Awareness and knowledge of developmental co-ordination disorder among physicians, teachers and parents.

BACKGROUND: Obtaining a diagnosis of developmental co-ordination disorder (DCD) is a long, inconsistent and frustrating journey for families, with apparently little awareness of DCD in schools or the medical community. METHODS: An online survey was completed by 1297 participants: parents (n = 501), teachers (n = 202), family/general physicians (n = 339) and paediatricians (n = 255). RESULTS: Only 20% of the sample had knowledge of DCD, with 41% of the paediatricians and 23% of family/general physicians familiar. Of participants who have awareness, only 11-59% have knowledge of the impact of DCD on social, emotional and physical health. Less than 30% of physicians have awareness of the secondary consequences. Few physicians diagnose DCD and less than one-third believe it is easy to make a diagnosis; this is in contrast to the fact that most parents report confidence in their physician's ability to make a timely diagnosis. CONCLUSIONS: If less than one-half of physicians have knowledge of DCD and even fewer are knowledgeable of the secondary consequences of the condition, it is not surprising that DCD is infrequently diagnosed and that families need to search for support. This survey confirms observations that the condition is not well known and there is a need for greater awareness of DCD.

Cross-cultural adaptation of the Developmental Coordination Disorder Questionnaire for brazilian children / Adaptação transcultural do Questionário de Transtorno do Desenvolvimento da Coordenação para crianças brasileiras

BACKGROUND: Developmental Coordination Disorder (DCD) is considered a major health problem among school-aged children worldwide. Although there are several instruments to identify children with DCD, none of them are translated into Portuguese and validated to be used in Brazil. OBJECTIVES: Considering that a parent questionnaire is a simple and effective method to screen children with DCD, this study describes the adaptation of the Developmental Coordination Disorder Questionnaire (DCDQ) and the pilot testing with Brazilian children. METHODS:Translation of the DCDQ into Portuguese was conducted according to current guidelines for cross-cultural adaptation of instruments. The questionnaire was completed by parents of 15 children with motor coordination problems and parents of 30 children who were typically developing, matched for age. Five parents randomly selected from each group completed the questionnaire twice, to examine test-retest reliability. The parent's opinion regarding the quality of the questionnaire was recorded. RESULTS: 91 percent of Brazilian parents reported no difficulty in completing the DCDQ. Examination of psychometric properties revealed that two items had limitations due to cultural differences. After item substitution, sensitivity increased from 0.66 to 0.73 and test-retest reliability from 0.95 to 0.97. Internal consistency also increased from 0.91 to 0.92. CONCLUSIONS:The translated instrument shows potential as a screening tool for children in Brazil and should be further examined. Research with a larger sample is needed in order to define cut-off scores and verify the instrument's validity and clinical utility. The use of the DCDQ will allow the comparison of epidemiological data from different countries.

CONTEXTUALIZAÇÃO: O transtorno do desenvolvimento da coordenação (TDC) é considerado, em vários países, um grande problema de saúde para crianças. Apesar de existirem vários instrumentos para identificar o TDC, nenhum deles foi traduzido e validado para uso no Brasil. OBJETIVOS: Considerando que um questionário de pais é um método simples e eficiente para fazer triagem de crianças com TDC, este estudo descreve a adaptação do Developmental Coordination Disorder Questionnaire (DCDQ) e o teste piloto com crianças brasileiras. MÉTODOS: A tradução do DCDQ para o português foi feita de acordo com normas atuais para adaptação transcultural de instrumentos. O questionário foi respondido pelos pais de 15 crianças com problemas de coordenação motora e 30 crianças com desenvolvimento típico, emparelhadas por idade. Cinco pais de cada grupo, selecionados aleatoriamente, responderam ao questionário duas vezes para examinar a confiabilidade teste-reteste. A opinião dos pais sobre a qualidade do questionário foi registrada. RESULTADOS: 91 por cento dos pais brasileiros reportaram que não tiveram dificuldade para responder ao DCDQ. Exame das propriedades psicométricas revelou que dois itens apresentavam limitações devido a diferenças culturais. Após a substituição desses itens, a sensibilidade aumentou de 0,66 para 0,73, e a confiabilidade teste-reteste passou de 0,95 para 0,97. A consistência interna aumentou de 0,91 para 0,92. CONCLUSÕES: O questionário final mostrou bom potencial para ser examinado como instrumento de triagem no Brasil e deve ser melhor examinado. É necessário coletar mais dados para definir o ponto de corte e verificar a validade e a utilidade clínica. O uso do DCDQ vai contribuir para a comparação de dados epidemiológicos de diferentes países.

Identifying developmental coordination disorder: consistency between tests.

