interventions promote increases in SE.

Fallas en la consolidación de redes inter organizacionales

Actualmente se manifiesta una tendencia a la “des-comoditización” de los alimentos, con mayor demanda de productos de calidad, saludables e inocuos. En este contexto, la cooperación en la cadena productiva surge como una estrategia posible para que productores agropecuarios de oferta atomizada amplíen sus capacidades, agreguen valor y logren ventajas competitivas mediante el trabajo en red, frente a otros actores con mayor poder de negociación. La literatura sobre redes inter organizacionales ha enfatizado las ventajas de la cooperación. Sólo recientemente han surgido estudios que analizan fallas de experiencias asociativas bajo un enfoque dinámico, en virtud de la alta tasa de redes que no llegan a consolidarse. Por lo tanto, el presente trabajo procura identificar los factores de fracaso presentes en la etapa de formación y desarrollo de alianzas en la cadena de la carne vacuna del Sudoeste bonaerense, dada la importancia que tiene la ganadería bovina para el desarrollo territorial local y las dificultades de coordinación que tradicionalmente presenta esta cadena en diferentes países. La investigación adopta el método de casos. A partir de entrevistas semi-estructuradas, se observaron como principales factores determinantes: el perfil de los participantes, su rivalidad, la oportunidad del lanzamiento y dificultades de gobernanza.

Psychometric Validation and Reference Norms for the European Spanish Developmental Coordination Disorder Questionnaire: DCDQ-ES.

The Developmental Coordination Disorder Questionnaire (DCDQ) is a widely used and well-validated tool that contributes to the diagnosis of Developmental Coordination Disorder (DCD). The aim of this study was to further analyze the psychometric properties of the European Spanish cross-culturally adapted version of the Developmental Coordination Disorder Questionnaire (DCDQ-ES) in a sample of Spanish children aged 6–11 years and to establish reference norms with respect to age groups. Parents of 540 typically developing children completed the DCDQ-ES. A second sample of 30 children with probable DCD (pDCD) was used to test its discriminant validity. Confirmatory factor analysis supported the original three-factor structure and the internal consistency was excellent (Cronbach’s α = 0.907). Significant differences between age groups were found. The pDCD group scored significantly lower than the reference sample in the three subscales and DCDQ-ES total score (p < 0.001; AUC = 0.872). The DCDQ-ES is a reliable and valid tool for screening motor coordination difficulties in Spanish children and for identifying children with probable DCD. The findings of this research suggest that context-specific cut-off scores should be systematically utilized when using cross-cultural adaptations of the DCDQ. Age-specific cut-off scores for Spanish children are provided.

Decision‐making in multiagency multiteam systems operating in extreme environments

Extreme environments such as disasters are often managed by several teams working towards a shared goal but with unique sub‐goals at individual and team levels. Whilst these multiteam systems provide potential access to a wide pool of knowledge and resources, public inquiries repeatedly highlight coordination difficulties, leading to conflicting decisions and actions. However, limited research has focused on examining the inter‐team processes used to coordinate decisions in situ within extreme environments in order to cross‐validate theory. Accordingly, the following study analyses naturalistic observations conducted during two large‐scale live disaster response exercises in order to examine (1) what inter‐team processes are used to coordinate decisions, and (2) the extent to which they correspond with a linear phase‐based ‘Joint Decision Model’ (JDM) introduced to national UK disaster response guidance. Findings show responders frequently either revert to gathering information rather than progressing to take action, or take action without deliberately considering options, powers, and policies to form a plan. These non‐linear decision processes remain largely similar across both exercises, indicating that the initial implementation of national JDM guidance has not yet led to substantial changes. Further focus is needed to identify mechanisms for improving coordination in practice, including the form and frequency of training required to maintain such complex skills.Practitioner points Difficulties coordinating information, decisions, and actions are repeatedly identified in multiteam systems operating in extreme environments. Limited research has focused on examining inter‐team processes used to coordinate decisions in situ within extreme environments, posing implications for developing targeted interventions. Findings highlight a tendency for multiagency discussions to either revert back to information gathering rather than progressing to form and implement plans, or moving straight from information gathering to implementing decisions without consciously forming plans. Strong leadership is vital for steering multiagency meetings but chairing these complex discussions is a cognitively demanding task.

Do motor coordination and sleep difficulties predict peer functioning in children and adolescents with attention-deficit and hyperactivity disorder after accounting for existing ADHD symptomology?

Children with attention-deficit and hyperactivity disorder (ADHD) are more likely to experience peer problems compared to their non-ADHD peers, though ADHD-specific symptoms only partially explain this association. This study examined whether sleep difficulties and motor coordination problems are additional predictors of peer problems in an ADHD population. An ADHD sample of 72 participants aged 6-14years (M=9.86years, SD=1.79years) was evaluated for an association of peer problems with measures of motor coordination, sleep difficulties as well as ADHD and comorbidity symptoms. Hierarchical multiple regression analysis (HMRA) was used to test the current study aims. Motor coordination, but not sleep difficulties, predicted additional variance in peer problems after controlling for inattention, hyperactivity/impulsivity, internalizing problems, oppositionality, and conduct problems. Poor motor coordination predicts peer problems beyond ADHD symptoms. Clinicians seeking to improve peer functioning in children with ADHD should also consider motor coordination difficulties in addition to existing treatment strategies. Statement of contribution What is already known Children with attention-deficit and hyperactivity disorder (ADHD) experience greater peer problems (i.e., making friends, being victimized, participating in play) than their typically developing peers. Previous studies have attributed this association between ADHD and peer problems to the symptoms of ADHD (i.e., inattention and/or hyperactivity) disrupting the typical trajectory of social development. However, quantitative studies have identified that symptoms of ADHD predict only portion of the variance in a child's peer problems - highlighting that there may be other unique factors that contribute to the higher incidence of peer problems typically observed in this population. What this study adds This study tested whether additional theoretically relevant factors could predict levels of peer problems in children with ADHD beyond the primary symptoms of the disorder. Internalizing symptomatology, conduct problems, oppositionality, motor coordination, and sleep difficulties were added to a regression model already including inattention and hyperactivity symptoms. These factors explained 51% of the variability in peer problems. In this sample of 72 ADHD children, the results of the final model highlighted that only motor coordination and conduct problems remained significant predictors of peer problems - highlighting two potentially important target areas for screening and intervention.