Study of clinical characteristics in young subjects with Developmental coordination disorder

Evaluating the impact of virtual reality game training on upper limb motor performance in children and adolescents with developmental coordination disorder: a scoping review using the ICF framework

OBJECTIVE

This scoping review aims to explore published literature testing Virtual Reality (VR) interventions for improving upper limb motor performance in children and adolescents with Developmental Coordination Disorder (DCD). Our primary focus was on the types of VR systems used and the measurement tools employed within the International Classification of Functioning, Disability and Health Children and Youth Version (ICF-CY) domains in these studies.

METHODS

A comprehensive search of six electronic databases up to 11th January 2024 was conducted using predefined terms. Inclusion and exclusion criteria were applied to determine study eligibility, with two authors independently assessing titles, abstracts, and full-text articles.

RESULTS

Out of 788 potential studies, 14 met the eligibility criteria. Studies predominantly utilized non-immersive VR (nVR) systems, for example, commercial platforms such as Nintendo Wii. Most interventions targeted general motor coordination or balance, with only four studies specifically focusing on upper limb motor performance. The Movement Assessment Battery for Children-2 was the predominant assessment tool. However, the use of game scores and trial durations raised concerns about the accuracy of assessments. The majority of studies reported no significant improvement in upper limb motor performance following VR interventions, though some noted improvements in specific tasks or overall outcomes.

CONCLUSION

The findings suggest that, while nVR interventions are being explored for paediatric motor rehabilitation, their impact on enhancing upper limb motor performance in children with DCD is unclear. The variability in intervention designs, outcome measures, and the predominant focus on general motor skills rather than specific upper limb improvements highlight the need for more targeted research in this area.

IMPACT

This review underscores the importance of developing precise and clinically relevant measurement tools in a broader range of VR technologies to optimize the use of VR in therapy for children with DCD. Future research should aim for more rigorous study designs and emerging immersive technologies to maximize therapeutic benefits.

Revisiting the effect of visual illusions on grasping in left and right handers

Visual illusions have provided compelling evidence for a dissociation between perception and action. For example, when two different-sized objects are placed on opposite ends of the Ponzo illusion, people erroneously perceive the physically smaller object to be bigger than the physically larger one, but when they pick up the objects, their grip aperture reflects the real difference in size between the objects. This and similar findings have been demonstrated almost entirely for the right hand in right handers. The scarce research that has examined right and left-handed subjects in this context, has typically used only small samples. Here, we extended this research with a larger sample size (more than 50 in each group) in a version of the Ponzo illusion that allowed us to disentangle the effects of real and illusory size on action and perception in much more powerful way. We also collected a wide range of kinematic measures to assess possible differences in visuomotor control in left and right handers. The results showed that the dissociation between perception and action persisted for both hands in right handers, but only for the right hand in left handers. The left hand of left handers was sensitive to the illusion. Left handers also showed more variable and slower movements, as well as larger safety margins in both hands. These findings suggest that grasping in left handers may require more cognitive supervision, which could lead to greater sensitivity to visual context , particularly with their dominant left hand.

Visuomotor tracking strategies in children: associations with neurodevelopmental symptoms

Children with neurodevelopmental disorders (NDDs) often display motor problems that may impact their daily lives. Studying specific motor characteristics related to spatiotemporal control may inform us about the mechanisms underlying their challenges. Fifty-eight children with varying neurodevelopmental symptoms load (median age: 5.6 years, range: 2.7-12.5 years) performed an interactive tablet-based tracking task. By investigating digit touch errors relative to the target's movement direction, we found that a load of neurodevelopmental symptoms was associated with reduced performance in the tracking of abrupt alternating directions (zigzag) and overshooting the target. In contrast, reduced performance in children without neurodevelopmental symptoms was associated with lagging behind the target. Neurodevelopmental symptom load was also associated with reduced flexibility in correcting for lateral deviations in smooth tracking (spiral). Our findings suggest that neurodevelopmental symptoms are associated with difficulties in motor regulation related to inhibitory control and reduced flexibility, impacting motor control in NDDs.

Social responsiveness in children with developmental coordination disorder

BACKGROUND

Developmental coordination disorder (DCD) is a neurodevelopmental disorder characterized by deficits in performing motor tasks. Research suggests social skills are also altered.

