Developmental Coordination Disorder and Cerebral Palsy: Is There a Continuum?

A systematic review of self and observer assessment of pain and related functioning in youth with brain-based developmental disabilities

ABSTRACT

Pain experiences of youth with brain-based developmental disabilities are often overlooked and/or misinterpreted, increasing the risk for poor or inadequate pain assessment and management. Ample measures exist to assess acute and chronic pain, yet their utility and frequency of use in youth with brain-based developmental disabilities is unclear and available measures do not have strong measurement properties for this diverse group. This systematic review identified the scope of self-reported and observer-reported pain assessment in studies of youth (aged 3-24 years) with brain-based developmental disabilities (phase 1) and summarized other measures of pain-related functioning for acute and chronic pain (ie, physical, emotional, social, sleep, and quality of life, within the subset of quantitative studies focused primarily on pain, phase 2). A comprehensive search for English-language studies was conducted in August 2022 in Web of Science, CINAHL, MEDLINE, Cochrane CENTRAL, EMBASE, and APA PsychINFO (PROSPERO registration: CRD42021237444). A total of 17,029 unique records were screened. Of the 707 articles included in phase 1, most assessed chronic pain (n = 314; 62.0%) and primarily used observer-report (n = 155; 31%) over self-report (n = 67; 13%). Of the 137 articles included in phase 2, other outcomes assessed alongside pain intensity included motor ability (16.8%), adaptive functioning (11%), quality of life (8%), pain interference (6.6%), mental health (5.8%), and communication ability (2.9%). Cerebral palsy was the most common population in both phase 1 (n = 343; 48.5%) and phase 2 (n = 83; 59.7%). This review provides a foundational understanding of pain assessment in brain-based developmental disabilities and highlights continued inequities in holistic pain assessment for this population.

The Co-Occurrence of Autism Spectrum Disorder and Cerebral Palsy and Associated Comorbid Conditions in Children and Adolescents

BACKGROUND

Comorbidity is the co-occurrence of two or more disorders in the same person.

AIM

This study investigated the frequency of comorbid conditions, in children and adolescents, with autism spectrum disorder (ASD), cerebral palsy (CP), and a comorbid diagnosis of ASD and CP.

METHOD

Ninety-six children and adolescents with ASD, CP, and both ASD and CP aged between 4 and 18 years participated in this study. Parents completed the Gastrointestinal Symptom Inventory, Children's Sleep Habits Questionnaire, Child Behavior Checklist, Social Communication Questionnaire, and the Vineland Adaptive Behavior Scales.

RESULTS

Results of ANOVA analyses revealed significant group differences in sleep problems, social communication difficulties, and adaptive behavior. Regression analysis found that the presence of an intellectual disability significantly predicted levels of adaptive behavior.

CONCLUSION

This research demonstrated the importance of studying comorbidities in children and adolescents with CP alone, ASD alone, and combined ASD and CP.

Gait performance in toddlers born preterm: A sensor based quantitative characterization

BACKGROUND AND OBJECTIVES

Preterm children have an increased risk of motor difficulties. Gait analysis and wearable technologies allow the assessment of motor performance in toddlers, identifying early deviations from typical development. Using a sensor-based approach, gait performance of full-term and preterm toddlers at different risk of motor delay was analysed. The aim was to measure quantitative differences among groups.

METHODS

Twenty-nine two-year old children born preterm (≤36 gestational weeks) and 17 full-term controls, matched for age and walking experience, participated in the study. Preterm children were further divided based on risk of motor delay: preterm at high risk (n = 8, born at ≤28 gestational weeks or with ≤1000 g of body weight), and at moderate risk (n = 21). Children were asked to walk along a corridor while wearing 3 inertial sensors on the lower back and on the ankles. Gait temporal parameters, their variability, and nonlinear metrics of trunk kinematics (i.e. recurrence quantification analysis, multiscale entropy) were extracted from the collected data and compared among groups.

RESULTS

Children born preterm showed significantly longer stance and double support phases, higher variability of temporal parameters, and lower multiscale entropy values than peers born full-term. No difference was found for the other parameters when comparing preterm and full-term children. When comparing children grouped according to risk of delay, with increasing risk, children showed longer stride-, stance- and double-support-time, higher variability of temporal parameters, higher recurrence- and lower multiscale entropy values.

