Quickstart for toddlers with autism spectrum disorder: A preliminary report of an adapted community-based early intervention program.

Background and Aims: Early intervention (EI) for young children with autism spectrum disorder (ASD) must be resource-efficient while remaining effective; thus, clinicians are challenged to create and implement useful methods. Clinical evidence from community-based interventions that include reliable diagnoses, individual EI programs, along with comprehensive descriptions of participants, procedures, and participant outcomes can inform practice, translational research, and local policy. Parent-mediated EI for toddlers with ASD can promote positive developmental outcomes and lifelong well-being, but evidence of successful community uptake of research-based EIs is somewhat limited. The community-based, parent-mediated, evidence-informed QuickStart EI program aims to encourage toddlers' early social communication, social interactions, and relationship-building, in a community clinic setting.We aim to (1) describe our adaptations to the evidence-based Parent-Delivered Early Start Denver Model and (2) present promising findings for toddlers with or at risk for ASD and their families who received QuickStart. We also intend to motivate a similar study of EI in real-world situations to advance evidence-based practice and create relevant dialogue and questions for research. Methods: Complete data were identified and analyzed for up to 89 toddlers diagnosed with, or at risk of, ASD. Pre- and post-intervention parent- or self-report data were analyzed using descriptive statistics and paired-sample t-tests, as appropriate. Pre-intervention measures included demographic information (n = 89) and the Early Screening of Autism and Communication (ESAC; n = 89). Measures taken pre- and post-intervention included the Adaptive Behavior Assessment System-II (n = 60), MacArthur-Bates Communication Development Inventories (n = 58), and the parental sense of competence scale (n = 62). The Measure of Processes of Care (n = 60) was taken post-intervention. On enrollment, parents signed standard clinical agreements that included statements allowing their anonymous data to be analyzed for research. Results: Using standardized parent/self-report measures, toddler gains were noted for social interaction, language, communication skills, and ASD symptoms, but not for parents' feelings of competence. Parents identified QuickStart procedures as family centered (Measure of Processes of Care). Conclusions: The QuickStart EI program, provided to toddlers and their families over 20 weeks in a community clinic, resulted in promising positive behavior and communication changes, as indicated on the parent-response measures, for a moderately large sample of toddlers. Implications: This study adds to the literature by describing a new EI program with clear procedures by which clinicians can create, provide, and evaluate a readily accessible, community-based EI for toddlers with or at risk of ASD. Methodological limitations inherent to our study design that precluded a control group and necessitated a reliance on available parent-report data are carefully critiqued and discussed.

Use of the Medical Research Council Framework to develop a complex intervention in pediatric occupational therapy: Assessing feasibility.

The United Kingdom Medical Research Council recommends use of a conceptual framework for designing and testing complex therapeutic interventions. Partnering for Change (P4C) is an innovative school-based intervention for children with Developmental Coordination Disorder (DCD) that was developed by an interdisciplinary team who were guided by this framework. The goals of P4C are to facilitate earlier identification, build capacity of educators and parents to manage DCD, and improve children's participation in school and at home. Eight occupational therapists worked in school settings during the 2009-2010 school year. Their mandate was to build capacity through collaboration and coaching with the school becoming the "client", rather than any individual student. Over 2600 students and 160 teachers in 11 elementary schools received service during the project. Results from questionnaires and individual interviews indicated that this model was highly successful in increasing knowledge and capacity. P4C intervention holds promise for transforming service delivery in schools.

Description of children identified by physicians as having developmental coordination disorder.

The aim of this study was to describe in detail a large group of children aged 4 to 12 years who were diagnosed with developmental coordination disorder (DCD) by physicians following a rigorous multidisciplinary procedure. As part of a community-based DCD knowledge translation program, physicians received specialized training and were invited to identify children with probable DCD who were referred for further investigation to help confirm the diagnosis. Of 116 children (87 males, 29 females; age range 4y 1mo - 12y 11mo, mean age 8y) identified as having probable DCD by physician participants, 88 (76%) were subsequently diagnosed with DCD and 77.3% of these demonstrated a high degree of motor impairment. All children who were diagnosed experienced difficulties in self-care and/or academic or leisure activities. The male:female ratio was 3:1 and the incidence of preterm births among this sample was 12.5%. We conclude that, given the expense involved with ruling out differential diagnoses, it can be difficult to adhere rigorously to diagnostic criteria for DCD in clinical practice and research. This description of a group of children actually diagnosed with DCD helps to clarify the characteristics of these children as well as issues related to the refinement of diagnostic criteria.

Enabling occupation through facilitating the diagnosis of developmental coordination disorder.

BACKGROUND: The largest proportion of children seen within school-based occupational therapy is referred for handwriting difficulties. Many of these children have Developmental Coordination Disorder (DCD), a disorder that often goes undiagnosed, making if difficult for children, parents, and teachers to access resources. PURPOSE: The purpose of this article is to outline the important role of occupational therapists in recognizing and facilitating the diagnosis of DCD. KEY ISSUES: In this paper, a case is made for an expansion of the role of school-based occupational therapists in facilitating diagnosis for children with DCD. Through a review of the literature, we establish the importance of a diagnosis for children and families and critically reflect on issues that may make therapists reluctant to become involved in facilitating this diagnosis. IMPLICATIONS: Occupational therapists working in schools are able to recognize children with DCD, an important first step in accessing key resources useful to improve occupational performance and quality of life.

