Evaluation of the Japanese version of the Developmental Coordination Disorder Questionnaire as a screening tool for clumsiness of Japanese children

Developmental Coordination Disorder (DCD) is characterized by clumsiness and coordination difficulties. DCD interferes with academic performance and participation in physical activities and psychosocial functions, such as self-esteem, cognition, or emotion, from childhood through adolescence to adulthood. DCD is a common pediatric condition and its prevalence is estimated to be 6% worldwide. Although English questionnaires are available, there is no questionnaire to identify DCD in Japan, and therefore, no information on its prevalence is available. Recently, we developed the Japanese version of the Developmental Coordination Disorder Questionnaire (DCDQ-J). The purpose of this study was to describe the applicability of the DCDQ-J for use with a community-based population of children in Japan and to investigate the relationships between coordination and attention-deficit hyperactivity disorder (ADHD) tendencies or intelligence. The DCDQ-J was completed by 6330 parents or guardians of children and adolescents. We employed the ADHD-rating scale and determined the intelligence quotient (IQ) of the children. Two-way analysis of variance showed that the scores linearly increased as the children's grades advanced in 2 subscales, namely, control during movement and fine motor. In contrast, non-linear changes were found in the scores of the general coordination subscale. The total scores of the DCDQ-J and ADHD-RS were significantly correlated, but no relationship between DCDQ-J scores and IQ was found. The DCDQ-J is expected to be a useful screening tool to identify and assess motor coordination difficulties of children in Japan and enable cross-cultural comparisons.     

Recruitment,use, and satisfaction with a web platform supporting families of children with suspected or diagnosed developmental coordination disorder: a randomized feasibility trial

ABSTRACT

Objectives. To determine the feasibility of recruiting families of children with suspected or diagnosed developmental coordination disorder (sdDCD) and explore their satisfaction with a web-based intervention

Design. A feasibility randomized trial was conducted. Participants were the parents of 5–12-year-old children with sdDCD. The intervention group had access to online resources, group and private forums, and videoconferencing with a therapist. Main outcomes were recruitement and retention rates. Satisfaction was documented through a post-intervention survey and interview.

Results. The recruitment rate was seven participants per month (n = 28 participants) and retention rate was 68%. Satisfaction was moderate. No differences in use and satisfaction were observed between groups. Participants formulated recommendations for improving the intervention, including targeting families earlier in the diagnosis process, and pre-scheduling meetings with therapists.

Conclusions. This study demonstrated the feasibility of future trials, and highlighted avenues for improvement. Parent involvement during the development of the intervention is discussed at length.

Abbreviations: DCD: Developmental Coordination Disorder; sdDCD: suspected or diagnosed Developmental Coordination Disorder; RCT: randomized-controled trial     

Age-related validity and reliability of the Dutch Little Developmental Coordination Disorder Questionnaire (LDCDQ-NL)

BackgroundEarly recognition of children at risk of Developmental Coordination Disorder (DCD) is important, but variability in motor development in preschool children affects the validity of instruments to reliably detect children at risk of DCD.AimsTo investigate the age-related validity and reliability of the Dutch version of the Little Developmental Coordination Disorder Questionnaire (LDCDQ-NL).Methods and proceduresTwo hundred and sixty 3- to 5-year old children were recruited in the Netherlands. Parents filled out the LDCDQ-NL and children were assessed with the Movement Assessment Battery for Children-2 Test (MABC-2 Test). Internal consistency of the LDCDQ-NL was determined by Cronbach’s alpha. Construct validity was investigated using factor analysis. Concurrent validity was measured by calculating correlations between the LDCDQ-NL and MABC-2. Receiver Operating Characteristics (ROC) were calculated to assess discriminant validity.Outcomes and resultsInternal consistency of the LDCDQ-NL was 0.91. Factor analysis resulted in three factors (Fine motor skills, Locomotor skills, Ball skills). Correlation between the LDCDQ-NL and MABC-2 Test increased with increasing age. With a sensitivity of 80%, specificity increased with age.Conclusions and implicationsThe LDCDQ-NL is a reliable and valid screening instrument for 4- and 5-year old Dutch children; concurrent and discriminant validity are low for 3-year olds.     