CONCLUSIONS

Sensor-based gait analysis allowed differentiating the gait performance of preterm from full-term toddlers, and of preterm toddlers at different risk of motor delay. When analysing the present results with respect to the expected trajectory of locomotor development, children born preterm, in particular those at higher risk of motor delay, exhibited a less mature motor control performance during gait: lower stability (i.e. longer support phases), and higher variability, although not structured towards the exploration of more complex movements (i.e. higher recurrence- and lower multiscale entropy values). These indexes can serve as biomarkers for monitoring locomotor development and early detecting risk to develop persistent motor impairments.

Association between General Movements Assessment and Later Motor Delay (excluding Cerebral Palsy) in Low-Birth-Weight Infants

The general movements (GMs) assessment is useful for the prediction of cerebral palsy (CP) and other developmental disorders. Developmental coordination disorder (DCD) is highly prevalent in low-birth-weight (LBW) infants. We investigated the association between aberrant GMs during early infancy and later motor development in LBW infants. The study included infants who fulfilled the following criteria: GMs assessed at 9–20 weeks post-term age; developmental quotient (DQ) assessed at 3 years of age using the Kyoto Scale; intelligence quotient (IQ) assessed at 6 years of age. Participants with normal IQs at 6 years of age without a diagnosis of CP (14 males and 37 females, 23–36 weeks gestation with birth weights of 492–1498 g) were categorized into normal (n = 39) and aberrant (n = 12) groups based on GMs assessment; DQ was compared between the groups. We investigated the items in the DQ assessment and found that the infants in the aberrant group were more frequently unable to perform. Infants in the aberrant group showed a significantly lower DQ in the ‘postural-motor domain’, and were more frequently unable to ‘climb the stairs with alternating legs’ and ‘Jump from a 15–20 cm platform’. This study highlights that GMs aberrancy in early infancy is associated with a delayed gross motor development, even in children with a typical development. The GMs assessment may be useful for the prediction of DCD.

Assessment, diagnosis, and management of developmental coordination disorder

Developmental coordination disorder (DCD) is a neurodevelopmental condition that affects 5% to 6% of school-aged children. DCD can significantly impact early development and life-long functioning. Evidence supports promising interventions for DCD, but the disorder continues to be under-recognized and under-diagnosed. Paediatricians play an important role in the identification and management of DCD. This practice point, with accompanying tables, assists and supports paediatricians in diagnosing and managing uncomplicated cases of DCD.

L'évaluation, le diagnostic et la prise en charge du trouble développemental de la coordination

Le trouble développemental de la coordination est une affection neurodéveloppementale qui touche de 5 % à 6 % des enfants d'âge scolaire. Il peut avoir des effets considérables sur le début du développement et le fonctionnement tout au long de la vie. Les données probantes appuient des interventions prometteuses, mais ce trouble continue d'être sous-estimé et sous-diagnostiqué. Les pédiatres jouent un rôle important dans son diagnostic et sa prise en charge. Le présent point de pratique et les tableaux qui l'accompagnent visent à aider les pédiatres à diagnostiquer et prendre en charge les cas de trouble développemental de la coordination non compliqué.

Systematic Review of Visual Motor Integration in Children with Developmental Disabilities

Original research articles regarding visual motor integration skills in children with developmental disabilities and the impact of occupational therapy were identified, appraised, and synthesized. Twenty-four articles were chosen for this review. Themes were noted during the critique of articles. Three themes emerged: "age," "gender," and "diagnosis." Regarding the impact on visual motor integration, there was strong evidence for age, moderate evidence for gender, and strong evidence for diagnosis. Future research investigating visual motor integration in children should control for age and diagnosis.

Risk factors in early life for developmental coordination disorder: a scoping review

AIM

To perform a scoping literature review of associations between risk factors in early life and developmental coordination disorder (DCD).

METHOD

PubMed, Embase, CINAHL, PsycINFO, and Web of Science (January 1994-March 2019) were searched to identify studies on early risk factors and motor impairment or DCD. The effect of single and multiple risk factors was assessed. Level of evidence was evaluated following the Centre for Evidence-Based Medicine guidelines. Meta-analysis on the effect of preterm birth was performed.

RESULTS

Thirty-six studies fulfilled inclusion criteria; 35 had evidence level 3, one had level 4. Highest evidence was available that preterm birth and male sex in term-born children were associated with DCD. The odds ratio of preterm birth was 2.02 (95% confidence interval: 1.43-2.85). Low to moderate evidence was available that parental subfertility, maternal smoking during pregnancy, postnatal corticosteroid treatment in infants born preterm, extra corporeal membrane oxygenation, retinopathy of prematurity, abnormalities on magnetic resonance imaging scans at term age, and accumulating perinatal or neonatal risk factors were associated with motor impairment.

