Children with preschool minor neurodevelopmental disorders. V: Neurodevelopmental profiles at age 13

Verbal Self-Guidance as a Treatment Approach for Children with Developmental Coordination Disorder: A Systematic Replication Study

Children with developmental coordination disorder (DCD) experience many occupational performance difficulties in all areas of daily living. For the most part, research has failed to identify an effective treatment approach for these children. Verbal self-guidance (VSG), a new approach, first explored by Wilcox and Polatajko (1993), appears to have good potential in helping children with DCD become competent in the occupations of their choice. The purpose of this study was to carry out a systematic replication of the first VSG study to determine if a different therapist could achieve similar results. Repeating the VSG procedure with four different children, using a single case study design, a different therapist was able to replicate the earlier findings. This provides further evidence of the potential of VSG as an effective approach for enabling children with DCD to surmount their motor challenges.

Desenvolvimento motor e autoconceito de escolares com transtorno do desenvolvimento da coordenação

Resumo Verificou-se a influência de um programa de intervenção motora no desenvolvimento motor e autoconceito de escolares com Transtorno do Desenvolvimento da Coordenação (TDC). Participaram do programa de intervenção de 16 semanas,12 crianças com idades de 10 anos (± 6 meses), divididas em dois grupos;sete escolares com indicativo TDC (GT) e cinco escolares com risco para TDC (GR). Utilizou-se a bateria motora MABC-2 (Henderson, Sugden, & Barnett, 2007) e a Escala de Auto-percepção para Crianças (Harter, 1982). Para analisar os efeitos da intervenção, utilizou-se o teste de Wilcoxon, o nível de significância foi de p>0,05. O programa se mostrou efetivo quando observado o TDC proporcionando influência positiva e significante nos valores das pontuações totais, pontuação padrão e percentis do Teste MABC-2. Entretanto, para o autoconceito essa efetividade não foi totalmente confirmada.

The Motor-Proficiency-Test for children between 4 and 6 years of age (MOT 4-6): an investigation of its suitability in Greece

Given the negative influence of motor difficulties on people's quality of life their early identification seems to be crucial and consequently the information provided by a sound assessment tool is of great importance. The aim of this study was to examine the suitability of the MOT 4-6 (Zimmer & Volkamer, 1987) for use with preschoolers in Greece. Seven hundred and seventy-eight Greek children aged 48-71 months participated in the study. The two-way ANOVA used on total MOT performance revealed significant differences among the age groups formed in preschool age within Greeks, while boys' and girls' scores were quite similar. From the comparisons of Greeks' scores with the German standardization sample's ones, statistically significant differences were found in two age groups. However according to the Cohen's d effect size they were not of great importance. The distribution of Greeks' scores according to the test cut-offs, revealed that the MOT can differentiate all levels of performance, although a slight deviation from the distribution of Germans' scores was noticed. Finally, both the test-retest reliability and internal consistency of the test were found to be excellent. The MOT 4-6 seems to be a valuable motor assessment tool for Greek preschoolers. Regarding its norms, despite the minor differences that were noticed between the motor development of Greek and German preschoolers, their adjustment was thought to be unnecessary. Instead of lowering the norms, efforts for preventing the motor performance decline should be enhanced.

French Canadian cross-cultural adaptation of the Developmental Coordination Disorder Questionnaire '07: DCDQ-FC

BACKGROUND

Parent-report measures, such as the Developmental Coordination Disorder Questionnaire'07 (DCDQ'07), are used to identify developmental coordination disorder (DCD) in children. Early identification of this condition is important to mitigate its social-emotional and health consequences. Unfortunately, few French-language assessments are available to therapists working with francophone populations.

PURPOSE

The aim of this study was to undertake a formal translation of the English DCDQ'07 and begin to examine its psychometric properties.

METHODS

The translation was done using Beaton, Bombardier, and Guillemin's (2000) guidelines for cross-cultural adaptation. Methodologies described by Haccoun (1987) and Vallerand (1989) were used to address the psychometric qualities of the translation.

FINDINGS

The DCDQ'07 and its French translation (DCDQ-FC) are equivalent, with excellent internal consistency and test-retest reliability. Concurrent and construct validity were adequate for a screening measure; however, low sensitivity was obtained with both measures.

IMPLICATIONS

The DCDQ-FC is a valid translation for use with a French Canadian population.

Can the movement assessment battery for children-test be the "gold standard" for the motor assessment of children with Developmental Coordination Disorder?

Developmental Coordination Disorder (DCD) is an important risk factor in the development of children that can have a significant academic and social impact. This reinforces the need for its timely identification using appropriate assessment methods and accurate screening tests. The commonly used standardized motor test for the DCD identification is the Movement Assessment Battery for Children-Test (M-ABC Test) (Henderson & Sugden, 1992). The aim of the present study was to examine if the M-ABC Test can be considered to be the "gold standard" for the motor assessment of children with the aforementioned disorder. For that purpose, a critical review of the extant literature regarding M-ABC Test's psychometric properties was conducted. Neither the test manual nor the studies reviewed provide support for the reliability and validity of the M-ABC Test results in children with DCD. Until sufficient evidence for its technical adequacy is accumulated, the M-ABC Test should not be used in isolation for children with DCD.

