Effectiveness of a Summer Camp Intervention for Children with Developmental Coordination Disorder

ABSTRACT

Background: Developmental coordination disorder (DCD) significantly affects a child's motor abilities and negatively impacts their self-efficacy and participation in physical activity. Using a task-specific approach and cognitive strategies in a group setting, we designed a summer camp intervention for children with DCD. Aims: Our purpose was to examine the effectiveness of the summer camp in meeting child-chosen functional motor goals and increasing self-efficacy and participation. Methods: This mixed methods study examined performance and satisfaction of child-chosen goals, self-efficacy, and participation of 11 children before and after the camp. Survey and interview data from three children and nine parents were collected to supplement quantitative findings. Results: Statistically significant improvement in performance and satisfaction of child-chosen goals was noted. While no measureable changes in self-efficacy and participation were observed, parents and children reported positive benefits to camp participation, including the confidence to try new activities, being with other children with DCD, and learning more about the disorder. Conclusion: The intensive, group-based summer camp may offer a valuable alternative to improve the functional skills of children with DCD, while providing other notable benefits.     

Entwicklungsbedingte Koordinationsstörungen und Lernverhalten

Developmental coordination disorders (DCD) are among the most common disorders in childhood. They are characterized by deficits in fine and gross motor skills without any sensory, neurological, or cognitive causation. Criterion B of the classification systems DSM-IV-TR and ICD-10 underscores the negative impact of DCD on school performance. The development of adequate social and learning behaviors is an important developmental task of preschool children and clears the way for a successful school career. Current studies state that children with DCD often show comorbid cognitive deficits as well as impairments of their social and learning behaviors. Therefore, a higher risk exists that these children will not accomplish their developmental tasks successfully. The early diagnosis and treatment of DCD is very important in order to counter learning difficulties.     

Developmental coordination disorder: A review and update

Present in approximately 5–6% of school-aged children, developmental coordination disorder (DCD) is a neuromotor disability in which a child's motor coordination difficulties significantly interfere with activities of daily living or academic achievement. These children typically have difficulty with fine and/or gross motor skills, with motor performance that is usually slower, less accurate, and more variable than that of their peers. In this paper, we review the history of various definitions leading up to the current definition of DCD, prevalence estimates for the disorder, etiology, common co-morbidities, the impact of DCD on the child's life, and prognosis. As well, we briefly describe current interventions for children with the disorder and results of recent neuroimaging studies of the brains of children with DCD, including research by the authors of this paper.     

Health Promotion in a Low-income Primary School: Children with and Without DCD Benefit,but Differently

ABSTRACT

Poor motor performance and reduced physical fitness are characteristic of children with Developmental Coordination Disorder (DCD). These features have also been identified more frequently among children living in low socio-economic circumstances. Aims: To evaluate the outcomes of a nine-week health promotion program (HPP) on the motor performance and fitness levels of children (6–10 years) with and without DCD attending a low-income primary school. Methods: The HPP was designed and implemented by undergraduate physiotherapy students using guidelines from the World Health Organization School Health Initiative and their physiotherapy curriculum. Children with DCD (n = 22) and a control group without DCD (n = 19) participated in the evaluation. Motor skill, functional strength, aerobic capacity, and anaerobic power were measured at baseline and after nine weeks. Results: Both groups of children improved on all measures at the conclusion of the HPP. Children with DCD showed greater improvement than the control group in motor performance and the control group showed greater improvement on one of the anaerobic fitness outcomes. Conclusions: A school-based HPP that focuses on increasing opportunities for physical activity may be effective in improving motor performance in children with DCD and can increase fitness levels in general.     

Motor coordination impairment and migraine in children: a new comorbidity?

