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Developmental Coordination Disorder

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OT Team 2

on 14 November 2012

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Transcript of Developmental Coordination Disorder

Team 2: Jacqui Axford, Renee Bucci, Kristin Collins, Meagan Firth, Isabel Gowdy, and Becky Reid Developmental Coordination Disorder “Clumsy Child Syndrome”
“Motor Impaired”
“Specific Development Disorder of Motor Function” Introduction to DCD Developmental Coordination Disorder (DCD) occurs when there is a delay in the development of motor skills and coordination, resulting in a child being unable to perform everyday tasks
Usually identified in children between the ages of 6 and 12 years of age
5% and 8% of all school-aged children Definition: DCD is a disorder in which the development of motor coordination is impaired and is not due to any specific acquired or congenital medical conditions.

Although there is no hard evidence supporting the cause of coordination disorder, there are various theories suggesting that DCD emanates from prenatal complications such as fetal malnutrition or prematurity. Causes Characteristics 1) Clumsy or awkward
2) Difficulty with Gross Motor Skills
3) Delayed development in motor skills
4) Discrepancies between abilities in certain motor skills and abilities in other areas
5) Difficulty learning new motor skills
6) Difficulty with activities that require constant change
7) Difficulty with coordinating both side of the body
8) Poor postural control and balance
9) Difficulty with hand writing and printing
10) Inconsistent performance References:

Barnhart,R.C., Davenport, M.J., Epps, S.B., & Nordquist, V. M. (2003). Physical Therapy. 83 (8). 722- 731.

Benson, T.M., Ingolia, P., & Koomar, J. (2002). Daily living skills and developmental coordination disorder. In Cermak, S.A. & Larkin, D. (Eds.). Developmental Coordination Disorder (pp. 140-156). Albany, NY: Delmar.

Developmental Coordination Disorder. (2012). Encyclopedia of Mental Disorders. Retrieved September 19th, 2012 from http://www.minddisorders.com/Del-Fi/Developmental-coordination-disorder.html#b

Dewey, D., Kaplan, B.J., Crawford, S. G., & Wilson, B.N. (2002). Developmental Coordination Disorder: Associated problems in attention, learning, and psychosocial adjustment. Human Movement Science, 21, 905-918.

Dunford,C., Missiuna, C., Street, E., & Sibert, J. (2005). Children’s perception of the impact of Developmental Coordination Disorder on activities of daily living. British Journal of Occupational Therapy, 68(5), 207-214.

Mirafkhami, S., Fakhraee, S.H., Yousefi, M, & Varzandehfar, M. (2010). Developmental Coordination Disorder in Children. Iran Journal of Child Neurology. 3(4). 17-22.

Missiuna, C., Pollock, N., Egan, M., DeLaat, D., Gaines, R., & Soucie, H. (2006). Enabiling occupation through facilitating the diagnosis of Developmental Coordination Disorder. Canadian Journal of Occupational Therapy, 75(1), 26-34.

Missiuna, C., Moll, S., King, G., Stewart, D., & Macdonald, K. (2008). Life experiences of young adults who have coordination difficulties. Canadian Journal of Occupational Therapy, 75(3), 157-166.

Missiuna, C. & Pollock, N. (2009). DCD: A resource guide for educators. Hamilton, ON:
CanChild. Retrieved on September 22nd/12 from http://dcd.canchild.ca/en/EducationalMaterials/ resources/MATCH20JK-SK20Dec209.pdf

Missiuna, C., Pollock, N. & Rivard, L. (2011). Children with developmental coordination
disorder: At home, at school, and in the community. Hamilton, ON: CanChild. Retrieved on September 22nd/12 from http://dcd.canchild.ca/en/EducationalMaterials/resources/dcd_developmental_coordination_disorder_home_school_community_booklet.pdf

Missiuna, C., Polatajko, H., Pollock, N., & Cameron, D. (2012). Neuromotor disorders: Can I learn to walk? In Lane, S.J. & Bundy, A.C. (Eds.), Kids Can Be Kids: A Childhood Occupational Approach (pp. 461-482). Philadelphia: F.A. Davis Company.

Missiuna, C. A., Pollock, N. A., Levac, D. E., Campbell, W. N., Sahagian Whalen, S. D., Bennett, S. M., Hecimovich, C. A, Gaines, R.B, Cairney, J., Russell, D. J. (2012). Partnering for Change: An innovative schoolbased occupational therapy service delivery model for children with developmental coordination disorder. Canadian Journal of Occupational Therapy, 79, 41-50.

Portwood, M. (1999). Development dyspraxia identification and intervention – A manual for parents and professionals. David Fulton Publishers Ltd.