Sensorimotor Therapy: Using Stereotypic Movements and Vestibular Stimulation to Increase Sensorimotor Proficiency of Children with Attentional and Motor Difficulties

The current naturalistic study examined whether sensorimotor therapy utilizing the training program, Retraining for Balance, might be an appropriate technique for sensorimotor proficiency. The 232 children (181 boys, 51 girls), whose mean age was 9.3 yr. ( SD = 2.7), presented attentional and motor difficulties (according to the School Health Care) as indicated by their parents before starting therapy. The children were divided into three groups, i.e., a younger group (7 yr. old or younger, n = 65), a middle group (8 to 10 yr. old, n = 91), and an older group (11 yr. old or older, n = 76). The program has seven parts, including fetal and neonatal movements, vestibular and auditory perceptual stimulation, and gross motor movements, among others. The treatment period was close to 3 yr. on the average. Analyses in a repeated-measures design indicated significant improvement of sensorimotor skills among the three age groups, but the older children performed better than the others on several tests. There were only a few sex differences. Retraining for Balance may be a functional technique for training children and youth with sensorimotor difficulties and might constitute a complement to regular treatment of Developmental Coordination Disorder, Learning Disability, and ADHD, but controlled studies are necessary before more decisive conclusions can be drawn.

Task-specific training, learning, and memory for children with developmental coordination disorder: a pilot study

This pilot study compared learning and memory profiles of 20 children (55% boys; M age = 7.3 yr., SD = 0.4) identified as having learning difficulties and having or suspected of having Developmental Coordination Disorder. 10 children participated in a 13-wk. program of task-specific motor exercises, while the other 10 received none. Analysis indicated significant improvement in motor skills and in visuospatial working memory by the intervention group; however, this effect did not transfer to reading and mathematics scores. Implications regarding the relations among motor skills, learning, and memory are discussed within the context of the intervention.

The effects of a motor and a cognitive concurrent task on walking in children with developmental coordination disorder

The effects of type (cognitive vs. motor) and difficulty level (easy vs. hard) of a concurrent task on walking were examined in 10 boys and 4 girls (age 4-6 years) with developmental coordination disorder (DCD) and 28 age- and gender-matched unaffected children. Each child performed free walking (single task), walking while carrying an empty tray (dual task, the concurrent task being motor and easy), walking while carrying a tray with 7 marbles (the concurrent task being motor and hard), walking while repeating a series of digits forward (the concurrent task being cognitive and easy), and walking while repeating the digits backward (the concurrent task being cognitive and hard). Walking was affected by the concurrent task (i.e., dual-task cost) in the children with DCD more so than in the comparison children. Greater task difficulty also increased the dual-task cost in the children with DCD more so than in the comparison children. These patterns were only noted for the motor concurrent task. The cognitive concurrent task also affected walking, but the dual-task costs did not differ between difficulty levels, nor between the groups.

Task-Specific Training, Learning, and Memory for Children with Developmental Coordination Disorder: A Pilot Study

This pilot study compared learning and memory profiles of 20 children (55% boys; M age = 73 yr., SD = 0.4) identified as having learning difficulties and having or suspected of having Developmental Coordination Disorder. 10 children participated in a 13-wk. program of task-specific motor exercises, while the other 10 received none. Analysis indicated significant improvement in motor skills and in visuospatial working memory by the intervention group; however, this effect did not transfer to reading and mathematics scores. Implications regarding the relations among motor skills, learning, and memory are discussed within the context of the intervention.

Stability and change in children with Developmental Coordination Disorder

BACKGROUND

Children with Developmental Coordination Disorder (DCD) are a heterogeneous group who have a marked impairment in the performance of functional motor skills. Provision for these children is usually made via a paediatrician through occupational or physiotherapy; though with a prevalence rate of 5%, regular provision is rarely possible because of limited professional resources.

METHODS

This study covers a period of nearly 4 years and initially examined a group of 31 children first identified as having DCD at 7-9 years of age. The children were observed and assessed before, during and after a total of 16 weeks of intervention carried out by parents and teachers. This was followed by a period of monitoring of performance for 26 of the children in the motor domain plus other abilities such as educational progress and self-concept. Individual children were tracked using a variety of qualitative and quantitative approaches, building up longitudinal whole child profiles.

RESULTS

Following intervention, 14 of the 26 children have shown improvement and stability in all areas and no longer display DCD symptoms. Eight children have profiles which have shown variability, with the children moving in and out of the DCD classification, while the remaining four children have consistently scored poorly in their movement skills and in addition received ongoing support in school for academic subjects.

CONCLUSIONS

The study has confirmed that children with DCD show varying profiles over a period of time and that the profiles have distinct characteristics related to events in the child's life. This approach to examining stability and change in the progressions of children's difficulties is in keeping with an ecological approach to explaining development with its multilayered influences creating changes.

