Partnering for Change: collaborating to transform occupational therapy services that support inclusive education.

The United Nations champions inclusive education as a moral obligation, requiring equitable learning environments that meet all individuals' diverse learning needs and abilities, including children and youth. Yet the practice of inclusive education is variable and implementation challenges persist. A participatory action research framework was used to develop a solution, Partnering for Change (P4C), which is a tiered service delivery model that bridges health and education by re-envisioning occupational therapy services and transforming the role of the occupational therapist from a service provider for individual children to a collaborative partner supporting the whole school community. This perspective article will describe the P4C model and its evolution, and will outline how it has been implemented in Canadian and international contexts to facilitate children's inclusion and participation in educational settings.

Effects of Comorbid Developmental Coordination Disorder and Symptoms of Attention Deficit Hyperactivity Disorder on Physical Activity in Children Aged 4-5 Years.

Developmental coordination disorder (DCD) is often comorbid with attention-deficit/hyperactivity disorder (ADHD). While children with DCD engage in less moderate-to-vigorous physical activity (MVPA) compared to typically developing (TD) children, research pertaining to how ADHD affects this relationship is limited. We investigated the effect of ADHD on MVPA among children at risk for DCD (DCDr). 507 children aged 4-5 years (DCDr = 233, TD = 274) participated. Motor skills were assessed using the Movement Assessment Battery for Children-2nd edition (DCDr; ≤ 16th percentile), ADHD symptoms were assessed using the Child Behaviour Checklist, and Actigraph accelerometers measured MVPA over seven days. DCD did not negatively affect MVPA, however, after adjusting for ADHD symptoms, the effect of DCD became significant and was driven by symptoms of inattention. Symptoms of ADHD may be suppressing the negative effects of DCD on MVPA, highlighting the importance of assessing and controlling for ADHD symptoms in this population.

Implementing Partnering for Change in Québec: Occupational Therapy Activities and Stakeholders' Perceptions.

BACKGROUND.: The occupational therapy school-based Partnering for Change (P4C) model has mostly been documented in Ontario. PURPOSE.: This implementation study describes the implementation of P4C in two Québec elementary schools (P4C-Q), as well as therapy practices, their impacts, factors perceived to influence implementation, and recommendations. METHOD.: A sequential mixed-methods design was applied. Therapists (n=2) completed daily journals, describing activities by P4C-Q level. Therapists and other school-stakeholders (n=11) participated in semi-structured interviews, analyzed through a content analysis framework. FINDINGS.: Daily journals illustrated that the majority of therapy time was spent on activities targeting the entire classroom, and on collaboration with educators. Interviews illustrated how coaching was used across different practices and the impact of these practices for schools (e.g., capacity-building) and children (e.g., increased functioning), and highlighted how relationship-building is key to facilitating the implementation of this model. IMPLICATIONS.: Lessons learned may be helpful for others implementing P4C in their own contexts.

Parents' attendance, participation and engagement in children's developmental rehabilitation services: Part 1. Contextualizing the journey to child health and happiness.

Purpose: A family-centered approach to developmental rehabilitation services emphasizes that children grow and develop in their family environment, and that parents are an integral part of therapy. The purpose of this study was to develop a theory of how parents attend, participate and engage in their child's developmental rehabilitation services.Methods: A constructivist grounded theory study was conducted. Recruitment was done at a single children's treatment center in Ontario, Canada and data collection included parent and clinician interviews, policy collection and child-health record review. Grounded theory methods of constant comparison and theoretical sampling were applied. Credibility was enhanced through reflexivity, triangulation, and peer debriefing.Results and conclusions: The results show that in order to understand how parents engage in therapy, we must understand the conditions related to family health and service complexity that affect parent engagement. This contextual understanding may increase service providers' sensitivity to the conditions that affect engagement as they join families on their journey towards child health and happiness.Implications for rehabilitationService providers can understand the ease or difficulty that parents may experience in attending, participating and engaging in their child's therapy if they ask about (i) who is a part of the family, (ii) the health of all family members, and (iii) the number of services and professionals that are involved with the familyAsking parents about their own mental health and ensuring they are connected with appropriate resources may help them to attend, participate and engage in their child's rehabilitation service.When families are involved with multiple services and professionals, they may benefit from support with service navigation and a collaborative interprofessional approach to care.

