Developmental coordination disorder: the impact on the family

Prevalence and associated factors of developmental coordination disorder in primary school children

Developmental coordination disorder (DCD) is one of the most frequently observed movement disorders in childhood, yet data on its prevalence are still unclear. This two-stage epidemiological study aims to determine the prevalence of DCD in children between 6 and 10 years of age according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). In the first stage, the Developmental Coordination Disorder Questionnaire (DCDQ'07) were given to primary school students. In the second stage, clinicians conducted psychiatric interviews with children who had an indication of DCD or were suspected of having DCD according to the DCDQ'07 and their parents. The interviews utilized the DSM-5 diagnostic criteria for DCD and applied the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-Turkish Adaptation (K-SADS-PL) and Wechsler Intelligence Scale for Children (WISC-R) to identify co-occurring disorders. In the first stage, 2,306 children were evaluated, and 205 were invited for a clinical interview. Of the 198 children interviewed, 49 met the diagnostic criteria for DCD. The prevalence of DCD in Türkiye was found to be 2.1%. High parental education level, a previous psychiatric admission of the child, mother's postpartum depressive symptoms, co-occurring disorders, and co-occurring attention deficit hyperactivity disorder (ADHD) were significantly more common among children with DCD. Potentially associated factors were evaluated by logistic regression analysis. The mother's education level, the presence of postpartum depressive symptoms, and co-occurring disorders in the child were found to be associated factors.

The impact for DCD - USA study: The current state of Developmental Coordination Disorder (DCD) in the United States of America

BACKGROUND

Developmental Coordination Disorder (DCD) is among the most under-recognized and under-supported disorders worldwide.

AIMS

To present a preliminary national study that evaluated the unmet needs of children with DCD in the USA using the Impact for DCD survey.

METHODS AND PROCEDURES

232 parents of individuals aged 5-18 years provided responses from 36 items in five domains (diagnosis, activity/participation, education, therapy, and social/emotional health).

OUTCOMES AND RESULTS

Most children (81.9%) had a formal diagnosis for movement difficulties, and 91.6% of parents reported that receiving a diagnosis was helpful, but most had not heard of the diagnosis before. The most common co-occurring diagnoses were childhood apraxia of speech and other speech-language disorders (24.6%), ADHD (23.1%), and anxiety (18.8%). Most parents reported that their children withdrew from or avoided movement-related activities (53%), and nearly all (94.8%) were concerned about the impact of motor difficulties on their children's social and emotional health. Only 37% of parents reported feeling that their child received sufficient therapy.

CONCLUSIONS AND IMPLICATIONS

Generally, parents reported feeling frustrated with others' understanding and awareness of the condition and with therapy services. The results shown here provide timely data that can support efforts for increased awareness, improved diagnosis, and increased availability of services for DCD in the USA.

Caregiver burden and mental health: Parent perspectives when raising a child with developmental coordination disorder

BACKGROUND

Children with Developmental Coordination Disorder (DCD) are at high risk for mental health disorders, stemming from challenges participating in motor activities. Parents of children with DCD report increased caregiver burden exacerbated by insufficient support and services for their child. A paucity of literature exists on parent and child mental health associated with a DCD diagnosis.

AIMS

To explore parent perceptions of their child's mental health, and the impact of DCD on family and parental mental health.

METHODS AND PROCEDURES

Implementation of a secondary analysis using the impACT for DCD, a cross-sectional online survey of parents of children with self-reported suspected or confirmed diagnosis of DCD living in British Columbia, Canada. Data analysis included descriptive and inferential statistics and content analysis.

OUTCOMES AND RESULTS

Of the 237 participants, more than one third of parents (36%) rated their own mental health to be fair or poor, and the majority (90%) expressed concern for their child's mental health. Themes emerged on the impact of DCD on child, parent, and family, influenced by access to resources.

CONCLUSIONS AND IMPLICATIONS

Standard of care for DCD needs to include services and supports that address caregiver burden and mental health of children with DCD and their families.

WHAT THIS PAPER ADDS

This paper explores parent perceptions of their child(ren)'s and their own mental health when raising a child with DCD in British Columbia (BC). In BC, there is a lack of research on the mental health challenges families face when their child has a diagnosis of DCD. Amongst health care providers, there tends to be a focus on DCD as a motor disorder, with limited understanding and acknowledgement of the mental health component for children and their families. Thus, this study will inform health-care providers, parents, educators, and policy makers on parent-identified mental health needs and the essential services and supports. Unique to this study was the inclusion of a descriptive and exploratory content analysis, providing a holistic understanding of parents' perceptions regarding the impact of DCD on their children and themselves. Our results revealed that parents perceive significant inter-connected impacts of DCD on the child, parents, and family, leading to poor mental health for parents and their child(ren). Limited access to resources and supports results in a negative trajectory for family mental health and well-being. Study results indicate the critical importance of addressing mental health, in addition to motor challenges. Healthcare providers need to adopt a family-centred approach to address the physical and psychosocial impairments associated with DCD, ensuring positive outcomes for children and their families.