Motor coordination difficulties in a municipality group and in a clinical sample of poor readers

The purpose of the study was to investigate incidence, severity and types of motor problems in two groups of poor readers compared to good reading controls. A group of children with severe dyslexia referred to specialist evaluation, a teacher selected municipality sample comprising the 5% poorest readers, and a control group consisting of the 5% best readers were all assessed applying a norm-based, standardized measure by Henderson and Sugden 1992; (The Movement Assessment Battery for Children. Kent: The Psychological Corporation). The three groups were compared with regard to total motor impairment scores as well as motor function within the areas of manual dexterity, ball-skills and balance. More than 50% of the children in both groups of poor readers showed definite motor coordination difficulties at or below the 5th centile, for which motor intervention is recommended. Children in both groups showed difficulties within the sub-area of manual dexterity in particular and also performed significantly worse than controls within the sub-area of balance, but not in ball-skills. The high incidence of motor coordination problems in the two groups of poor readers indicates that all children with reading difficulties should be screened for possible motor difficulties.

Relationship between motor proficiency, attention, impulse, and activity in children with ADHD

The aim of this study was to investigate the relationship between motor performance, attention deficit, impulsiveness, and hyperactivity in children with attention-deficit--hyperactivity disorder (ADHD). Participants were 42 school-aged children with ADHD (36 males, 6 females; mean age 8 years 2 months, SD 1 year 2 months; range 6 years to 11 years), and 42 age- and sex-matched children without ADHD (mean age 8 years 3 months, SD 1 year 1 month; range 6 years to 11 years). Motor abilities were assessed with the Bruininks-Oseretsky Test of Motor Proficiency. Attention and impulse control were measured with the Gordon Diagnostic System, and assessment of activity level was based on two Activity Level Rating Scales that were completed by parents and teachers. Analysis by t-test revealed a significant difference between children with and without ADHD in fine and gross motor skills, impulse control, and attention. Stepwise regression indicated that attention, impulse control, and parent ratings of activity level were the three best predictors of gross motor skills for children with ADHD, accounting for 55.9% of the variance. Attention and impulse control were the two best predictors of fine motor skills, accounting for 45.7% of the variance. Attention and impulse control were consistently found to be important predictors of both fine and gross motor skills in children with ADHD. However, the fact that activity level was a predictor for gross motor proficiency but not for fine motor tasks suggests that different behavioral processes are involved in fine and gross motor performance to different extents.

Two distinct pathways for developmental coordination disorder: Persistence and resolution

This article describes the perceptual motor, educational and social outcome of early motor delay in a group of 17-18 year old Finnish adolescents who were originally evaluated at age 5. The study group consisted of 65 adolescents: 22 with significant motor problems (or developmental coordination disorder, DCD), 23 with minor motor problems (intermediate group) and 20 controls. The goal of this study was to reassess the results obtained when they were age 15 and to determine whether the variables used earlier could still discriminate the adolescents at age 17. The results showed that at age 17 all perceptual motor tasks differentiated the three groups. The DCD group performed less well than the control group on all tasks, with the intermediate group situated between these two. Discriminant function analyses showed that more classification errors occurred between the control and intermediate groups at age 17 than at age 15, suggesting that the distinction between these groups becomes more difficult with age. In the educational domain, similar to the findings at age 15, the adolescents with DCD had the lowest WAIS scores and shortest school careers of the three groups. In the social domain, as found two years earlier, the DCD group had the lowest perceptions of athletic and scholastic competence while the intermediate and control groups did not differ. In addition, the interview results indicated that the three groups were in different stages of identity development. In sum, the outcome at age 17 was a replication of the results obtained at age 15 and suggests two developmental paths for those with early perceptual motor problems: 'persistence' and 'catching up'.

Developmental coordination impairments in adulthood

The aim of this study was to extend the understanding of Developmental Coordination Disorder (DCD) into adulthood. We recruited 19 adults aged between 18 and 65 who had received diagnoses of DCD or dyspraxia or who self-reported as having motor impairments consistent with a history of DCD, together with age- and gender-matched controls. Participants were given tests of manual dexterity, handwriting, construction, obstacle avoidance, dynamic balance, static balance, dual task performance, ball skills, reaction time, movement time and sequencing. As a group, adults with DCD performed more poorly than controls across all tasks. Slowness and variability of movement was a pervasive feature of their performance and many individuals had considerable problems with sequencing and with dual task performance. A discriminant function analysis conducted using six performance measures correctly classified participants as car drivers or non-drivers. Adults do retain motor difficulties and these can exclude them from important activities of daily living.

Early identification and risk management of children with developmental coordination disorder

PURPOSE

The purpose of this study was to determine the motor control issues, motor learning differences, and secondary impairments of children with developmental coordination disorder (DCD) and to explore physical therapists' contribution to their early management.

SUMMARY OF KEY POINTS

DCD is a condition involving limitations in gross motor, postural, and/or fine motor performance that is not attributable to other neurological disorders. Manifestation is varied across children and depends, in part, on their level of anticipatory motor control, response to specific task demands, and ability to attend to feedback to obtain flexible, adaptive movement solutions. Children with DCD rely primarily on vision for feedback, frequently use "fixing" strategies, and exhibit limited motor repertoires. As a result of their movement problems, they tend to avoid physical activity and are prone to secondary impairments, including decreased strength and power.