OBJECTIVE

To investigate (1) whether the presence of DCD affects social responsiveness, (2) whether the co-occurrence of autism spectrum disorder (ASD) affects social responsiveness in children with DCD, and (3) whether there is an association between motor performance and social responsiveness in children with DCD.

METHODS

Based on parental reports, children aged 5 to 15.5 years were assigned to one of three groups: DCD only (noASD, n = 67), DCD and suspected ASD (sASD, n = 13), and DCD and confirmed ASD (cASD, n = 22). Parental answers to the Social Responsiveness Scale (SRS-2) and the DCD-Questionnaire (DCD-Q) were compared to norm values using one sample t-tests, and between groups using ANOVA and MANOVA. Pearson correlation coefficients explored the relationship between the SRS-2 and DCD-Q in the total group and per group.

RESULTS

Compared to norm values, difficulties in all areas of social responsiveness were reported in children with DCD, regardless of group (p<0.001). Compared to the noASD group, more unfavorable SRS-2 total T-scores and poorer DCD-Q scores were observed in sASD and cASD groups. Only in the total group, motor performance showed significant weak to moderate associations with the SRS-2 total T-score and all subscales except for 'social motivation' (r=-0.306 to -0.405; p ≤ 0.02).

CONCLUSION

Social responsiveness difficulties are more common in children with DCD and are more severe in the ASD groups. Motor performance and social responsiveness are weak to moderately associated.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05092893 (https://clinicaltrials.gov/study/NCT05092893).

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.

Parental report of early features of developmental coordination disorder: A qualitative study

BACKGROUND

Developmental Coordination Disorder (DCD) is a neurodevelopmental condition usually diagnosed after five years of age.

AIMS

To evaluate parent-reported early markers of DCD between birth and six years of age.

METHODS AND PROCEDURES

In-depth semi-structured interviews were conducted with parents of twelve children diagnosed with DCD. Up to three interviews were performed per family. The interviews were then transcribed ad-verbatim and analyzed using an inductive thematic analysis approach.

OUTCOMES AND RESULTS

The first theme 'Child-specific features' discusses the children's challenges in diverse developmental domains (motor milestones, activities of daily living, play and exploration, fatigue and sleep, participation, sensory processing, coping skills and friendships, and verbal skills), varying in severity for each child and each domain. The second theme 'Features in the context' discusses subtle markers in the direct environment of the children such as quests for explanations and therapy, specific participation choices, concerns by other caregivers, and the emergence of secondary consequences.

CONCLUSIONS AND IMPLICATIONS

This study reports the presence of early features of DCD from the first year of life and suggests important topics to discuss with parents in the diagnostic process of DCD.

Atypical procedural learning skills in children with Developmental Coordination Disorder

We investigated the procedural learning deficit hypothesis in Developmental Coordination Disorder (DCD) while controlling for global performance such as slower reaction times (RTs) and variability. Procedural (sequence) learning was assessed in 31 children with DCD and 31 age-matched typically developing (TD) children through a serial reaction time task (SRTT). Sequential and random trial conditions were intermixed within five training epochs. Two repeated measures ANOVAs were conducted on a Sequence-Specific Learning Index (SSLI) and a Global Performance Index (GPI, speed/accuracy measure) with Epoch (for SSLI and GPI) and Condition (for GPI) as within-subjects factors, and Group as between-subjects factor. Controlling for RTs differences through normalized RTs, revealed a global reduction of SSLI in children with DCD compared with TD peers suggesting reduced sequence learning skills in DCD. Still, a significant Group x Condition interaction observed on GPI indicated that children from both groups were able to discriminate between sequential and random trials. DCD presented reduced procedural learning skills after controlling for global performance. This finding highlights the importance of considering the general functioning of the child while assessing learning skills in patients.

