Deborah Dewey

DCD may not be a discrete disorder

The primary aim of this paper is to explore some of the issues surrounding the concept of DCD as a ‘‘specific’’ learning diAculty. Questions relating to the assessment and identification of DCD are addressed. The arguments we present are derived from data obtained in a study which compared 224 children referred because of learning and attention problems (but not motor diAculties) and 155 typically developing children. These 379 children were all assessed on a range of formal and informal tests, including several sensorimotor tests. Working criteria for classifying a child as DCD were derived. In addition to the high prevalence figures obtained for DCD in this group of children, the degree of comorbidity observed between DCD and the other developmental disorders (reading disability and attention-deficit/hyperactivity disorder) was also striking. These results prompted us to re-evaluate the usefulness of discrete diagnostic categories, and to consider a reconceptualization of childhood disorders in general. It is proposed that the comorbidity found in childhood disorders reflects a single underlying etiology: Atypical Brain Development. This deficit may be manifested in a variety of ways, including DCD, and explains why some childhood disorders are so often seen together. ” 1998 Elsevier Science B.V. All rights reserved. PsycINFO classification: 2221; 2330; 3230; 3253; 3270

Developmental coordination disorder: Associated problems in attention, learning, and psychosocial adjustment

This study investigated the problems of attention, learning and psychosocial adjustment evidenced by children with developmental coordination disorder (DCD). Forty-five children identified with DCD, 51 children identified as being suspect for DCD and 78 comparison children without motor problems on standardized tests of motor function participated in this study. Results revealed that both children with DCD and children suspect for DCD obtained significantly poorer scores on measures of attention and learning (reading, writing and spelling) than comparison children. Children with DCD and those suspect for DCD were also found to evidence a relatively high level of social problems and display a relatively high level of somatic complaints based on parent report. These findings indicate that all children with movement problems are at risk for problems in attention, learning and psychosocial adjustment. Assessment of children with movement problems, regardless of the degree or severity of these problems should examine a wide range of functions in addition to motor functioning. Such an approach, would assist in determining the types of intervention that would provide the most benefit to these children.

Epidemiology of Postconcussion Syndrome in Pediatric Mild Traumatic Brain Injury

BACKGROUND: Much disagreement exists as to whether postconcussion syndrome (PCS) is attributable to brain injury or to other factors such as trauma alone, preexisting psychosocial problems, or medicolegal issues. We investigated the epidemiology and natural history of PCS symptoms in a large cohort of children with a mild traumatic brain injury (mTBI) and compared them with children with an extracranial injury (ECI). METHODS: This investigation was a prospective, consecutive controlled-cohort study of 670 children who presented to a tertiary referral emergency department with mTBI and 197 children who presented with ECI. For all participants, data were collected by use of a telephone interview of a parent 7 to 10 days after injury. If a change from preinjury symptoms was reported by a parent, follow-up continued monthly until symptom resolution. Outcomes were measured by using the Post Concussion Symptom Inventory, Rivermead Postconcussion Symptom Questionnaire, Brief Symptom Inventory, and Family Assessment Device. RESULTS: There was a significant difference between the mTBI and ECI groups in their survival curves for time to symptom resolution (log rank [Mantel-Cox] 11.15, P < .001). Three months after injury, 11% of the children in the mTBI group were symptomatic (13.7% of children older than 6 years) compared with 0.5% of the children in the ECI group. The prevalence of persistent symptoms at 1 year was 2.3% in the mTBI group and 0.01% in the ECI group. Family functioning and maternal adjustment did not differ between groups. CONCLUSIONS: Among school-aged children with mTBI, 13.7% were symptomatic 3 months after injury. This finding could not be explained by trauma, family dysfunction, or maternal psychological adjustment. The results of this study provide clear support for the validity of the diagnosis of PCS in children.

Motor and gestural performance in children with autism spectrum disorders, developmental coordination disorder, and/or attention deficit hyperactivity disorder

Motor and gestural skills of children with autism spectrum disorders (ASD), developmental coordination disorder (DCD), and/or attention deficit hyperactivity disorder (ADHD) were investigated. A total of 49 children with ASD, 46 children with DCD, 38 children with DCD+ADHD, 27 children with ADHD, and 78 typically developing control children participated. Motor skills were assessed with the Bruininks-Oseretsky Test of Motor Proficiency Short Form, and gestural skills were assessed using a test that required children to produce meaningful gestures to command and imitation. Children with ASD, DCD, and DCD+ADHD were significantly impaired on motor coordination skills; however, only children with ASD showed a generalized impairment in gestural performance. Examination of types of gestural errors revealed that children with ASD made significantly more incorrect action and orientation errors to command, and significantly more orientation and distortion errors to imitation than children with DCD, DCD+ADHD, ADHD, and typically developing control children. These findings suggest that gestural impairments displayed by the children with ASD were not solely attributable to deficits in motor coordination skills.

