Jo Sibert

Children's Perceptions of the Impact of Developmental Coordination Disorder on Activities of Daily Living

Children with developmental coordination disorder (DCD) have a motor impairment that affects their ability to perform everyday tasks. Although severity of motor impairment can be measured, methods for assessing the perceived impact of DCD on daily activities have not been established. The purpose of this study was to use a child-focused approach to understand childrens views of the impact of DCD on the activities that they perform daily. Children aged 5–10 years, referred with coordination difficulties to occupational therapists, were assessed using the Movement Assessment Battery for Children: children who received scores below the 15th percentile were included. The Perceived Efficacy and Goal Setting System (PEGS), a pictorial scale validated as a method for engaging children with disabilities, was administered to examine the childrens perceptions of their competence in performing everyday activities and to identify goals for therapy. Parent and teacher concerns were collected by a questionnaire. The children, parents and teachers shared many concerns about the impact of DCD on physical tasks and on academic activities such as handwriting. The children expressed additional concerns, however, about their ability to perform daily self-care tasks and leisure activities, which were rarely recognised by the adults. Children require specialised methods to enable them to express their views and the PEGS appears to be suitable for this purpose.

Who is speaking for children and adolescents and for their health at the policy level

Personal view p 249 The Bristol inquiry has put children at the heart of the publics agenda on health. This contrasts with the seemingly low position of children on the Westminster governments own health agenda. This status is exemplified by the current consultation exercise to draw up a national plan for health. Although this, together with the increase in funding for the NHS, is welcome, paediatricians are dismayed at the inadequate voice for children and adolescents in the modernisation action teams that are taking forward the definition of the plan.1 Only one registered childrens nurse and a health visitor have been appointed to be custodians of the interests of all children and young people. This reinforces a widely held perception by childrens doctors and nurses that the government is not committed to ensure that the interests of children and adolescents—whose needs are different from those of adults—are spoken for as a client group in the health service. We argue that there is an urgent need for children and adolescents to be explicitly represented at all levels of health policy. Furthermore, measures need to be implemented to deliver not only a coherent strategy for childrens health in England, but also more effective responsibility for integrating service delivery at the local level. #### Summary points Children and young people are a nations most precious resource, and their health is vital for the future success of our society Despite this, improving the health of English children is not a key government target Children are not young adults: their special health needs should be acknowledged A strategy needs to be defined for children and young people, with responsibility allocated for integrating care within the health service and between sectors It needs to be recognised that children have fundamental human rights for which protection is needed These …

EARLY DEVELOPMENT OF BOYS WITH DUCHENNE MUSCULAR DYSTROPHY

Thirty‐three boys with Duchenne muscular dystrophy (DMD) and a mean age of 3–4 years were assessed with the Griffiths Developmental Scales, the Reynell Language Scales and the British Picture Vocabulary Scales at six‐monthly intervals over a one‐year period. The boys showed developmental delay, which was most severe in the locomotor and language areas. The locomotor quotients deteriorated over time, but the other quotients did not. Maternal intelligence, home environment and social class had little effect on the aetiology of the developmental delay, and the behavioural problems seen in young boys with DMD may be secondary to it.

Preventing deaths by drowning in children in the United Kingdom: have we made progress in 10 years? Population based incidence study.

Detailed information on drowning in children is not routinely collected by offices of national statistics. Few studies have been carried out in the United Kingdom, and none has been done on British children abroad. In 1988-9, two of the authors (AMK and JRS) combined information from national statistical offices, police forces (Royal Life Saving Society), and from a press cutting service (Royal Society for Prevention of Accidents) for a detailed analysis of deaths by drowning in children.1, 2, 3 This analysis found that 149 children had drowned in the United Kingdom during 1998-9. It also identified a safety agenda, which focused on young children in garden ponds and pools and on older children swimming without supervision. Over the past 10 years there have been initiatives on childrens safety in water, particularly swimming. We obtained similar information for 1998-9 to identify changes that have …

Post-Traumatic Stress Reactions in Children

An audit of 55 children referred for medico-legal assessment following accidents is outlined. The childrens reaction to the traumatic event is described. The variation of symptom-range, intensity and duration is suggestive of a spectrum of stress reactions to traumatic events in which post-traumatic stress disorder is at the extreme end. A number of symptoms not included in the DSM-III-R criteria for PTSD were identified. PTSD was established clinically only in the older age group. Parental responses to their childs difficulties are described. The need for research into developmental changes in childrens reaction to trauma is highlighted.