Journeying with developmental coordination disorder: The family experience

Background

Developmental coordination disorder (DCD) is a neurodevelopmental disorder impacting 5% - 6% of children and continues into adulthood for 50% - 70% of cases. Despite the multidomain and lifelong influence of this disorder, little consideration has been given to the experiences of the family. Post-diagnostic support has been recommended however, the specific areas requiring support remain vague.

Objectives

This study described the familial experiences of living with a member diagnosed with DCD.

Method

A qualitative descriptive study using a phenomenological approach allowed insight into the lived experiences of families journeying with DCD. Forty-four participants representing 8 countries participated in an online questionnaire with 12 participating in an online semi-structured interview.

Results

Themes generated reveal that obtaining a diagnosis and navigating the healthcare and education systems can be troublesome. Upon diagnosis, families tend to experience positive emotions such as relief. However, the daily challenges soon result in dominant negative emotional responses. DCD places significant financial burdens on families and impacts marital, parental and sibling relationships. Families often feel isolated from their communities as DCD is poorly understood.

Conclusion

DCD places families at risk as daily struggles require support which targets identified motor, cognitive, academic and emotional challenges. Creating awareness in society, education and healthcare would alleviate continual frustrations.

Contribution

This study provides insight into the wide-ranging impact that DCD has on families so that individualised support can be tailored, and general awareness raised.

Advances in Genetics and Epigenetics of Developmental Coordination Disorder in Children

Developmental coordination disorder (DCD) is a developmental disorder characterized by impaired motor coordination, often co-occurring with attention deficit disorder, autism spectrum disorders, and other psychological and behavioural conditions. The aetiology of DCD is believed to involve brain changes and environmental factors, with genetics also playing a role in its pathogenesis. Recent research has identified several candidate genes and genetic factors associated with motor impairment, including deletions, copy number variations, single nucleotide polymorphisms, and epigenetic modifications. This review provides an overview of the current knowledge in genetic research on DCD, highlighting the importance of continued research into the underlying genetic mechanisms. While evidence suggests a genetic contribution to DCD, the evidence is still in its early stages, and much of the current evidence is based on studies of co-occurring conditions. Further research to better understand the genetic basis of DCD could have important implications for diagnosis, treatment, and our understanding of the condition's aetiology.

Emotional distress and quality of life among adults with developmental coordination disorder during COVID-19

Introduction

Individuals with developmental coordination disorder frequently report emotional and functional difficulties. A stressful era as COVID-19 pandemic may enhance emotional load. The present study aimed to (1) examine the emotional distress and quality of life among adults with developmental coordination disorder during COVID-19 as compared to typical controls, and (2) examine the relationships between these factors in adults with developmental coordination disorder.

Method

Participants were 317 adults, aged 18-66, recruited during the first year of COVID-19: 227 were included in the developmental coordination disorder group, and 90 in the control group (normal motor performance) based on the Adult Developmental Co-ordination Disorders/Dyspraxia Checklist cutoff score. Participants completed a sociodemographic health status/daily life under COVID-19 questionnaire and self-reports about their emotional status (depression, anxiety, stress) and a quality of life.

Results

The developmental coordination disorder group had significantly greater depression, anxiety, stress, and lower quality of life. Participants with developmental coordination disorder who were infected by COVID-19 or reported reduction of working hours due to COVID-19 had the lowest social and environmental quality of life. Depression significantly predicted reduced quality of life and mediated between developmental coordination disorder severity and quality of life.

Conclusions

Prevention and intervention programs for adults with developmental coordination disorder should be elaborated, with reference to emotional load and to implications on daily life, especially in times of crisis, like COVID-19.

Psychometric properties of the Belgian LDCDQ (LDCDQ-BE) in a population based sample

BACKGROUND

Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder usually diagnosed at school-age. It is related to secondary consequences urging early identification. The Little Developmental Coordination Questionnaire (LDCDQ) is a tool to identify young children at risk of a later DCD diagnosis.

AIMS

To explore psychometric properties and cut-off scores for the Belgian version the LDCDQ (LDCDQ-BE).

METHODS AND PROCEDURES

Questionnaires were completed by parents (n = 637) and teachers (n = 249) of children aged 3-5 years in regular schools. Additionally, motor development of 82 children was assessed with the M-ABC-2, Beery-VMI-6 and teacher's Motor Skill Checklist (MSC).

