Rhythmic motor dual-tasking in children with and without Developmental Coordination Disorder: a systematic review and meta-analysis.

BACKGROUND: Rhythmic motor tasks are often performed while dual-tasking. In typically developing children (TDC), who are still refining their motor skills, and in those with motor difficulties such as Developmental Coordination Disorder (DCD), dual-tasking can lead to reduced performance. OBJECTIVE: This systematic review and meta-analysis aims to 1) summarize current literature on rhythmic motor task execution under single- and dual-task conditions in TDC and children with DCD, and 2) explore how age, type of additional task, and task complexity influence execution under dual-task conditions. METHODS: We included studies comparing single- versus dual-task execution in TDC or children with DCD. We conducted meta-analyses of gait-related spatiotemporal, variability, and balance parameters using Standardized Mean Differences (SMD), and subgroup analyses by age and task type. Additionally, we calculated dual-task effects (DTE), with negative values indicating dual-task costs. Finally, we analyzed studies on non-gait rhythmic motor tasks and DCD descriptively. RESULTS: We included 72 articles on TDC and 5 on DCD, yielding 449 gait parameters for the meta-analysis. In TDC (n = 1825 children), dual-tasking significantly impaired spatiotemporal (SMD = -1.08, P < 0.001, n = 329), variability (SMD = -1.04, P < 0.001, n = 106), and balance (SMD = -0.24, P < 0.05, n = 14) parameters. Cognitive tasks caused greater interference than motor tasks, and temporal adjustments tended to exceed spatial ones. No significant age effect was found. DTE values calculated for 686 gait parameters showed consistent dual-task costs across gait domains. Children with DCD (n = 112) did not show exaggerated execution decrements, although 2 studies reported preliminary evidence for increased mental effort compared to TDC. CONCLUSION: Dual-tasking disrupts spatiotemporal, variability, and balance gait parameters in TDC. In children with DCD, the absence of larger execution decrements alongside possible increased cognitive effort highlights the need to investigate potential compensatory motor control mechanisms. REGISTRATION: PROSPERO (CRD42023459391).