CLINICAL IMPLICATIONS AND RECOMMENDATIONS

Physical therapists can 1) use their keen observational skills to identify children with DCD earlier in life and 2) use their knowledge of the secondary impairments and movement difficulties to work with families to engage children in continuous movement activities to maintain strength and power and thus obtain the physical, social, and psychosocial benefits of physical activity.

Psychomotor development in the children of mothers with type 1 diabetes mellitus or gestational diabetes mellitus

The purpose of this study was to examine psychomotor development in children born to mothers with type 1 diabetes mellitus (DM1) or gestational diabetes mellitus (GDM). The influence of metabolic control in pregnant diabetic mothers and complications during labor on their children's psychological and physical development was evaluated. The analysis included 59 children, 20 of mothers with GDM, 19 of mothers with DM1, and 20 children of healthy mothers. Clinical observations and medical history were recorded and children were assessed using the Brunet-Lezine Psychomotor Development Scale. Abnormalities were found more often in the children of mothers with DM1 whose illness was insufficiently controlled during pregnancy and of mothers with serious hypoglycemia while pregnant. Speech, eye-movement coordination and social aspects were affected.

MCMI-II personality traits and symptom traits in parents of children with selective mutism: a case-control study

The etiology of selective mutism (SM) in children is unknown but is regarded as multifactorial. SM is frequently associated with social anxiety and language disorder or delay. The present study addresses SM and social anxiety as a familial phenomenon by comparing self-reported personality traits and symptom traits (Millon Clinical Multiaxial Inventory) in parents of 50 SM children with control parents. Personality and symptom traits reflecting social anxiety are also explored separately in the parents of SM children with and without a comorbid communication disorder. The results confirm SM and social anxiety as a familial phenomenon. Assessment and treatment planning should take this into account. The family data also suggest different family transmissions of SM and social anxiety in the SM group with and without a comorbid communication disorder.

A pilot trial of a cognitive treatment for children with developmental coordination disorder

This pilot study compared a new treatment approach, the Cognitive Orientation to daily Occupational Performance (CO-OP) to the Contemporary Treatment Approach (CTA) to treating children with Developmental Coordination Disorder (DCD). CO-OP emphasises problem-solving strategies and guided discovery of child and task specific strategies. CTA encompasses a variety of approaches, such as neuromuscular, multi-sensory, and biomechanical, focusing on motor aspects of skill acquisition. Twenty children with a mean age of 9.05 years (S.D. = 1.23) participated in the study. All children had normal intelligence, scored below the 15th percentile on a standardised test of motor ability, and demonstrated motor difficulties significant enough to warrant referral for treatment. Pre- and post-measures included the Canadian Occupational Performance Measure (COPM), the Vineland Adaptive Behavior Scales (VABS), the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), the Developmental Test of Visual-Motor Integration-Revised (VMI), the motor items of the Self-Perception Profile for Children (SPPC), and the Performance Quality Rating Scale (PQRS). In both groups, treatment goals were child-chosen. Both treatments lead to improved COPM self-ratings of performance and satisfaction; however, improvements in the CO-OP group were greater than those in the CTA group. These results were paralleled by PQRS scores, and the Motor scores on the VABS, but not on the BOTMP measures. This outcome still needs replication as no control group was involved and because of the occurrence of pre-treatment differences between the CO-OP and CTA groups on relevant measures. Follow-up data indicated that children who received CO-OP tended to experience greater long-term maintenance of their motor goals and acquired strategies; follow-up parent-report rated CO-OP treatment as more useful than CTA treatment. Self-report, observer report, standardised assessment, and follow-up all demonstrated the effectiveness of the CO-OP approach, supporting the use of CO-OP and suggesting further investigation of this new cognitive intervention.

Psychosocial implications of poor motor coordination in children and adolescents

Utilising Harter's theory of competence motivation (Harter, S. The determinants and mediational role of global self-worth in children. In: N. Eisenberg, Contemporary topics in developmental psychology, Wiley, New York, 1987, pp. 219-242.), the current study examined perceived competence and social support, and their influence on self-worth and anxiety in children and adolescents with and without developmental coordination disorder (DCD). A group of children aged 8-10 years, and a group of adolescents aged 12-14 years, with significant movement problems were compared with matched control groups on measures of perceived competence, perceived social support, self-worth and anxiety. Those with DCD were found to perceive themselves as less competent in several domains, and having less social support than control participants. Overall, DCD groups had lower self-worth and higher levels of anxiety than the control groups. Adolescents also perceived themselves as less competent with poorer social support and lower self-worth than younger children. In addition, anxiety was significantly higher for the adolescent group compared to their younger counterparts.

