Brain functional connectivity in children with developmental coordination disorder following rehabilitation intervention

Abstract

Background Children with developmental coordination disorder (DCD) show improved motor function after Cognitive Orientation to Occupational Performance (CO-OP) intervention; however, the neural basis for these improvements is unknown. Methods In this randomized waitlist-controlled trial, 78 children with DCD (with/without ADHD) were randomly assigned to either a treatment or waitlist group and underwent three resting-state MRI scans over six months. The treatment group received intervention between the first and second scan; the waitlist group received intervention between the second and third scan. Results After CO-OP intervention, children with DCD [13 male, 8 female; mean (SD) age: 10.0 (1.7) years] showed increased functional connectivity between the default mode network and right anterior cingulate gyrus (p < 0.01). Additional gains were noted at follow-up three months after the intervention, with greater functional connectivity between the dorsal attention network and precentral gyrus (p < 0.02). However, children with DCD + ADHD [18 male, 1 female; mean (SD) age: 10.0 (1.14) years] did not show brain changes following CO-OP. Conclusion For children with DCD, increased functional connectivity in networks associated with self-, emotion-, and attention-regulation may underlie motor skill improvements observed after CO-OP intervention. Modifications to the CO-OP protocol may be required to induce similar brain changes in children with DCD + ADHD. Impact This study provides neuroscientific evidence for the Cognitive Orientation to Occupational Performance (CO-OP) approach as an effective rehabilitation intervention to induce brain and behavioral changes in children with DCD. While children with DCD ± ADHD showed improved motor function after CO-OP, only children with DCD showed brain changes after intervention. Children with DCD showed increased functional connectivity in networks associated with self-, emotion-, and attention-regulation after the intervention. Treatment modifications may be required to induce similar brain changes in children with DCD + ADHD. Pediatricians are encouraged to refer children with DCD with and without ADHD for CO-OP intervention to improve their motor skills.

Behavioral and Neuroimaging Research on Developmental Coordination Disorder (DCD): A Combined Systematic Review and Meta-Analysis of Recent Findings

“…The attendant gains in skill, however small, have a reinforcing effect on the motivation of children and their willingness to persist in training. Interestingly, recent evidence shows that gains in motor performance following a Cognitive Orientation to Occupational Performance (CO-OP) intervention are accompanied by a sustained increase in white matter microstructure and functional connectivity between brain networks associated with emotion regulation, action inhibition, and attention for those with DCD (but not DCD+ADHD) (Izadi-Najafabadi and Zwicker, 2021 ; Izadi-Najafabadi et al, 2021 ). Together, the available evidence provides encouraging support for science-led intervention.…”

Effectiveness of Cognitive Orientation to Occupational Performance intervention in improving motor skills of children with developmental coordination disorder: A randomized waitlist-control trial

“…This study reports behavioural results of a randomized waitlist control trial (RCT) (ClinicalTrials.gov ID: NCT02597751) investigating brain changes 16,17 Deficit Hyperactivity Disorder Clinic, caseloads of occupational and/or physical therapists from Sunny Hill and the Vancouver Regional Pediatric Team, and from advertisements in the community. Developmental coordination disorder diagnosis was confirmed as per the Diagnostic and Statistical Manual -5th ed.…”

“…This study reports behavioural results of a randomized waitlist control trial (RCT) (ClinicalTrials.gov ID: NCT02597751) investigating brain changes 16 , 17 associated with Cognitive Orientation to daily Occupational Performance intervention. From September 2014 to July 2019, 115 children (35 typically-developing children, 37 children with developmental coordination disorder, and 43 children with developmental coordination disorder with co-occurring attention deficit hyperactivity disorder) were recruited in Greater Vancouver area from the Developmental Coordination Disorder Clinic at Sunny Hill Health Centre, BC Children's Hospital Attention Deficit Hyperactivity Disorder Clinic, caseloads of occupational and/or physical therapists from Sunny Hill and the Vancouver Regional Pediatric Team, and from advertisements in the community.…”

Perspective: Acknowledging complexity to advance the understanding of developmental coordination disorder

“…For example, several studies have investigated resting state fMRI connectivity between children with DCD and/or ADHD, identifying notable distinctions in the corpus callosum between children with DCD versus ADHD (Langevin et al, 2014a;McLeod et al, 2014;Rohr et al, 2021). Unique structural differences have also been noted between those with DCD, ADHD, and both conditions, with more regions implicated in co-occurring cases (Langevin et al, 2014a,b) and reduced responsiveness to intervention (Izadi-Najafabadi et al, 2022). This signifies that individuals with co-occurring DCD and ADHD have a unique, and likely more severe, symptomatic profile compared to those with just DCD or ADHD.…”