DCE Flashcards
Define DCD
motor coordination markedly below expected levels for the child’s chronological age and intelligence which sig interferes with ADLs and school
T/F: DCD is typically due to a medical condition
FALSE
it is not due to a general medical condition
does not meet criteria for a pervasive developmental disorder
is it possible to have intellectual disability along with DCD?
YES
but if present, the motor difficulties are in excess of those usually associated with intellectual disability
What are the exclusion criteria for a dx of DCD?
- motor impairment must not be caused by, or have the symptoms of an identifiable neurological problem
- the child must not have disturbances in tone (ataxia or spasticity), sensory loss, or involuntary movements
List previous terms associated with DCD
- Developmental clumsiness
- clumsy child
- developmental apraxia
- perceptual motor difficulties
list frequently encountered comorbidities to DCD
- ADHD
- learning disability
what is the prevalence of DCD?
- 5-8% of all school-aged children
- boys > girls
- usually ID between 6-12 years of age
what is the pathology of DCD?
- heterogenous disorder → difficult to isolate cause
- several theories exist
- continuum of CP → but neuronal damage is at the cellular level or neurotransmitter-receptor level
- neuronal processing deficit → disorder of complex interaction of various levels of the CNS
List common impairments in DCD
- poor strength and coordination
- jerky movements
- poor visual perception
- joint laxity
- poor spatial organization
- inadequate info processing
- poor sequencing
- poor feedback and feedforward motor control
- poor short and long term memory
list common activity limitations in DCD
- awkward, slow gait
- delayed and poor quality of fine and gross motor skills
- hopping
- jumping
- ball skills
- writing
- delayed oral motor skills
List participation restriction in DCD that are environmental factors
- doors too heavy to open
- PE is competitive and skills oriented
- late to class b/c passing time is too short
- time to dress and undress reduces participation in recess and readiness for home and community activities
- slow and messy written communication in class limits academic performance
- peers don’t want to try to understand conversations
list participations restrictions in DCD that are personal factors
- depression
- quit trying to participate, unmotivated
- low self-esteem
- poor fitness
- activities performed w/o concern for time restrictions
- vocational anxiety
list soft neurological signs of DCD
- hypotonia
- persistence of primitive reflexes
- immature balance reactions
what are possible early indicators of DCD?
- difficulty managing a spoon, manipulating a toy, pedaling a tricycle, scribbling
- difficulty with self care skills such as putting on and taking off clothes, tying shoes, managing zippers, snaps
T/F: children can outgrow DCD
FALSE
they can learn to compensate
Give some examples of interview questions for the parent when trying to ID DCD
- how does your child feel about physical activity?
- how does your child feel about participating in group physical activities?
- are there particular group activities he/she dislikes?
- does your child often trip, fall down, or bump into things?
Give some examples of interview questions for a child you suspect has DCD
- what do you like/dislike about PE?
- what is your fav type of physical activity?
- do you participate in any of these activities with your friends/family?
- do you think you are good at them?
- do you think you are as good at physical activities as other children your age?
- do you ever get frustrated when participating in physical activity with your friends?
List assessment tools to include in your eval of a child who may have DCD
- PDMS-2
- BOT
- MABC
- Canadian Occupational performance measure
- School function assessment
things to keep in mind with the BOT
- appropriate for children over 4
- caution → may miss some children with DCD as it does not look at quality of movement just completion
things to keep in mind with MABC
Movement Assessment battery for Children
- for children 4-12 years old
- included qualitative descriptors of motor behavior
- gold standard for this population
what is a bottom-up approach to intervention?
focuses on remediating underlying deficits though selective transmittal of sensory info, which the CNS interprets and organizes into the development of an appropriate movement strategy
ie sensory system impaired lets beef it up
give some examples of bottom-up interventions
- SI therapy
- process-oriented treatment
- perceptual motor training
what is a top-down approach to intervention?
emphasis on cognitive or problem-solving skills to select and implement the most appropriate strategies for successful task performance
give some examples of top-down interventions
- task-specific intervention
- cognitive approaches
which approach has more research support?
Top Down
what is a task specific intervention?
focuses on direct teaching of a skill
motor tasks are broken down into steps
what are cognitive approaches to intervention?
emphasize active problem solving
child uses verbal guidance
what the benefit of a task specific and cognitive approach to intervention?
- provide repetition and practice of specific motor skills
- cognitive approach has added advantage of promoting independent problem solving
- both require attention to task and working memory
what types of modifications to the home can we encourage in a child with DCD?
- encourage participation in sports/activities that are interesting to the child
- physical activity and enjoyment should be emphasized rather than proficiency or competition
- try introducing child to new sport or playground on individual basis before being in a group
- private lessons may help
- ask simple questions to ensure comprehension
- during functional tasks prompt problem solving (ask “what do you need to do first?”)
- select clothing the child can independently manage
what types of modifications to school should we encourage in children with DCD?
- make sure child is properly positioned
- set realistic short term goals
- provide child with extra time to complete fine motor activities
- introduce computers early
- adapted pencil grips, markers
what types of modifications to PE should we make for children with DCD?
- break down gym activity into smaller parts, while ensuring that each part is meaningful and achievable
- try to choose activities that will ensure success for the child at least 50% of the time
- reward effort not skill
- try to incorporate activities which require a coordinated response from arms and/or legs
other things we should keep in mind in children with DCD
- encourage children to develop skills using their hands in a dominant/assistant fashion
- baseball, hockey
- keep the environment predictable when teaching a new skill
- make participation, not competition the major goal
Briefly describe ADHD
- frequently involve motor problems as well
- 30-50% have DCD
- core symptoms:
- inattention
- impulsivity
- hyperactivity
Briefly describe ADHD
- frequently involve motor problems as well
- 30-50% have DCD
- core symptoms:
- inattention
- impulsivity
- hyperactivity