A grounded theory of parents' attendance, participation and engagement in children's developmental rehabilitation services: Part 2. The journey to child health and happiness.

Purpose: Parents' attendance, participation and engagement are thought to be critical components of children's rehabilitation services; however, these elements of therapy are typically under-investigated. The purpose of this study was to develop a substantive theory of parents' attendance, participation and engagement in children's rehabilitation services.Methods: A constructivist grounded theory study was conducted. Data collection included interviews with parents (n = 20) and clinicians (n = 4), policies regarding discharge, and child-health records. Data was analyzed using constant comparison, coding and memoing. To promote credibility, authors engaged in reflexivity, peer debriefing, member checking, triangulation and recorded an audit trail.Results and conclusions: The Phoenix Theory of Attendance, Participation and Engagement was developed. This theory is described metaphorically as a journey to child health and happiness that has six components including: parent's feelings, skills, knowledge, logistics, values and beliefs and parent's relationship with the professional. The child, parent, service provider, and organizational factors that impact engagement are described. Service providers, policy makers, organizational leaders and researchers can use this information to promote engagement in children's developmental rehabilitation services.

Emotional and Behavioral Problems in 4- and 5-Year Old Children With and Without Motor Delays.

Background: An increased prevalence of psychological and behavioral conditions has been observed in youth and adolescents with DCD. The majority of research examining the relationship between motor skill proficiency and psychological problems has focused on older children and adolescents. The aim of the present study was to examine the relationship between motor skill proficiency and emotional and behavioral problems among pre-school age children with DCD to help determine how young children are when more severe problems begin to emerge (i.e., symptoms meet clinical thresholds) and the prevalence of comorbidity. Methods: Children 4 to 5 years of age (n = 589) from the Coordination and Activity Tracking in CHildren (CATCH) study were divided into two groups: at risk for DCD (rDCD; n = 288) and typically developing (TD; n = 301). Inclusion in the rDCD group required a score ≤16th percentile on the Movement Assessment Battery for Children-2. Emotional and behavioral problems were assessed using the Child Behavior Checklist (CBCL) 1.5 to 5 year parent-report questionnaire. CBCL data were scored using the CBCL syndrome scales as well as the DSM V revised scale scoring. Results: Seven children had missing or incomplete data on the CBCL and were excluded from the present analysis, leaving 582 participants. The mean age was 5.0 (SD 0.6) years and 57% of children were male (TD: 48% male, rDCD group: 67% male). After adjusting for sex, rDCD children scored significantly higher on all CBCL syndrome scales, all DSM-V scales, and all three summative scales. They were also significantly more likely to score at or above the syndrome scale clinical threshold on anxiety, withdrawn, emotionally reactive, aggression, ADHD, internalizing, externalizing, and total problems; and above the DSM-V thresholds on depression and autism. In addition, rDCD status was associated with a higher probability of meeting criteria for one, two, or more disorders in an ordinal logistic regression model. Conclusion: Preschool-age children with rDCD have more parent-reported psychological problems, and are more likely to be above the clinical threshold for many psychological problems and meet criteria for multiple conditions.

Cohort profile: the Canadian coordination and activity tracking in children (CATCH) longitudinal cohort.

