Linda T. Miller

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.

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.

Cognitive orientation to daily occupational performance (CO-OP): part II--the evidence.

CO-OP is a child-centred, cognitive based intervention, focused on enabling children to achieve their functional goals. It has been developed over the last nine years through a series of systematic studies that have specified the treatment protocol and evaluated its effect. Initially CO-OP was explored in two series of single case experimental studies. Subsequently, an informal follow-up study and a detailed analysis of the video-taped sessions of the approach were completed. Based on information from these studies, the approach was refined, key features elucidated and the protocol was specified. Next, a pilot randomized clinical trial was completed. The trial was conducted to determine how best to approach a full scale randomized clinical trial on the effectiveness of CO-OP, relative to the current therapeutic approach. Finally, a retrospective chart audit was carried out to examine the cumulative evidence on the effectiveness of CO-OP in improving the performance of children with DCD. This paper presents a detailed summary of these five studies and discusses the implications of the findings.

High School‐Aged Youths' Attitudes Toward their Peers with Disabilities: the role of school and student interpersonal Factors

Negative peer attitudes are generally recognised as being a major barrier to full social inclusion at school for children and youth with disabilities. The present study examined the attitudes of 1,872 grade nine high school students in Ontario, Canada toward their peers with disabilities. A bioecological perspective and a structural equation modeling approach were adopted to investigate how various aspects of school culture and student interpersonal factors influenced attitudes. The majority of students (61%) held attitudes toward peers with disabilities that ranged from slightly above neutral to very positive. However, a substantial number (21%) held slightly below neutral to very negative attitudes. Positive student relationships at the school level and a school goal task structure that promoted learning and understanding for all students, rather than social comparison and competition among students, were two aspects of school culture that had both direct associations with positive attitudes and indirect associations through student interpersonal factors. Teacher and student relationships at the school level was an aspect of school culture that had an indirect association with positive attitudes via interpersonal support from teachers. Results support the development of ecologically based programs aimed at promoting aspects of school culture that contribute to positive attitudes of students toward their peers with disabilities.

Treatment of Children with Developmental Coordination Disorder: What Is the Evidence?

Summary Children with Developmental Coordination Disorder (DCD) experience significant difficulty performing everyday tasks and management of these children is a great source of debate. Because little is understood about the etiology of the disorder, treatment design has been driven by competing theories of motor development and motor skill acquisition. Traditional approaches to treatment have been based on neuromaturational, hierarchical theories and, consequently, therapies have focused on remeditating underlying deficits with the expectation of subsequent improvement in motor performance. Contemporary approaches, drawn from human movement science, propose that treatment methods be based on the assumption that skill acquisition emerges from the interaction of the child, the task and the environment. This paper provides a review of the treatment literature over the past 15 years, highlighting the fact that little evidence exists to suggest any one approach is better than another. Given current demands for evidence-based practice, and evolving concepts in skill acquisition, a movement toward interventions that are based on functional outcomes is recom-mended.

The search for subtypes of DCD: Is cluster analysis the answer?

Studies using cluster analysis as a method to identify distinct subtypes of developmental coordination disorder (DCD) have been inconclusive leading some authors to conclude that the method of cluster analysis should be abandoned while others call for the validation of previously defined subtypes. The objective of the current study was to examine the use of cluster analysis as a method of searching for subtypes of DCD to gain a better understanding of how different samples and different measures influence the interpretation of results. The paper provides a detailed review of three commonly cited cluster analytical studies and then explores the possible reasons for the discrepant results by replicating the approach with a different clinical sample. The results highlight the impact of different measures on cluster structure and the importance of adoption of a common standard to facilitate interpretation across studies.

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.

Chronic physical health conditions and disability among Canadian school-aged children: a national profile

Objective: The objective of this study was to provide a national health and disability profile of Canadian school-aged children based on the World Health Organizations definitions of health condition and disability that would facilitate international comparisons of child health data. Methods: Data were used from the National Longitudinal Survey of Children and Youth, a 1994 – 95 population-based sample of 22 831 children. Findings: An estimated total of 30.3% of Canadian children aged 6 to 11 had one or more chronic physical health conditions/impairments, while 3.6% had activity-limiting conditions/impairments. Children living with one parent were significantly more likely to have activity-limiting conditions/impairments than those living with two parents. Children with conditions/impairments, particularly those with activity limitations, were significantly more likely than children without health problems to have experienced mental health conditions and learning disabilities, missed school days, received special education, visited health professionals, been hospitalized, and used prescription medication. Conclusion: Important differences were found among children in a number of areas as a function of overall physical health status. The findings emphasize the importance of measuring activity limitations distinctly from chronic conditions and impairments, and, perhaps, of measuring impairments distinctly from chronic conditions, and of comparing children with such health problems to children without health problems in order to obtain a more accurate picture of the impact of health on childrens lives. The World Health Organizations distinct definitions of health condition and disability facilitate a dimensional approach for describing child health that can serve to clarify this field of study and improve comparability of data across countries.

Intelligence, Reaction Time, and Working Memory in 4- to 6-Year-Old Children.

Abstract The purpose of this study was to determine whether the results previously found in adults, demonstrating a relationship between intellectual ability, speed of information processing, and memory capacity, could also be found in young children. A sample of 109 children ages 4 years, 0 months to 6 years, 12 months ( M = 5.56, SD = .84) were tested with a battery of computer-administered reaction time tests, a battery of computer-administered memory tests, and the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R). As expected, results revealed distinct developmental trends in processing speed and memory capacity. Similar to research with adults, the factor structure of each of the three test batteries revealed evidence of a general factor in each battery. However, the relationships between the general intelligence, general reaction time, and general memory factors in children are not comparable to those found in adults. A significant relationship between general intelligence and general memory was found in children; however, the relationship between general intelligence and general reaction time was found to be weak. These findings suggest that childrens intelligence cannot be explained using a model of adult intelligence.

The general factor in short-term memory, intelligence, and reaction time

Abstract This study investigated the notion of the generality of the general intelligence factor (g) across three relatively homogeneous and relatively distinct batteries of ability measures. A short-term memory battery, the Multidimensional Aptitude Battery (MAB) and a reaction time battery were administered to 170 subjects in four 1-hour test sessions. Significant intercorrelations among the component scores generated for the first unrotated (or general) component derived from each battery were obtained. Furthermore, partial correlations demonstrated that controlling for the short-term memory g substantially decreased the correlation between the reaction time g and the MAB g, suggesting that short-term memory mediates the relationship between intelligence and reaction time. Regression analyses revealed that although both the short-term memory g and the reaction time g could significantly predict the MAB g, the short-term memory g was the better predictor. In addition, a second reaction time component, orthogonal to the first and representing a long-term memory factor, was found to significantly increase the prediction of the MAB g beyond that predicted by the reaction time g. Results not only support the notion of the generality of g, but also implicate short-term memory as being an essential aspect of intelligence. The results also demonstrate that general intelligence is not a unitary construct, but comprises at least two distinct components.