Development of a movement questionnaire adapted for Japanese culture for elementary school children

AimsCurrent tools to evaluate Developmental Coordination Disorder (DCD) symptoms are not adapted to Japanese cultural and educational contexts. We aimed to develop a new tool, the Developmental Coordination Disorder Checklist (DCDC), that can be applied specifically to elementary school–aged children in Japan, by generating a list of culturally relevant items.MethodsWe designed an 18-item questionnaire that was distributed to parents and teachers of elementary school–aged children. The degree of negative influence on a child’s life from their motor ability was estimated using a visual analogue scale (VAS).ResultsWe analyzed the responses from parents/guardians (n = 1174) and teachers (n = 688) of elementary school children (age range: 75–147 months, 1st–6th grades). An exploratory analysis showed that the DCD items could be divided into three factors: fine motor, gross motor, and catch and throw. Internal consistency reliabilities of each factor and of total DCDC were sufficiently high (all coefficients of Cronbach’s alpha: > 0.75). Inter-rater reliability between parent/guardian and teacher was moderate in each sub-score and total DCDC score. Parents/guardians evaluated the degree of difficulty in the fine motor factor more severely than teachers. Total DCDC score was correlated significantly with VAS value (r = 0.545), with each factor in DCDC proving useful in predicting negative impact on daily life.ConclusionsDCDC is an efficient and culturally relevant assessment tool for DCD symptoms within Japan, particularly for measuring any practical deficits in daily life activities.     

Health-related quality of life of children with Developmental Coordination Disorder

BackgroundAlthough Developmental Coordination Disorder (DCD) is primarily a motor disorder, it can also impact emotional and psychosocial functioning of children with this condition. Evidence suggests that children with DCD experience lower quality of life than their peers, but few studies have explicitly examined the health-related quality of life (HRQOL) of these children.AimsTo: (1) describe HRQOL of children with DCD compared to typically-developing children; (2) compare HRQOL from the perspectives of children with DCD and their parents; and (3) explore predictors of HRQOL for children with DCD.MethodsData from the KidScreen-52 and Strength and Difficulties Questionnaire were collected from 50 children with DCD [Mean(SD) age: 9.8 (1.2) years] and their parents and compared to normative data.ResultsChildren with DCD and their parents report significantly lower HRQOL compared to published norms. Caregivers have a significantly lower perception of their child’s HRQOL than their child’s self-report in many domains. Parents of children with DCD report that their children experience significantly more emotional and behavioral disturbances compared to norms. Poor motor function and attentional difficulties predict HRQOL.Conclusion and implicationsDCD appears to contribute to lower perceived HRQOL. Findings inform therapeutic targets for children with DCD, beyond motor skill intervention.     

Influence of methylphenidate on motor performance and attention in children with developmental coordination disorder and attention deficit hyperactive disorder

Individuals with attention deficit hyperactive disorder (ADHD) often have coexisting developmental coordination disorder (DCD). The positive therapeutic effect of methylphenidate on ADHD symptoms is well documented, but its effects on motor coordination are less studied. We assessed the influence of methylphenidate on motor performance in children with comorbid DCD and ADHD. Participants were 30 children (24 boys) aged 5.10–12.7 years diagnosed with both DCD and ADHD. Conners’ Parent Rating Scale was used to reaffirm ADHD diagnosis and the Developmental Coordination Disorder Questionnaire was used to diagnose DCD. The Movement Assessment Battery for Children-2 and the online continuous performance test were administrated to all participants twice, with and without methylphenidate. The tests were administered on two separate days in a blind design. Motor performance and attention scores were significantly better with methylphenidate than without it (p < 0.001 for improvement in the Movement Assessment Battery for Children-2 and p < 0.006 for the online continuous performance test scores).The findings suggest that methylphenidate improves both attention and motor coordination in children with coexisting DCD and ADHD. More research is needed to disentangle the causality of the improvement effect and whether improvement in motor coordination is directly affected by methylphenidate or mediated by improvement in attention.     