PURPOSE: Developmental coordination disorder (DCD) is a prevalent, neurodevelopmental disorder affecting 2% to 5% of children, which is characterised by fine and gross motor problems. Children with DCD have been shown to be less fit and physically active than other children; however, the direction of causality is unknown as previous studies have typically been done in older children when the differences in fitness and physical activity are already present. The aim of the Coordination and Activity Tracking in Children (CATCH) study is to specifically address the issue of precedence by recruiting a large sample of children in early childhood. PARTICIPANTS: CATCH comprises a community-based sample of parents and children 4 to 5 years of age divided into two groups: at risk for DCD (rDCD; n=287) and typically developing (TD; n=301). Inclusion in the rDCD group required a score at or below the 16th percentile on a standardised test of motor coordination and a score above 70 on a standardised test of intelligence. FINDINGS TO DATE: Children in the rDCD group contained a higher proportion of males (67% vs 48%, χ2=21.9, p<0.001). Children in the rDCD group had lower mean IQs, aerobic and musculoskeletal fitness than children in the TD group (p<0.001 for all). There were no differences observed between groups for body composition or physical activity. Parent characteristics did not differ, with one exception: partners of reporting parents of rDCD children were less likely to hold a university degree (44% vs 57%, χ2=7.4, p=0.004). According to parent report, rDCD children experienced more problems in self-care, school and leisure activities (p<0.001 for all). FUTURE PLANS: Children are being followed up annually for 3 years. At each follow-up, motor coordination testing is repeated, and data are collected on physical activity, fitness and social-emotional problems.

Physical activity in young children at risk for developmental coordination disorder.

AIM: To examine cross-sectional differences in patterns of daily physical activity accumulation between preschool children at risk for developmental coordination disorder (DCD) compared to typically developing children. METHOD: In total, 514 children (292 males, 222 females; 4-5y) were recruited as part of the Coordination and Activity Tracking in CHildren (CATCH) study. Motor competence was assessed using the Movement Assessment Battery for Children, Second Edition; children scoring ≤5th centile comprised the probable DCD group (pDCD, n=87), between the 6th and 16th centile were considered to be at risk for DCD (rDCD, n=149), and >16th centile were considered typically developing (n=278). Seven-day physical activity was measured using hip-worn accelerometers. Average daily intensity of activity, frequency, and duration of moderate-to-vigorous physical activity (MVPA) bouts, and triaxial activity counts per minute were determined. RESULTS: No differences in daily activity in any intensity or axis of movement were found among the three groups. However, young children with pDCD accumulated their MVPA in slightly shorter bouts compared to typically developing children. INTERPRETATION: Young children at risk for DCD are not yet in an activity deficit. This may be because of the low motor skill demands of play in this age group. Early motor interventions may be able to promote continued physical activity participation in children with DCD. WHAT THIS PAPER ADDS: Preschool children at risk for developmental coordination disorder (DCD) are not less active than their peers. Overall intensity and frequency of daily activity bouts are similar among motor groups. Children with probable DCD accumulate their activity in shorter bouts.

ACTIVIDAD FÍSICA EN NIÑOS PEQUEÑOS CON RIESGO DE TRASTORNO DEL DESARROLLO DE LA COORDINACIÓN: OBJETIVO: Examinar por medio de un corte transversal las diferencias en los patrones de actividad física entre los niños en edad preescolar con riesgo de trastorno del desarrollo de la coordinación (TDC) en comparación con niños con un desarrollo típico MÉTODO: En total, se reclutaron 514 niños (292 varones, 222 mujeres; de 4 y 5 años) como parte del estudio Coordinación y Seguimiento de Actividad en niños (CATCH). Las capacidades motrices se evaluaron utilizando el test MABC 2 (Movement Assessment Battery for Children). Los niños con puntaje ≤5 percentilo formaron el grupo con TDC probable (pTDC, n = 87), entre percentilos 6 y 16 se consideraron en riesgo de TDC (rTDC, n = 149), y > percentilo 16 se consideraron con desarrollo típico (o normal, n = 278). La actividad física a lo largo de siete días se midió utilizando acelerómetros portados en la cadera. Se determinó la intensidad diaria promedio de la actividad, la frecuencia y la duración de los momentos de actividad física moderada a intensa (MVPA), y los recuentos de actividad triaxial por minuto. RESULTADOS: No se encontraron diferencias en la actividad diaria en ninguna intensidad o eje de movimiento entre los tres grupos. Sin embargo, los niños pequeños con pTDC desarrollaron su MVPA (actividad física moderada a intensa) en episodios ligeramente más cortos en comparación con los niños con un desarrollo típico. INTERPRETACIÓN: Los niños pequeños en riesgo de TDC aún no presentan un déficit de actividad. Esto puede ser debido a las bajas exigencias motrices del juego en este grupo etario. Las intervenciones motoras tempranas pueden promover la participación en actividades físicas de los niños con TDC.

