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

Aim To expand the understanding of stereotypic movement disorder (SMD) and its differentiation from tics and autistic stereotypies.Method Forty‐two children (31 males, mean age 6y 3mo, SD 2y 8mo; 11 females, mean age 6y 7mo, SD 1y 9mo) consecutively diagnosed with SMD, without‐self‐injurious behavior, intellectual disability, sensory impairment, or an autistic spectrum disorder (ASD), were assessed in a neuropsychiatry clinic. A list of probe questions on the nature of the stereotypy was administered to parents (and to children if developmentally ready). Questionnaires administered included the Stereotypy Severity Scale, Short Sensory Profile, Strengths and Difficulties Questionnaire, Repetitive Behavior Scale – Revised, and the Developmental Coordination Disorder Questionnaire. The stereotyped movement patterns were directly observed and in some cases further documented by video recordings made by parents. The probe questions were used again on follow‐up at a mean age of 10 years 7 months (SD 4y 4mo).Results Mean age at onset was 17 months. Males exceeded females by 3:1. Family history of a pattern of SMD was reported in 13 and neuropsychiatric comorbidity in 30 (attention‐deficit–hyperactivity disorder in 16, tics in 18, and developmental coordination disorder in 16). Obsessive–compulsive disorder occurred in only two. The Short Sensory Profile correlated with comorbidity (p<0.001), the Stereotypy Severity Scale (p=0.009), and the Repetitive Behavior Scale (p<0.001); the last correlated with the Stereotypy Severity Scale (p=0.001). Children (but not their parents) liked their movements, which were usually associated with excitement or imaginative play. Mean length of follow‐up was 4 years 8 months (SD 2y 10mo). Of the 39 children followed for longer than 6 months, the behavior stopped or was gradually shaped so as to occur primarily privately in 25. Misdiagnosis was common: 26 were initially referred as tics, 10 as ASD, five as compulsions, and one as epilepsy. Co‐occurring facial grimacing in 15 children and vocalization in 22 contributed to diagnostic confusion.Interpretation SMD occurs in children without ASD or intellectual disability. The generally favorable clinical course is largely due to a gradual increase in private expression of the movements. Severity of the stereotypy is associated with sensory differences and psychopathology. Differentiation of SMD from tics and ASD is important to avoid misdiagnosis and unnecessary treatment.

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“…These different patterns of comorbidity suggest that SMD may involve somewhat different underlying brain mechanisms or circuits than tics. 23 …”

Section: Discussionmentioning

confidence: 99%

Stereotypic movement disorder: easily missed

Fréeman

Soltanifar

Baer

2010

Develop Med Child Neuro

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“…This risk is attributable to their physically less active life style. Recently, interventions for motor coordination problems were reviewed (Wilson 2005). It seems that especially the child-centred and task-oriented methods that include cognitive components are useful therapies (Schoemaker et al 2003;Polatajko and Cantin 2005;Niemeijer et al 2007;Sugden 2007).…”

Section: Discussionmentioning

confidence: 99%

“…These percentages are dependent of the type of motor assessment, referral sources and the cut-off points used (Gillberg 1998;Kadesjo and Gillberg 1998;Geuze et al 2001;Wilson 2005). Motor coordination problems have previously been labelled ''Clumsy Child Syndrome'', ''Non-cerebral-palsy motor-perception dysfunction'', ''Minor Neurological Dysfunction'' or ''Dyspraxia of childhood'' (Miyahara and Mobs 1995;Hadders-Algra 2002;Magalhaes et al 2006).…”

Section: Introductionmentioning

confidence: 99%

Motor coordination problems in children and adolescents with ADHD rated by parents and teachers: effects of age and gender

