Wenonah Campbell

Partnering for Change: An Innovative School-Based Occupational Therapy Service Delivery Model for Children with Developmental Coordination Disorder

Background. Developmental coordination disorder (DCD) is a common, chronic health condition that is poorly recognized and understood in school settings. Without appropriate support, children with DCD are at increased risk of depression, decreased fitness, and obesity. Evidence shows that occupational therapy intervention needs to shift from remediation of impairment to chronic disease management. Purpose. This paper describes Partnering for Change (P4C), an innovative, empirically derived school health service delivery model for children with DCD. Key Issues. The model emphasizes the partnership of the occupational therapist with educators and parents to change the life and daily environment of a child. The P4C partnership focuses on capacity building through collaboration and coaching in context. The model uses a tiered approach which includes whole class instruction, dynamic performance analysis, and monitoring response to intervention. Implications. P4C is a model that responds to the needs of this population, addresses issues identified in research, and provides a continuum of services designed to build capacity.

Psychological distress in children with developmental coordination disorder and attention-deficit hyperactivity disorder.

This study explored whether or not a population-based sample of children with developmental coordination disorder (DCD), with and without comorbid attention deficit/hyperactivity disorder (ADHD), experienced higher levels of psychological distress than their peers. A two-stage procedure was used to identify 244 children: 68 with DCD only, 54 with ADHD only, 31 with comorbid DCD and ADHD, and 91 randomly selected typically developing (TD) children. Symptoms of depression and anxiety were measured by child and parent report. Child sex and caregiver ethnicity differed across groups, with a higher ratio of boys to girls in the ADHD only group and a slightly higher proportion of non-Caucasian caregivers in the TD group. After controlling for age, sex, and caregiver ethnicity, there was significant variation across groups in both anxiety (by parent report, F(3,235)=8.9, p<0.001; by child report, F(3,236)=5.6, p=0.001) and depression (parent report, F(3,236)=23.7, p<0.001; child report, F(3,238)=9.9, p<0.001). In general, children in all three disorder groups had significantly higher levels of symptoms than TD children, but most pairwise differences among those three groups were not significant. The one exception was the higher level of depressive symptoms noted by parent report in the ADHD/DCD group. In conclusion, children identified on the basis of motor coordination problems through a population-based screen showed significantly more symptoms of depression and anxiety than typically developing children. Children who have both DCD and ADHD are particularly at heightened risk of psychological distress.

Developmental Coordination Disorder

“There is something wrong with my child”. What physician hasn’t heard these words at some point from a parent whose preschool or school-aged child seems to be developing well, may have achieved major motor and cognitive milestones on time … but where something is just not right? The concerns begin when parents notice their toddler sitting back and watching, while other children climb on play equipment or manipulate toys. Instead of supervising from a nearby bench, parents find themselves standing at the bottom of the ladder of the slide, ready to catch their child when he falls off. These same parents are still helping to put coats and boots on when the child is six, tying shoelaces at eight, cutting meat at ten and still encouraging pants with an elastic waist at age twelve instead of jeans. It is puzzling. These children are often of average or above-average intellectual ability, are well supported and stimulated in their home environment, walked on schedule, give good eye contact, interact well and look quite normal physically. Parents usually raise concerns with their primary health-care provider before their child enters school, but the issues are often vague (Missiuna, Moll, Law, King, & King, 2006). “He’s tired a lot”, “She gets frustrated easily”, “He doesn’t want to go out and play”, “Should she still be having toileting accidents in Grade 2?”, “She whines, and wants me to do everything for her”, “He falls all the time, and has lots of cuts and bruises”. These children usually achieve basic motor milestones like sitting or standing on time but are slow to learn new motor skills such as holding and using a spoon, fork, crayon, pencil, pair of scissors; doing up buttons, zippers, shoelaces; learning to go downstairs with alternating feet, to ride a bicycle, to turn a doorknob ... everyday motor skills that require coordination (Missiuna, Moll, King, King, & Law, 2006). Children with these motor challenges have developmental coordination disorder (DCD).

Implementation Science: Buzzword or Game Changer?