OUTCOMES AND RESULTS

The LDCDQ-BE demonstrates excellent internal consistency (Cronbach's α = 0.92), moderate convergent validity with M-ABC-2 (r = 0.42), and weak to moderate concurrent validity to Beery-VMI-6 (r = 0.30-0.31) and teacher's rating on MSC (r = 0.27). Discriminant validity with M-ABC-2 and Beery-VMI-6 subtest Visual-Motor Integration is poor, but moderate with Beery-VMI-6 subtest Motor Coordination (p = 0.023) and MSC (p = 0.021). A fair agreement was established between parent's and teacher's rating (=0.308; p < 0.001).

CONCLUSIONS AND IMPLICATIONS

Sensitivity of the LDCDQ-BE is low to moderate. It should be interpreted cautiously as predictive validity in children with DCD has yet to be established.

Developmental Coordination Disorder and Most Prevalent Comorbidities: A Narrative Review

This narrative review describes, in detail, the relationships between Developmental Coordination Disorder (DCD) and most prevalent associated comorbidities in their complexity, heterogeneity and multifactoriality. The research has been conducted on the main scientific databases, excluding single case papers. Blurred borders between the different nosographic entities have been described and advances in this field have been highlighted. In this multifaceted framework a specific profiling for co-occurring DCD, ADHD and ASD signs and symptoms is proposed, confirming the need for a multidisciplinary approach to define new diagnostic paradigms in early childhood.

Supporting the social-emotional needs of children and young people with developmental coordination disorder: Occupational therapists’ perceptions of practice in England

Introduction

The social-emotional impacts of Developmental Coordination Disorder (DCD) for children and young people (CYP) are often the most disabling. Occupational therapists (OTs) have a central role in facilitating holistic service provision for this population. There is a need to understand OTs’ perceptions regarding provision of support for the social-emotional needs of CYP with DCD.

Method

A focus group ( n = 9) explored issues pertaining to OT support for the social-emotional needs of this population. Qualitative data were analysed through collaborative coding, organization and reorganization following the classic analysis strategy.

Results

Findings suggest that social-emotional support is not explicitly addressed in service provision for CYP with DCD. It appears that OTs know what needs to happen to improve social-emotional outcomes, and have made some progress, but more remains to be done. Holistic service provision depends upon varied factors, many of which are outside individual therapists’ control.

Conclusion

In England, OTs working with CYP with DCD may be providing services in settings not geared to supporting social-emotional needs. This raises concerns as to whether practitioners are enabled to stay true to holistic principles, as well as concerns related to delivering evidence-based practice in light of growing evidence regarding this population’s social-emotional risks.

Experiences of adult siblings of those with developmental coordination disorder (DCD): a qualitative study

This qualitative study explored the childhood experiences of growing up with a sibling with Developmental Coordination Disorder (DCD) to offer an ‘outsider’s’ view of this condition. Ten individuals who had grown up with a sibling with DCD were interviewed about their experiences. Data were analysed using Thematic Analysis. Analysis described three main themes: i)‘witnessing the challenges for their sibling with DCD’ ii) ‘experiencing the impact on the family’; iii) ‘a vacuum of knowledge’. Not all experiences were negative and transcending these themes was the notion ‘resolution and finding benefit’ highlighting access to support, being more empathic and resilient, becoming a role model for others and finding success. Participants play witness to their sibling’s experiences which can often be negative sometimes impacted by a vacuum of knowledge but they also describe how a diagnosis of DCD comes with some benefits which are discussed in the context of ‘posttraumatic growth’.

Genome-Wide Association Study of Motor Coordination

The ability to finely control our movement is key to achieving many of the educational milestones and life-skills we develop throughout our lives. Despite the centrality of coordination to early development, there is a vast gap in our understanding of the underlying biology. Like most complex traits, both genetics and environment influence motor coordination, however, the specific genes, early environmental risk factors and molecular pathways are unknown. Previous studies have shown that about 5% of school-age children experience unexplained difficulties with motor coordination. These children are said to have Developmental Coordination Disorder (DCD). For children with DCD, these motor coordination difficulties significantly impact their everyday life and learning. DCD is associated with poorer academic achievement, reduced quality of life, it can constrain career opportunities and increase the risk of mental health issues in adulthood. Despite the high prevalence of coordination difficulties, many children remain undiagnosed by healthcare professionals. Compounding under-diagnosis in the clinic, research into the etiology of DCD is severely underrepresented in the literature. Here we present the first genome-wide association study to examine the genetic basis of early motor coordination in the context of motor difficulties. Using data from the Avon Longitudinal Study of Parents and Children we generate a derived measure of motor coordination from four components of the Movement Assessment Battery for Children, providing an overall measure of coordination across the full range of ability. We perform the first genome-wide association analysis focused on motor coordination (N = 4542). No single nucleotide polymorphisms (SNPs) met the threshold for genome-wide significance, however, 59 SNPs showed suggestive associations. Three regions contained multiple suggestively associated SNPs, within five preliminary candidate genes: IQSEC1, LRCC1, SYNJ2B2, ADAM20, and ADAM21. Association to the gene IQSEC1 suggests a potential link to axon guidance and dendritic projection processes as a potential underlying mechanism of motor coordination difficulties. This represents an interesting potential mechanism, and whilst further validation is essential, it generates a direct window into the biology of motor coordination difficulties. This research has identified potential biological drivers of DCD, a first step towards understanding this common, yet neglected neurodevelopmental disorder.