Survival Without Disability to Age 5 Years After Neonatal Caffeine Therapy for Apnea of Prematurity

CONTEXT Very preterm infants are prone to apnea and have an increased risk of death or disability. Caffeine therapy for apnea of prematurity reduces the rates of cerebral palsy and cognitive delay at 18 months of age. OBJECTIVE To determine whether neonatal caffeine therapy has lasting benefits or newly apparent risks at early school age. DESIGN, SETTING, AND PARTICIPANTS Five-year follow-up from 2005 to 2011 in 31 of 35 academic hospitals in Canada, Australia, Europe, and Israel, where 1932 of 2006 participants (96.3%) had been enrolled in the randomized, placebo-controlled Caffeine for Apnea of Prematurity trial between 1999 and 2004. A total of 1640 children (84.9%) with birth weights of 500 to 1250 g had adequate data for the main outcome at 5 years. MAIN OUTCOME MEASURES Combined outcome of death or survival to 5 years with 1 or more of motor impairment (defined as a Gross Motor Function Classification System level of 3 to 5), cognitive impairment (defined as a Full Scale IQ<70), behavior problems, poor general health, deafness, and blindness. RESULTS The combined outcome of death or disability was not significantly different for the 833 children assigned to caffeine from that for the 807 children assigned to placebo (21.1% vs 24.8%; odds ratio adjusted for center, 0.82; 95% CI, 0.65-1.03; P = .09). The rates of death, motor impairment, behavior problems, poor general health, deafness, and blindness did not differ significantly between the 2 groups. The incidence of cognitive impairment was lower at 5 years than at 18 months and similar in the 2 groups (4.9% vs 5.1%; odds ratio adjusted for center, 0.97; 95% CI, 0.61-1.55; P = .89). CONCLUSION Neonatal caffeine therapy was no longer associated with a significantly improved rate of survival without disability in children with very low birth weights who were assessed at 5 years.

Identifying developmental coordination disorder: consistency between tests.

Summary In the absence of a gold standard to identify the presence of developmental coordination disorder in children, it is useful to examine the consistency of different tests used in physical and occupational therapy. This study examined three measures of motor skills to determine whether they consistently identified the same children. In total, 379 children participated in this study. The final matched samples consisted of 202 children ranging in age from 8 to 17 years: 101 met criteria for DCD and 101 children did not show any evidence of DCD. The results indicated that the overall agreement between the Bruininks Oseretsky Test of Motor Proficiency (BOT), the Movement Assessment Battery for Children (M-ABC) and the Developmental Coordination Disorder Questionnaire (DCDQ) was less than 80%. The difference in structure and style of administration between the BOT and the M-ABC appears to contribute to their tendency to identify different children. This studyemphasizes the need for therapists to use clinical reasoning to examine multiple sources of information about a childs abilities.

Psychosocial adjustment in siblings of children with autism

BACKGROUND This study investigated psychosocial adjustment in siblings of children with autism compared to siblings of children with Down syndrome and siblings of normally developing children. In addition, the relationships between feelings of loneliness, social support and psychosocial adjustment, and the influence of gender and family size on psychological adjustment were examined. METHODS Ninety siblings (30 per group) between the ages of 8 and 18 and one parent of each child participated in this study. RESULTS Results indicated that siblings of children with autism, as well as comparison siblings, were well adjusted and reported low levels of loneliness. Siblings of children with autism also reported that they received high levels of social support in their lives. CONCLUSIONS Large family size appears to facilitate healthy adjustment in siblings of children with autism.

Siblings Relationships of Children with Autism.

This study investigated sibling relationships of children with autism compared to children with Down syndrome and siblings of normally developing children. Ninety siblings (30 per group) between the ages of 8 and 18 participated in this study. Results indicated that sibling relationships in families of children with autism were characterized by less intimacy, prosocial behavior, and nurturance than those of the two comparison groups. Both siblings of children with autism and siblings of children with Down syndrome reported greater admiration of their sibling and less quarreling and competition in their relationships relative to normally developing comparison children.

Developmental Coordination Disorder

Summary This paper begins with a discussion of the historical basis for the concept of developmental coordination disorder (DCD). The definition of this disorder as it appears in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) is then provided. The four diagnostic criteria proposed by the DSM-IV are used to describe the disorder. Problems associated with the assessment of DCD are discussed and suggestions for further research are identified. This is followed by a discussion of intervention approaches that can be used with children identified with DCD.

Activities of daily living in children with developmental coordination disorder: Dressing, personal hygiene, and eating skills

In order to understand how age, culture, and problems in motor coordination impact the performance of activities of daily living, we used focus groups and in-depth interviews with Australian and Canadian parents to examine activities of daily living of younger (5-7 years of age) and older (8-9 years of age) children with and without DCD. By comparison with their typically developing age group, children with DCD had more difficulty with dressing, personal hygiene, and eating skills. Difficulties with postural control and fine-motor skills were reported to contribute to poorer performance of activities of daily living. As expected, competence in the performance of activities of daily living improved in the older children with and without DCD and there were few differences in the performance of daily living tasks between typical children in Australia and Canada. Overall, the motor difficulties of children with DCD had a significant impact on performance of a wide range of daily activities.