The association between motor coordination, behavior, cognition and brain structure in children: an ABCD study.

UNLABELLED: The prevalence of behavioral and cognitive difficulties in children is high and often remains undetected. Evidence suggests that poor motor coordination may be an early indicator of these difficulties. However, the underlying mechanisms are unknown. This study investigates whether motor coordination is associated with behavioral and cognitive outcomes, and whether white matter microstructure characteristics mediate these relationships. Data from 9342 children participating in the Adolescent Brain Cognitive Development (ABCD) study was analyzed. Children were categorized in two groups: normal (n = 8239; mean age = 9.93; 48.5% female) and poor motor coordination (n = 1103; mean age = 9.88; 42.3% female) based on parent-report. Behavior was assessed using the Child Behavior Checklist, cognitive functioning using the Youth National Institute of Health toolbox, and white matter microstructure using diffusion magnetic resonance imaging. Children with poor motor coordination had significantly more behavioral difficulties, lower cognitive functioning and altered white matter microstructure. White matter microstructure partly mediated the associations between motor coordination and behavioral and cognitive outcomes.These findings underline the importance of early identification of poor motor coordination to support children at risk of broader developmental concerns, including behavioral and cognitive difficulties.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00787-025-02931-2.