The impact for DCD - USA study: The current state of Developmental Coordination Disorder (DCD) in the United States of America.

BACKGROUND: Developmental Coordination Disorder (DCD) is among the most under-recognized and under-supported disorders worldwide. AIMS: To present a preliminary national study that evaluated the unmet needs of children with DCD in the USA using the Impact for DCD survey. METHODS AND PROCEDURES: 232 parents of individuals aged 5-18 years provided responses from 36 items in five domains (diagnosis, activity/participation, education, therapy, and social/emotional health). OUTCOMES AND RESULTS: Most children (81.9%) had a formal diagnosis for movement difficulties, and 91.6% of parents reported that receiving a diagnosis was helpful, but most had not heard of the diagnosis before. The most common co-occurring diagnoses were childhood apraxia of speech and other speech-language disorders (24.6%), ADHD (23.1%), and anxiety (18.8%). Most parents reported that their children withdrew from or avoided movement-related activities (53%), and nearly all (94.8%) were concerned about the impact of motor difficulties on their children's social and emotional health. Only 37% of parents reported feeling that their child received sufficient therapy. CONCLUSIONS AND IMPLICATIONS: Generally, parents reported feeling frustrated with others' understanding and awareness of the condition and with therapy services. The results shown here provide timely data that can support efforts for increased awareness, improved diagnosis, and increased availability of services for DCD in the USA.

Motor problems in autism: Co-occurrence or feature?

Motor features of autism have long been acknowledged by clinicians, researchers, and community stakeholders. Current DSM-5 and ICD-11 guidelines allow clinicians to assign a co-occurring diagnosis of developmental [motor] coordination disorder (DCD) for autistic individuals with significant motor problems. DCD is characterized by poor motor proficiency with an onset of symptoms in early development. Studies have shown considerable overlap in the behavioral motor features observed in autism and DCD. However, others indicate that motor problems in autism and DCD may stem from different underlying sensorimotor mechanisms. Regardless of whether autism has a unique motor phenotype or an overlap with DCD, changes need to be made in the clinical pipeline to address motor problems in autism at the stages of recognition, assessment, diagnosis, and intervention. Consensus is needed to address unmet needs in research on the etiology of motor problems in autism and their overlap with DCD, to optimize clinical practice guidelines. The development of screening and assessment tools for motor problems that are valid and reliable for use with autistic individuals is essential, and an evidence-based clinical pipeline for motor problems in autism is urgently needed. WHAT THIS PAPER ADDS: Motor problems in autism are highly prevalent, yet underdiagnosed and poorly managed. An evidence-based clinical pipeline for motor problems in autism is urgently needed.

Transcranial direct current stimulation to facilitate neurofunctional rehabilitation in children with autism spectrum disorder: a protocol for a randomized, sham-controlled, double-blind clinical trial.

Background: Anodal transcranial direct current stimulation (tDCS) over the primary motor cortex and cerebellum is gaining prominence in the literature due to its potential to favor learning and motor performance. If administered during motor training, tDCS is capable of increasing the effect of training. Considering the motor impairment presented by children with Autism Spectrum Disorders (ASD), atDCS applied during motor training may contribute to the rehabilitation of these children. However, it is necessary to examine and compare the effects of atDCS over the motor cortex and the cerebellum on the motor skills of children with ASD. This information may benefit future clinical indications of tDCS for rehabilitation of children with ASD. The aim of the proposed study is to determine whether anodal tDCS over the primary motor cortex and cerebellum can enhance the effects of gait training and postural control on motor skills, mobility, functional balance, cortical excitability, cognitive aspects and behavioral aspects in children with ASD. Our hypothesis is the active tDCS combined with motor training will enhance the performance of the participants in comparison to sham tDCS. Methods and design: A randomized, sham-controlled, double-blind clinical trial will be conducted involving 30 children with ASD that will be recruited to receive ten sessions of sham or ten sessions of active anodal tDCS (1 mA, 20 min) over the primary motor cortex or cerebellun combined with motor training. The participants will be assessed before as well as one, four and eight weeks after the interventions. The primary outcome will be gross and fine motor skills. The secondary outcomes will be mobility, functional balance, motor cortical excitability, cognitive aspects and behavioral aspects. Discussion: Although abnormalities in gait and balance are not primary characteristics of ASD, such abnormalities compromise independence and global functioning during the execution of routine activities of childhood. If demonstrated that anodal tDCS administered over areas of the brain involved in motor control, such as the primary motor cortex and cerebellum, can enhance the effects of gait and balance training in only ten sessions in two consecutive weeks, the clinical applicability of this stimulation modality will be expanded as well as more scientifically founded.Clinical trial registration February 16, 2023 (https://ensaiosclinicos.gov.br/rg/RBR-3bskhwf).

