DCD Flashcards
1
Q
DCD background
A
- only relatively recently added to DSM
- much less studied than other childhood disorders
- also called dyspraxia
- used to be called clumsy child syndrome amongst other names
- the DSM uses the term DCD but educational psychologists and professionals tend to use the term dyspraxia
2
Q
DCD prevalence
A
1.8%-6% of children
3
Q
DCD impact
A
- significant impact on school and daily life for 2% of children
- 3% have some impairment in daily life
- thats out of all children but estimates do vary quite a lot
- lifelong: increased anxiety, depression, decreased educational achievement, lower life-satisfaction in adulthood
4
Q
DCD and occupational therapists
A
- occupational therapists mainly deal with sensory-motor disorders
- e.g. Germany spends 400mil euros on OT a year and it accounts for 90% of spending on 15 year olds
5
Q
DSM and DCD
A
- only added recently
- DSM-V has 4 criteria you must meet:
- so ‘motor performance substantially below expected levels given persons chronological age and previous opportunities for skill aquisition’
- ‘significantly and persistently interferes with activities of daily living or academic achievment’
- onset in early developmental period
- motor skills are not better explained by intellectual disability, visual impairment or neurological conditons affecting movement
6
Q
DCD co-occurence
A
- co morbidity sounds too severe so usually use co-occurence
- until DSM-V (2013) you coldnt have a formal diagnosis of DCD and others (e.g. ADHD, ASD), they just shoved you in the DCD category if they weren’t sure what you had or if you had a mix of symptoms
- there are clear motor impairments in ASD and ADHD so they do need to be looked at separately
- since DSM-V, 2013, any other disorders must not better explain the motor symptoms and you can be diagnosed with multiple things now, as long as nothing else better explains the movement problems
- DCD co-occurs with ADHD (50%), SLI (70%), ODD (20%) RD (20%)
7
Q
DCD assessment for DSM criteria (general)
A
- standardised movement coordination tests, perform in bottom 5% then probable DCD, bottom 15% and you’re ‘at risk’
- teacher, parent etc will explain how affects life or school
8
Q
Meta-analyses of DCD intervention studies
A
- Pless & Carlson, 2000 - 13 intervention studies between 1976 - 1996. Interventions work best over 5 years of age. Task-oriented was best (effect size of 1.2) and sensory integration was awful (0.2), general was OK (0.7)
- Smits-Engelsman et al 2013 looked at 26 studied and found task oriented was best as well (0.89), Occupational therapy (0.83) but also found methylphenidate treatment had large effect size (0.79) in 3 of the studies
- this is an ADHD drug which does rather not help - are people being treated for ADHD therefore performing better on motor tasks? or were their problems due to ADHD and had been misdiagnosed?
- Preston 2014 found the best kind of task-oriented interventions were neuromotor task training, motor training and motor imagery and practice training
- Lukas 2016 did a metaanalysis of 9 studies and found using strict citeria there was no effect, and with liberal critetia effect was largec (0.8). They say this shows how weak and low quality the evidence is
- Miyahara 2016, review of 4 meta analyses. Quality of reviews poor, AMSTAR score 0% to 55% (which is medium). They say intervention is better than none but the evidence for the interventions are crap
9
Q
Discuss CO-OP in DCD
A
- cognitive orientation to daily occupational performance
- one of the most successful interventions as is a cognitively-based child-centred intervention focusing on the whole child not just their movement - Missiuna, 2001, and Polatajko 2001 (diff studies)
- so maybe it will help non motor deficits and emotional problems in adulthood?
10
Q
What are the non-motor deficits of DCD
A
- motor imagery problems Noten 2014
- visual-perceptual and spatial processing (Tsai 2008)
- attention Gillberg 2003
11
Q
Name 3 DCD movement assessments
A
- MABC-2
- BOT
- DCDQ’07
12
Q
Describe the DCD movement assessment MABC-2
A
- movement assessment battery for children 2
- assesses 3 domains of movement with 8-10 total tasks
- assesses in 3 age bands, 4-7, 8-10, 11-16
- Manual dexterity: moving pegs, threading lace, drawing a trail
- aiming and catching: throwing a beanbag or ball
- balance: standing on one leg, hopping, walking in a straight line
- the bottom 15% in each of three movement domains is pretty much none overlapping and 1/3rd of children are in the bottom for one or more domains
- so you have to be in bottom 5% on all 3 domains
- what if youre like 1% 1% and 6%, or youre just quite good at balance but nothing else? you can still be really impaired but undiagnosed
13
Q
What is criticism of the MABC-2
A
- 7 of the 8 tasks are not normally distributed which suggests they are poorly calibrated tests
14
Q
What is the BOT? how does it differ from the MABC-2?
A
= Bruininks-Oseretsky Test of Motor Proficiency 2
- wider age range than MABC-2 as looks at 4-21 years rather than 4-16
- better able to discriminate between children with good performance but the MABC-2 can discriminate better against poor performance
- has 8 subtests: fine motor precision, fine motor integration, manual dexterity, bilateral coordination, balance, running, upper-limb coordination, strength
15
Q
What is the DCDQ’07
A
- DCD questionnaire ‘07
- short quetionnaire for parents to compare childs movement skill with their peers
- 15 questions
- 3 subscales
- control during movement
- fine motor/handwriting
- general coordination
- but most parents (over half) think their child performs worse than their peers!
