A narrative meta-review of a series of systematic and meta-analytic reviews on the intervention outcome for children with developmental co-ordination disorder.

BACKGROUND: Systematic reviews and meta-analyses are considered to be the 'gold standards' for synthesizing research evidence in particular areas of enquiry. However, such reviews are only useful if they themselves are conducted to a sufficiently high standard. The aim of this study was to conduct a narrative meta-review of existing analyses of the effectiveness of interventions designed for children with developmental co-ordination disorder (DCD). METHODS: A narrative meta-review of systematic and meta-analytic reviews aimed at evaluating the effectiveness of intervention for children with DCD was conducted on studies published between 1950 and 2014. We identified suitable reviews, using a modification of the Population, Intervention, Comparison, Outcome (PICO) system and evaluated their methodological quality using the Assessment of Multiple Systematic Reviews (AMSTAR). In addition, the consistency of the quality of evidence and classification of intervention approaches was assessed independently by two assessors. RESULTS: The literature search yielded a total of four appropriate reviews published in the selected time span. The Assessment of Multiple Systematic Reviews percentage quality scores assigned to each review ranged from 0% (low quality) to 55% (medium quality). Evaluation of the quality of evidence and classification of intervention approaches yielded a discrepancy rate of 25%. All reviews concluded that some kind of intervention was better than none at all. CONCLUSIONS: Although the quality of the reviews progressively improved over the years, the shortcomings identified need to be addressed before concrete evidence regarding the best approach to intervention for children with DCD can be specified.

Provision for children with developmental co-ordination disorder (DCD): audit of the service provider.

BACKGROUND: The aim of this study was to conduct an audit of parent/carer satisfaction with the service provided for children presenting with movement difficulties [developmental co-ordination disorder (DCD)/dyspraxia] at the out-patient physiotherapy clinic of a specialist tertiary referral paediatric hospital. METHOD: A postal questionnaire was used to obtain objective and subjective data on the service offered. Factual information on aspects such as waiting time for first appointment, type of intervention offered, etc. was checked against clinical records. Satisfaction with the service was assessed using ratings and open-ended comment. RESULTS: Forty-five families completed the questionnaire. The results showed that the service was generally rated highly. The opportunity to discuss the child's problems and its implications was considered valuable. Among families offered 1 : 1 intervention, a statistically significant correlation emerged between the number of sessions attended and perceived effectiveness. Among families offered a home programme, perceived effectiveness was related to the number of times per week the child practised the programme. CONCLUSIONS: This study showed that many children from mainstream schools with co-ordination problems continued to find it difficult to obtain a clear diagnosis. Once a referral and assessment had been achieved, however, parents/carers were shown to be satisfied with the package offered by this service provider.

Can the Griffiths scales predict neuromotor and perceptual-motor impairment in term infants with neonatal encephalopathy?

AIMS: To examine the predictive value of early developmental testing for identifying neuromotor and perceptual-motor impairment at school age in children with neonatal encephalopathy (NE). METHODS: Eighty full term infants with NE were followed longitudinally. Where possible, children were tested on the Griffiths scales at 1 and 2 years and at 5-6 years, on the Touwen Examination, Movement ABC, and WPPSI. The relation between the Griffiths scores and later outcome measures was examined using correlation coefficients and sensitivity and specificity values. RESULTS: By 2 years, 25 children with cerebral palsy were too severely impaired to be formally assessed and remained so at 5-6 years. Abnormal Griffiths scores were obtained by 12% and 7% of the children at 1 and 2 years respectively. At 5-6 years, 33% had poor Movement ABC scores and 15% poor WPPSI scores. The highest correlation between Griffiths scores and the outcome measures was for the Movement ABC (0.72), although this accounted for only 50% of the variance. Sensitivity scores for the Movement ABC were below 70% but specificity was 100%. CONCLUSIONS: A poor score on the Griffiths scales at 1 and/or 2 years is a good predictor of impairment at school age. However, a normal score in the early years cannot preclude later neurological, perceptual-motor, or cognitive abnormalities.

Clumsiness, dyspraxia and developmental co-ordination disorder: how do health and educational professionals in the UK define the terms?