Zoia, S., Barnett, P., & Hill, E. (2006). Developmental Coordination Disorder: Current Issues. Child: Care, Health and Development 32 (6), 613-618 . Developmental Coordination Disorder can have an impact on all domains of occupation.
Generally, children with DCD perform functional activities at a slower developmental pace and in less effective ways than their peers. Impact on Activity Participation Dressing
Grooming/Toileting Self-Care Handwriting
Organization Productivity Play
Sports Leisure Difficulties with personal space
Low self-esteem and introversion
Anxiety and withdrawal from social activities with peers Social Interaction and Participation A Difference of Opinion? Children's Concerns
Cursive Writing
Playing football
Being more independent in wiping
Going high on a swing Parent's Concerns
Academic/ School related skills (including handwriting)
Attention/ Concentration
Motor skills/ Coordination difficulty
Social acceptance Teachers Concerns
Motor skills
“Other school related activities” As children transition to High School and young adulthood, some difficulties that were encountered in younger years resolve while some new challenges arise. Lasting Impact on Activity Participation What happens as children with DCD age into adolescence and young adulthood? New Challenges:
Vocational Pursuits Strengths:
Handwriting typing
Physical education classes are no longer a requirement
More peer and self-acceptance
Learning to adapt to challenges
Learning of coping strategies:
Finding a match
Using humor
Changing roles/Changing rules
“Just do it” Assessment of DCD The Role of the OT:
OT’s are skilled in the observation of fine and gross motor task performance and can assist with identifying and assessing children with DCD
OT’s can be helpful in confirming the presence of DCD, providing information on the severity of the difficulties and determine the impact of the disorder on the child’s daily functioning Issues with Assessment of DCD:

Multiple factors contribute to the motor difficulties associated with DCD (motor ability, perceptual motor influences, neuro-behavioural influences)

Depending on the assessment procedure and the background and experience of the assessor, the incidence can range from 3% to 22% Areas of Assessment for DCD Motor Coordination:

Peabody Developmental Motor Scale (PDMS): Preschool-aged Children:

Movement Assessment Battery for Children (MABC): Children aged 4 + Areas of Assessment for DCD Daily Functioning:
Through interview, questionnaires and observation, OTs can describe the impact of motor skills delays and in-coordination on:
Self-Care (dressing, eating, toileting, hygiene, bathing)
Leisure (sports, arts and crafts, outings with family and playing with friends)
School Activities (academic progress, social relationships, following classroom routines and completing homework) Areas of Assessment for DCD Goal Setting:
Perceived Efficacy and Goal Setting System (PEGS): Children under 8

Canadian Occupational Performance Measure (COPM): Children over 8 Interventions OTs Role:

We are the consultant and the parent is the leader
We observe the child while performing tasks and make recommendations to the parents

Recommendations could include:
Strategies to assist with ADL’s and other tasks performed at home
Modifications to the child’s environment
Ways to promote physical activity and social interaction/participation with others
Assistance with setting appropriate goals and expectations to ensure success Home-Based Interventions Matching the activity/task to the child
Can be used for any intervention

Modify the Task
Alter your Expectations
Teaching Strategies
Change the Environment
Help by Understanding M.A.T.C.H. Strategy Dressing
Elastic waist pants, Velcro fasteners, elastic shoe laces
Eating and drinking
Textured food, cut food up into smaller pieces, doubled-handled cup
Pump shampoo bottles, automatic soap dispensers
Elastic waist pants, small box to rest feet ADL Interventions Activities should not require constant monitoring or feedback
Sports/active activities should incorporate repetitive movement sequences
Swimming, cycling, skating, and running
Promote group activities and participation
Art, music, drama, clubs
To prevent injury adapt activities and environment accordingly
Provide necessary equipment - helmets, arm and knees pads
Parents/caregivers should help to organize activities
Provide clear verbal instructions for all activities Leisure Interventions Parent

Task-specific interventions
Resist the temptation to complete tasks
Allowing enough time to complete tasks
Scaffolding - reduce assistance gradually
Avoid situations that will cause distress
Just Right’ challenge
Recognize and reinforce strengths
Encourage participation in activities that are interesting to your child and provide practice in & exposure to motor activities Education Child

•Educate the child on DCD
Focusing on their strengths and acknowledging limitations
Teaching them ways they can compensate
•If the child understands the condition, they are more likely to experience success OT in Schools

•Frustrating activities in the classroom
Younger grades: Printing, cutting, opening lunch containers, playing games at recess, getting changed for recess, etc.
Older grades: organization of time/materials, quality/speed of written output, participation in physical education class and sports

What is the most common school-based referral for OT services? School-Based Interventions Model of remediation and consultation (1:1 intervention)
Limitations: number of visits, unclear distribution of responsibilities between collaborating partners, wait list of up to 2 years in most of Ontario
Intervention types: remediation approach to gross and fine motor skills, handwriting often the main focus with 1:1 out of classroom sessions Previous OT Interventions Partnering for Change (P4C)
Emphasis on partnerships to enhance participation
Collaborating and coaching
Transferring skills not direct service
Teachers as agent of intervention

What are the benefits of this intervention approach over direct consultation and remediation? Are there drawbacks? New OT School Intervention Delivery Models Thank you for listening! Questions? Comments? By the end of this presentation, students will be able to :
Define and identify the causes and characteristics of DCD and its impact on participation.
Gain an understanding of the relevant assessments for this population.
Apply appropriate home and school based interventions for children with DCD. Learning Objectives Children with DCD have both strengths and weakness that impact their occupational engagement and participation.
OTs play a significant role in assessment and interventions with this population.
The focus of OT intervention is shifting from remediation to adaptation, with consideration of interprofessional perspectives. Take Home Messages
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