PURPOSE The purpose of this supplement article is to provide a resource of pertinent information concerning implementation science for immediate research application in communication sciences and disorders. METHOD Key terminology related to implementation science is reviewed. Practical suggestions for the application of implementation science theories and methodologies are provided, including an overview of hybrid research designs that simultaneously investigate clinical effectiveness and implementation as well as an introduction to approaches for engaging stakeholders in the research process. A detailed example from education is shared to show how implementation science was utilized to move an intervention program for autism into routine practice in the public school system. In particular, the example highlights the value of strong partnership among researchers, policy makers, and frontline practitioners in implementing and sustaining new evidence-based practices. CONCLUSIONS Implementation science is not just a buzzword. This is a new field of study that can make a substantive contribution in communication sciences and disorders by informing research agendas, reducing health and education disparities, improving accountability and quality control, increasing clinician satisfaction and competence, and improving client outcomes.

Supporting evidence-based practice in speech-language pathology: A review of implementation strategies for promoting health professional behavior change

Abstract Evidence-based practice (EBP) is recognized as being essential to optimizing service provision and attaining positive client outcomes in speech-language pathology. Yet, there are a number of barriers to attaining EBP in speech-language pathology, including how to support clinicians to successfully change their practices and behaviors. Drawing from the field of implementation science, the authors describe several implementation strategies that researchers can use to facilitate the behavior of health professionals towards adopting empirically supported practices. Key studies are identified that provide practical advice for researchers on how to select and study specific implementation strategies in the service of enhancing EBP in real-world environments. An illustrative example from physical and occupational therapy illustrates how researchers might apply this advice in their own research designs. Ultimately, well-designed studies using multifaceted implementation strategies are needed to reduce the research-to-practice gap in speech-language pathology.

Reflections on Using a Community-Based and Multisystem Approach to Transforming School-Based Intervention for Children with Developmental Motor Disorders

Evidence-based management of developmental coordination disorder (DCD) in school-age children requires putting into practice the best and most current research findings, including evidence that early identification, self-management, prevention of secondary disability, and enhanced participation are the most appropriate foci of school-based occupational therapy. Partnering for Change (P4C) is a new school-based intervention based upon these principles that has been developed and evaluated in Ontario, Canada, over an 8-year period. Our experience to date indicates that its implementation in schools is highly complex with involvement of multiple stakeholders across health and education sectors. In this paper, we describe and reflect upon our team’s experience in using community-based participatory action research, knowledge translation, and implementation science to transform evidence-informed practice with children who have DCD.

A Quasi-Experimental Study of a Movement and Preliteracy Program for 3- and 4-Year-Old Children

Objective Approximately 28% of children are not ready for kindergarten, 91% are inactive according to current guidelines, and 21% are overweight/obese. Early intervention to strengthen movement and preliteracy skills may help to curb the concerning rates of poor school readiness, inactivity, obesity, and subsequently positively impact health across the lifespan. The objective of this pilot study was to evaluate the effectiveness of a motor and preliteracy skill program for a community sample of 3- to 4-year-old children. Methods A quasi-experimental study design was used. The program was run for 1 h/week for 10 weeks and consisted of movement skill instruction, free play, and an interactive reading circle with care-giver involvement throughout each session. Movement and preliteracy skills were assessed in all children pre- and post-intervention using the Peabody Developmental Motor Scales-2nd edition, the Preschool Word and Print Awareness tool, and the Phonological Awareness Literacy Screening tool. Results Nineteen families (experimental group, n = 8; control group, n = 11) were recruited (mean age = 3 years, 8 m; 47% male). There was a significant effect of group on gross motor raw scores overall [F(1, 16) = 4.67, p < 0.05; ωp2=0.16] and print-concept knowledge [F(1, 16) = 11.9, p < 0.05; ωp2=0.38]. Conclusion This study was one of the first to examine the impact of a community-based movement skill and preliteracy program with care-giver involvement in preschool children. Future research should continue to explore the effects of the program with larger and more diverse samples on multiple health and developmental outcomes. Clinical Trial Registration Play and Preliteracy among Young Children (PLAY) NCT02432443.