INTERPRETATION

Limited information on early risk factors of DCD is available. Only preterm birth and male sex were consistently associated with an increased risk of DCD.

WHAT THIS PAPER ADDS

Preterm birth is a risk factor for developmental coordination disorder (DCD). In term-born children, male sex was consistently associated with DCD. Risk factors for DCD are similar to risk factors for cerebral palsy.

Rates of Developmental Coordination Disorder in Children Born Very Preterm

OBJECTIVE

To examine the stability of developmental coordination disorder (DCD) throughout childhood in children born very preterm and term. Further, in the very preterm group, to compare perinatal variables and neurobehavioral outcomes at 13 years of age for children with persisting DCD and those with typical motor development.

STUDY DESIGN

Prospective study of 180 very preterm and 73 term-born children assessed at 5, 7, and/or 13 years of age using the Movement Assessment Battery for Children, with scores ≤16th percentile used to classify DCD. Children with cerebral palsy or an IQ of <80 were excluded.

RESULTS

Children born very preterm had increased odds for DCD at 5 (OR, 5.53; 95% CI, 2.53-12.0; P < .001), 7 (OR, 3.63; 95% CI, 1.43-9.18; P = .06), and 13 years (OR, 4.34; 95% CI, 1.61-11.7; P = .004) compared with term-born children. The rates of DCD in very preterm children reduced from 47.9% at 5 years of age, to 28.5% at 7 years and 27.8% at 13 years of age (OR per year of age, 0.81; 95% CI, 0.75-0.87; P < .001), but less so for term-born children (15.3%, 10.0%, and 8.5% at 5, 7, and 13-years respectively [OR, 0.91; 95% CI, 0.75-1.09; P = .31]). Within the very preterm group at 13 years of age, there was evidence that children with persisting DCD performed poorer across several cognitive domains compared with children with typical motor development, with differences in the order of 0.5-1.0 SD.

CONCLUSIONS

Although the rates of DCD decreased across middle childhood for both groups, the odds for DCD were consistently higher for very preterm children compared with term, with important implications for cognitive functioning in the very preterm group.

Mental rotation performance in young adults with and without developmental coordination disorder

While there have been consistent behavioural reports of atypical hand rotation task (HRT) performance in adults with developmental coordination disorder (DCD), this study aimed to clarify whether this deficit could be attributed to specific difficulties in motor imagery (MI), as opposed to broad deficits in general mental rotation. Participants were 57 young adults aged 18-30 years with (n = 22) and without DCD (n = 35). Participants were compared on the HRT, a measure of MI, and the letter number rotation task (LNRT), a common visual imagery task. Only participants whose behavioural performance on the HRT suggested use of a MI strategy were included in group comparisons. Young adults with DCD were significantly less efficient compared to controls when completing the HRT yet showed comparable performance on the LNRT relative to adults with typical motor ability. Our data are consistent with the view that atypical HRT performance in adults with DCD is likely to be attributed to specific difficulties engaging in MI, as opposed to deficits in general mental rotation. Based on the theory that MI provides insight into the integrity of internal action representations, these findings offer further support for the internal modelling deficit hypothesis of DCD.

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.

Altered sense of agency in children with developmental coordination disorder

BACKGROUND

There is increasing evidence that children with developmental coordination disorder (DCD) have deficits in sensory-motor integration, but it is unclear whether the sense of agency (SoA) generated by sensory-motor integration is altered.

AIMS

To investigate whether there is a difference in the time window for SoA between children with DCD and typically developing (TD) children.

METHODS AND PROCEDURES

An agency attribution task was used to quantitatively measure and compare the time window for SoA in 15 children with DCD and 46 children in the TD group. Variables that correlated with the time window for SoA were also examined in both groups of children.

OUTCOMES AND RESULTS

The time window for SoA was significantly extended in children with DCD compared to TD children. The time window for SoA in TD children was significantly associated with manual dexterity, whereas the time window for SoA in children with DCD was significantly associated with depressive tendency.

CONCLUSIONS AND IMPLICATIONS

The time window for SoA is altered in children with DCD. The present results suggest that there may be a bidirectional relationship between an internal model deficit and depressive tendency and SoA in children with DCD.