At the turn of the century, the idea that there might be a discrete childhood syndrome, which had 'clumsiness' of movement as its defining symptom, began to emerge. Since then numerous labels have been applied to the syndrome. In spite of recent attempts to standardise the terminology used, variation continues to compromise inter-professional communication and interpretation of research. The aim of this study was to determine how the three terms 'Clumsy', 'Dyspraxia' and 'Developmental Co-ordination Disorder (DCD)' are viewed by health and educational professionals in the UK. Two hundred and thirty-four adults (57% from the health professions and 43% from education) provided a written definition of each term. Content analysis of the 702 definitions was used to determine: (1) the extent to which the terms were familiar/acceptable to the respondents; and (2) to capture differences in the meaning of the term being defined. The results indicated that the terms 'DCD' and 'Dyspraxia' were less familiar than the term 'clumsy' which was, however, least acceptable. Amongst those professionals who were familiar with all three terms, there was general agreement that all were used to describe some sort of overall movement difficulty. Beyond that point, divergence of understanding and inter-professional differences in emphasis emerged. The implications of these differences for clinical and educational practice, research and policy making are discussed.

The Movement Assessment Battery for Children: a comparison of 4-year-old to 6-year-old children from Hong Kong and the United States.

OBJECTIVE: There is little information available on the appropriateness of tests developed in the West for children of different ethnicities. The aim of this study was to examine the suitability of the Movement Assessment Battery for Children (Movement ABC) for use with Hong Kong Chinese preschool children. METHOD: The performance of 255 Hong Kong Chinese children between the ages of 4 years and 6 years was compared with that of the 493 children of the same age from the United States who took part in the most recent standardization of the Movement ABC. RESULTS: The test content was found to be suitable for use with Hong Kong Chinese children. However, cross-cultural differences were found on a number of the test items. Chinese children performed significantly better on items contained in the manual dexterity and dynamic balance sections, whereas American children were better at the projection and reception of moving objects. CONCLUSION: These findings highlight the need to ensure that norms for all tests are appropriate for the specific cultural groups being assessed.

Minor neurological signs and perceptual-motor difficulties in prematurely born children.

AIM: To examine the spectrum of neurological dysfunction and perceptual-motor difficulties at school age in a cohort of prematurely born children, and the relation of these measures to neonatal brain lesions, intelligence quotient, and behavioural adjustment. METHOD: One hundred and eighty three children were tested at the age of 6 years using Touwen's Examination of the Child with Minor Neurological Dysfunction, the Movement Assessment Battery for Children (Movement ABC), the Developmental Test of Visual-Motor Integration (VMI), British Ability Scales, and Rutter Scales. RESULTS: Twenty six children had definite cerebral palsy and one was blind. Of the remaining 156, the proportions falling below the 15th centile point were 31% on Touwen's Examination, 44% on the Movement ABC, and 17% on the VMI. Forty two passed all three tests. No child with a normal ultrasound scan developed cerebral palsy, whereas nearly all those with major lesions did. Minor lesions, however, were not generally predictive of later outcome. Correlations between the tests were generally low. CONCLUSIONS: These findings stress the need to assess neurological and perceptual motor functioning separately at school age and to monitor relationships with other aspects of development.

The remediation of clumsiness. I: An evaluation of Laszlo's kinaesthetic approach.

The effectiveness of a kinaesthetic training programme proposed by Laszlo for children with movement difficulties was evaluated by comparing two groups of 10 'clumsy' children matched pairwise on age, IQ and sex as well as degree of kinaesthetic and motor impairment. Tests of kinaesthetic ability, using the Parameter Estimation by Sequential Testing (PEST) procedure, and motor competence administered before and after treatment revealed an improvement in both groups on all measures but no differential effect of the training programme. Immediately after training, the changes we obtained in motor performance were confined to balance skills but, at follow up, 3 months later, changes in manual and ball skills were also evident. This unusual pattern of change requires replication. Our findings forced us to consider the possibility that any effect of Laszlo's recommended training programme had been obscured by our use of the PEST procedure, which had in itself facilitated motor learning.

The remediation of clumsiness. II. Is kinaesthesis the answer?

The paper reports the second of two studies designed to evaluate the effectiveness of the Kinaesthetic Training Programme (Laszlo and Bairstow, 1985) for children with movement difficulties. Three groups of 12 children were matched on age, IQ and sex as well as degree of kinaesthetic and motor impairment. One group received the Laszlo training, another received a training programme designed to avoid explicit reference to kinaesthesis and the third group received no training. Children receiving no intervention failed to show a change in performance. By contrast, the motor competence of both groups of treated children improved significantly. There was no advantage for the Laszlo trained group. It seems that in designing a remediation programme for clumsy children, the way that training is presented is as important as its actual content.

