Evaluating the Sensory Integrative Functions of Mainstream Schoolchildren with Specific Developmental Disorders

Clinicians and educators are becoming increasingly aware of sensory integrative dysfunctions (SIDs) in mainstream schoolchildren with specific developmental disorders (SDDs). This study was designed (1) to determine whether or not SID occurred significantly in mainstream schoolchildren aged 5–8 years, referred to the Ealing Paediatric Occupational Therapy Service (EPOTS); (2) to explore the patterns and nature of SID found In such a group; and (3) to ascertain any relationships between certain types of SID and specific behavioural traits.

The study adopted a differential research method. The subjects were two groups of children aged 5–8 years. The experimental group (EG) consisted of 25 children referred to EPOTS. The control group (CG) consisted of 18 mainstream schoolchildren with no known dysfunction. All subjects were administered the Sensory Integration and Praxis Tests (SIPT) and Clinical Observations of neurobehavioural and neuromuscular functions. The Conners' Parent Rating Scales – 93 (CPRS-93) was used to evaluate specific behavioural traits in the EG children.

The results of statistical analysis supported that mainstream schoolchildren with SDD (EG, n=25) referred to EPOTS had significantly lower scores (p<.001) in the SIPT than a normal control group of children (CG, n=18) with matched demographic data. The EG children showed significant neurobehavioural and neuromuscular dysfunctions (p<.05) in comparison with the CG in the Clinical Observations. The percentage of EG children with scores similar to the six SIPT clusters was 44%, which is higher than the figure of 29.6% produced by the test publisher. There was no consistent correlation between the SIPT variables and the variables identified in the CPRS-93. Although the findings were not conclusive, some partial pattern could be identified.

Follow-up Assessment of Children Receiving Sensory Integration Treatment

Following the completion of a study of the efficacy of sensory integration (SI) treatment compared with tutoring, the question raised was whether a greater difference between the two groups would exist after a period of time had elapsed after treatment ended. Twenty-two of the original 29 subjects completed follow-up assessment two years after the completion of their treatment. Only one significant difference between the two groups was seen at follow-up: The gross motor performance of the group who received SI treatment was significantly greater than that of children who received tutoring. There was no difference between the groups on measures of reading skills, fine motor skills, visual motor skills, or behavioral factors. There were no significant correlations between the amount of improvement a child made during treatment and the maintenance of the gains.

Mediational Techniques: Origins and Application to Occupational Therapy in Paediatrics

For a variety of reasons, occupational therapists are beginning to explore the use of cognitive, or “top-down” approaches during intervention. While these approaches have a long history within education and psychology, the steps involved in problem-solving and the techniques that are used to mediate a child's occupational performance are unfamiliar to most therapists. In this paper, the historical underpinnings of cognitive approaches and mediational techniques are reviewed and the steps involved in teaching a child to problem solve are outlined. As each is described from the literature, it is interpreted and applied to paediatric occupational therapy practice. Finally, the problem-solving steps and techniques are combined to demonstrate usage of a cognitive approach in order to address a common occupational performance issue in childhood.

Motor Proficiency in Children Reporting Low Levels of Participation in Physical Activity

This study examined the motor proficiency and physical activity levels of young children with low levels of perceived self-efficacy regarding their participation in physical activities. This group (n=48) was compared with 400 of their peers in Grades 4–8 attending the same schools and also with a group (n=44) who reported high levels of perceived self-efficacy. Although none of the students with poor self-efficacy had been identified by their schools as having a learning or behavioural disorder, these children were found to have characteristics which are typical of children with developmental coordination disorder (DCD). These findings suggest that an instrument which asks children about their confidence when participating in physical leisure activities, and their enjoyment of those same activities may have potential as a possible screening tool for DCD.

Developmental coordination disorder: a review and update

Present in approximately 5-6% of school-aged children, developmental coordination disorder (DCD) is a neuromotor disability in which a child's motor coordination difficulties significantly interfere with activities of daily living or academic achievement. These children typically have difficulty with fine and/or gross motor skills, with motor performance that is usually slower, less accurate, and more variable than that of their peers. In this paper, we review the history of various definitions leading up to the current definition of DCD, prevalence estimates for the disorder, etiology, common co-morbidities, the impact of DCD on the child's life, and prognosis. As well, we briefly describe current interventions for children with the disorder and results of recent neuroimaging studies of the brains of children with DCD, including research by the authors of this paper.

Attention deficit hyperactivity disorder and sensory modulation disorder: a comparison of behavior and physiology

Children with attention deficit hyperactivity disorder (ADHD) are impulsive, inattentive and hyperactive, while children with sensory modulation disorder (SMD), one subtype of Sensory Processing Disorder, have difficulty responding adaptively to daily sensory experiences. ADHD and SMD are often difficult to distinguish. To differentiate these disorders in children, clinical ADHD, SMD, and dual diagnoses were assessed. All groups had significantly more sensory, attention, activity, impulsivity, and emotional difficulties than typical children, but with distinct profiles. Inattention was greater in ADHD compared to SMD. Dual diagnoses had more sensory-related behaviors than ADHD and more attentional difficulties than SMD. SMD had more sensory issues, somatic complaints, anxiety/depression, and difficulty adapting than ADHD. SMD had greater physiological/electrodermal reactivity to sensory stimuli than ADHD and typical controls. Parent-report measures identifying sensory, attentional, hyperactive, and impulsive difficulties varied in agreement with clinician's diagnoses. Evidence suggests ADHD and SMD are distinct diagnoses.