Educational outreach and collaborative care enhances physician's perceived knowledge about Developmental Coordination Disorder.

BACKGROUND: Developmental Coordination Disorder (DCD) is a chronic neurodevelopmental condition that affects 5-6% of children. When not recognized and properly managed during the child's development, DCD can lead to academic failure, mental health problems and poor physical fitness. Physicians, working in collaboration with rehabilitation professionals, are in an excellent position to recognize and manage DCD. This study was designed to determine the feasibility and impact of an educational outreach and collaborative care model to improve chronic disease management of children with DCD. METHODS: The intervention included educational outreach and collaborative care for children with suspected DCD. Physicians were educated by and worked with rehabilitation professionals from February 2005 to April 2006. Mixed methods evaluation approach documented the process and impact of the intervention. RESULTS: Physicians: 750 primary care physicians from one major urban area and outlying regions were invited to participate; 147 physicians enrolled in the project. Children: 125 children were identified and referred with suspected DCD. The main outcome was improvement in knowledge and perceived skill of physicians concerning their ability to screen, diagnose and manage DCD. At baseline 91.1% of physicians were unaware of the diagnosis of DCD, and only 1.6% could diagnose condition. Post-intervention, 91% of participating physicians reported greater knowledge about DCD and 29.2% were able to diagnose DCD compared to 0.5% of non-participating physicians. 100% of physicians who participated in collaborative care indicated they would continue to use the project materials and resources and 59.4% reported they would recommend or share the materials with medical colleagues. In addition, 17.6% of physicians not formally enrolled in the project reported an increase in knowledge of DCD. CONCLUSION: Physicians receiving educational outreach visits significantly improved their knowledge about DCD and their ability to identify and diagnose children with this condition. Physicians who collaborated with occupational therapists in providing care reported more confidence in diagnosing children with DCD and were more likely to continue to use screening measures and to provide educational materials to families.

Clinical expression of developmental coordination disorder in a large Canadian family.

Previous studies of the phenotype of developmental coordination disorder (DCD) have largely concentrated on population-based samples. The present study reports on an in-depth examination of a large Canadian family with eight children, after three children who were suspected to have DCD were referred for evaluation. Subsequently, five of the six children whose motor impairments could be measured, and the mother, met the diagnostic criteria for DCD as per the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders - fourth edition. The family members diagnosed with DCD showed remarkably similar profiles of motor difficulties. Additionally, the five children diagnosed with DCD had current speech articulation difficulties, with four of them having visited speech/language pathologists; the mother had a lateral lisp. More in-depth testing for three children revealed intact intellectual, academic and language comprehension skills. Three of the children diagnosed with DCD were obese. The present report highlights familial clustering of DCD and the presence of comorbid conditions in the affected children.

The impact of newborn hearing screening on communication development.

OBJECTIVE: Universal newborn hearing screening has become standard practice in many countries. The primary goal of this study was to assess the impact of early identification of permanent childhood hearing loss on oral communication development. SETTING: Participants were recruited from three clinical programmes in two cities in the province of Ontario, Canada. The study sample was born during two consecutive periods of newborn hearing screening. The first period, prior to 2002, was targeted on high-risk infants only, and the second, from 2002, included both high- and standard-risk infants (universal newborn hearing screening - UNHS). All children were enrolled in rehabilitation programmes focused on oral language development. METHODS: In this multicentre observational study, 65 children under the age of five years with onset of hearing loss before six months of age, 26 identified through systematic newborn screening (14 through targeted screening and 12 through UNHS) and 39 without screening, were assessed with an extensive battery of child- and parent-administered speech and language measures. The degree of hearing loss ranged from mild to profound with 22 children in the mild, moderate and moderately severe categories and 43 in the severe and profound categories. Data are reported for the three-year study period. RESULTS: The screened group of children was identified at a median age of 6.6 (interquartile range, 3.0-8.2) months and children referred from sources other than newborn screening were diagnosed at a median age of 16.5 (interquartile range, 10.2-29.0) months. Assessment of oral communication development showed no significant difference between the screened and unscreened groups. The communication outcomes for children identified before 12 months of age did not differ from those of later identified children. CONCLUSIONS: Systematic screening of newborn hearing results in earlier identification and intervention for children with permanent hearing loss. Superior language outcome following newborn screening was not demonstrable in the setting of this study.

Parental questions about developmental coordination disorder: A synopsis of current evidence.

In recent years, knowledge about developmental coordination disorder (DCD) has accumulated very rapidly. Considerable progress has been made in the understanding of DCD, but recent studies have not been compiled in a way that makes them easily accessible to practicing paediatricians. In the present paper, the literature is reviewed and organized around the questions commonly raised by parents of children with DCD when they meet with their paediatrician. Parents express concern and seek information about their child's movement difficulties. They want to know what causes their child's lack of coordination and whether DCD is the correct diagnosis. Are other developmental disorders involved? What can they do to help their child's daily frustrations? The present review addresses frequently asked questions through a critical appraisal of current research literature. Paediatricians who are familiar with the research evidence will be better able to recognize these children and to share information with parents.