Investigating Subtypes of Motor Skills and Activities of Daily Living among Young Children with Motor Delay

The purpose of this study was to classify preschool children into subtypes based on motor skills and to characterize the activities of daily living for each subtype. The subjects were 45 preschool children whose scores on the Movement Assessment Battery for Children-Second Edition (MABC-2) and the Functional Independence Measure for Children (WeeFIM) were measured. The fine score and gross score were calculated from the MABC-2, and a cluster analysis was performed. The difference between the fine score and the gross score was evaluated for each subtype, and multiple comparisons among subtypes were performed for the fine, gross, and WeeFIM scores. Subtype analysis showed that the fine score was significantly lower than the gross score for subtype I (p < 0.001), and the gross score was significantly lower than the fine score for subtype III (p = 0.018). Subtype II had a significantly lower score than subtype I and subtype III (p < 0.001). Children with subtype II had more difficulty dressing movements and less communication skills than subtype III (p < 0.05). Classification into three subtypes according to motor ability and some of the characteristics of ADLs were identified.

Examining frustration intolerance beliefs among adults with dyslexia or developmental coordination disorder

BACKGROUND

Research suggests that adults diagnosed with specific learning disorders, such as dyslexia or developmental coordination disorder (DCD), are at greater risk of emotional problems related to frustration and anger.

AIMS

The purpose of this study was to investigate patterns of frustration intolerance beliefs among two groups of adults with a specific learning disorder (dyslexia or DCD), compared with typical adults.

METHODS AND PROCEDURES

Participants were 235 French adults (students or in employment) with dyslexia (M_age = 35.8 years, SD = 13.3; females = 63 %), DCD (M_age = 32.9 years, SD = 11.8; females = 58 %) or typical development (M_age = 33.2 years, SD = 12.7; females = 65 %), who completed an online self-report questionnaire.

OUTCOMES AND RESULTS

Analysis of variance revealed a significant between-groups difference, as both learning disorder groups had higher frustration intolerance beliefs than the typical adults. Post hoc analysis showed that participants with DCD scored higher than those with dyslexia on each type of frustration intolerance belief, while participants with dyslexia scored higher than typical adults on achievement frustration and discomfort intolerance.

CONCLUSIONS AND IMPLICATIONS

These results underline the usefulness of distinguishing between frustration intolerance dimensions, and of using rational emotive behavior therapy to reduce the irrational beliefs of people with DCD or dyslexia.

Practice schedule and testing per se affect children's transfer abilities in a grapho-motor task

Children's ability to transfer the gains of a motor experience, such as learning to write a letter, to novel conditions, such as cursive writing of the same letter, are affected by the way in which the learning experience is parsed. Parsing may have limitations because a short session may hamper the engagement of procedural memory consolidation processes. Here, we compared the effects of two practice schedules with the total amount of practice identical training provided in a single-session practice versus multi-session practice, wherein each session on its own was insufficient for generating long-term gains. A total of 40 7- and 8-year-old children practiced the production of a novel letter form by connecting dots, namely, the Invented Letter Task (ILT). Multiple ILT-related transfer tasks were assessed at 24 h post-training and again at 4-5 weeks post-training. Although by the end of training the single-session practice group outperformed the multi-session practice group in speed and accuracy, at 24 h post-training both groups showed comparable gains. However, after multi-session practice, children were as fast or faster and more accurate in the transfer tasks. By 4-5 weeks post-training, the multi-session practice group showed larger gains in the trained condition, a speed advantage in the transfer tasks, and a significant improvement on the transfer tasks. The results suggest that parsing training over several brief sessions may lead to long-term gains in children's grapho-motor skills. Moreover, multi-session practice protocols may contribute to the potential for transfer and to more effective learning from experiences such as transfer tasks.

Second Graders' Grapho-Motor Skill Learning and Verbal Learning: The Effects of Socio-Educational Factors