How local is the impact of a specific learning difficulty on premature children's evaluation of their own competence?

The aim of this study was to determine whether children's perceptions of their own competence levels reflected their actual strengths and weaknesses (Specificity Hypothesis) or transcended these (Generality Hypothesis). Harter and Pike's measure of self-perception was administered to 163 prematurely born 6-year-olds with or without motor co-ordination and/or reading problems. Associations between children's self-perceptions and their scores on standardised tests of motor co-ordination and reading were assessed in three distinct ways. These analyses produced converging results: self-perceptions of physical competence were associated specifically with performance on the Movement ABC Test, and self-perceptions of cognitive competence were associated specifically with performance on the BAS Word Reading Scale. Our results support the Specificity Hypothesis.

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Visuospatial difficulties and clumsiness: on the interpretation of conjoined deficits.

Sixteen children with motor difficulties and 16 controls, matched on age, gender and verbal I.Q., were assessed on the Test Of Motor Impairment, various graphic tasks and a measure of visuospatial discrimination. Poor perceptual and motor performance tended to co-occur but contrary to the visuospatial deficit account of clumsiness these abilities were uncorrelated even when attention was restricted to the less proficient children. There was no tendency for the control group's superiority in graphic reproduction to diminish when visual feedback was withheld. Some suggestions are offered concerning more appropriate methods for framing and testing causal deficit hypotheses.

Some aspects of the reliability of Touwen's examination of the child with minor neurological dysfunction.

Three studies concerning the inter-rater and test-retest reliability of the Touwen examination are presented. The results of the first study showed that it was not possible to achieve acceptable levels of reliability using the manual as the only reference for instruction. Although the reliability estimates of the total scores were good, inter-rater reliability for the nine groups of items and the individual tasks within them was poor. When methodology and interpretation of performance was agreed between observers, a second study showed that these disagreements diminished. The third study demonstrated that the short-term stability of total scores is good, but reliability for group and individual item scores remained poor.

Some observations in the figure drawings of clumsy children.

This paper presents two exploratory studies of figure drawing by clumsy children. In the first, the drawings of 42 such children and controls, matched pairwise on chronological age and verbal IQ, were compared. Not only were the impaired children's drawings found to be generally delayed but there was also a suggestion that some fell further behind their peers as they got older. In a follow up study of a subset of the clumsy group it was found that increasing delay was indeed characteristic of some children, but others improved. In spite of improvement in some aspects of figure representation, however, the children's poor motor control persisted.

Clumsiness in children--do they grow out of it? A 10-year follow-up study.

The question of whether problems of motor co-ordination in early childhood recede with age has rarely been addressed. This paper reports the findings from a follow-up study of 17 children, identified by their teachers as having poor motor co-ordination at age six. Now age 16, these children and their matched controls completed a battery of assessments. The results suggest that the majority of children still have difficulties with motor co-ordination, have poor self-concept and are experiencing problems of various kinds in school. However, there are individual differences in the extent to which the children have learned to cope with their continuing difficulties over the years.

Concomitants of clumsiness in young schoolchildren.

Teachers in four schools for normal children aged between five and eight years took part in a two-year investigation of developmental clumsiness. After a year's preliminary discussion they identified 20 children from a total of 400 who met the following criteria: (1) had poor motor co-ordination for their age and (b) whose poor motor co-ordination was affecting their schoolwork. The teachers' assessments were compared with those of a paediatric neurologist and a psychologist, and were shown to be very accurate. The group of children identified as 'clumsy' scored significantly poorly in relation to a control group on several measures of motor performance, and had a higher incidence of other educational and social problems. The heterogeneity of the group emphasised the difficulty of identifying a specific syndrome of 'clumsiness' in children.

Performance of Down syndrome and other retarded children on the Cratty Gross-Motor Test.

The Cratty Test of Gross-Motor Performance was administered to 18 Down syndrome and 18 other mentally retarded children between the ages of 7 and 14 years. Subjects were individually matched on both MA and CA. Examination of their test profiles showed that the Down syndrome children had consistently lower scores that did the matched control children, but only two of the differences were significant. The findings, therefore, provide tentative support for the notion that Down syndrome children suffer a specific deficit in some areas of motor coordination. A number of criticisms of the internal consistency of the test were discussed in terms of their theoretical and practical implications.