Migraine without aura (MoA) could be considered the most frequent form of primary headache in children, associated with many known comorbidities, but only the recent literature has begun to consider the importance of motor impairment linked to the attacks. The developmental coordination disorder (DCD) is a very common problem among children, with a prevalence ranging up to 19?%. The aim of this study was to evaluate the presence of motor coordination impairment in a population of children affected by MoA, and its role as putative risk factor for motor skills impairment. This observational study was performed in the Clinic of Child and Adolescent Neuropsychiatry of the Second University of Naples. MoA was diagnosed according to the International Classification of Headache Disorders (IHS-2) criteria. The study population consisted of 27 patients affected by MoA (16 females, 11 males) (mean age: 8.7?±?2.15 years) and 59 typically developing children (34 females, 25 males) (mean age: 8.0?±?2.1 years). The whole population underwent a clinical evaluation in order to assess the total IQ level, the visual motor integration skills, and the presence of DCD. Our results showed that MoA children had more impairments in motor coordination (p?<?0.001) and visual motor integration (p?<?0.001) than control group. To our knowledge, this is the first study to assess the association of poor motor coordination and MoA in children using objective measurements. These findings suggest a new perspective in the management of migraine disease in children, pinpointing that the relationship between DCD and migraine could represent a not yet understood or identified comorbidity, even if further reports are necessary, and that migraine probably could be considered not only a painful syndrome in future.     

Developmental coordination disorder in extremely low birth weight children at nine years

Developmental coordination disorder (DCD) is defined as an impairment in the development of motor coordination that interferes with academic achievement or activities of daily living (DSM-IV). DCD has been reported to affect 5% to 9% of children in the normal population. This study describes the prevalence of DCD in a cohort of extremely low birth weight children (ELBW, < or = l800 g) at 8.9 years of age, from which were excluded children with major impairments. Seventy-three children were included in the study group, along with 18 term-born, socially matched controls. Of the 73 ELBW children, 37 (51%) were classified as having DCD. ELBW children with DCD also had significantly lower Performance IQ (PIQ) scores and were more likely (43%) to have a learning difficulty in arithmetic than ELBW children who did not have DCD. This study found that DCD is a common problem in school-aged ELBW children.     

Multidisciplinary Assessment of Children with Developmental Coordination Disorder: Using the ICF Framework to Inform Assessment

The aim of this study was to describe relationships in young children with motor coordination problems between measures of motor, functional, self-efficacy, and communication administered by a multidisciplinary team and the fit of these measures within the framework of the International Classification of Functioning, Disability and Health (ICF) (). Sixty children, 40 males and 20 females, with mean age 72.5 months (SD = 11.4 months) referred to a university physiotherapy clinic met the inclusion criteria for developmental coordination disorder (DCD). Each measure provided a different perspective of performance when considered within the framework of the ICF. The findings suggest caution when using the Movement Assessment Battery for Children (M-ABC) for the purpose of diagnosis with young referred children, since 25 of the 60 children scored > 15th percentile, despite demonstrating motor deficits at home and school. Further research is needed to address assessment at the participation level. Viewing children from the multiple perspective of each discipline highlights the range of challenges faced by children with DCD.     

Adaptation and Extension of the European Recommendations (EACD) on Developmental Coordination Disorder (DCD) for the UK context

ABSTRACT

Background: Developmental Coordination Disorder (DCD) affects the learning and performance of everyday motor skills. It commonly co-occurs with other developmental disorders and a range of associated psycho-social impairments. Recent evidence-based guidelines on diagnosis, assessment, and intervention provide valuable information for practitioners. However these are directed primarily at German-speaking countries and focus on work with children. Aim: The aim of this project was to consider the application of these guidelines in the UK and to extend them for use with adults with DCD. Methods: Individuals with DCD, parents, and professionals from a wide range of disciplines were invited to two workshops to discuss and debate the guidelines, to adapt them for the UK and produce dissemination materials. Results: A working definition of DCD was agreed, minor revisions were made to the guidelines to reflect the UK context, an extension for adults was compiled and a series of leaflets was produced to disseminate this information to health and education professionals, parents, and employers. Conclusions: This work will raise awareness of the condition across different professional groups. It provides information to help those working with children and adults with DCD in the UK to assist in the process of diagnosis, assessment, and intervention.     