Impaired visuo-motor sequence learning in Developmental Coordination Disorder

The defining feature of Developmental Coordination Disorder (DCD) is the marked impairment in the development of motor coordination (DSM-IV-TR, American Psychiatric Association, 2000). In the current study, we focused on one core aspect of motor coordination: learning to correctly sequence movements. We investigated the procedural, visuo-motor sequence learning abilities of 18 children with DCD and 20 matched typically developing (TD) children, by means of the serial reaction time (SRT) task. Reaction time measurements yielded two important findings. Overall, DCD children demonstrated general learning of visuo-motor task demands comparable to that of TD children but failed to learn the visuo-motor sequence. Interestingly, a sequence recall test, administered after the SRT task, indicated some awareness of the repeating sequence pattern. This suggests that the sequence learning problems of DCD children might be located at the stage of motor planning rather than sequence acquisition.     

A preliminary study on the effect of methylphenidate on motor performance in children with comorbid DCD and ADHD

Attention Deficit Hyperactive Disorder (ADHD) and Developmental Coordination Disorder (DCD) are two developmental disorders with considerable comorbidity. The impact of Methylphenidate (MPH) on ADHD symptoms is well documented. However, the effects of MPH on motor coordination are less studied. We assessed the influence of MPH on motor performance of children with comorbid DCD and ADHD. Participants were 18 children (13 boys, mean age 8.3 years) diagnosed with comorbid DCD and ADHD. A structured clinical interview (K-SADS-PL) was used to determine psychopathology and the Movement Assessment Battery for Children–Checklist were used to determine criterion for motor deficits. The Movement Assessment Battery for Children (M-ABC) was administrated to all participants once under the influence of MPH and once under a placebo pill condition. The motor tests were administered on two separate days in a double-blinded design. Participants’ motor performance with MPH was significantly superior to their performance in the placebo condition. Significant improvement was observed in all the M-ABC sub-tasks except for static balance performance. The findings suggest that MPH improves motor coordination in children with comorbid DCD and ADHD but clinically significant improvement was found in only 33% of the children.     

Functional performance of children with developmental coordination disorder at home and at school

This study investigated the functional performance of daily activities at home and at school in a population-based sample of children with different degrees of motor coordination impairment and competence. Sixteen children (seven males, nine females; mean age 8y, SD 9mo) with developmental coordination disorder (DCD), 25 with suspected DCD ([sDCD] 17 males, eight females; mean age 7y 6mo, SD 8mo), and 63 children without motor problems (39 males, 24 females; mean age 7y 9mo, SD 7mo) were recruited from public schools (Grades 1–3, age 6y 4mo–9y 10mo) using the Chinese version of the Developmental Coordination Disorder Questionnaire, the Movement Assessment Battery for Children, and the Bruininks-Oseretsky Test of Motor Proficiency. Functional performance was assessed using the Chinese versions of the Vineland Adaptive Behavior Scales and the School Function Assessment–Chinese version. The functional performance of children with DCD and sDCD was statistically significantly lower than those without DCD ( p's <0.05). χ² and logistic regression analyses showed significant differences among all groups in the proportion of children scoring at the 'inadequate' adaptive level of home performance ( p's <0.05). There were also significant differences among the groups in the proportion of children scoring below the cut-off in school performance ( p's <0.05). The findings show the pervasive impact of DCD on children's functional performance in daily activities at home and at school.     

Participation patterns of school-aged children with and without DCD

Participation is recognized as a key to one's health and well-being and is considered to be a vital part of the development of children and youth. The purpose of this study was to examine the participation patterns of children with and without Developmental Coordination Disorder (DCD) in their out-of-school-time (OST) activities, and to see whether there is a relationship between the children's motor abilities and their choices and participation. Methods: 50 children (5-7 years old), 25 who met diagnostic criteria of DCD and 25 without DCD, completed the Children Assessment of Participation and Enjoyment (CAPE) and were administered the Motor Assessment Battery for Children (MABC) and the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI). Results: A relationship was found between participation patterns and motor ability. Children with DCD had limited participation diversity in which they participated less frequently, and chose activities that were quieter and more socially isolated compared to children without DCD; there were no differences in their levels of enjoyment. Conclusions: The present study emphasizes the importance of looking at the children's participation from a broad perspective, and the many difficulties children with DCD experience in OST participation. Future studies might consider other factors (e.g., environment) while examining participation among children with DCD.     