Introduction: Children from low socioeconomic status (SES) families, and in particular, those with a lower level of maternal education, show lower fine-motor skills and lower vocabulary scores than their SES peers whose mothers have a higher level of education. Furthermore, low SES children frequently have difficulties in reading and spelling. These difficulties are attributed to deficits in the acquisition of skills through practice, such as those required for developing visual-motor routines, alongside deficits in the intentional acquisition of knowledge, such as those required in verbal learning. The aim of the current study was to test the effect of two background factors: low maternal education (ME) and risk of reading and spelling difficulties on practice-dependent learning of a motor task and intentional learning of a verbal task in second graders from low SES families. Methods: In 2016/17, 134 low-SES second graders with higher and lower ME (95 typical learners and 39 with reading and spelling difficulties) were assessed with (a) the Invented Letter Task (ILT; a grapho-motor skill learning task) across five time-points (initial- and end-training Day 1; initial- and end-training Day 2; and 2-weeks post-training), as well as an ILT transfer task; and (b) The Rey Auditory Verbal Learning Test (RAVLT; an intentional word-learning task in which a word list is read to children for five learning trials and is recalled 20 min later). Findings: Lower ME was associated with surplus segments in the performance of the motor task and its transfer to a novel condition as well as with lower recall on the verbal task, but not with the learning of both the motor and the verbal task. Having reading and spelling difficulties affected motor-task accuracy and also the way children learned the task, as evidenced by surplus segments at the beginning of Day 2, which were reduced with further practice. Conclusion: Low ME affected overall performance level. Reading and spelling difficulties resulted in atypical learning of the motor task. Future research on practice-dependent learning in the context of children coming from low SES families should focus on subgroups within this heterogeneous population.

Differences in walking and running gait in children with and without developmental coordination disorder: A systematic review and meta-analysis

BACKGROUND

Developmental coordination disorder (DCD) is a common motor skills disorder in children. Although gait changes are often reported clinically, affecting children's participation in play and sport, there has been no synthesis of research evidence comparing gait of children with and without DCD. Thus, the aim of this research was to determine differences in gait between children with and without DCD METHODS: A search of electronic databases (AMED, CINAHL, Cochrane Library, Embase, Medline, SPORTDiscus, & Web of Science) was conducted from inception to August 2019 for studies comparing walking and/or running gait of children with and without DCD. The McMaster Critical Appraisal Form for Quantitative Studies was used to assess risk of bias amongst included studies. Meta-analysis was completed on measures with four or more homogenous outcomes.

RESULTS

20 studies fulfilled the inclusion criteria and were eligible for review - three of which were pre-post designs, and 17 were cross-sectional designs. Data was extracted in five domains: kinetics, kinematics, physical function, electromyography, and temporospatial parameters. Meta-analysis was performed on one outcome measure - the 6 min Walk Test (6MWT), finding that children with DCD walked significantly shorter distances, indicating reduced endurance in walking gait. Other statistically significant results all favoured typically developing children, however there is little consistency between studies.

CONCLUSION

Although a clear gait pattern for children with DCD is not evident, functional deficits appear to be present in endurance and cardiorespiratory fitness. The current evidence base for gait changes in DCD is currently low-level, and further high quality research is warranted.

PROSPERO REGISTRATION NUMBER

CRD42018106791.

What Can We Do to Promote Mental Health Among Individuals With Developmental Coordination Disorder?

Purpose of the Review

It is well-documented that individuals with DCD experience mental health problems, in both psychosocial and psychiatric domains. In this review, we propose a series of diverse options to improve mental health among individuals with DCD.

Recent Findings

Despite recognition of mental health problems in DCD, relatively little work has been done to develop effective interventions. There is an urgent need for action in this matter. We present and discuss options based on a societal perspective (awareness and understanding), parental perspective (access to services and resources), and child perspective (participation).

Summary

In order to improve mental health, interventions must take into account multiple levels in a complex framework that includes community, family, and the individual. While more research on intervention effectiveness is necessary, researchers, practitioners, and community advocates can use existing initiatives as a starting point to address the urgent need for improving mental health in DCD.

Motor skill learning with impaired transfer by children with developmental coordination disorder

BACKGROUND

DSM-5 criteria for developmental coordination disorder (DCD) emphasize deficits in the acquisition and execution of coordinated motor skills. Previous studies of motor skill learning in DCD suggest deficits in the execution of motor skills but do not reveal a deficit in learning new skills, possibly because of the heterogeneity of motor deficits in DCD.

AIM

In light of the high prevalence of handwriting difficulties among children with DCD, the current study compared motor skill learning in 5-6-year-old children with DCD and their peers using a grapho-motor learning task that resembles a letter-writing practice.

METHODS

Thirty-two boys, 16 with DCD, learned to produce a new "letter" formed by connecting three dots. Training, following-day consolidation, 1-week post-training retention, and far-transfer to a no-dot condition were tested.