Clinical and research diagnostic criteria for developmental coordination disorder: a review and discussion

The aim of this review was to investigate the selection criteria used in the past in studies of children with developmental motor problems (excluding those suffering from neurological dysfunctions such as cerebral palsy, muscular dystrophy, etc.). We therefore conducted an extensive analysis of 176 publications. First, an overview of the main characteristics of these studies (terminology, population, type and purpose) and the selection criteria that are reported in these publications are presented. Following this, the DSM-IV selection criteria for developmental coordination disorder (DCD) are contrasted with the selection criteria reported in 41 publications that have used this terminology to classify the children. The results of this comparison show that the inclusion criteria are largely followed, albeit with little consistency concerning selection instruments and quantitative cut-offs, while adherence to the exclusion criteria is not common practice. Strengths and weaknesses of the DSM-IV criteria, complementary to the previous discussion by Henderson and Barnett in the HMS special issue on DCD in 1998 on this same topic, are discussed. The results of the review also show that many studies have used additional selection criteria related to the specific research questions of the study concerned. In the broader context of clinical practice as well as basic research, the latter result suggests the usefulness of a distinction between Clinical Diagnostic Criteria and Research Diagnostic Criteria. This distinction helps to develop a unifying view on the use of diagnostic criteria for research and clinical practice. We conclude with a number of recommendations concerning the selection criteria for children with DCD.

Clinical description of children with developmental coordination disorder

Occupational therapists working within School Health Support Services are receiving increasing numbers of referrals, relative to past rates, for children who are experiencing motor problems and may have developmental coordination disorder. Based upon clinical experience, therapists indicate that these children are typically referred in the early school years and that most have handwriting difficulties; to date, however, there has been little empirical evidence to support these observations. In this paper, descriptive information is presented for 556 children who may be presumed to have developmental coordination disorder and who had been referred to school-based health services in two centres. Typical reasons for referral, co-morbidity information, and assessment practices are presented. Findings confirmed the presence of many occupational performance issues in this population, including handwriting difficulties, and challenge therapists to broaden the current scope of school health assessment and intervention practices.

Natural outcome of ADHD with developmental coordination disorder at age 22 years: a controlled, longitudinal, community-based study

OBJECTIVE

There is a need for controlled longitudinal studies in the field of attention disorders in the general population.

METHOD

In a community-based follow-up study, 55 of 61 subjects aged 22 years, who had attention-deficit/hyperactivity disorder (ADHD) with and without comorbid developmental coordination disorder (DCD) at initial workup at age 7 years, were compared, on a multitude of outcome variables, with 46 of 51 age-matched subjects without such diagnoses. None of the subjects had received stimulant treatment. Psychiatrists performing the follow-up study were blind to original diagnostic group status.

RESULTS

In the ADHD/DCD group 58% had a poor outcome compared with 13% in the comparison group (p < .001). Remaining symptoms of ADHD, antisocial personality disorder, alcohol abuse, criminal offending, reading disorders, and low educational level were overrepresented in the ADHD/DCD groups. The combination of ADHD and DCD appeared to carry a particularly gloomy outlook.

CONCLUSIONS

Childhood ADHD and DCD appears to be a most important predictor of poor psychosocial functioning in early adulthood. It would seem appropriate to screen for such disorders in schools and clinics so that therapies may be started early.

[Neurologic semiology of a group of first grade students in an elementary school]

We evaluated children in the first grade of a elementary school using neurological examination. With no previous knowledge of their educational performance, were invited all children attending five classes of the first grade of an elementary public school chosen randomly, in Itatiba / Sao Paulo / Brazil, whose parents assigned a Commitment Term for participation in this research. Children who missed three evaluations in different days or whose parents did not assigned the Commitment Term were excluded. The Traditional Neurological Examination (ENT) (Lefevre, 1972) was applied. It was considered for normal the measurement of the skull circumference, proposed by Diament & Rodrigues (1976), and the application of all ENT items. The data were stored in a database of the Epi6 Program (Epidemiologic Information), and analyzed by percentage calculation and by the chi2 test. The significance level was 0.05. Children evaluated were 124. The ENT results were normal in 87 (70.16%) and altered in 37 (29.83%). Among the alterations, there were observed: light tremor, light muscular hypotonia, speech acquisition delay, macrocephaly, microcephaly, hyperactivity, cranial nerve syndrome, central facial paralysis. One child presented corticospinal tract impairment syndrome of the distal lower extremities.

Selective mutism and comorbidity with developmental disorder/delay, anxiety disorder, and elimination disorder

OBJECTIVES

To assess the comorbidity of developmental disorder/delay in children with selective mutism (SM) and to assess other comorbid symptoms such as anxiety, enuresis, and encopresis.

METHOD

Subjects with SM and their matched controls were evaluated by a comprehensive assessment of the child and by means of a parental structured diagnostic interview with focus on developmental history. Diagnoses were made according to DSM-IV.

RESULTS

A total of 54 children with SM and 108 control children were evaluated. Of the children with SM, 68.5% met the criteria for a diagnosis reflecting developmental disorder/delay compared with 13.0% in the control group. The criteria for any anxiety diagnosis were met by 74.1% in the SM group and for an elimination disorder by 31.5% versus 7.4% and 9.3%, respectively, in the control group. In the SM group, 46.3% of the children met the criteria for both an anxiety diagnosis and a diagnosis reflecting developmental disorder/delay versus 0.9% in the controls.