Early Motor Trajectories Predict Motor but not Cognitive Function in Preterm- and Term-Born Adults without Pre-existing Neurological Conditions

Very preterm (VP; <32 weeks gestation) and/or very low birth weight (VLBW; <1500 g) birth has been associated with an increased risk of adverse motor and cognitive outcomes that may persist into adulthood. The aim of this study was to determine whether motor development in the first five years of life is associated with motor and cognitive outcomes in adulthood. A prospective observational study in Germany followed 260 VP/VLBW and 229 term-born individuals from birth into adulthood. Early motor trajectories (i.e., high and low degree of motor difficulties) were determined from neurological examinations from birth to 56 months. Adult motor and cognitive outcomes were determined from information from multiple instruments and IQ tests, respectively. Associations of VP/VLBW birth and early motor difficulties on adult outcomes were assessed using regression analyses. VP/VLBW individuals had an increased risk for early motor difficulties (Relative Risk: 11.77, 95% confidence interval (CI): 4.28, 32.35). Early motor difficulties were associated with poorer motor competence in adulthood (β = 0.22, p < 0.001), independent of VP/VLBW birth. Adult IQ was predicted by VP/VLBW (β = −0.12, p < 0.05) and child IQ (β = 0.51, p < 0.001), while early motor difficulties ceased to be associated with adult IQ once participants with a neurological impairment were excluded (β = 0.02, p > 0.05). Motor problems in childhood were homotypically associated with poorer motor competence in adulthood. Similarly, early cognitive problems were homotypically associated with adult cognitive outcomes. Thus, both motor and cognitive function should be assessed in routine follow-up during childhood.

Identifying Developmental Motor Difficulties: A Review of Tests to Assess Motor Coordination in Children

The latest guidelines recommend early identification of children with motor impairments using a standardized norm-referenced test. Motor coordination difficulties in developmental age have been studied extensively over recent years, with experimental literature on developmental coordination disorder (DCD) suggesting that motor proficiency assessments depend on the nature of the task at hand. In this article we reviewed 14 assessment tools to measure movement performance in childhood and adolescence, which are often referred to in an international context. This updated review aims to compare motor tests depending on a) the nature of the tasks included in the battery (i.e., questionnaire and clinical examination), b) psychometric properties, and c) cultural adaptation to relevant developmental norms. Finally, implications for diagnosis and clinical practice are discussed. Considering there are several tests used for DCD, it is important to better define their reliability and validity in different cultures in order to better compare the validation studies and select the most appropriate test to use in the assessment procedure.

White matter organization in developmental coordination disorder: A pilot study exploring the added value of constrained spherical deconvolution

Previous studies of white matter organization in sensorimotor tracts in developmental coordination disorder (DCD) have adopted diffusion tensor imaging (DTI), a method unable to reconcile pathways with ‘crossing fibres’. In response to limitations of the commonly adopted DTI approach, the present study employed a framework that can reconcile the ‘crossing fibre’ problem (i.e., constrained spherical deconvolution- CSD) to characterize white matter tissue organization of sensorimotor tracts in young adults with DCD. Participants were 19 healthy adults aged 18–46: 7 met diagnostic criteria for DCD (4 females) and 12 were controls (3 females). All underwent high angular diffusion MRI. After preprocessing, the left and right corticospinal tracts (CST) and superior longitudinal fasciculi (SLF) were delineated and all tracts were then generated using both CSD and DTI tractography respectively. Based on the CSD model, individuals with DCD demonstrated significantly decreased mean apparent fibre density (AFD) in the left SLF relative to controls (with large effect size, Cohen's d = 1.32) and a trend for decreased tract volume of the right SLF (with medium-large effect size, Cohen's d = 0.73). No differences in SLF microstructure were found between groups using DTI, nor were differences in CST microstructure observed across groups regardless of hemisphere or diffusion model. Our data are consistent with the view that motor impairment characteristic of DCD may be subserved by white matter abnormalities in sensorimotor tracts, specifically the left and right SLF. Our data further highlight the benefits of higher order diffusion MRI (e.g. CSD) relative to DTI for clarifying earlier inconsistencies in reports speaking to white matter organization in DCD, and its contribution to poor motor skill in DCD.

