Dcd Flashcards
physio/ OT interventions of DCD
Carried out by physiotherapists and occupational therapists
Functional skill approaches (e.g. CO-OP, NTT) more effective than process approaches
Structured program to help child master particular motor tasks
Break down tasks into component skills
CO-OP: child led; Goal, Plan, Do, Check
NTT: therapist led; assessment of child’s strengths and difficulties; analyses cognitive and motor processes that are deficient
CO-OP and NTT: improvements are promising and long-lasting, but tend to be specific to the motor task trained
School-based interventions for DCD
Basic skills teaching: emphasised more in primary; e.g. motor skills group (see next slide), classroom practice activities, handwriting programme, other skill programmes (e.g. speech or social skills)
Compensatory strategies: emphasised more at secondary school level; techniques to minimise writing, e.g. mind mapping and touch typing
Modifications to the environment: sloping board, bean bag or carpet square for sitting, pencil grip, access to IT, adult/friend recording homework, amanuensis for exams, organisational support
motor skills programme
Group esteem club (Ripley, 2001): run by a teacher; children attended weekly sessions; set structure; wide variety of motor skill activities; children setting individual targets and evaluating their own progress; positively evaluated through questionnaires to children and parents
McWilliams (2005): small-scale evaluation of a motor skills group run by Occupational Therapists; even if groups may not run for sufficient time to impact on motor skills, they can have positive benefits to children’s self-esteem
DCD screening tools
Screening (rating scales for parents and teachers):
Early Years Movement Skills Checklist (Chambers & Sugden, 2006)
Developmental Coordination Disorder Questionnaire (DCDQ; Wilson et al., 2000)
Assessments of motor skills:
Movement Assessment Battery for Children 2 (Movement ABC-2; Henderson, Sugden & Barnett, 2007): 3-16; manipulative skills, ball skills and balance skills
Bruininks-Oseretsky Test of Motor Proficiency (BOTMP; Bruininks, 1978): 4.5-14.5; fine and gross motor skills
80% agreement between Movement ABC and BOTMP for diagnosis of DCD (Crawford, Wilson & Dewey, 2001)
risk factors for DCD
high heritability low birth weight prematurity multiple genes involved in utero exposure to alcohol and drugs
prevalence and persistence of DCD
Varies from 5-18% of population (depends on cut-off/test used for diagnosis)
More prevalent in boys than girls: estimates range from 4:1 to 7/8:1
Difficult to diagnose DCD reliably in preschool children
Minority of children grow out of their difficulties; most children with DCD have persistent difficulties in adolescence and adulthood
DSM 5 criteria of DCD
A) Motor performance that is substantially below expected levels, given the person’s chronologic age and previous opportunities for skill acquisition. The poor motor performance may manifest as coordination problems, poor balance, clumsiness, dropping or bumping into things; marked delays in achieving developmental motor milestones (e.g., walking, crawling, sitting) or in the acquisition of basic motor skills (e.g., catching, throwing, kicking, running, jumping, hopping, cutting, colouring, printing, writing).
B) The disturbance in Criterion A, without accommodations, significantly and persistently interferes with activities of daily living or academic achievement.
C) Onset of symptoms is in the early developmental period.
D) The motor skill deficits are not better explained by intellectual disability (intellectual development disorder) or visual impairment and are not attributable to a neurological condition affecting movement (e.g., cerebral palsy, muscular dystrophy, degenerative disorder).
impact of DCD in childhood
Early Years:
often most noticeable in self-help skills, e.g. dressing, eating
late to achieve motor milestones and may miss stages e.g. crawling
Primary School:
Smyth and Anderson (2000) observed 55 DCD children and 55 controls, aged 6-10 years in six schools; DCD group were found to spend significantly:
more time playing alone or just watching other children
more time playing with one other child
less time playing in larger groups of children
classroom impact: understanding classroom language, writing skills, visual perceptual issues e.g. reading, organising work (Ripley 2001)
Secondary School:
self-esteem
recording work
organisational skills, e.g. finding way around the school, books, timetables, homework
subject specific issues, e.g. practical subjects, PE
(Cantell et al., 2003)
impact of DCD in adultdhood
Cousins and Smyth (2003) studied 19 adults aged 18-65 with a history of DCD and 19 controls matched for age, gender and educational background
The DCD group performed significantly poorer on a wide range of motor tasks, including:
manual dexterity (e.g. pegboard)
handwriting (speed)
block construction (similar to WISC Block Design)
static and dynamic balance
ball skills
Results indicate that DCD is a lifelong condition that does not usually improve with age, so it is important to develop compensatory strategies
symptoms of DCD
Learning, thought and memory:
difficulty in planning and organising thought
poor memory, especially short-term memory; may forget and lose things
unfocused and erratic; can be messy and cluttered
Emotion and behaviour:
problems with team work
slow to adapt to new or unpredictable situations; sometimes avoids them altogether
impulsive; tendency to be easily frustrated, wanting immediate gratification
may show other emotional issues: getting stressed, depressed, anxious easily; emotional outbursts, phobias, fears, obsessions, compulsions, addictive behaviours; difficulty sleeping; poor self-esteem
Speech and language:
may talk continuously and repeat themselves
May have difficulty with organising the content and sequence of their language
Eye movements: difficulty in following a moving object (tracking) smoothly with eyes without moving head excessively
Perception:
may be over-sensitive to light
difficulty in distinguishing sounds from background noise; tendency to be over-sensitive to noise
lack of awareness of body position in space and spatial relationships
Poorly established hand dominance: may use either hand for different tasks at different times
Gross motor co-ordination skills:
poor balance
poor posture and fatigue; difficulty in standing for a long time as a result of weak muscle tone
poor integration of the two sides of the body; difficulty with some sports involving jumping and cycling
poor hand-eye co-ordination; difficulty with team sports, especially those which involve catching a ball and batting; difficulties with driving a car
lack of rhythm when dancing, doing aerobics
Fine motor co-ordination skills:
lack of manual dexterity; poor at two-handed tasks, causing problems with using cutlery, cleaning, cooking, ironing, craft work, playing musical instruments
poor manipulative skills; difficulty with typing, handwriting and drawing; may have a poor pen grip, press too hard when writing and have difficulty when writing along a line
comorbidity on DCD
ADHD Autism spectrum disorders (ASD) Deafness Specific language impairment (SLI) Learning and attentional problems Reading difficulties
theories of DCD
1) visual perceptual deficits
2) difficulties with balance and postural control
3) problems with kinesthetic perception
4) defivcit in integration of vidual and kinesthetic info
Movement-ABC
The Movement-ABC is the most widely-used assessment tool for DCD. It comprises two parts:
Checklist (5-12 years only):
child stationary; env stable (e.g. stand on tip-toe)
child moving; env stable (e.g. climb a ladder)
child stationary; env changing (e.g. catching a ball)
child moving; env changing (e.g. run to kick a moving ball)
Performance test (3-16):
manual dexterity (e.g. bead-threading)
ball skills (e.g. throwing and catching)
static and dynamic balance (e.g. balancing on one leg and balancing a ball on a board)
DCD assessment tools
aAssessments of motor skills:
Movement Assessment Battery for Children 2 (Movement ABC-2; Henderson, Sugden & Barnett, 2007): 3-16; manipulative skills, ball skills and balance skills
Bruininks-Oseretsky Test of Motor Proficiency (BOTMP; Bruininks, 1978): 4.5-14.5; fine and gross motor skills
80% agreement between Movement ABC and BOTMP for diagnosis of DCD (Crawford, Wilson & Dewey, 2001)