Overweight/obesity and socio-demographic disparities in children's motor and cognitive function.

Fundamental motor skills (FMS) and cognitive function are important indicators of development in early childhood. Using a cross-sectional design, the purpose of this study was to investigate obesity (healthy weight vs. overweight/obese) and socio-demographic (i.e., gender, SES) disparities in FMS (locomotor and ball skills) and cognitive function (reaction time [RT] and movement time [MT]), in preschoolers. There were 74 preschoolers (girl = 38; Mage = 4.02 ± 0.73) recruited from two childcare centers and were categorized into healthy weight (n = 58, BMI percentile < 85%) and overweight/obese (n = 16, BMI percentile ≥ 85%) categories. Children's FMS were assessed using the TGMD-3; cognitive function was assessed by the iPad-based CANTAB™ software using the Reaction Time Task (RTI), including reaction time (RT; Simple RT [SRT], choice RT [CRT]) and movement time (MT; simple MT [SMT], choice MT [CMT]). Children presented less FMS proficiency compared to recent data. Both weight groups performed comparably in FMS (ps > 0.05; ball skill Cohen's d = 0.40; locomotor Cohen's d = 0.02). Children in the overweight/obese group performed significantly worse on all cognitive tests compared to healthy weight peers (ps < 0.05; Cohen's d range from -0.93 to -1.43). No significant gender or SES disparities were observed. Maintaining healthy weight status is critical for cognitive development among preschoolers, which may influence their developmental trajectory and school readiness.

Self-esteem, self-efficacy, and social support mediate the relationship between motor proficiency and internalizing problems in adults: Exploring the environmental stress hypothesis in adulthood.

The Environmental Stress Hypothesis (ESH) is a theoretical model used to understand the factors mediating the relationship between motor proficiency and internalizing problems. The aim of this study is to explore a potential extension of the ESH by examining whether BMI, physical activity levels, self-esteem, self-efficacy and social support are potential mediators between motor proficiency and internalizing problems in young adults. 290 adults aged between 18 and 30 years old (150 women, 140 men) were evaluated with the following instruments: Adult Developmental Coordination Disorders Checklist (ADC), Depression, Anxiety and Stress Scale (DASS 21), Social Support Satisfaction Scale (SSSS), Perceived General Self-Efficacy Scale (GSE), Rosenberg Self-Esteem Scale (RSES), International Physical Activity Questionnaire (IPAQ), and self-reported body mass index (BMI). The results indicated that self-esteem, self-efficacy, and social support mediate the relationship between motor proficiency and internalizing problems in this sample. Thus, the findings reinforce the notion that early intervention and preventive psychological care can serve as protective aspects of mental health in adults at risk for low motor proficiency.

Distinct mental health profiles in children with Developmental Coordination Disorder: A latent class analysis and associations.