A comprehensive description of functioning and disability in children with velopharyngeal insufficiency

UNLABELLED Children with velopharyngeal insufficiency (VPI) experience functional impairments in a variety of areas that extend beyond the primary physical impairment associated with this disorder. At present, the physical deficits associated with VPI have been studied extensively; however, a comprehensive description of social and communicative participation in this population is needed. Therefore, a biopsychosocial framework such as the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), may offer an enhanced understanding of the daily experiences of children with VPI. Specifically, the ICF-CY framework is intended to model complex nonlinear systems, and as such, to describe functioning as the interaction of multiple components from which a limitation in communicative participation may emerge. This paper describes how the ICF-CY framework can be utilized to comprehensively describe functioning and disability in children with VPI by describing the interaction of components of this framework. LEARNING OUTCOMES As a result of this activity, the reader will be able to: (1) discuss the utility of the ICF-CY in describing the multi-dimensional nature of velopharyngeal insufficiency (VPI); (2) describe interrelationships between functioning and disability in children with VPI; and (3) identify how limitations in communicative participation may emerge from the interaction of components of the ICF-CY in children with VPI.

Building Bridges Between Education and Health Care in Canada: How the ICF and Universal Design for Learning Frameworks Mutually Support Inclusion of Children With Special Needs in School Settings

Since the 1990s, educators have prioritized inclusion of students with disabilities in general educational settings. Concurrently, healthcare professionals (HCPs) have recognized the need to support students’ academic functioning and participation at school. Despite this recognition, integration of health support services in schools remains a significant challenge and the extent to which students with special needs fully participate at school is often less than optimal. In this paper, we suggest that combining health and education conceptual frameworks would advance the goal of inclusion by enhancing inter-professional communication and collaboration. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) is a health framework that focuses on functioning and participation via a lens of inclusivity, universality, and a holistic approach to health and disability. Similarly, Universal Design for Learning (UDL) is an educational framework for guiding the design of instructional materials, methods, and assessments to be inclusive and accessible for all. Both frameworks are well-established in their respective fields, but have yet to “cross the border” to influence each discipline’s practices. While researchers have alluded to the potential utilization of both frameworks in education settings, there is limited guidance on how these two frameworks may be combined in practice. In this paper, we will compare the ICF and UDL frameworks, and provide insight into how utilization of both frameworks may enhance inter-professional collaboration and support inclusion in school settings.

Evaluation of a Direct-Instruction Intervention to Improve Movement and Preliteracy Skills among Young Children: A Within-Subject Repeated-Measures Design

Objective School readiness involves the development of foundational skills such as emergent literacy and fundamental movement skills as well as the capacity to attentively engage in instructional situations. Children do not develop these skills naturally; therefore, they need the opportunity to develop these skills in their early years prior to entering school. The objective of the current study was to evaluate the effectiveness and feasibility of a direct-instruction movement and preliteracy intervention in children aged 3–4 years. Methods A within-subject repeated-measures design, embedded within a wait-list control study, was used to evaluate the intervention. The intervention was run across 10 weeks with 1 h weekly sessions. Each weekly session consisted of 30-min of movement skill instruction (e.g., through single-step acquisition strategies), 15-min of free play during which time children had access to a variety of equipment (e.g., balls, hula hoops, etc.) or toys (e.g., puzzles, building blocks), and a 15-min interactive reading circle during which children read a storybook and were taught 1–2 preliteracy skills (e.g., alphabet knowledge, narrative knowledge, etc.). A convenience sample of 11 children (mean age = 45.6 months, SD = 7.3) was recruited. All children were assessed four times: baseline (Time 1), pre-intervention (Time 2), post-intervention (Time 3), and 5-week follow-up (Time 4). Gross motor skills and preliteracy skills were assessed at each time point. Results There was a statistically significant effect of time on the change in gross motor skills (Wilks’ lambda = 0.09, p = .002), print-concept skills (Wilks’ lambda = 0.09, p = .001), and alphabet knowledge (Wilks’ lambda = 0.29, p = .046). Post hoc analyses reveal non-significant changes between time 1 and 2 for motor and print-concept skills and significant changes in all three outcomes between time 2 and time 3. Conclusion Participation in a direct-instruction movement and preliteracy program led to positive improvements in gross motor skills, print-concept knowledge, and alphabet knowledge in 3- to 4-year-old children over time. Future research needs to evaluate the effectiveness of this movement and preliteracy skill intervention on various other indicators of child development and health. Clinical Trial Registration Play and Pre-Literacy among Young Children (PLAY) NCT02432443.