Developmental coordination disorder (dyspraxia): an overview of the state of the art

A large number of school-aged children present with motor-based performance problems that have significant negative effects on their ability to participate fully in the daily activities of home, school, and play. These children have a neurodevelopmental disorder most commonly known as developmental coordination disorder (DCD). These children are frequently brought to the attention of the family doctor and referred to health care professionals in search of answers and services. Therapists treating these children have a large number of intervention approaches at their disposal. This paper presents an overview of these approaches and a review of the available evidence. The evidence for the older, deficit-oriented approaches remains inconclusive, at best; whereas the task-oriented approaches, seem to be better supported. While more work is needed to validate the use of the task-oriented approaches, the results suggest that a shift in perspective from a deficit-oriented to a task-oriented perspective would be appropriate.

Practitioner review: approaches to assessment and treatment of children with DCD: an evaluative review

BACKGROUND

Movement clumsiness (or Developmental Coordination Disorder--DCD) has gained increasing recognition as a significant condition of childhood. However, some uncertainty still exists about diagnosis. Accordingly, approaches to assessment and treatment are varied, each drawing on distinct theoretical assumptions about the aetiology of the condition and its developmental course.

METHOD

This review evaluates the current status of different approaches to motor assessment and treatment for children with DCD. These approaches are divided according to their broad conceptual origin (or explanatory framework): Normative Functional Skill Approach, General Abilities Approach, Neurodevelopmental Theory, Dynamical Systems Theory, and the Cognitive Neuroscientific Approach.

CONCLUSIONS

Each conceptual framework is shown to support assessment and treatment methods with varying degrees of conceptual and psychometric integrity. The normative functional skill approach supports the major screening devices for DCD and cognitive (or top-down) approaches to intervention. The general abilities approach and traditional neurodevelopmental theory are not well supported by recent research. The dynamical systems approach supports promising trends in biomechanical or kinematic analysis of movement, ecological task analysis, and task-specific intervention. Finally, and more recently, the cognitive neuroscientific approach has generated some examples of process-oriented assessment and treatment based on validated (brain-behaviour) models of motor control and learning. A multi-level approach to movement assessment and treatment is recommended for DCD, providing a more complete representation of motor development at different levels of function--behavioural, neurocognitive, and emotional.

Occupational therapy using a sensory integrative approach for children with developmental disabilities

This article provides an introduction and overview of sensory integration theory as it is used in occupational therapy practice for children with developmental disabilities. This review of the theoretical tenets of the theory, its historical foundations, and early research provides the reader with a basis for exploring current uses and applications. The key principles of the sensory integrative approach, including concepts such as "the just right challenge" and "the adaptive response" as conceptualized by A. Jean Ayres, the theory's founder, are presented to familiarize the reader with the approach. The state of research in this area is presented, including studies underway to further delineate the subtypes of sensory integrative dysfunction, the neurobiological mechanisms of poor sensory processing, advances in theory development, and the development of a fidelity measure for use in intervention studies. Finally, this article reviews the current state of the evidence to support this approach and suggests that consensual knowledge and empirical research are needed to further elucidate the theory and its utility for a variety of children with developmental disabilities. This is especially critical given the public pressure by parents of children with autism and other developmental disabilities to obtain services and who have anecdotally noted the utility of sensory integration therapy for helping their children function more independently. Key limiting factors to research include lack of funding, paucity of doctorate trained clinicians and researchers in occupational therapy, and the inherent heterogeneity of the population of children affected by sensory integrative dysfunction. A call to action for occupational therapy researchers, funding agencies, and other professions is made to support ongoing efforts and to develop initiatives that will lead to better diagnoses and effective intervention for sensory integrative dysfunction, which will improve the lives of children and their families.

Cognitive strategy use in school-aged children with developmental coordination disorder

Over the past decade, cognitive approaches with children with developmental coordination disorder (DCD) have been investigated. Although studies have focused on intervention outcomes, few have documented the components of the approach that support the enhancement of children's performance. This study used systematic observation of videotaped intervention sessions to identify the frequency and type of strategies that four children with DCD used during a cognitive intervention (CO-OP). The strategies used by younger and older children were compared, with differences found in verbal-based strategy use. Cognitive strategy use appears to be more related to the individual child and intervention goal than to age.

