Cheryl Missiuna

A pilot trial of a cognitive treatment for children with developmental coordination disorder

This pilot study compared a new treatment approach, the Cognitive Orientation to daily Occupational Performance (CO-OP) to the Contemporary Treatment Approach (CTA) to treating children with Developmental Coordination Disorder (DCD). CO-OP emphasises problem-solving strategies and guided discovery of child and task specific strategies. CTA encompasses a variety of approaches, such as neuromuscular, multi-sensory, and biomechanical, focusing on motor aspects of skill acquisition. Twenty children with a mean age of 9.05 years (S.D. = 1.23) participated in the study. All children had normal intelligence, scored below the 15th percentile on a standardised test of motor ability, and demonstrated motor difficulties significant enough to warrant referral for treatment. Pre- and post-measures included the Canadian Occupational Performance Measure (COPM), the Vineland Adaptive Behavior Scales (VABS), the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), the Developmental Test of Visual-Motor Integration-Revised (VMI), the motor items of the Self-Perception Profile for Children (SPPC), and the Performance Quality Rating Scale (PQRS). In both groups, treatment goals were child-chosen. Both treatments lead to improved COPM self-ratings of performance and satisfaction; however, improvements in the CO-OP group were greater than those in the CTA group. These results were paralleled by PQRS scores, and the Motor scores on the VABS, but not on the BOTMP measures. This outcome still needs replication as no control group was involved and because of the occurrence of pre-treatment differences between the CO-OP and CTA groups on relevant measures. Follow-up data indicated that children who received CO-OP tended to experience greater long-term maintenance of their motor goals and acquired strategies; follow-up parent-report rated CO-OP treatment as more useful than CTA treatment. Self-report, observer report, standardised assessment, and follow-up all demonstrated the effectiveness of the CO-OP approach, supporting the use of CO-OP and suggesting further investigation of this new cognitive intervention.

An International Consensus on Children with Developmental Coordination Disorder

Within every elementary school classroom there is usually at least one child, distinguished by a pervasive slowness in the easy acquisition of the everyday motor skills learnt by his/her peers without apparent effort. In spite of normal intelligence and freedom from diagnosed neurological disorders, this child has a great deal of difficulty mastering motor tasks requiring precision, timing and accuracy. As a consequence, the child experiences a great deal of difficulty in numerous areas of performance both in the school and in the home. Parents and teachers alike search for answers to problems manifestly beyond their power to influence. With increased frequency they are turning to the occupational therapist working in the school for remediation of the associated difficulties in handwriting, independent management of self-care activities, leisure activities and social interaction. Unfortunately the resources, both economic and informational, necessary to provide adequate intervention for these children with mild motor problems are frequently inadequate to meet the need. This inadequacy is, in no small measure, due to the lack of consensus existing around the disability. For many years, in many disciplines, the disability has been discussed under a variety of labels including: minimal cerebral palsy; minimal brain dysfunction; MOTS DES CLÉS

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 childs 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 childs 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.

A Trajectory of Troubles: Parents' Impressions of the Impact of Developmental Coordination Disorder.

Objective: To explore parent perspectives regarding the early experiences of their children with Developmental Coordination Disorder (DCD). Methods: A phenomenological approach was used to explore the meaning of developmental experiences for children with DCD and their families. Parents of 13 children with DCD, aged 6–14, were recruited through purposeful sampling. Parents completed two indepth interviews, and a set of questionnaires. Transcripts and questionnaires were systematically coded to identify emergent themes. Results: There was an evolution over time in the differences that parents noticed and the concerns that they had for their child. There seemed to be a progression from motor and play concerns in the early years, to self-care, academic and peer problems in middle childhood, to significant challenges with self-esteem and emotional health in later childhood. Conclusions: Defining the developmental trajectory of children with DCD highlights the importance of understanding the impact of this disorder as it relates to developmental age and environmental expectations. Implications for early screening and increased awareness of health care professionals are discussed.