CONCLUSIONS

SM is associated with developmental disorder/delay nearly as frequently as with anxiety disorders. The mutism may conceal developmental problems in children with SM. Children with SM often meet diagnostic criteria for both a developmental and an anxiety disorder.

Satisfaction with a physiotherapy service to preschools

This paper explores satisfaction with a newly developed physiotherapy service to preschools. In collaboration with the South Australian Department of Education Training and Employment, the School of Physiotherapy at the University of South Australia began a visiting physiotherapy service to Adelaide preschools in 1997. The service aims to provide on-site assessment and programming recommendations for children at risk of gross motor delay. In addition, training workshops run by the physiotherapist are held for preschool staff as part of the program. Physiotherapy students are involved in the visits and workshops as part of their clinical training. Satisfaction with the service was evaluated at the end of 1997 and 1998. The majority of comments from preschool directors, parents and physiotherapy students have been extremely positive and there is strong support for the service to continue.

Intervention approaches and children with developmental coordination disorder

Children with Developmental Coordination Disorder (DCD) have a marked impairment in the performance of functional motor skills required to succeed at school. Longitudinal studies show that without intervention children with DCD often do not improve with development and the poor motor behaviour appears to have a detrimental effect on other aspects of functioning such as school achievement, behaviour and self esteem. Outside of clinical situations, there are only a small number of controlled empirical investigations, and from this small number two types of approaches emerge. The first concentrates on processes underlying motor skills and purports to improve areas such as kinesthesis or sensory motor processes. The second concentrates on teaching functional tasks aiming to specifically intervene in the deficient areas. Evaluations of these approaches show that they both work, producing significant improvements over control groups but show no differences between other approaches. It is hypothesized that more general learning principles are producing the effect, such as accurate assessment and tailoring activities to meet the needs of any individual child. Further, it is suggested that work with non-specialists in the motor area, such as teachers and parents, is a way forward with all but the most severely affected children.

Do hyperactive children have motor organization and/or execution deficits?

Hyperactive children have been described as motorically clumsy. To explore the validity of this assertion, an experiment using the additive factor method was designed to examine motor organization and execution in hyperactive children. Four groups of boys aged 7 to 8 years took part in the study: (1) a pure hyperactive (HA) group, N=20; (2) a pure conduct-disordered (CD) group, N=18; (3) a mixed hyperactive/conduct-disordered (HA+CD) group, N=12; (4) a normal (N) control group, N=22. While the small sample size precluded a definitive conclusion, the results indicated that neither HA nor CD children showed any motor organization or execution deficit in a simple sequential key-tapping task. Given previous findings indicating that hyperactive children show deficits in more complex motor coordination skills, the generalizability of our negative results needs to be examined on other more complex tasks.

Neuromotor functioning in children with Tourette syndrome with and without attention deficit hyperactivity disorder

Neuromotor function was assessed in 94 children of normal intelligence with Tourette syndrome, Tourette syndrome and attention-deficit hyperactivity disorder (ADHD), or ADHD only, using the Physical and Neurological Examination of Subtle Signs (PANESS). Time to complete six motor movements was analyzed separately by side (left and right) and complexity (simple and patterned). All groups performed faster on their preferred, dominant side. Although all groups took longer to complete patterned versus simple movements, the group with ADHD had a larger discrepancy for complexity than the other two groups. The speed for simple and patterned tasks was at or faster than age expectations for 54% of tasks in the group with Tourette syndrome but only 15% of tasks in the other two groups. More children in the group with Tourette syndrome (76%) than the groups with Tourette syndrome with ADHD (54%) or ADHD (54%) or ADHD only (65%) performed movements within normal time limits for age. Findings suggest that Tourette syndrome is not associated with motor slowing.

Asperger syndrome, autism and attention disorders: a comparative study of the cognitive profiles of 120 children

The Wechsler Intelligence Scale for Children-Revised (WISC-R) was applied (in a Swedish version) in 120 children with Asperger syndrome, autistic disorder, and attention disorders. Using stepwise logistic regression analysis, the WISC's discriminating ability was investigated. The overall rate of correct diagnostic classification was 63%. Further, WISC profiles were analysed within each group. The group with autistic disorder was characterised by a peak on Block Design. The Asperger syndrome group had good verbal ability and troughs on Object Assembly and Coding. The group with attention disorders had troughs on Coding and Arithmetic. The results suggest that Kaufman's Verbal Comprehension, Perceptual Organisation and Freedom from Distractibility factors rather than verbal IQ and performance IQ account for the variance on the WISC. Furthermore, the Asperger syndrome and autistic disorder groups differed in respect of "fluid" and "crystallised" cognitive ability.