BACKGROUND: Children with Developmental Coordination Disorder (DCD) show indications for mental health problems. However, these problems are poorly understood. AIMS: To identify patterns (profiles) of mental health in this population and to analyze the associations between profiles and child characteristics. METHODS AND PROCEDURES: Parents of 119 children with DCD completed the Strengths and Difficulties Questionnaire. OUTCOMES AND RESULTS: Results indicated that a four latent class was the best model. Profile 1 was defined as "no" mental health problems (n = 28; 24 %), Profile 2 was defined as "hyperactivity" problems (n = 53; 43.3 %), for clinical indications for hyperactivity, Profile 3 was defined as "internalizing" problems (n = 8; 7.3 %), for clinical indications for emotional symptoms and peer problems, and Profile 4 was defined as "internalizing and externalizing problems" (n = 30; 25.4 %), for clinical indications for problems in both areas. In addition, having a co-occurring disorder, accommodation plans, and using medications were associated with the profiles. CONCLUSIONS AND IMPLICATIONS: There are distinct and unique profiles that children with DCD exhibit. Clinicians can use these profiles to better understand the presentation of mental health symptoms in this population and provide adequate services or support if mental health difficulties are present.

Identity and Discourse Among #ActuallyAutistic Twitter Users With Motor Differences.

Despite a growing awareness of the prevalence of motor differences in the autistic community, their functional impact is poorly understood. Social media offers the ideal setting to observe this discourse in a less-contrived setting than lab-based structured interviews. The aims of the present study were (a) to determine the proportion of Twitter users who self-identify as autistic and dyspraxic/having developmental coordination disorder, relative to autistic alone, and (b) to identify common themes emerging from two moderated chat threads with motor-related prompts. Using the Twitter research application programming interface, we harvested data from users' public profiles and tweets containing terms related to autism and developmental coordination disorder within a 1-month time period. We also harvested data from two #AutChat threads related to motor skills, which included 151 tweets from 31 unique autistic users (two with co-occurring developmental coordination disorder). Of these tweets, 44 were explicitly about motor differences, while the remainder consisted of discussion topics more loosely associated with motor skills. The following common themes were quantified: manual dexterity, lower extremity, oral motor, gross motor, posture, balance, stimming, movement pain, and coordination. Together, these findings indicate that motor differences are highly recognized and discussed among autistic individuals but are not overtly integrated into their identities at the same rate.

#DCD/Dyspraxia in Real Life: Twitter Users' Unprompted Expression of Experiences With Motor Differences.

Little is known about adults' experiences with developmental coordination disorder (DCD; sometimes also referred to as dyspraxia). Social media is an accessible opportunity for those who identify as dyspraxic or as having DCD to provide valuable insight into the lifespan impact of this condition on functional ability, participation, compensatory strategies, and well-being. We used the Twitter research application programming interface to identify users who self-identified with the keywords Developmental Coordination Disorder, #DCD, #dyspraxic (or # dyspraxia), or clumsy in their profile descriptions between October 10 and November 10, 2021. During that period, 818 tweets were harvested with 524 remaining after removing duplicates (e.g., multiple promotions of a single resource) and unrelated tweets. They were labeled according to motor differences (general motor, coordination, fine motor skills, oral motor skills, manual dexterity, driving, gross motor skills, movement pain and fatigue, posture and balance, and lower extremity); functional impact (advocacy/awareness, support for others, resources, information, and education, intervention, accommodation, and work); or other related topics (stimming and sensory, co-occurrence and diagnostic overlap, cognitive, social and communication speech, and emotional and mental health). The DCD/dyspraxic community has clearly identified a lifelong impact of motor differences across multiple contexts. DCD/dyspraxic Twitter users shared compensatory strategies that could help others, and offered insight into their experience of co-occurring conditions and cognitive/emotional sequelae of motor challenges.

Harvesting Twitter Data for Studying Motor Behavior in Disabled Populations: An Introduction and Tutorial in Python.