Comparing Activity Patterns,Biological, and Family Factors in Children with and Without Developmental Coordination Disorder

ABSTRACT

The association between motor proficiency and moderate to vigorous physical activity (MVPA) suggests children with developmental coordination disorder (DCD) may be susceptible to inactivity-related conditions such as cardiovascular diseases. The aim of this study was to compare children with and without DCD on physical activity patterns, activity types, body composition, strength, and cardiovascular fitness. Additionally, factors potentially influencing MVPA were also explored. Eighteen children (7–11 years) with and without DCD (n = 9/group) participated. Motor coordination, physical activity, strength, cardiovascular fitness, body mass index (BMI), and family factors were measured. Children with DCD participated in significantly less MVPA and had higher BMIs and decreased strength and cardiovascular fitness. Strength, activity type, and family factors correlated significantly with MVPA for children with DCD. The results suggest that strength, activity types, parent perception of their child's motor abilities, and parent activity participation should be considered to maximize health benefits associated with MVPA for children with DCD.     

Motor Planning and Gait Coordination Assessments for Children with Developmental Coordination Disorder

Aims: The purposes were to examine construct validity of the Motor Planning Maze Assessment (Maze) and three items from the Functional Gait Assessment (FGA) that were modified for children (pediatric modified FGA, pmFGA), by comparing performance of children with DCD and age matched peers with typical development (TD); the construct validity of total scores of the Dynamic Gait Index (DGI) and the FGA. Methods: Twenty pairs of children with DCD and TD, age from 5 to 12 years, participated in this study. Children in both groups were tested on the Maze, pmFGA, DGI, and FGA. Paired t-tests and agreement tables were used to compare the motor performances between two groups. Results: The DCD group showed higher summary scores in the Maze (p < 0.001) and demonstrated significantly fewer steps (p ≤ 0.001) while doing the pmFGA items than the TD group. However, the FGA quality scores demonstrated minimal differences between the two groups on all three items. Children with DCD showed significantly lower DGI and FGA total scores (p < 0.001) than the TD group. Conclusion: The Maze, DGI, and FGA tests are easily applied in clinical settings and can differentiate motor planning and gait coordination between children with DCD and with TD.     

Knowledge to Practice in Developmental Coordination Disorder: Utility of an Evidence-Based Online Module for Physical Therapists

ABSTRACT

Aims: Developmental coordination disorder (DCD) is a chronic condition with potential negative health consequences. Therapists working with children with DCD need access to tailored, synthesized, evidence-based information; however a knowledge-to-practice gap exists. The aim of this study was to develop and evaluate the utility of an evidence-based online DCD module tailored to physical therapists’ (PTs) needs. Methods: Guided by the Knowledge to Action framework, we interviewed PTs working with children with DCD (n = 9) to identify their information needs. Their recommendations, along with synthesized DCD research evidence, informed module development. These PTs as well as others (n = 50) evaluated the module's usefulness. Results: The module incorporated important content areas including: (1) identification; (2) planning interventions and goals; (3) evidence-based practice; (4) management; and (5) resources. Case scenarios, clinical applications, interactive media, links to resources, and interactive learning opportunities were also embedded. PTs perceived the module to be comprehensive and useful and provided feedback to improve module navigation. Conclusions: Involving end-users throughout the development and evaluation of an online PT DCD module contributed to its relevance, applicability, and utility. It will be important to evaluate whether use of this module improves the quality of services provided by PTs.     