The effects of a sensory motor activities protocol based on the theory of sensory integration on children diagnosed with preprimary impairments

According to the theory of sensory integration (SI), when an infant successfully meets the challenges of his/her environment, the brain learns to organize the sensation for production of adaptive responses. Research studies have shown mixed results about the effects of the SI therapy and most studies have used single system designs. The objective of this study was to evaluate the effectiveness of the Sensory Integrative Treatment Protocol (SITP) in treating children with preprimary impairments. Two intact classrooms were used as experimental and control groups. The experimental group consisted of 15 children and the control group consisted of 16 children diagnosed with preprimary impairments. Descriptive statistics and a 2 (group) × 2 (time) repeated measures ANOVA were employed in data analyses. DeGangi-Berk Test of Sensory Integration (TSI) and the Miller Assessment for Preschoolers (MAP) were used as the instruments to measure change within and between the two groups before and after the intervention. TSI and MAP scores went up considerably for the children in the experimental group following the intervention. Based on the results, the researchers suggest that "Sensory Integration Treatment Protocol" based on the theory of sensory integration was effective in reducing sensory integration dysfunction and improving preschool performance in children diagnosed with pre-primary impairments.

Developmental coordination disorder in extremely low birth weight children at nine years

Developmental coordination disorder (DCD) is defined as an impairment in the development of motor coordination that interferes with academic achievement or activities of daily living (DSM-IV). DCD has been reported to affect 5% to 9% of children in the normal population. This study describes the prevalence of DCD in a cohort of extremely low birth weight children (ELBW, < or = l800 g) at 8.9 years of age, from which were excluded children with major impairments. Seventy-three children were included in the study group, along with 18 term-born, socially matched controls. Of the 73 ELBW children, 37 (51%) were classified as having DCD. ELBW children with DCD also had significantly lower Performance IQ (PIQ) scores and were more likely (43%) to have a learning difficulty in arithmetic than ELBW children who did not have DCD. This study found that DCD is a common problem in school-aged ELBW children.

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.

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.

Is Sensory Integration Effective for Children With Language-Learning Disorders?

Sensory integration therapy has become widely accepted as an intervention for enhancing language-learning disorders and academic difficulties in hildren. However, much controversy surrounds this approach because of the small amount of empirical evidence to support its application to this clinical population. The purpose of this article is threefold: review the relevant research pertaining to treatment efficacy studies involving sensory integration conducted over the last three decades, discuss the perspectives from which various researchers and clinicians view language disorders in children, and discuss parameters for evaluating efficacy studies and the clinical use of sensory integration, suggesting directions for future research.

The remediation of clumsiness. I: An evaluation of Laszlo's kinaesthetic approach

The effectiveness of a kinaesthetic training programme proposed by Laszlo for children with movement difficulties was evaluated by comparing two groups of 10 'clumsy' children matched pairwise on age, IQ and sex as well as degree of kinaesthetic and motor impairment. Tests of kinaesthetic ability, using the Parameter Estimation by Sequential Testing (PEST) procedure, and motor competence administered before and after treatment revealed an improvement in both groups on all measures but no differential effect of the training programme. Immediately after training, the changes we obtained in motor performance were confined to balance skills but, at follow up, 3 months later, changes in manual and ball skills were also evident. This unusual pattern of change requires replication. Our findings forced us to consider the possibility that any effect of Laszlo's recommended training programme had been obscured by our use of the PEST procedure, which had in itself facilitated motor learning.

Use of an occupational therapy motor performance checklist by a school health service: a pilot study

OBJECTIVE

The aim of this pilot study was to assess whether the School Health Service could play a role in identifying the children in most need of community occupational therapy services.

METHODOLOGY

A two-tiered referral system, which incorporated a Motor Performance Checklist (MPC) devised by the authors, was used. This checklist consisted of 12 gross and fine motor items and was administered to 123 children in their first year of school. Comparison was made between parent/teacher referrals alone and the two-tiered referral system as measured against a 'gold standard' test (the Bruininks-Oseretsky Test of Motor Proficiency) in a smaller subgroup.

RESULTS

Results indicated that the two-tiered referral system incorporating the MPC had a sensitivity of 75% and specificity of 95% while the teacher/parent referrals had a sensitivity of 88% but a low specificity of only 41%. There was no significant difference in sensitivity (z = 0, P > 0.05) but a highly significant difference in specificity (z = 3.56, P < 0.005) between these two systems.

CONCLUSIONS

This two-tiered referral system has the potential to impact significantly on paediatric occupational therapy utilization, service delivery and waiting times in the community health setting.

A clinical trial of the process-oriented treatment approach for children with developmental co-ordination disorder

The process-oriented treatment (POR chi) approach is a time-limited programme aimed at increasing the kinaesthetic performance of children with mild motor problems in order to improve their motor performance. The approach was compared with a traditional or general motor approach and with no treatment in a randomized clinical trial of 75 children with developmental co-ordination disorder. The children were assessed before and after treatment and after a six-week follow-up period. The results were mixed. The study provides evidence of the severity of so-called 'mild' motor problems of children referred to occupational therapy. The data suggest that these children do not improve spontaneously, and that their motor problems are very resistant to treatment. The data also suggest that an appropriate treatment strategy might be one that involves direct, repetitive training of a specific skill.