ATIVIDADE FÍSICA EM CRIANÇAS PEQUENAS COM RISCO DE TRANSTORNO DO DESENVOLVIMENTO DA COORDENAÇÃO: OBJETIVO: Observar as diferenças transversais nos padrões de acumulação de atividade física diária entre crianças na idade pré-escolar com risco de transtorno do desenvolvimento da coordenação (TDC) e crianças de desenvolvimento típico. MÉTODOS: Um total de 512 crianças (292 meninos, 222 meninas; de idade entre 4 e 5 anos) foram recrutadas como parte do estudo Acompanhamento da Coordenação e de Atividades de Crianças (Coordination and Activity Tracking in CHildren - CATCH). As competências motoras foram avaliadas por meio da Bateria de Avaliação do Movimento para Crianças (Movement Assessment Battery for Children - MABC) segunda edição. Crianças com pontuação abaixo do quinto percentil compunham o provável grupo com TDC (pDDC, n=87), entre o percentil 6 e 16 foram consideradas com risco de DDC (rTDC, n=149), e aquelas com pontuação acima do percentil 16 foram consideradas de desenvolvimento típico (n=278). A atividade física ao longo de 7 dias foi mensurada utilizando-se acelerômetros posicionados no quadril. Foram avaliadas a média de intensidade da atividade diária, frequência e duração das atividades físicas moderadas a vigorosas e contagem das atividades triaxiais por minuto. RESULTADOS: Não foram encontradas diferenças entre os três grupos avaliados para intensidade ou eixo de movimento. Entretanto, crianças do grupo pTDC acumularam suas atividades físicas moderadas a vigorosas em blocos ligeiramente mais curtos do que crianças de desenvolvimento típico. INTERPRETAÇÃO: Crianças mais novas com risco de TDC ainda não apresentam déficits de atividade física. Isso pode ser devido às baixas demandas motoras de brincar nessa faixa etária. Intervenções motoras precoces podem ser capazes de promover participação em atividades físicas continuada em crianças com TDC.

Recommended practices to organize and deliver school-based services for children with disabilities: A scoping review.

BACKGROUND: Inclusive educational environments can have a positive effect on the general health and well-being of children with disabilities. However, their level of academic success and participation remains limited. Considering scarce resources and high needs, identifying efficient methods for providing interdisciplinary services is critical. This scoping review, therefore, aims to (a) synthesize current evidence about principles for organizing and delivering interdisciplinary school-based support services for students with disabilities and (b) ascertain useful strategies for implementation of principles in the school setting. METHODS: Scholarly and grey literature in rehabilitation and education were reviewed collaboratively with school-based stakeholders. A search of five databases identified 13,141 references and resulted in 56 relevant articles published from 1998 to 2017. Information (e.g., principles to organize services and strategies for implementation) was extracted, and thematic analysis was used to summarize findings. RESULTS: Within the documents retained, 65% were scientific and 35% were grey. Services primarily targeted students with behavioral issues, followed by those with cognitive and learning disabilities with a focus on improving social-emotional functioning and academic performance. Thematic analysis revealed 10 common principles to guide service organization (e.g., collaborative interventions and support for teachers) and seven implementation strategies (e.g., training and coordination) for employing these principles. CONCLUSIONS: Findings can guide rehabilitation professionals, educators, and policy makers in restructuring well-coordinated collaborative services involving training and capacity-building of school-based service providers. Such knowledge can contribute to the improved provision of care and, consequently, promote children's school participation and inclusion.