Clinical expression of developmental coordination disorder in a large Canadian family

Previous studies of the phenotype of developmental coordination disorder (DCD) have largely concentrated on population-based samples. The present study reports on an in-depth examination of a large Canadian family with eight children, after three children who were suspected to have DCD were referred for evaluation. Subsequently, five of the six children whose motor impairments could be measured, and the mother, met the diagnostic criteria for DCD as per the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – fourth edition. The family members diagnosed with DCD showed remarkably similar profiles of motor difficulties. Additionally, the five children diagnosed with DCD had current speech articulation difficulties, with four of them having visited speech/language pathologists; the mother had a lateral lisp. More in-depth testing for three children revealed intact intellectual, academic and language comprehension skills. Three of the children diagnosed with DCD were obese. The present report highlights familial clustering of DCD and the presence of comorbid conditions in the affected children.     

Practitioner review: approaches to assessment and treatment of children with DCD: an evaluative review

BACKGROUND: Movement clumsiness (or Developmental Coordination Disorder--DCD) has gained increasing recognition as a significant condition of childhood. However, some uncertainty still exists about diagnosis. Accordingly, approaches to assessment and treatment are varied, each drawing on distinct theoretical assumptions about the aetiology of the condition and its developmental course. METHOD: This review evaluates the current status of different approaches to motor assessment and treatment for children with DCD. These approaches are divided according to their broad conceptual origin (or explanatory framework): Normative Functional Skill Approach, General Abilities Approach, Neurodevelopmental Theory, Dynamical Systems Theory, and the Cognitive Neuroscientific Approach. CONCLUSIONS: Each conceptual framework is shown to support assessment and treatment methods with varying degrees of conceptual and psychometric integrity. The normative functional skill approach supports the major screening devices for DCD and cognitive (or top-down) approaches to intervention. The general abilities approach and traditional neurodevelopmental theory are not well supported by recent research. The dynamical systems approach supports promising trends in biomechanical or kinematic analysis of movement, ecological task analysis, and task-specific intervention. Finally, and more recently, the cognitive neuroscientific approach has generated some examples of process-oriented assessment and treatment based on validated (brain-behaviour) models of motor control and learning. A multi-level approach to movement assessment and treatment is recommended for DCD, providing a more complete representation of motor development at different levels of function--behavioural, neurocognitive, and emotional.     

Ecosystemic Needs Assessment for Children with Developmental Coordination Disorder in Elementary School: Multiple Case Studies

ABSTRACT

This study explored the needs of children with developmental coordination disorder (DCD) from an ecosystemic viewpoint as part of a theory-driven program evaluation process. A multiple case study needs assessment was conducted. Participants included ten children with DCD, their parents (n = 12), teachers (n = 9), and service providers (n = 6). Data collection involved semi-structured interviews, validated questionnaires, and a review of the children's records. The results support the relevance of using an ecosystemic model to assess the needs of children with DCD in their life and social contexts. More specifically, the results highlight the need to provide additional services at school, such as occupational therapy and special education, as well as information and training regarding DCD for parents and teachers. The results also point to the relevant variables to consider in an intervention program based on theory-driven evaluations. This study shows how employing an ecosystemic frame of reference provides a better understanding of the needs of children with DCD. Future research should document the ecosystemic profiles and evolution of the needs of children with DCD with a larger sample from diverse socioeconomic backgrounds using a longitudinal study design.     

Goal-Orientated Group Intervention for Children with Developmental Coordination Disorder

ABSTRACT

This study measures the effectiveness of a goal-orientated group intervention using concentrated practice schedules for children with developmental coordination disorder (DCD). The study design is repeated measures. The sample comprises eight children with DCD, aged 7–11 years. Outcome measures are the Movement Assessment Battery for Children (MABC), the Canadian Occupational Performance Measure (COPM), Harter's Scale of Perceived Competence/Harter and Pike's Pictorial Scale of Perceived Competence, and clinical observations. The children set goals with the perceived efficacy and goal setting system with parents/caregivers input. The intervention used a goal-oriented approach combining motor learning and cognitive strategies consisting of eight 50-min sessions over 2 weeks. The results show significant improvements in the COPM and MABC scores following intervention but no changes in Harter's scores. Fifty-six goals were identified with 34 met totally, 12 met partially, and 10 remained unmet. A goal-oriented group intervention shows potential as an effective intervention method.     