Low birthweight and neuromotor development: a population based, controlled study

The aims of the study were to investigate: (a) the relationship between low birthweight (LBW) and pre-school neuromotor development; and (b) the predictive value of various pre-, peri-, and neonatal factors for neuromotor development in LBW pre-school children. A population based sample of 144 5-year-old LBW children (birthweight < 2000 g) with no major handicaps was compared with a random sample of 163 normal birthweight term controls. Using the Peabody Developmental Motor Scales, impaired performance on the balance scale was seen more often in LBW boys than in controls (odds ratio 5.5, 95% CI 1.5-20.3), while performance on the eye-hand coordination and locomotor scales was comparable for the two groups. LBW girls were comparable to controls on all these scales. On neurological examination, an increased frequency of minor neurological signs was found in LBW boys, while increased ankle tone and/or leg hyperreflexia was more common in LBW girls compared to controls. Small head circumference at birth was associated with an increased frequency of minor neurological signs in LBW boys, and lack of breastmilk in the neonatal period with impaired balance in LBW boys. None of the other pre-, peri- or neonatal factors were predictive of neuromotor development. We conclude that motor functions essential for daily activities are intact in most LBW preschoolers.

Parent satisfaction with the Minimal Motor Dysfunction Unit: a survey

This study investigated parent satisfaction with the Minimal Motor Dysfunction Unit (MMDU), a service for clumsy children based in Adelaide. A questionnaire was developed and mailed to 102 parents whose children had attended the MMDU between 1991 and 1993. The response rate was 76 per cent. The level of parent satisfaction with the overall MMDU service was 86 per cent. Parents rated the processes of service delivery and the resulting outcomes as more important to them than structural aspects of the service. Based on parent comments, recommendations were made to assist in further improving the quality of the MMDU service. Parent satisfaction should be investigated as an outcome measure for other paediatric physiotherapy services.

Current perspectives on minimal cerebral dysfunction

Children with minimal cerebral dysfunction (MCD) are a large client group for many paediatric physiotherapists. The increasing number of research papers published in the area of MCD are often complex and difficult to interpret because the children to whom they refer do not form an easily definable, homogeneous group and their prognosis is unclear. This review presents a summary of current findings about MCD and poses a number of questions about physiotherapy intervention. The need for physiotherapists to validate their role in the management of children with MCD is emphasised.

Children with deficits in attention, motor control and perception (DAMP) almost grown up: psychiatric and personality disorders at age 16 years

Fifty-six cases with childhood onset deficits in attention, motor control and perception (DAMP) were followed-up at age 16 years and compared with 45 children without DAMP. Both groups had originally been recruited from the general population at the age of 6 years. Psychiatric disorders (affective disorders in particular) were more common in the DAMP group. Personality disorders were common in both groups, but the DAMP group much more often had a combination of several different personality disorders. The reasons for the discrepancies between teenagers with and without a prior history of DAMP are discussed.

Anorexia nervosa: physical health and neurodevelopment at 16 and 21 years

Fifty-one cases of anorexia nervosa (AN) and 51 age-, sex- and school-matched controls, all drawn from a community sample of 15- to 16-year-olds, were compared at 16 and 21 years with regard to physical health and neurodevelopment. The AN group had significantly lower mean height than the comparison group at age 21 years. There were significantly more individuals that were overweight and underweight in the AN group at age 21 years. Fractures were slightly, but significantly, more common. Dysdiadochokinesis was very much more common in the AN group at both ages, and its occurrence was not correlated with low weight. It is suggested that diadochokinesis in AN might mirror some inherent underlying immaturity or other abnormality of the central nervous system in a subgroup of cases. The presence of dysdiadochokinesis was associated with a tendency towards poorer psychosocial outcome, even in cases that were no longer underweight.

Neurobehavioural relationships after the onset of puberty

The behavioural and cognitive development were studied of 68 children with and 259 without minor neurological function (MND) at 14 years, when the majority of children showed three or more physical signs of puberty. MND was differentiated into fine manipulative disability, co-ordination problems, choreiform dyskinesia and hypotonia. The normal group was subdivided into those who had been normal at 12 years and those who had had MND. All types of MND were related to cognitive and behavioural problems. Fine manipulative disability was related to behavioural and cognitive difficulties; co-ordination problems to learning difficulties; and choreiform dyskinesia and hypotonia were related to attention difficulties and school failure, notwithstanding normal IQ. Besides MND, socio-economic class, family adversities and female gender contributed to the development of behavioural and cognitive problems. The behaviour of children with MND at 12 years who were normal at 14 years did not differ from that of normal children.

Children with deficits in attention, motor control and perception (DAMP) almost grown up: The contribution of various background factors to outcome at age 16 years

Fifty-six children with and forty-five children without deficits in attention, motor control and perception (DAMP) had been recruited from the general population at age 7 years. They were followed up neuropsychiatrically at age 16 years after intermediate term follow up at age 10 and 13 years. Cases were subdivided into those with good and not good outcome on the basis of absence or presence of psychiatric and personality disorders, multiple traumatic accidents and speech and language problems at age 16 years. The presence of DAMP in itself was the strongest predictor of poor outcome. High scores for minor neurological dysfunction, low performance IQ, autistic features at age 7 years and poor reading skills at age 10 and/or 13 years were important background factors in cases with poor outcome. In the small subgroup with poor outcome among those without DAMP at age 7 years, major life events was the most important background factor.