Social media platforms are rich and dynamic spaces where individuals communicate on a person-to-person level and to broader audiences. These platforms provide a wealth of publicly available data that can shed light on the lived experiences of people from numerous clinical populations. Twitter can be used to examine individual expressions and community discussions about specific characteristics (e.g., motor skills, burnout) associated with a diagnostic group. These data are useful for understanding the perspectives of a diverse, international group of self-advocates representing a wide range of clinical populations. Here, we provide a framework for how to harvest data from Twitter through their free, academic researcher application programming interface access using Python, a free, open-source programming language. We also provide a sample data set harvested using this framework and a set of analyses on these data specifically related to motor differences in neurodevelopmental conditions. This framework offers a cost-effective and flexible means of harvesting and analyzing Twitter data. Researchers should utilize these resources to advance our understanding of the lived experiences of clinical populations through social media platforms and to determine the critical questions that are of most importance to improving quality of life.

Socially assistive robotics and older family caregivers of young adults with Intellectual and Developmental Disabilities (IDD): A pilot study exploring respite, acceptance, and usefulness.

INTRODUCTION: The need for caregiver respite is well-documented for the care of persons with IDD. Social Assistive Robotics (SAR) offer promise in addressing the need for caregiver respite through 'complementary caregiving' activities that promote engagement and learning opportunities for a care recipient (CR) with IDD. This study explored the acceptability and usefulness of a SAR caregiver respite program responsive to feedback from both young adults with IDD and their older family caregivers (age 55+). METHOD: Young adults with IDD and caregiver dyads (N = 11) were recruited. A mixed methods research design was deployed in three phases: Phase I with four focus groups to inform the program design; Phase II for program demonstration and evaluation with pre- and post-surveys; and Phase III with post-program interviews for feedback and suggestions. RESULTS: Both young adults with IDD and their caregivers scored favorably the social presence of, social engagement, and satisfaction with robot Pepper. Though there was no significant improvement of caregiving burden/stress as well as well-being of the young adults with IDD based on surveys, results from interviews suggested that the SAR may offer physical/emotional respite to caregivers by providing companionship/friendship as well as promoting independence, safety/monitoring, and interactive engagement with children. DISCUSSION: SAR has potential in providing respite for older family caregivers. Future studies need a longer program design and larger sample size to develop a promising intervention and test its feasibility and efficacy.

An Investigation of Developmental Coordination Disorder Characteristics in Children With Childhood Apraxia of Speech.

PURPOSE: Children with childhood apraxia of speech (CAS) evidence a high rate of co-occurring fine and gross motor deficits. This clinical focus article reports a preliminary investigation of characteristics of developmental coordination disorder (DCD), a neurodevelopmental disorder categorized by poor motor proficiency and functional limitations, in this population. METHOD: Children with CAS underwent a comprehensive motor evaluation using the Movement Assessment Battery for Children-Second Edition, the Developmental Coordination Disorder Questionnaire, and a developmental history questionnaire to determine if they met criteria for a DCD diagnosis as specified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). RESULTS: Six out of seven participants met DCD criteria based on the DSM-5 criteria. Four of these children had a co-occurring diagnosis of developmental language disorder, and all met criteria for DCD. CONCLUSIONS: Consistent with previous research, the majority of participants demonstrated motor deficits and 85% met criteria for DCD. Despite this high rate of motor deficits, only 57% had previously undergone a physical/occupational therapy evaluation and intervention and only one had a previous diagnosis of DCD. These findings suggest that formal movement assessments are essential for children with a CAS diagnosis. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20540193.

Parent-Reported Motivators and Barriers to Participation in a Community-Based Intervention Designed for Children With Motor Skill Difficulties: A Qualitative Program Evaluation.