The influence of Chinese one-child family status on Developmental Coordination Disorder status

We conducted a population-based study on Developmental Coordination Disorder (DCD) in mainland China to explore the influence of one-child status in Chinese families on DCD. A total of 4001 children selected from 160 classes in 15 public nursery schools. The Movement Assessment Battery for Children assessed motor function. The prevalence of DCD in Chinese one-child families (8.7%) was higher than that in multi-child families (5.9%). Chinese one-child family status (compared with younger children in multi-child families) were negatively related with total score (−1.793), Manual dexterity (−0.228), Aiming and catching (−1.145), Balance (−0.433) of MABC-2 and DCD (OR = 2.294) when adjusted for the children's and family's characteristics, and perinatal factors (each p < 0.05). As one of the studies in this Chinese context, it provides a platform for future intervention programs in one-child families in preventing children's developmental disorders.     

Psychometric properties of the DCD-Q-07 in children ages to 4–6

It is important to identify Developmental Coordination Disorder (DCD) early in a child's life to allow for proper and timely intervention and support, and to reduce the negative secondary consequences associated with this condition. In this study we assessed the psychometric properties (construct validity, concurrent validity, reliability and test accuracy) of the Developmental Coordination Disorder Questionnaire (DCD-Q-07) in preschool children. A community-based sample of children ages 4–6 (n = 181) were screened for motor difficulties using the Movement Assessment Battery for Children (M-ABC-2). Use of the M-ABC-2 resulted in the identification of 29 children below the 15th percentile, which we classified as probable DCD. Parents of these children concurrently completed the DCD-Q-07 to report their child's motor performance. The DCD-Q-07 demonstrated high internal consistency for both the full scale (alpha = 0.881) and each subscale: control during movement (alpha = 0.813), fine motor and handwriting (alpha = 0.869) and general coordination (alpha = 0.728). Moderate correlations (r = 0.47–0.63) were also seen between the subscales on the DCD-Q-07, the strongest correlation being between control during movement and general coordination (r = 0.63). Based on published age and sex cut points, the DCD-Q-07 showed poor sensitivity (20.7%) but high specificity (92.1%) against the M-ABC-2. Overall agreement with the M-ABC-2 was low using ROC analysis (area under the curve = 0.654). Although it is important to screen for DCD in young children, the DCD-Q-07 may not be the best choice as a screening tool for DCD in preschool children ages 4–6 due to its low test accuracy.     

The association between motor coordination impairment and restricted/repetitive behaviors in autistic children: The partial mediating effect of executive function

BackgroundIt has been strongly argued that impaired motor function contributes to the restricted/repetitive behaviors (RRBs) of autistic children, but the mechanism exploration of these claims has been limited by the absence of potential confounders such as executive function.MethodWe investigated the role that executive function (EF) plays in the relationship between motor coordination, EF, and RRBs in a school-aged autism population (n = 188, age = 7.42 ± 1.46 years, 86.7% males) via a structural equation model in a statistically robust way. The Developmental Coordination Disorder Questionnaire, Behavior Rating Inventory of Executive Function, and Restrictive Behavior Scale-Revised were collected to measure motor coordination, EF, and RRBs, respectively.ResultsAmong the participants, 33.5% (n = 63) were classified as intellectual disability, 46.8% (n = 88) had EF dysfunction and 35.1% (n = 66) had motor coordination impairment. We found a direct effect of motor coordination impairment on RRBs among children with ASD and without intellectual disability (β = -0.334, p<0.001), as well as an indirect effect through EF, which was a partial mediator of the relationship (β = −0.140, p = 0.001).ConclusionsMotor coordination impairment should be included in the routine evaluation of autism surveillance and rehabilitation procedure, to address the ASD children who need additional support. It is important to add motor skills and motor coordination training in the daily intervention of autism, which could also improve EF and decrease RRBs in these children.     