The epidemiology of Asperger syndrome. A total population study

This paper describes a total population study of Asperger syndrome using a two-stage procedure. All school children in an outer Göteborg borough were screened. Final case selection based on clinical work-up showed a minimum prevalence of 3.6 per 1.000 children (7-16 years of age) using Gillberg and Gillberg's criteria and a male to female ratio of 4:1. Including suspected and possible Asperger syndrome cases, the prevalence rose to 7.1 per 1.000 children and the male:female ratio dropped to 2.3:1. These findings are discussed as they relate to previously published results in the field and to findings obtained using Szatmari et al.'s and ICD-10 draft criteria for the disorder.

Children with deficits in attention, motor control and perception (DAMP) almost grown up: general health at 16 years

One hundred and one children (56 with and 45 without deficits in attention, motor control and perception (DAMP)), originally diagnosed at six or seven years of age and belonging to a representative cohort of children from the general population were followed up at 16 and 17 years of age. There was a significant excess of substance abuse, fractures and other accidents in the DAMP group than among controls, in addition to more motor co-ordination problems, clumsiness, and height and weight problems. Mean complex visual reaction time was significantly longer in the DAMP group, accounted for by the number of boys in the group. It appears that 10-year outcome for children who had attention problems and clumsiness during the preschool period is considerably poorer than for those who did not have such problems.

Early maturation of motor-delayed children at school age

Children underwent motor and sensory testing during each of 3 consecutive years beginning at kindergarten entrance. Children were assigned to either a motor-normal or motor-delayed group based on results from testing during the 1st year of the study. Motor-normal subjects (n = 17) had standard scores on a global motor-sensory test that fell within one standard deviation of the mean. Motor-delayed subjects (n = 12) had a global motor-sensory test standard score indicating greater than one standard deviation of motor delay and, in addition, were delayed by a minimum of one standard deviation on four of five of the motor-sensory test subtests. At the conclusion of the 3-year study, the mean standard score of the motor-delayed group remained greater than one standard deviation below the performance of the motor-normal group as measured by the global motor-sensory test. Statistical analysis using repeated measures analysis of variance indicated that the motor-delayed group made gains but did not close the gap between themselves and the motor-normal group during the 3-year study. Group x time interaction effects showed that during the study, significant gain was made by the motor-delayed group on the motor coordination subtest of the motor-sensory test. The study supports the conclusion that motor-delayed children without early intervention fail to outgrow their motor delays by age 8 years.

A follow-up study of child psychiatric clinic attenders with minor neurological dysfunction

Thirty-two child psychiatric patients with minor neurological dysfunction (MND) were followed-up after a mean interval of 5.3 years. Six clusters were analyzed that measured posture and muscle tonus, reflexes, coordination and balance, fine manipulative ability, choreiform dyskinesia, and associated movements. In the majority of cases, remission occurred for posture and muscle tonus, and choreiform dyskinesia and reflexes. Problems with fine manipulative ability and associated movements, however, persisted in most cases. Change in the total MND-abnormality score was also analyzed. Elevated scores and greater age at the initial assessment, and longer intervals between the initial assessment and follow-up were associated with greater improvement, indicating that biological maturation is an important factor in symptom remission. Slow background activity was the predominant EEG-pattern that tended to persist rather than to remit over time. A wide spectrum of psychiatric diagnoses was recorded on both occasions. In general, the tendency for remission of psychiatric disorders was stronger than that of persistence and new manifestation. In addition, with regard to behavioural abnormalities, the total score and subscore for emotional disorders diminished over time.

Evaluation of care for the preterm infant: review of literature on follow-up of preterm and low birthweight infants. Report from the collaborative Project on Preterm and Small for Gestational Age Infants (POPS) in The Netherlands

Since the introduction of neonatal intensive care in the 1960s, mortality in very preterm and very low birthweight infants has been decreasing steadily. Consequently, interest in the outcome of surviving infants is growing. Restriction of health care resources has stressed the need for information concerning the effect of individual treatment components on mortality and morbidity. Concern about the quality in apparently normal survivors has been increasing as well. The current flood of papers on these subjects illustrates the interest in these issues. The first part of this paper reviews the methodology used in follow-up studies in the past decades. It aims at methodological problems that hamper comparison between studies and preclude unequivocal conclusions. New treatment techniques seldom were but should be evaluated by randomised trials. To monitor the combined effects of changing obstetric and neonatal techniques on perinatal outcome, studies in geographically defined populations are recommended using data from early pregnancy until at least preschool age. Comparability of outcomes could be enhanced by international agreement on standardisation of assessment methods and outcome measures. In the second part the results concerning gestational age- and birthweight-specific mortality, impairments and disabilities and the risk factors for such disorders are discussed. Increased survival of even the tiniest infants is clearly established. This increase in survival has not yet been accompanied by an apparent increase in major morbidity. However, many minor impairments are reported, occurring often in combination and predisposing these children to deviations of normal development. Important changes in the manifestation of brain damage appear to occur during development. These findings stress the importance of long-term follow-up studies.