INTRODUCTION: Parents play a critical role in their child's participation in community-based intervention programs. Yet, their perspectives remain largely overlooked in the literature. This qualitative program evaluation used social cognitive theory to understand parents' motivators and barriers to participation in a community-based intervention program designed for children with motor skill difficulties. METHOD: Parents (n = 15) of children with motor skill difficulties enrolled in a community-based intervention program participated in semistructured interviews. RESULTS: Thematic analysis revealed six motivators (child needs, satisfaction, perceived impact, affordability, design, and program culture) and three perceived barriers (parent knowledge, access, and accommodations). DISCUSSION: Parents' motivators and barriers reflected a combination of personal and environmental factors consistent with social cognitive theory. This study revealed novel insight into program-related environmental motivators and barriers. Program leaders should consider ongoing evaluation and application of parental perspectives to optimize family participation and retention in community-based interventions.

The "humane in the loop": Inclusive research design and policy approaches to foster capacity building assistive technologies in the COVID-19 era.

The COVID-19 pandemic is emerging as a driver of greater reliance on wireless technologies, including intelligent assistive technologies, such as robots and artificial intelligence. We must integrate the humane "into the loop" of human-AT interactions to realize the full potential of wireless inclusion for people with disabilities and older adults. Embedding ethics into these new technologies is critical and requires a co-design approach, with end users participating throughout. Developing humane AT begins with a participatory, user-centered design embedded in an iterative co-creation process, and guided by an ethos prioritizing beneficence, user autonomy and agency. To gain insight into plausible AT development pathways ("futures"), we use scenario planning as a tool to articulate themes in the research literature. Four plausible scenarios are developed and compared to identify one as a desired "humane" future for AT development. Policy and practice recommendations derived from this scenario, and their implications for the role of AT in the advancement of human potential are explored.

Externalizing problems mediate the relationship between motor proficiency and internalizing problems in children: An extension of the Environmental Stress Hypothesis.

The Environmental Stress Hypothesis (ESH) is a causal theoretical framework that provides a flexible context for understanding factors that mediate the relationship between low motor proficiency and internalizing problems in children. The purpose of the present study was to use the ESH framework to determine whether body mass index (BMI), physical activity levels, psychosocial health and physical health, self-efficacy, perceived social status, prosocial behavior and externalizing problems were potential mediators between motor proficiency and internalizing factors in a population of Brazilian children. 431 children aged 7- to 10 years (240 females, 191 males) participated in the study. The variables were measured with the Movement Assessment Battery for Children, 2nd ed. (MABC-2), the Pediatric Quality of Life Inventory (PedsQL), the Strengths and Difficulties Questionnaire (SDQ), the MacArthur Subjective Social Status Scale (MacArthur SSS), the Self-efficacy Sense Assessment Roadmap (RASAE), and the Physical Activity Questionnaire (PAQ). The results indicated a direct relationship between motor proficiency and internalizing problems in a population of Brazilian children, with externalizing problems being the only variable mediating that relationship. To the best of our knowledge, this is the first time that externalizing problems were tested in the context of the ESH. Understanding and evaluating potential mediators in the relationship between motor proficiency and internalizing problems using the ESH framework is essential to promote prevention policies and interventions for school-age children.

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.

A Mediation Analysis of the Association between Fundamental Motor Skills and Physical Activity during Middle Childhood.

The purposes of the study were: (1) to investigate the associations between fundamental motor skills (FMS), health-related fitness (HRF) and physical activity (PA) during middle childhood; and (2) to examine whether HRF serves as a mediator in these pathways. The participants were 342 children (156 girls; Mage = 8.40, SD = 0.50) recruited in Texas. Children's FMS (locomotor and ball skills) were assessed. School-based PA that included light, moderate, and vigorous PA was captured by accelerometers. The FITNESSGRAM battery was used to measure children's HRF, including body composition, cardiorespiratory fitness, and muscular fitness. Structural equation models were used to evaluate two proposed models (model-1 = FMS¼HRF¼PA; model-2 = PA¼HRF¼FMS). Both locomotor and ball skills were associated with all components of HRF (p < 0.01), but not PA. The SEM analyses supported associations between FMS, HRF and PA, with sound goodness-of-fit indices: (1) model-1: CFI = 0.95; RMSEA = 0.072; and (2) model-2: CFI = 0.95; RMSEA = 0.071, respectively. The relationship between FMS and PA was fully mediated by the HRF in both directions. The behavioral mechanism (e.g., maintaining appropriate levels of HRF) provides meaningful insights to understand the obesity trajectory during middle childhood.