In the absence of a gold standard to identify the presence of developmental coordination disorder in children, it is useful to examine the consistency of different tests used in physical and occupational therapy. This study examined three measures of motor skills to determine whether they consistently identified the same children. In total, 379 children participated in this study. The final matched samples consisted of 202 children ranging in age from 8 to 17 years: 101 met criteria for DCD and 101 children did not show any evidence of DCD. The results indicated that the overall agreement between the Bruininks Oseretsky Test of Motor Proficiency (BOT), the Movement Assessment Battery for Children (M-ABC) and the Developmental Coordination Disorder Questionnaire (DCDQ) was less than 80%. The difference in structure and style of administration between the BOT and the M-ABC appears to contribute to their tendency to identify different children. This study emphasizes the need for therapists to use clinical reasoning to examine multiple sources of information about a child's abilities.

Developmental coordination disorder: what is it?

This paper begins with a discussion of the historical basis for the concept of developmental coordination disorder (DCD). The definition of this disorder as it appears in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) is then provided. The four diagnostic criteria proposed by the DSM-IV are used to describe the disorder. Problems associated with the assessment of DCD are discussed and suggestions for further research are identified. This is followed by a discussion of intervention approaches that can be used with children identified with DCD.

The term comorbidity is of questionable value in reference to developmental disorders: data and theory.

Over the last decade, there has been an enormous increase in the number of studies evaluating the overlap of developmental syndromes or disorders in both children and adults. This overlap of symptoms is often referred to as comorbidity, a term we criticize in this article because of its unsubstantiated presumption of independent etiologies. The premise of this article is that discrete categories do not exist in real life, and that it is misleading to refer to overlapping categories or symptoms as "comorbidities." We illustrate our point by presenting data from 179 school-age children evaluated with rigorous research criteria for seven disorders: reading disability (RD), attention-deficit/hyperactivity disorder (ADHD), developmental coordination disorder (DCD), oppositional defiant disorder (ODD), conduct disorder (CD), depression, and anxiety. Fully 50% of this sample met the criteria for at least two diagnoses. The children with ADHD were at higher risk of having at least a second disorder compared to the children with RD. Overall, the high rates of overlap of these behavioral, emotional, and educational deficits in this broadly ascertained sample support the idea that the concept of comorbidity is inadequate. We discuss the concept of atypical brain development as an explanatory idea to interpret the high rate of overlap of developmental disorders.

Reliability and validity of a parent questionnaire on childhood motor skills.

OBJECTIVE: As the consequences of clumsiness in children become better understood, the need for valid measurement tools is apparent. Parent report has the potential for providing historical knowledge of the child's motor skills, as well as perceptions of their children's motor difficulties. The objective was to develop a parent questionnaire to identify motor difficulties in children. METHOD: A sample of 306 children participated in the development of a 17-item parent questionnaire, called the Developmental Coordination Disorder Questionnaire (DCDQ). Internal consistency, concurrent and construct validity were examined. RESULTS: The DCDQ proved capable of distinguishing children who had motor problems (as measured by standardized tests) from children without motor problems. Correlations with standardized tests were significant. Two other studies confirmed the construct validity of the DCDQ. Factor analysis revealed four distinct factors, useful in defining the nature of the difficulties. CONCLUSION: The DCDQ is a succinct and useful measure for use by occupational therapists.

Use of the Bruininks-Oseretsky test of motor proficiency in occupational therapy.

OBJECTIVE: In addition to the need for good measurement tools in occupational therapy, there is a need for the tools to be used knowledgeably. The purpose of this article is to investigate the usefulness of the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) for both descriptive (diagnostic) and evaluative (change over time) purposes. METHOD: The typical profile of subtest scores for children with mild motor problems revealed that certain subtests of the BOTMP may be better indicators of motor problems for these children than others. An analysis also was performed to compare the use of raw (point) scores with standard (age-adjusted) scores in evaluating change. RESULTS: Four subtests that provide a greater degree of discrimination between children with and without motor problems were identified. Raw (points) scores were found to provide a more valid measure of change over time than standard (age-related) scores. CONCLUSION: We recommend that, for clinical use, the BOTMP subtest standard scores be used for diagnostic purposes and that the raw scores be used for evaluative purposes.

Reexamination of sensory integration treatment: a combination of two efficacy studies.

Little empirical support exists for the application of sensory integration treatment (SIT) to assist children with learning problems. Treatment efficacy studies are expensive and difficult to carry out, and they have necessarily employed small samples that are inevitably heterogeneous. We have reanalyzed the efficacy of SIT by combining the data from one study involving 29 children in Alberta and a second study involving 67 children in Ontario. The results from each individual study, and now the results from the combined study, lead one to the conclusion that the therapeutic effect of SIT on children with learning deficits is not greater than other, more traditional methods of intervention.