Validity and reliability of the Perceived Efficacy and Goal Setting System (PEGS) for Brazilian children / Validade e confiabilidade do Perceived Efficacy and Goal Setting System (PEGS) para crianças brasileiras

Abstract Introduction: The engagement in client-centered practice requires instrumentation that allows the participation of the child and family in the definition of treatment goals. Objective: The aim of the present study was to pilot a translated version of the Perceived Efficacy and Goal Setting System (PEGS) and determine its validity and reliability for clinical use with Brazilian children. Method: Eighty children six to nine years old (40 public school children and 40 private school children), as well as their caregivers and teachers, completed the PEGS. Results: The children understood the pictures and interview procedures. Caregivers and teachers reported no difficulties in understanding the questionnaires. Gender, age, and type of school had no significant influence over the children's scores. Cultural influence on the response to two items was identified but could be resolved with extra explanation. Stability of the goals was supported and the children, caregivers, and teachers appear to share views regarding the overall abilities of the children. Conclusion: The PEGS has potential for clinical use with Brazilian children, but clinicians should be aware that some items require further instructions. The usefulness of the PEGS as a tool to promote client-centered practice among Brazilian occupational therapists should be investigated.

Resumo Introdução: O envolvimento da prática centrada no cliente requer instrumentação adequada que permita as participações da criança e da família na definição das metas de tratamento. Objetivo: O objetivo do presente trabalho foi realizar estudo piloto da versão traduzida Perceived Efficacy and Goal Setting System (PEGS), assim como determinar a validade e a confiabilidade deste instrumento para uso clínico com crianças brasileiras. Método: Oitenta crianças de seis a nove anos de idade (40 crianças de escolas públicas e 40 crianças de escolas particulares), bem como seus cuidadores e professores, completaram o PEGS. Resultados: As crianças compreenderam tanto as figuras quanto os procedimentos da entrevista. Cuidadores e professores não relataram dificuldades na compreensão dos questionários. Gênero, idade e tipo de escola não tiveram influência significativa nas pontuações das crianças. Porém, as respostas à dois itens do estudo piloto, parecem ter sido influenciadas pela cultura, ; mas pôde ser resolvida com explicação extra. A estabilidade das metas foi mantida, e as crianças, cuidadores e professores pareceram compartilhar pontos de vista em comum com relação às habilidades gerais das crianças. Conclusão: O PEGS tem potencial para uso clínico com crianças brasileiras; no entanto, os profissionais devem estar conscientes de que alguns itens requerem instruções adicionais. A utilidade do PEGS, como ferramenta para promover a prática centrada no cliente entre terapeutas ocupacionais brasileiros, deve ser investigada.

Health-related Fitness in Preschool Children with and without Motor Delays.

PURPOSE: School-age children with developmental coordination disorder (DCD) have poor health-related fitness (HRF), but little is known about when these deficits emerge. The purpose of this study was to determine if 4- and 5-yr-old children who meet the criteria for DCD exhibit poorer HRF compared with typically developing (TD) children, and if this relationship is mediated by vigorous physical activity (VPA) engagement. METHODS: Five hundred and ninety-two children participated (age, 5.0 ± 0.6 yr) from the Coordination and Activity Tracking in CHildren study. Motor skills were assessed using the Movement Assessment Battery for Children-2, with groups defined as having DCD (≤5th percentile), at risk for DCD (6th-16th percentile), and TD (>16th percentile). Measures of body composition included body mass index, waist circumference, and body fat percentage. Musculoskeletal fitness assessments included standing long jump distance, as well as peak and mean power assessed using a 30-s Wingate protocol on a pediatric cycle ergometer. Time to exhaustion on a progressive, treadmill test was used to determine aerobic fitness. Flexibility and VPA were assessed using a sit-and-reach test and 7-d accelerometry, respectively. RESULTS: Children in the DCD group had the poorest musculoskeletal and aerobic fitness, whereas TD children had the highest. No differences in body composition among groups were found. Daily VPA was similar among groups and did not explain HRF differences. CONCLUSIONS: Preschool children with DCD have decreased anaerobic and aerobic fitness compared with TD children; however, VPA and body composition seem to be less affected by DCD in the early years. Early motor interventions may be able to improve fitness and reduce the risk of hypoactivity and obesity as children with DCD get older.