Self-efficacy profile in daily activities: Children at risk and with developmental coordination disorder

AimThe objectives of this study were: 1) to compare the perceptions of self-efficacy in the daily activities (self-care, schoolwork, and leisure) of boys and girls with DCD, or in children at risk for DCD (r-DCD) and in typical children (TD); 2) to investigate if a self-efficacy assessment could be a support tool in the establishment of children with the DCD profile.MethodsChildren between 6 to 8 years old (N=115: 35 with DCD, 40 with r-DCD, 40 with TD) were assessed using the Movement Assessment Battery for Children (MABC-2) and the Perceived Efficacy and Goal Setting System (PEGS). A two-way MANOVA showed significant effect for the perceived self-efficacy group.ResultsThe Bonferroni post hoc test indicated that in the self-care, schoolwork, leisure, and general self-efficacy dimensions the children with DCD presented significantly lower scores compared to children with r-DCD and TD (p < 0.001). A similar result was observed for r-DCD children in comparison with TD (p < 0.001). The discriminate analysis showed that perceived self-efficacy in leisure activities was the variable that most contributed to the discrimination of the groups.ConclusionThe judgment of children with DCD and r-DCD on the effectiveness of the execution of schoolwork and leisure activities may have been influenced by the motor skill difficulties showed by the children.     

A Group Motor Skills Program for Children with Coordination Difficulties: Effect on Fundamental Movement Skills and Physical Activity Participation

Aims: Children with coordination difficulties are at risk of low levels of physical activity (PA) participation. This intervention examined the effects of a multidisciplinary program that emphasized parent participation on motor skill performance and PA. Methods: Ten boys (5–7 years) completed a group program consisting of conditioning exercises and activities designed to address child-selected goals. Motor proficiency and PA participation were assessed before and after the program using the Test of Gross Motor Development (TGMD-2) and triaxial accelerometers, respectively. Rating scales captured child and parent perceptions of performance for each child's goals. Results: TGMD-2 subtest raw scores, age equivalent and percentile scores improved, along with parent ratings of their child's performance. Six children reported skill improvements. On average, moderate to vigorous PA improved by 10 min per day although these gains were not significant. Time spent in sedentary activities was unchanged. None of the children met the Canadian PA and sedentary behaviour guidelines. Conclusions: The results support effectiveness of a group program to improve gross motor performance and levels of PA in children with coordination difficulties. Gains in both of these domains also have the potential to impact quality of life and reduce health risks associated with inactivity.     

The Association of Motor Skills and Adaptive Functioning in XXY/Klinefelter and XXYY Syndromes

Aims: Klinefelter (XXY) and XXYY syndromes are genetic disorders in males characterized by additional sex chromosomes compared to the typical male karyotype of 46, XY. Both conditions have been previously associated with motor delays and motor skills deficits. We aimed to describe and compare motor skills in males with XXY and XXYY syndromes, and to analyze associations with age, cognitive abilities, and adaptive functioning. Methods: Sixty-four males with XXY and 46 males with XXYY, ages 4–20 were evaluated using the Beery Test of Visual Motor Integration and the Bruininks-Oseretsky Test of Motor Proficiency – 2nd Edition assessments, Vineland–2 adaptive scales, and cognitive testing. Results: Motor coordination impairments were found in 39% of the males with XXY and 73% of the males with XXYY. Both groups showed strengths in visual perceptual skills. Males with XXYY had lower mean scores compared to males with XXY across all assessments. Fine motor dexterity and coordination deficits were common. There was a positive correlation between VMI scores and adaptive functioning. Conclusion: Occupational and physical therapists should be aware of the motor phenotype in XXY and XXYY both to aid in diagnosis of unidentified cases and to guide intervention.