RESULTS

Children with DCD exhibited rates of learning similar to those of their peers, but with overall poorer performance, replicating previous findings. Contrary to reports of intact skill transfer following a consolidation period in DCD, impaired transfer of the learned symbol was observed.

CONCLUSIONS

These findings may explain some of the motor difficulties experienced by children with DCD as well as contribute to the discussion on mechanisms involved in skill learning in these children.

Determining the clinical knowledge and practice of Australian podiatrists on children with developmental coordination disorder: a cross-sectional survey

Background

Developmental coordination disorder (DCD) is a common condition in children affecting motor coordination. This impacts on academic performance, and activities of daily living. Literature surrounding interventions for DCD has focused mostly on physical and occupational therapies. However, it is known that children with DCD present to podiatrists as these children often also have abnormalities in lower limb functioning associated with the condition. This study aimed to determine current knowledge of Australian podiatrists regarding presentation, assessment, and management of children with developmental coordination disorder.

Methods

A single-round survey, developed using SurveyMonkey®, was completed by a sample of Australian podiatrists. Data were collected through either online or paper means. Participants were asked about their familiarity with DCD and depending on their response, were directed via skip logic to questions on presentation, assessment and management strategies of DCD in children. Participants were also asked about their willingness and preferences for further education on DCD. Descriptive statistics were used to describe the data.

Results

There were 365 Australian podiatrists who completed the survey. There were 30% (n = 109) who reported being familiar with DCD as a diagnosis, while a further 37% (n = 134) reported familiarity with alternate or outdated terminology associated with the DCD diagnosis. Participants who were familiar with DCD or terminology relating to DCD, showed good knowledge of signs and symptoms associated with DCD. Both familiar and unfamiliar participants favoured referral to other health professionals over completing assessments. Common podiatric management strategies such as footwear advice, orthoses, and strength training were the most frequently chosen by both groups, despite current evidence only supporting strength training as an intervention. Participants were willing to receive education on DCD through a range of both online and in-person mediums.

Conclusion

The majority of Australian podiatrists were unfamiliar with DCD, despite its prevalence and symptomology falling within the podiatric scope. However, participants did overwhelmingly show willingness to receive further education on DCD. Further research should consider understanding the role of podiatrists in the assessment and management of children with DCD and the impact of the type of treatment strategies that may be provided.

Electronic supplementary material

The online version of this article (10.1186/s13047-019-0353-y) contains supplementary material, which is available to authorized users.

Subtyping children with developmental coordination disorder based on physical fitness outcomes

PURPOSE

Children with Developmental Coordination Disorder (DCD) are known to have poor physical fitness. However, differentiating homogenous subgroups of DCD using fitness performance has not yet been established. Therefore the purpose of this study was to identify subtypes in children with and without DCD using measures of physical fitness.

METHOD

Children (aged 6-10 years, n = 217) constituted the sample for this study. They were assessed on 1) aerobic fitness (20m Shuttle Run test), 2) anaerobic fitness (Muscle Power Sprint Test), 3) isometric muscle strength (handheld dynamometry) 4) functional upper and lower body strength (Functional Strength Measurement) and 5) motor coordination [Movement Assessment Battery for Children-2nd edition (MABC-2) test]. The Ward method was used to identify the various clusters.

RESULTS

Five subtypes emerged in the entire sample. In the typically developing (TD) children mainly 2 subtypes (number 5 and 2) were found containing 89% of the TD children (n = 55), with the largest group demonstrating above average performance on all measures (cluster 5). Children in subtype 2 had just above average motor coordination and good aerobic fitness but lower muscle strength. Subtypes 1, 3 and 4 were clearly "DCD" clusters, however they showed difference in fitness performance. Subtype 1 contained children with DCD who showed poor performance on all fitness outcomes (n = 45). Children with DCD in subtype 3 had poor aerobic but average strength and anaerobic fitness (n = 48). Subtype 4 contained children with DCD (n = 45) who had good muscle strength and anaerobic fitness. Of these, 36% were at risk of DCD while 24% had definite motor coordination problems.

CONCLUSION

Our findings indicate that children with and without DCD demonstrate heterogeneous physical fitness profiles. The majority of the children (66%) with DCD belonged to subtypes with lower fitness performance. Further studies are needed to confirm these findings in other samples of DCD children.