Early developmental influences on self-esteem trajectories from adolescence through adulthood: Impact of birth weight and motor skills.

While the trajectory of self-esteem from adolescence to adulthood varies from person to person, little research has examined how differences in early developmental processes might affect these pathways. This study examined how early motor skill development interacted with preterm birth status to predict self-esteem from adolescence through the early 30s. We addressed this using the oldest known, prospectively followed cohort of extremely low birth weight (<1000 g) survivors (N = 179) and normal birth weight controls (N = 145) in the world, born between 1977 and 1982. Motor skills were measured using a performance-based assessment at age 8 and a retrospective self-report, and self-esteem was reported during three follow-up periods (age 12-16, age 22-26, and age 29-36). We found that birth weight status moderated the association between early motor skills and self-esteem. Stable over three decades, the self-esteem of normal birth weight participants was sensitive to early motor skills such that those with poorer motor functioning manifested lower self-esteem, while those with better motor skills manifested higher self-esteem. Conversely, differences in motor skill development did not affect the self-esteem from adolescence to adulthood in individuals born at extremely low birth weight. Early motor skill development may exert differential effects on self-esteem, depending on whether one is born at term or prematurely.

Supporting occupational therapists implementing a capacity-building model in schools: Appuyer les ergothérapeutes mettant en œuvre un modèle de renforcement des capacités dans les écoles.

BACKGROUND: Adopting a new model of clinical practice is complex. Professional development programs based on best-practice principles may facilitate this process. PURPOSE: This paper describes the development and evaluation of a multifaceted professional development program designed to support school-based occupational therapists to deliver a capacity-building model of service. METHOD: Twenty-two therapists participated in the program; completed pre-post evaluations of knowledge, skills, and beliefs; evaluated specific components of the training program; and participated in focus groups. Quantitative data were analyzed using descriptive and inferential statistics. Qualitative data were analyzed using a directed content analysis. FINDINGS: Therapists' perceptions of their knowledge and skills showed statistically significant change. Both training and mentorship were highly valued; however, having opportunities to build peer networks was considered essential. IMPLICATIONS: Multifaceted professional development programs designed using best-practice principles are an important mechanism for facilitating practice change. Including a process for peer support is advised.

Measuring Participation of Children and Environmental Factors at Home, School, and in Community: Construct Validation of the Korean PEM-CY.

AIMS: To determine construct validity of the Korean Participation and Environment Measure for Children and Youth (KPEM-CY) in South Korea. METHODS: A total of 184 parents of children with (n = 80) and without disabilities (n = 104) aged 5 to 13 years completed the KPEM-CY. Construct validity was analyzed by assessing differences in the participation and environment scores for children with and without disabilities across age and gender. RESULTS: Validity of the KPEM-CY was supported by significant differences in participation and environmental factors for subgroups (p < .05). Children with disabilities participated less in typical activities and had more environmental barriers than those without disabilities across all settings. Parents of children with disabilities reported a higher level of desire to change their children's participation patterns. Similar participation patterns and environmental factors, which were influenced by interaction effects between disability and age, were confirmed at home and in the community. CONCLUSIONS: KPEM-CY is a valid measure to assess participation and environmental factors in home, school, and community settings for Korean children, aged 5-13 years, with and without disabilities.

