Motor skills and internalizing problems throughout development: An integrative research review and update of the environmental stress hypothesis research.
Social rejection, not low self-esteem, is the main bridge between poor motor skills and later anxiety—so target peer inclusion first.
01Research in Context
What this study did
Mancini et al. (2019) read every paper they could find on clumsy kids who also feel anxious or sad. They hunted for clues about why poor motor skills and internalizing problems travel together.
The team grouped possible causes into two buckets: inside-the-child factors like low self-esteem, and outside-the-child factors like peer rejection. They then counted which bucket had stronger evidence.
What they found
Social-peer variables won. Studies again and again showed that when kids move poorly, classmates tease or exclude them, and that social pain leads to anxiety or depression.
Self-esteem, IQ, and other inside-the-child traits still mattered, but the data linking them were weaker and less consistent.
How this fits with other research
Papadopoulos et al. (2012) already showed that kids with ASD who struggle with ball skills and balance are also the ones with the worst emotional outbursts. Vincent folds that finding into the bigger story: motor trouble → social trouble → mood trouble.
Chezan et al. (2019) asked, "Can we fix the motor side?" Their review found training boosts balance in kids with ID, but benefits for ball or running skills remain unclear. Vincent’s paper answers the next question: even if we improve balance, we still have to address the peer-rejection piece or anxiety may stay.
Kuang et al. (2025) looked even earlier. Preschoolers at risk for DCD already showed motor gaps, yet their activity levels matched peers. This supports Vincent’s timeline: motor deficit appears first, social consequences bloom later, and emotional fallout follows if we don’t act.
Why it matters
For BCBAs, the message is clear: when you see both clumsiness and anxiety, write goals that get the child accepted, not just coordinated. Embed peer buddies in gross-motor games, script friendly feedback, and teach the group how to cheer effort instead of talent. Motor drills alone are unlikely to dissolve the child’s worry if the social sting remains.
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02At a glance
03Original abstract
BACKGROUND: The Environmental Stress Hypothesis provides a conceptual framework detailing the complex relationship between poor motor skills and internalizing problems. AIMS: This integrative research aimed to synthesize studies that have evaluated complex pathways posited in the framework. METHOD: This study followed the four stages of an integrative research review: (i) problem formation and research aims, (ii) literature search and data collection, (iii) data evaluation and analysis, and (iv) results and discussion. OUTCOMES AND RESULTS: Twelve peer-reviewed, English language studies published within 2010-2018 were identified. These used mostly cross-sectional, correlational methods and provided varying levels of support for relationships posited in the framework in samples spanning early childhood to adulthood. Compared to intrapersonal factors (e.g., self-esteem/ perceived competence), interpersonal factors (e.g., social support, peer problems) were found to more strongly and consistently mediate the relationship between motor skills and internalizing problems. CONCLUSIONS AND IMPLICATIONS: There is growing empirical support for many of the Environmental Stress Hypothesis pathways. However, research to date is limited in the ability to establish causal relationships between variables, which is integral to the Environmental Stress Hypothesis. Intervention studies provide a useful type of experimental research that could establish causality between variables, while working to improve the physical and psychosocial functioning of people with poor motor skills.
Research in developmental disabilities, 2019 · doi:10.1016/j.ridd.2018.07.003