Short-term motor learning of dynamic balance control in children with probable Developmental Coordination Disorder

PurposeTo explore the differences in learning a dynamic balance task between children with and without probable Developmental Coordination Disorder (p-DCD) from different cultural backgrounds.ParticipantsTwenty-eight Dutch children with DCD (p-DCD-NL), a similar group of 17 South African children (p-DCD-SA) and 21 Dutch typically developing children (TD-NL) participated in the study.MethodsAll children performed the Wii Fit protocol. The slope of the learning curve was used to estimate motor learning for each group. The protocol was repeated after six weeks. Level of motor skill was assessed with the Movement ABC-2.ResultsNo significant difference in motor learning rate was found between p-DCD-NL and p-DCD-SA, but the learning rate of children with p-DCD was slower than the learning rate of TD children. Speed–accuracy trade off, as a way to improve performance by slowing down in the beginning was only seen in the TD children, indicating that TD children and p-DCD children used different strategies. Retention of the level of learned control of the game after six weeks was found in all three groups after six weeks. The learning slope was associated with the level of balance skill for all children. This study provides evidence that children with p-DCD have limitations in motor learning on a complex balance task. In addition, the data do not support the contention that learning in DCD differs depending on cultural background.     

Compromised motor control in children with DCD: A deficit in the internal model?—A systematic review

A viable hypothesis to explain the compromised motor ability of children with Developmental Coordination Disorder (DCD) suggests a fundamental deficit in their ability to utilize internal models for motor control. Dysfunction in this mode of control is thought to compromise their motor learning capabilities. The aim of this systematic review is to examine the available evidence for the internal modeling deficit (IMD) hypothesis. A systematic review using five databases identified 48 relevant articles. These studies were categorized according to the effector system involved in the evaluation of motor control and were evaluated for methodological quality. In most papers, DSM-IV-TR criteria for the classification of DCD were not completely fulfilled and possible attentional problems not accounted for. Results showed compromised control of overt and covert eye movements, dynamic postural control, manual control for tasks that vary in complexity, and for motor imagery of manual and whole-body postures. Importantly, this review shows support for general hypothesis that deficits of predictive control manifest in DCD across effector systems.     

Developmental Coordination Disorder, gender, and body weight: examining the impact of participation in active play

BackgroundTo examine whether differences in participation in active play (PAP) can account for gender differences in the relationship between Developmental Coordination Disorder (DCD) and body weight/fat (BMI and percentage fat) in youth.MethodsA cross-sectional investigation of students in grades four through eight (n = 590). Height, weight (BMI), and percentage body fat using bioelectrical impedance analysis (BIA; RJL Systems, MI) were collected. Motor proficiency and physical activity levels were also evaluated.ResultsWe found gender specific patterns in the relationship between PAP, DCD, and BMI and body fat. Among boys with DCD, greater participation in active play is associated with higher BMI and percentage body fat. For girls with the disorder, the opposite relationship is observed.ConclusionsParticipation in active play moderates the association between DCD, gender and body weight. Three possible explanations for why PAP is associated with higher BMI and percentage body fat in boys with DCD are provided.     

Suboptimal bone status for adolescents with low motor competence and developmental coordination disorder—It’s sex specific

BackgroundAustralian adolescents with low motor competence (LMC) have higher fracture rates and poorer bone health compared to European normative data, but currently no normative data exists for Australians.AimsTo examine whether there were bone health differences in Australian adolescents with LMC or Developmental Coordination Disorder (DCD) when compared to typically developing age-matched Australian adolescents.Methods and ProceduresAustralian adolescents aged 12–18 years with LMC/DCD (n = 39; male = 27; female = 12) and an Australian comparison sample (n = 188; boys = 101; girls = 87) undertook radial and tibial peripheral Quantitative Computed Tomography (pQCT) scans. Stress Strain Index (SSI (mm³)), Total Bone Area (TBA (mm²)), Muscle Density (MuD [mgcm³]), Muscle Area (MuA [cm²]), Subcutaneous Fat Area (ScFA [cm²]), Cortical Density (CoD [mgcm³]), Cortical Area (CoD [mm²]), cortical concentric ring volumetric densities, Functional Muscle Bone Unit Index (FMBU: (SSI/bone length)) and Robustness Index (SSI/bone length^3), group and sex differences were examined.Outcome and ResultsThe main finding was a significant sex-x-group interaction for Tibial FMBU (p = .021), Radial MuD (p = .036), and radial ScFA (p = .002). Boys with LMC/DCD had lower tibial FMBU scores, radial MuD and higher ScFA than the typically developing age-matched sample.Conclusion and ImplicationsComparisons of bone measures with Australian comparative data are similar to European findings however sex differences were found in the present study. Australian adolescent boys with LMC/DCD had less robust bones compared to their well-coordinated Australian peers, whereas there were no differences between groups for girls. These differences may be due to lower levels of habitual weight–bearing physical activity, which may be more distinct in adolescent boys with LMC/DCD compared to girls.     