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All previous diffusion studies of white matter in DCD have employed a tensor model

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We employed a non-tensor model to characterize microstructure in adults with DCD

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The non-tensor model showed atypical white matter organization in the SLF in DCD

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The tensor model failed to detect microstructural group differences for any tract

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Motor impairment characteristic of DCD may be subserved by white matter abnormalities

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We need to move beyond the tensor model in characterizing white matter in DCD

Motor impairments in children: More than just the clumsy child

Developmental co-ordination disorder is a motor skill disorder that affects an estimated 5-6% of children but lacks recognition and understanding, leading to under-diagnosis. Essential for diagnosis is a marked impairment in motor co-ordination that significantly impacts daily living, including education. Although 'clumsiness' is often dismissed, the impact of this disorder is significant and extends beyond motor skills into physical and psychological health and educational and vocational success. This is discussed here with regard to the framework of the International Classification of Functioning, Disability and Health. This review also discusses the importance of an accurate, early diagnosis and factors that inhibit this; dual diagnosis with comorbid neurodevelopmental disorders; the multidisciplinary approach to diagnosis and the role of the paediatrician within this; and current evidence regarding the most effective interventions.

Associations between tactile localization and motor function in children with motor deficits

Children with developmental disorders often have poor motor performance. This study aimed to address the association between tactile localization ability, an indicator of body image, and motor function in children with motor deficits. Eighteen children with motor deficits participated, and their upper and lower limbs were assessed. To assess the level to which the patient's body image was developed, a tactile localization task (TLT) was used. In the TLT, experimenters touched a child's fingers, toes, or lower extremities (L/E), and the participants were asked to identify the location of the touch on a body part illustration. We compared TLT ability between high and low motor function groups, and investigated the correlation between TLT and the measures of motor function, age, and non-verbal intelligence. The high motor function group had significantly higher L/E TLT scores than the low motor function group, except in the tests involving the fingers and toes. Furthermore, the L/E TLT correlated only with motor function measures (Gross Motor Function Measure score, measured using one-leg standing time and one-leg hopping ability). The results suggest that children with motor deficits experience developmental delay in terms of their body image.

Reduced motor imagery efficiency is associated with online control difficulties in children with probable developmental coordination disorder

Recent evidence indicates that the ability to correct reaching movements in response to unexpected target changes (i.e., online control) is reduced in children with developmental coordination disorder (DCD). Recent computational modeling of human reaching suggests that these inefficiencies may result from difficulties generating and/or monitoring internal representations of movement. This study was the first to test this putative relationship empirically. We did so by investigating the degree to which the capacity to correct reaching mid-flight could be predicted by motor imagery (MI) proficiency in a sample of children with probable DCD (pDCD). Thirty-four children aged 8 to 12 years (17 children with pDCD and 17 age-matched controls) completed the hand rotation task, a well-validated measure of MI, and a double-step reaching task (DSRT), a protocol commonly adopted to infer one's capacity for correcting reaching online. As per previous research, children with pDCD demonstrated inefficiencies in their ability to generate internal action representations and correct their reaching online, demonstrated by inefficient hand rotation performance and slower correction to the reach trajectory following unexpected target perturbation during the DSRT compared to age-matched controls. Critically, hierarchical moderating regression demonstrated that even after general reaching ability was controlled for, MI efficiency was a significant predictor of reaching correction efficiency, a relationship that was constant across groups. Ours is the first study to provide direct pilot evidence in support of the view that a decreased capacity for online control of reaching typical of DCD may be associated with inefficiencies generating and/or using internal representations of action.

Motor imagery is less efficient in adults with probable developmental coordination disorder: evidence from the hand rotation task

The present study aimed to provide preliminary insight into the integrity of motor imagery (MI) in adults with probable developmental coordination disorder (pDCD). Based on a strong body of evidence indicating that paediatric samples of DCD often experience difficulties engaging MI, we hypothesised that young adults with pDCD would demonstrate similar difficulties. The performance of 12 young adults (19-35 years) with pDCD was compared to 47 age-matched controls on a traditional mental hand rotation task. Mean inverse efficiency scores were generated for each participant by dividing each participant's mean RT by their proportion of correct responses at each of the stimuli presentation conditions. Preliminary analysis revealed that the performance profiles of individuals with pDCD and age-matched controls showed evidence of being constrained by the biomechanical and postural constraints of real movement, suggesting that both groups engaged in an embodied (MI) strategy to complete the task. Despite engaging in a MI strategy, however, young adults with pDCD were nonetheless significantly less efficient when doing so, shown by significant main effects for group on all group efficiency comparisons. Based on the assumption that MI provides insight into the internal 'neural' action representation that precedes action, we argue that the less efficient MI performance demonstrated by young adults with pDCD may indicate inefficiencies engaging or implementing internal action representations. Implications and directions for future research are discussed.