An Integrated Care Strategy for Pre-schoolers with Suspected Developmental Disorders: The Optimus Co-design Project that has Made it to Regular Care

Introduction:

Multiple neurodevelopmental problems affect 7–8% of children and require evaluation by more than one profession, posing a challenge to care systems.

Description:

The local problem comprised distressed parents, diagnostic processes averaging 36 months and 28 visits with 42% of children >4 years at referral to adequate services, and no routines for patient involvement. The co-design project was developed through a series of workshops using standard quality improvement methodology, where representatives of all services, as well as parents participated.

The resulting integrated care model comprises a team of professionals who evaluate the child during an average of 5.4 appointments (N = 95), taking 4.8 weeks. Parents were satisfied with the holistic service model and 70% of children were under 4 at referral (p < 0.05). While 75% of children were referred, 25% required further follow-up by the team.

Discussion:

The Optimus model has elements of vertical, clinical and service integration. Reasons for success included leadership support, buy-in from the different organisations, careful process management, a team co-ordinator, and insistent user involvement.

Conclusion:

Evaluating multiple neurodevelopmental problems in children requires an integrated care approach. The Optimus care model is a relevant showcase for how people-initiated integrated care reforms can make it into usual care.

Standardized motor assessments before the age of five predicting school-aged motor outcome including DCD: A systematic review

AIM

Developmental Coordination Disorder (DCD) is a common neurodevelopmental disorder usually diagnosed at primary-school-age. This systematic review aimed to summarize available standardized motor assessments before five years of age predicting DCD, complex Minor Neurological Disorder (cMND) and motor delay assessed by a standardized motor test.

METHODS

A systematic search was performed in MEDLINE, CINAHL, WoS, Scopus, CENTRAL and ERIC. A hand search was executed. Only data of non-Cerebral Palsy children was included.

RESULTS

At or before two years, the BSID, motor subtests of GMDS, NOMAS, and NSMDA might be valuable in detecting school-aged motor delay, while starting at three years, the PDMS, motor subtests of GMDS, NSDMA, M-ABC-2, and CAMPB show promising results. General movements Assessment is associated with cMND, but does not seem sensitive enough to detect DCD. Predictive values are superior in high-risk groups and improve as children age. However, no assessment instrument reached 80% sensitivity and specificity.

CONCLUSION

Standardized motor assessments before five years seem valuable in detecting early motor problems. More longitudinal research commencing in infancy, including multiple assessments over time and the implementation of clear diagnostic criteria is imperative.

NOÇÃO TEMPORAL DE CRIANÇAS COM DESENVOLVIMENTO TÍPICO E TRANSTORNO DO DESENVOLVIMENTO DA COORDENAÇÃO

RESUMO O objetivo do estudo foi comparar o desenvolvimento da noção de tempo entre crianças com Desenvolvimento Típico (DT) e com Transtorno do Desenvolvimento da Coordenação (TDC). Participaram 34 crianças, divididas nos grupos: DT 6-7 anos (n=9), DT 8-9 anos (n=8), TDC 6-7 anos (n=7) e TDC 8-9 (n=10). As crianças com TDC foram indicadas pelos professores por meio do checklist do MABC-2 e as crianças com DT por apresentarem bom desempenho. Posteriormente, todas foram avaliadas com a bateria do MABC-2. Para a análise da noção temporal, utilizou-se uma adaptação de uma prova proposta por Piaget, que visa compreender a sucessão dos acontecimentos percebidos, realizada em contexto experimental. Sendo assim, utilizaram-se dois brinquedos de madeira que realizavam movimentos distintos em relação ao tempo e ao ponto de chegada. O conceito dessa tarefa foi adaptado para duas tarefas de corrida em contexto aplicado. As crianças foram questionadas separadamente sobre questões temporais das tarefas e suas respostas gravadas e transcritas. Empregou-se o teste Mann-Whitney, observando-se que as crianças com TDC expressaram níveis operatórios de pensamento, não demonstrando diferença significativa entre grupos.