Psychometric properties of a Chinese version of the Developmental Coordination Disorder Questionnaire in community-based children

The aim of this study was to adapt and evaluate the Developmental Coordination Disorder Questionnaire (DCDQ) for use in Chinese-speaking countries. A total of 1082 parents completed the DCDQ and 35 parents repeated it after 2 weeks for test–retest reliability. Two items were deleted after examination of test consistency. Cronbach's α for the total score was 0.89 and test–retest reliability was 0.94. Exploratory and confirmatory factor analyses showed this version to be compatible with the original and two adaptations of the DCDQ. One-way ANOVA and the post hoc tests revealed that the non-DCD group scored significantly higher than the DCD group and the suspect DCD group, but the latter two did not differ significantly. Sensitivity and specificity of the DCDQ were 73% and 54%. The estimated area under the Receiver Operating Characteristic curve was 0.68. Compared to the dichotomized grouping in assessing sensitivity and specificity, which provides clinicians with all or none information about a child's probability of being DCD, the informative conditional effect plot could alert clinicians to the child with less conspicuous movement problems. This adaptation of the DCDQ could be used for identifying motor coordination problems in Chinese-speaking societies.     

Self-reported mood,general health,wellbeing and employment status in adults with suspected DCD

Developmental Coordination Disorder (DCD) affects around 2–6% of the population and is diagnosed on the basis of poor motor coordination in the absence of other neurological disorders. Its psychosocial impact has been delineated in childhood but until recently there has been little understanding of the implications of the disorder beyond this. This study aims to focus on the longer term impact of having DCD in adulthood and, in particular, considers the effect of employment on this group in relation to psychosocial health and wellbeing. Self-reported levels of life satisfaction, general health and symptoms of anxiety and depression were investigated in a group of adults with a diagnosis of DCD and those with suspected DCD using a number of published self-report questionnaire measures. A comparison between those in and out of employment was undertaken. As a group, the unemployed adults with DCD reported significantly lower levels of life satisfaction. Whilst there was no significant difference between those who were employed and unemployed on General Health Questionnaire scores; both groups reported numbers of health related issues reflective of general health problems in DCD irrespective of employment status. While both groups reported high levels of depressive symptoms and rated their satisfaction with life quite poorly, the unemployed group reported significantly more depressive symptoms and less satisfaction. Additionally, the results identified high levels of self-reported anxiety in both groups, with the majority sitting outside of the normal range using the Hospital Anxiety and Depression Scale. These findings add to the small but increasing body of literature on physical and mental health and wellbeing in adults with DCD. Furthermore, they are the first to provide insight into the possible mediating effects of employment status in adults with DCD.     

Convergent validity of the developmental coordination disorder checklist using soft neurological signs

AimsTo investigate the convergent validity of a new questionnaire, the Developmental Coordination Disorder Checklist (DCDC), we examined the relationship between the DCDC score and Soft Neurological Signs (SNS) which highly correlated with the Movement Assessment Battery for Children (MABC), which is widely applied to assess fine and gross motor skills.MethodsThe patients were 70 elementary school children without intellectual disabilities who were referred to our clinic, examined for SNS, and whose parents completed the DCDC. The DCDC consists of 16 items that focus on three factors: fine motor, gross motor, and catch and throw. We used a previously described method to assess SNS, which included five tasks: (1) standing on one leg with closed eyes, (2) finger opposition test, (3) diadochokinesis, (4) associated movements during diadochokinesis, and (5) motor persistence (laterally fixed gaze).ResultsDCDC scores and SNS were strongly and positively correlated, with higher DCDC scores (indicating greater coordination problems) associated with a higher number of positive SNS.ConclusionsDCDC scores have been proven to be strongly correlated with SNS, and these data suggest that DCDC has good convergent validity.