Clinical Description of Children with Developmental Coordination Disorder

Occupational therapists working within School Health Support Services are receiving increasing numbers of referrals, relative to past rates, for children who are experiencing motor problems and may have developmental coordination disorder. Based upon clinical experience, therapists indicate that these children are typically referred in the early school years and that most have handwriting difficulties; to date, however, there has been little empirical evidence to support these observations. In this paper, descriptive information is presented for 556 children who may be presumed to have developmental coordination disorder and who had been referred to school-based health services in two centres. Typical reasons for referral, co-morbidity information, and assessment practices are presented. Findings confirmed the presence of many occupational performance issues in this population, including handwriting difficulties, and challenge therapists to broaden the current scope of school health assessment and intervention practices.

Neural correlates of developmental coordination disorder: a review of hypotheses.

Affecting 5% to 6% of school-age children, developmental coordination disorder is characterized by a marked impairment of motor coordination that significantly interferes with activities of daily living and academic achievement. Little is known about the etiology of developmental coordination disorder, but the disorder often coexists with attention-deficit hyperactivity disorder (ADHD), speech/language impairment, and/or reading disability. This comprehensive review examines the literature supporting or refuting hypothesized neural correlates of developmental coordination disorder and suggests directions for future research. Potential sources of neuropathology include the cerebellum, parietal lobe, corpus callosum, and basal ganglia. Comorbidities and deficits associated with developmental coordination disorder are highly suggestive of cerebellar dysfunction; yet, given the heterogeneity of this disorder, it is likely that the cerebellum is not the only neural correlate. Neuroimaging studies and behavioral investigations of learning-related change in motor behavior are the next critical step in enhancing our understanding of developmental coordination disorder.

Brain activation associated with motor skill practice in children with developmental coordination disorder: an fMRI study.

Children with developmental coordination disorder (DCD) have difficulty in learning new motor skills. At present, it is not known whether these children employ a different set of brain regions than typically developing (TD) children during skilled motor practice. Using functional magnetic resonance imaging, we mapped brain activity associated with skilled motor practice of a trail‐tracing task in 7 children with DCD and 7 age‐matched controls (aged 8–12 years). We indexed change in motor performance as a reduction in tracing error from early practice to retention. Children with DCD showed less blood‐oxygen‐level‐dependent signal as compared to TD children in a network of brain regions associated with skilled motor practice: bilateral inferior parietal lobules (Brodmann Area (BA) 40), right lingual gyrus (BA 18), right middle frontal gyrus (BA 9), left fusiform gyrus (BA 37), right cerebellar crus I, left cerebellar lobule VI, and left cerebellar lobule IX. While no statistically significant differences were detected, effect size testing revealed that children with DCD demonstrated poorer tracing accuracy than TD children at retention (d = 0.48). Our results suggest that, compared to TD peers, children with DCD demonstrate under‐activation in cerebellar–parietal and cerebellar–prefrontal networks and in brain regions associated with visual‐spatial learning. These data suggest a neurobiological correlation with impaired learning of motor skills in children with DCD, which will need to be confirmed with a larger sample.

Developmental coordination disorder, sex, and activity deficit over time: a longitudinal analysis of participation trajectories in children with and without coordination difficulties

Aim  Children with developmental coordination disorder (DCD) are known to participate in active play less than typically developing children. However, it is not known whether the activity deficit between children with and without DCD widens or diminishes over time.

Cognitive orientation to daily occupational performance (CO-OP): part I--theoretical foundations

This paper is the first in a series of three papers that present the systematic development and evaluation of Cognitive Orientation to daily Occupational Performance (CO-OP). CO-OP is a cognitively based, child-centred intervention that enables children to achieve their functional goals. In Part I, the breadth of literature that provides the theoretical underpinnings for the approach is reviewed. Parts II and III provide a description of the approach and present the evidence to support its use with children with developmental coordination disorder.

Cognitive orientation to daily occupational performance (CO-OP): part III--the protocol in brief.

Parts I and II of this series introduced the Cognitive Orientation to daily Occupational Performance (CO-OP), a new approach to intervention that is based on the premise that cognition plays an important role in the acquisition of occupational skills and the development of occupational competency. Developed for use with children who have occupational performance deficits, CO-OP is an individualized, client-centred approach focused on strategy-based skill acquisition. This third paper in this series presents a brief description of the actual CO-OP protocol including its objectives, prerequisites and key features.