Shared Features or Co-occurrence? Evaluating Symptoms of Developmental Coordination Disorder in Children and Adolescents with Autism Spectrum Disorder.

Motor differences are common in Autism Spectrum Disorder (ASD), but rarely evaluated against diagnostic criteria for Developmental Coordination Disorder (DCD). We aimed to determine whether motor problems in ASD represent the possible co-occurrence of DCD. We retrospectively reviewed standardized assessments and parent-reports to evaluate motor ability in 43 individuals with ASD against diagnostic criteria for DCD, and compared to 18 individuals with DCD. Over 97% of cases in the ASD group scored below the 16th percentile in motor ability, with most below the 5th percentile. Over 90% of cases in the ASD group met criteria for co-occurring DCD. Motor challenges are a clinically-significant problem in ASD; systematically assessing the prevalence of co-occurring ASD + DCD is necessary to optimize assessment and intervention.

A Causal Pathway of Physical Activity to Motor Competence in Childhood:Evidence from a School-based Intervention.

This study aimed to examine whether changes in physical activity (PA) after an 8-week pedometer-based intervention would result in changes on motor competence through competence beliefs towards physical education (PE). The study also evaluated whether the hypothesized causal pathway differed by gender. Participants were 259 children (Mean age  = 10.88, SD =.78), randomly allocated to three intervention groups. Children's PA, competence beliefs towards PE, and motor competence were measured at pre- and post-tests. Significant relationships between PA and competence beliefs towards PE were found at pre- and post-tests. The magnitude of the relationship between competence beliefs towards PE and motor competence was larger at post-test than at pre-test (.33 vs.20). The structural invariance test suggested that the differences between boys and girls for the hypothesized models were insignificant (CMIN = 15.97, df = 12; p =.193). In general, the results suggest that changes on PA may cause changes in competence beliefs towards PE, which could result in changes on motor competence in middle to later childhood, regardless of gender. These data offer the possibility of using competence beliefs towards PE as a mediator in PA interventions designed to increase motor competence in childhood.

Preliminary Improvements in Dynamic Postural Control after A Group-based Intervention Program for Children with Developmental Coordination Disorder: A Brief Report.

OBJECTIVE: To determine the value of a traditional (easy to implement) group-based intervention program on both static and dynamic postural control in children with Developmental Coordination Disorder (DCD). METHODS: Sway and stability indices were measured with the Clinical Test of Sensory Integration in Balance (CTSIB) and efficiency of goal-directed movement was measured during a Limits-of-Stability (LoS) task, before and after the intervention program. The intervention involved a total of 10 one-hour group sessions, administered once per week for 10 weeks. RESULTS: Results indicated significant group increases in dynamic postural control (p <.05). These results suggest it is possible to improve dynamic postural control in this population. This type of intervention does not require any expensive materials, it is feasible, and easy-to-implement to a group of children. CONCLUSION: We conclude that this simple form of intervention involving fun group activities can significantly improve dynamic postural control in children with DCD.

Accuracy and Vividness in Motor Imagery Ability: Differences between Children and Young Adults.

Motor imagery (MI) refers to the imagination of a motor task without actual movement execution. The purpose of this study was to compare MI accuracy and vividness, and motor proficiency between children (n = 101; 7-12 years) and young adults (n = 140; 18-25 years). Results indicated that young adults were significantly more accurate and rated their MI significantly more vivid than children. For MI accuracy, between-subject effects showed that young adults had higher scores than children on three of the four subscales and the action subscale significantly predicted motor proficiency. These findings indicate that MI ability continues to develop into adulthood.