Robin Gaines

Description of children identified by physicians as having developmental coordination disorder

The aim of this study was to describe in detail a large group of children aged 4 to 12 years who were diagnosed with developmental coordination disorder (DCD) by physicians following a rigorous multidisciplinary procedure. As part of a community‐based DCD knowledge translation program, physicians received specialized training and were invited to identify children with probable DCD who were referred for further investigation to help confirm the diagnosis. Of 116 children (87 males, 29 females; age range 4y 1mo ‐ 12y 11mo, mean age 8y) identified as having probable DCD by physician participants, 88 (76%) were subsequently diagnosed with DCD and 77.3% of these demonstrated a high degree of motor impairment. All children who were diagnosed experienced difficulties in self‐care and/or academic or leisure activities. The male:female ratio was 3:1 and the incidence of preterm births among this sample was 12.5%. We conclude that, given the expense involved with ruling out differential diagnoses, it can be difficult to adhere rigorously to diagnostic criteria for DCD in clinical practice and research. This description of a group of children actually diagnosed with DCD helps to clarify the characteristics of these children as well as issues related to the refinement of diagnostic criteria.

Enabling Occupation through Facilitating the Diagnosis of Developmental Coordination Disorder

Background. The largest proportion of children seen within school-based occupational therapy is referred for handwriting difficulties. Many of these children have Developmental Coordination Disorder (DCD), a disorder that often goes undiagnosed, making if difficult for children, parents, and teachers to access resources. Purpose. The purpose of this article is to outline the important role of occupational therapists in recognizing and facilitating the diagnosis of DCD. Key Issues. In this paper, a case is made for an expansion of the role of school-based occupational therapists in facilitating diagnosis for children with DCD. Through a review of the literature, we establish the importance of a diagnosis for children and families and critically reflect on issues that may make therapists reluctant to become involved in facilitating this diagnosis. Implications. Occupational therapists working in schools are able to recognize children with DCD, an important first step in accessing key resources useful to improve occupational performance and quality of life.

Educational outreach and collaborative care enhances physician's perceived knowledge about Developmental Coordination Disorder.

BackgroundDevelopmental Coordination Disorder (DCD) is a chronic neurodevelopmental condition that affects 5–6% of children. When not recognized and properly managed during the childs development, DCD can lead to academic failure, mental health problems and poor physical fitness. Physicians, working in collaboration with rehabilitation professionals, are in an excellent position to recognize and manage DCD. This study was designed to determine the feasibility and impact of an educational outreach and collaborative care model to improve chronic disease management of children with DCD.MethodsThe intervention included educational outreach and collaborative care for children with suspected DCD. Physicians were educated by and worked with rehabilitation professionals from February 2005 to April 2006. Mixed methods evaluation approach documented the process and impact of the intervention.ResultsPhysicians: 750 primary care physicians from one major urban area and outlying regions were invited to participate; 147 physicians enrolled in the project. Children: 125 children were identified and referred with suspected DCD. The main outcome was improvement in knowledge and perceived skill of physicians concerning their ability to screen, diagnose and manage DCD. At baseline 91.1% of physicians were unaware of the diagnosis of DCD, and only 1.6% could diagnose condition. Post-intervention, 91% of participating physicians reported greater knowledge about DCD and 29.2% were able to diagnose DCD compared to 0.5% of non-participating physicians. 100% of physicians who participated in collaborative care indicated they would continue to use the project materials and resources and 59.4% reported they would recommend or share the materials with medical colleagues. In addition, 17.6% of physicians not formally enrolled in the project reported an increase in knowledge of DCD.ConclusionPhysicians receiving educational outreach visits significantly improved their knowledge about DCD and their ability to identify and diagnose children with this condition. Physicians who collaborated with occupational therapists in providing care reported more confidence in diagnosing children with DCD and were more likely to continue to use screening measures and to provide educational materials to families.

Interprofessional care in the management of a chronic childhood condition: Developmental Coordination Disorder

Five to six percent of school-aged children have Developmental Coordination Disorder (DCD) (American Psychiatric Association, 2000). This chronic condition is largely unrecognized by physicians (Hamilton, 2002), yet it is common and is often comorbid with other childhood disorders including speech/language difficulties and attention-deficit/ hyperactivity disorder. Children with DCD have difficulty performing everyday motor tasks despite having at least average intellectual ability and no other diagnosable neurological disorder (American Psychiatric Association, 2000). While it was once believed that children with DCD would outgrow their motor difficulties, research evidence has now shown that these difficulties remain through adolescence and into adulthood (see reviews by Missiuna, Gaines, Soucie, & McLean, 2006; Polatajko & Cantin, 2006). If not managed adequately, DCD can lead to long-term negative consequences including academic failure, poor social relationships, emotional and behavioural difficulties plus diminished physical fitness (Missiuna, Gaines, & Soucie, 2006; Polatajko & Cantin, 2006). Families often raise vague concerns with their primary care physicians when their child is young (Hamilton, 2002). Research has shown that they are frequently referred by their physicians to numerous healthcare professionals in an effort to understand their child’s motor difficulties (Missiuna, Moll, Law, King, & King, 2006). Figure 1 provides one example of the typical lengthy and costly care pathway travelled by a family ‘‘Before’’ this project. An alternative service delivery model was clearly needed to decrease family stress and facilitate early identification of children with this chronic condition.