et al. 2007

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Summary. Objective. ADHD is frequently accompanied by motor coordination problems. However, the co-occurrence of poor motor performance has received less attention in research than other coexisting problems in ADHD. The underlying mechanisms of this association remain unclear. Therefore, we investigated the prevalence of motor coordination problems in a large sample of children with ADHD, and the relationship between motor coordination problems and inattentive and hyperactive=impulsive symptoms. Furthermore, we assessed whether the association between ADHD and motor coordination problems was comparable across ages and was similar for both genders.Method. We investigated 486 children with ADHD and 269 normal controls. Motor coordination problems were rated by parents (Developmental Coordination Disorder Questionnaire) and teachers (Groningen Motor Observation Scale).Results. Parents and teachers reported motor coordination problems in about one third of children with ADHD. Problems of fine and gross motor skills, coordination skills and motor control were all related to inattentive rather than hyperactive=impulsive symptoms. Relative to controls, motor coordination problems in ADHD were still present in teenagers according to parents; the prevalence diminished somewhat according to teachers. Boys and girls with ADHD were comparably affected, but motor performance in controls was better in girls than in boys.Conclusions. Motor coordination problems were reported in one third of children with ADHD and affected both boys and girls. These problems were also apparent in adolescents with ADHD. Clinicians treating children with ADHD should pay attention to co-occurring motor coordination problems because of the high prevalence and the negative impact of motor coordination problems on daily life.

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“…10 Task-oriented approaches are generally based on dynamic systems theory. Although NTT is a task-oriented approach, the theoretical framework behind it differs from those behind other task-oriented approaches, such as the cognitive orientation to daily occupational performance (CO-OP) which was recently developed in Canada.…”

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confidence: 99%

Neuromotor task training for children with developmental coordination disorder: a controlled trial

Niemeijer

Smits-Engelsman

Schoemaker

2007

Develop Med Child Neuro

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The aim of this study was to evaluate neuromotor task training (NTT), a recently developed child-centred and taskoriented treatment programme for children with developmental coordination disorder (DCD). A treatment and a non-treatment control group of children with DCD were included. Children were selected if they scored below the 15th centile on the Movement Assessment Battery for Children (MABC). The children in the treatment group were recently referred for physiotherapy (n=26; 20 males, 6 females; mean age 7y 2mo [SD 1y 3mo]). The parents of the non-treated children were concerned about their children's motor performance and responded to advertisements for free testing (n=13; 10 males, 3 females; mean age 7y 2mo [SD 2y 1mo]). Before and after nine weekly 30-minute sessions of NTT or at least 9 weeks of no intervention, the MABC and the Test of Gross Motor Development -2 (TGMD-2) were administered. Therapists reported per session on treatment goals and tasks trained. The results indicate that motor performance does not improve spontaneously and that NTT is effective. During the intervention period, only the treated group improved on the MABC and the TGMD-2. Children improved most on tasks similar to those trained. In older children with poorer motor patterns, NTT's treatment success was higher. The Child Behavior Checklist subscales withdrawn, thought problems, anxious/depressed, and delinquency were determinants of effects on motor patterns.Approximately 5 to 10% of schoolchildren have difficulty learning motor skills. 1 A child is diagnosed with developmental coordination disorder (DCD) if the performance in daily activities that require motor coordination is substantially below that expected given the child's chronological age and intelligence, in the absence of any known neurological disorder or pervasive developmental disorder (PDD). 2 To diagnose a child as having DCD, inadequate proficiency in movement performance should negatively interfere with activities of daily life. 2 This latter criterion, and the fact that most children do not outgrow DCD, which can have potentially long-term consequences, 3,4 support the need for intervention.Evidence is lacking for the efficacy of treatment approaches that concentrate on the deficits in processes assumed to underlie poor motor coordination, such as sensory integration therapy and kinaesthetic training. 5,6 For a decade, more task-oriented approaches have been emphasized and reveal promising results. These approaches focus directly on the functional skills hindering the child. Because only a few studies have investigated task-oriented approaches, more efficacy research is needed.In the Netherlands, neuromotor task training (NTT) has recently been developed especially for children with DCD, because the existing intervention programmes show no or little effect, and are not explicitly developed for these children. 7,8 Until the introduction of NTT, Dutch therapists eclectically used what they had learned on various courses. 9 NTT is based upon a cognitive neurosc...

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

Cited by 193 publications

References 106 publications

Stereotypic movement disorder: easily missed

Stereotypic movement disorder: easily missed

Motor coordination problems in children and adolescents with ADHD rated by parents and teachers: effects of age and gender

Neuromotor task training for children with developmental coordination disorder: a controlled trial

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