Depression in youth recovering from concussion: Correlates and predictors.

OBJECTIVES: Although depression can be a serious consequence of concussion, little is known about the factors that predict depression and concussion recovery outcomes in children. The purpose of this study was to explore the risk and possible predictors of developing significant depressive symptoms in children recovering from concussion. METHODS: A prospective cohort study was conducted in a paediatric tertiary care clinic. Depression data were collected from 92 children using the Children's Depression Inventory-2 (CDI-2) screening tool. Correlations, t-tests and logistic regression were used to examine the associations between depression scores and demographic as well as injury-related factors. RESULTS: Depressive symptoms were found in 22% of the children (T score on CDI-2 >65). Children with evidence of depressive symptomatology had significantly higher mean post-concussive symptom inventory (PCSI) scores in recovery (p = 0.004) than children who were not depressed. Variables of i) Sex; ii) hospital admission; iii) number of head injuries; iv) post-concussion symptom score and v) experience of prolonged symptoms were predictive of clinically significant CDI T scores, explaining 36% of the variation in the binary logistic model. CONCLUSION: Depression is commonly reported in this subset of children. High post-concussive symptom scores and hospital admission were strong predictors of depression. Screening for depression should be standard practice in concussion management in children and youth.

Cognitive Orientation to daily Occupational Performance (CO-OP): A New Approach for Children with Cerebral Palsy.

AIMS: The results of a small single-case study series suggested that Cognitive Orientation to daily Occupational Performance (CO-OP) may be a successful approach for children with cerebral palsy (CP). Therefore a pilot randomized controlled trial was conducted with the following research questions-is CO-OP a feasible approach to use with children with CP, what are the effects of CO-OP when compared to usual practice, and is a larger study warranted? METHODS: 18 children between age 7 and 12 (nine in CO-OP group and nine in Current Usual Practice Approach (CUPA) group) received ten 1-hour sessions of intervention on average once per week at home. Primary outcome measures were the Canadian Occupational Performance Measure and the Performance Quality Rating Scale (PQRS). PQRS assessors were blind to group allocation and timing of assessment. RESULTS: All children in the CO-OP group were able to learn the strategies and achieve their chosen goals, thus demonstrating the feasibility of the approach. Both approaches equally promoted skill acquisition and skill maintenance at follow-up. Effect sizes suggest that CO-OP may show some advantage for transfer and maintenance. CONCLUSION: Based on these initial findings, further research is warranted.

Using an evidence-based online module to improve parents' ability to support their child with Developmental Coordination Disorder.

BACKGROUND: Developmental Coordination Disorder (DCD) is a prevalent neurodevelopmental disorder. Best practices include raising parents' awareness and building capacity but few interventions incorporating these best practices are documented. OBJECTIVE: To examine whether an evidence-based online module can increase the perceived knowledge and skills of parents of children with DCD, and lead to behavioral changes when managing their child's health condition. METHODS: A mixed-methods, before-after design guided by the Theory of Planned Behavior was employed. Data about the knowledge, skills and behaviors of parents of children with DCD were collected using questionnaires prior to completing the module, immediately after, and three months later. Paired T-tests, sensitivity analyses and thematic analyses were performed on data as appropriate. RESULTS: One hundred-sixteen, 81 and 58 participants respectively completed the three questionnaires. For knowledge and skills, post- and follow-up scores were significantly higher than baseline scores (p < 0.01). Fifty-two (64%) participants reported an intention to change behavior post-intervention and 29 (50%) participants had tried recommended strategies at follow-up. Three themes emerged to describe parents' behavioral change: sharing information, trialing strategies and changing attitudes. Factors influencing parents' ability to implement these behavioral changes included clear recommendations, time, and 'right' attitude. Perceived outcomes associated with the parental behavioral changes involved improvement in well-being for the children at school, at home, and for the family as a whole. CONCLUSIONS: The online module increased parents' self-reported knowledge and skills in DCD management. Future research should explore its impacts on children's long-term outcomes.

