The impact of developmental coordination disorder on educational achievement in secondary school.

BACKGROUND: Developmental coordination disorder (DCD) is a common developmental disorder but its long term impact on health and education are poorly understood. AIM: To assess the impact of DCD diagnosed at 7 years, and co-occurring developmental difficulties, on educational achievement at 16 years. METHODS: A prospective cohort study using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). National General Certificate of Secondary Education (GCSE) exam results and Special Educational Needs provision were compared for adolescents with DCD (n=284) and controls (n=5425). RESULTS: Adolescents with DCD achieved a median of 2 GCSEs whilst controls achieved a median of 7 GCSEs. Compared to controls, adolescents with DCD were much less likely to achieve 5 or more GCSEs in secondary school (OR 0.27, 95% CI 0.21-0.34), even after adjustment for gender, socio-economic status and IQ (OR 0.6, 95% CI 0.44-0.81). Those with DCD were more likely to have persistent difficulties with reading, social communication and hyperactivity/inattention, which all affected educational achievement. Nearly 40% of adolescents with DCD were not in receipt of additional formal support during school. CONCLUSIONS: DCD has a significant impact on educational achievement and therefore life chances. Co-occurring problems with reading skills, social communication difficulties and hyperactivity/inattention are common and contribute to educational difficulties. Greater understanding of DCD among educational and medical professionals and policy makers is crucial to improve the support provided for these individuals.

Mental health outcomes of developmental coordination disorder in late adolescence.

AIM: To assess the relationship between developmental coordination disorder (DCD) and mental health outcomes in late adolescence. METHOD: Data were analyzed from the Avon Longitudinal Study of Parents and Children. Moderate-to-severe DCD was defined at 7 to 8 years according to the DSM-IV-TR criteria. Mental health was assessed at 16 to 18 years using self-reported questionnaires: Strengths and Difficulties Questionnaire, Short Moods and Feelings Questionnaire, and the Warwick-Edinburgh Mental Well-being Scale. Logistic and linear regressions assessed the associations between DCD and mental health, using multiple imputation to account for missing data. Adjustments were made for socio-economic status, IQ, and social communication difficulties. RESULTS: Adolescents with DCD (n=168) had an increased risk of mental health difficulties (total Strengths and Difficulties Questionnaire score) than their peers (n=3750) (odds ratio 1.78, 95% confidence interval 1.12-2.83, adjusted for socio-economic status and IQ). This was, in part, mediated through poor social communication skills. Adolescent females with DCD (n=59) were more prone to mental health difficulties than males. Greater mental well-being was associated with better self-esteem (ß 0.82, p<0.001). INTERPRETATION: Individuals with DCD, particularly females, had increased risk of mental health difficulties in late adolescence. Interventions that aim to promote resilience in DCD should involve improving social communication skills and self-esteem.

Posterior approach to optimise patient-reported outcome from revision hip arthroplasty.

INTRODUCTION: Most total hip arthroplasties (THAs) in the UK are performed through a posterior or lateral surgical approach. We aimed to investigate any difference in outcome from revision THA according to the approach at primary and revision THA surgery. METHODS: A retrospective cohort study of 205 patients who underwent revision THA for aseptic loosening. Patients rated their pain from 0-10 and completed the Self-Administered Patient Satisfaction Scale (SAPS), Oxford Hip Score (OHS), WOMAC and Short form-12 questionnaires. RESULTS: 205 patients (209 hips) from a cohort of 238 patients (243 hips, 86%) were available for analysis. The mean follow-up was 5 years (SD 1.71). Grouping by approach 20% (43/209) had both primary and revision procedures via a lateral approach, 20% (43/209) had their primary surgery via a lateral approach and their revision surgery via a posterior approach, whilst 60% (123/209) had both procedures via a posterior approach.The WOMAC and OHS were significantly better in patients who had a posterior approach for both primary and revision surgery, compared to those that did not (OHS p = 0.028, WOMAC p = 0.026). We found no significant differences in pain, satisfaction or health-related quality of life between the groups. DISCUSSION: Choice of approach for revision hip arthroplasty is influenced by a number of factors, but in clinical situations where either a lateral or posterior approach could be used, the posterior approach appears to be associated with better joint-specific outcomes. Registry data may help further explore the associations between surgical approach and the outcome from revision THA.