Children Who Use Communication Aids Instructing Peer and Adult Partners During Play-Based Activity.

Little is known about how children with severe motor impairments who use communication aids provide instructions when given control over interaction. In this study, 35 children - 18 who used communication aids and 17 who used natural speech - were videotaped in play-based activities. Both groups successfully instructed partners to build replications of models the partners could not see. The results demonstrate that children using communication aids can also have an active role in play-based activities using language, but that their experience with activities may be limited and their instructions may take longer to give. The children who used natural speech provided more detailed instructions and were more successful in guiding their partners. Creating opportunities for active participation in play may be important for the development of communicative autonomy.

Evaluation of the revised Nipissing District Developmental Screening (NDDS) tool for use in general population samples of infants and children.

BACKGROUND: There is widespread interest in identification of developmental delay in the first six years of life. This requires, however, a reliable and valid measure for screening. In Ontario, the 18-month enhanced well-baby visit includes province-wide administration of a parent-reported survey, the Nipissing District Developmental Screening (NDDS) tool, to facilitate early identification of delay. Yet, at present the psychometric properties of the NDDS are largely unknown. METHOD: 812 children and their families were recruited from the community. Parents (most often mothers) completed the NDDS. A sub-sample (n = 111) of parents completed the NDDS again within a two-week period to assess test-retest reliability. For children 3 or younger, the criterion measure was the Bayley Scales of Infant Development, 3rd edition; for older children, a battery of other measures was used. All criterion measures were administered by trained assessors. Mild and severe delays were identified based on both published cut-points and on the distribution of raw scores. Sensitivity, specificity, positive and negative predictive values were calculated to assess agreement between tests. RESULTS: Test-retest reliability was modest (Spearman's rho = .62, p < 001). Regardless of the age of the child, the definition of delay (mild versus severe), or the cut-point used on the NDDS, sensitivities (from 29 to 68 %) and specificities (from 58 to 88 %) were poor to moderate. CONCLUSION: The modest test-retest results, coupled with the generally poor observed agreement with criterion measures, suggests the NDDS should not be used on its own for identification of developmental delay in community or population-based settings.

Childhood motor coordination and adult psychopathology in extremely low birth weight survivors.

OBJECTIVE: To determine if childhood motor coordination is associated with lifetime major depressive disorder (MDD), current generalized anxiety disorder (GAD), and attention-deficit/hyperactivity disorder (ADHD) in adulthood, and to examine if extremely low birth weight (ELBW; <1000 g) status moderates the strength of these associations. METHOD: Prospective study of a cohort of normal birth weight (NBW) controls and ELBW survivors. Participants completed the short form Bruininks-Oseretsky Test of Motor Proficiency (BOTMP-SF) at age 8. At age 29-36, participants completed the Mini International Neuropsychiatric Interview to diagnose the psychiatric disorders of interest. RESULTS: Birth weight status significantly influenced the strength and direction of associations between childhood motor coordination and adult psychiatric outcomes such that the odds of MDD (Pinteraction=.02) and GAD (Pinteraction=.01) increased with worsening motor scores in NBW adults but not ELBW survivors. Stratified analyses indicated that in NBW adults, for each one-point decrease in BOTMP-SF score, the odds of lifetime MDD increased by 10% (OR=1.10, 95% CI: 1.01-1.20). LIMITATIONS: Participant attrition reduced sample size and that may have limited our ability to detect statistically significant results for some of our analyses. CONCLUSION: Poorer motor coordination in early life has a negative long-term impact on the development of MDD and GAD of individuals born at NBW. The long-term mental health risks of childhood motor coordination problems are significant and highlight the importance of recognizing motor deficits in all children, so that associated psychological difficulties can be identified and treated at an early age.