Developing Service Provision Models for Children with Developmental Coordination Disorder

Keeping Current © Cheryl Missiuna, 2003

What is Developmental  Coordination Disorder?

Developmental Coordination Disorder (DCD) is a motor skill disorder that affects 5 to 6 % of school-aged children. These children lack the motor coordination necessary to perform tasks that are considered to be appropriate for their age, given normal intellectual ability and the absence of other neurological disorders (American Psychiatric Association, 2000). A child with DCD may demonstrate significant difficulty with self-care tasks (e.g., dressing, using utensils, managing transitions); academic tasks (e.g., printing, handwriting, copying, organizing seatwork, gym class); and/or leisure activities (e.g., sports, playground activities, social interactions).

Why did we do this research?

When children have difficulty performing everyday motor tasks, the problem can impact on their self-esteem, socialization, behaviour, academic performance and physical fitness (see Cantell & Kooistra, 2002). Early identification, assessment and intervention need to happen during the preschool years to help children with DCD develop pre-academic skills, facilitate transition into school and prevent the development of secondary problems. Consideration also needs to be given to service delivery models for school-aged children since little direct intervention is currently taking place.

What led us to look at children with DCD more closely?

In 2000, The Rotary Children's Centre decided to expand its services to be more inclusive of children with developmental disabilities, including children with DCD. A review of evidence-based practice was needed to develop procedures and materials that would promote awareness and enhance services for children with DCD. With funding from the Cloverleaf Foundation, the Centre dedicated resources to a project that would develop proposals for service delivery. CanChild Centre for Childhood Disability Research became a partner in this process.

What did we want to know?

Several key questions were asked:

  • Could children with DCD be identified prior to school age?
  • Were there tools available that could assist with early identification and assessment?
  • What interventions were being used for children with DCD?
  • Were they effective?

What information was gathered?

  • Surveys were conducted with Rotary Children’s Centre speech and language pathologists (SLP), occupational therapists (OT) and physical therapists (PT) to determine their current level of knowledge regarding DCD and the service delivery models most frequently used.
  • A comprehensive literature review was conducted to enhance knowledge regarding the nature of DCD, the relationship between DCD and other conditions (e.g., attention deficit disorder, specific language impairment), current assessments used to identify children with DCD, and current interventions and their effectiveness.
  • A student pilot study was conducted in collaboration with CanChild and the School of Rehabilitation Science at McMaster University. Students videotaped children participating in speech therapy sessions to see whether they could identify child behaviours and clinician helping behaviours that might assist in earlier identification of children with DCD.
  • Researchers studying children with DCD and clinicians from other Ontario Association of Children’s Rehabilitation Services (OACRS) centres were contacted to gather information regarding their early identification, assessment and intervention practices for children with DCD.

What was found?

  • Service providers at the Rotary Children’s Centre
  • (SLP, OT, PT) identified the need for more education regarding how to recognize and provide service to children with DCD.
  • The majority of the published literature focuses on school-aged children with DCD.
  • Literature regarding traditional interventions indicates small or non-existent gains (e.g., Mandich, Polatajko, Macnab, and Miller, 2001)
  • Contemporary interventions show some promise with school-aged children with DCD (Revie and Larkin, 1993; Miller, Polatajko, Missiuna, Mandich, Macnab & Malloy-Miller, 2001).
  • The pilot study revealed that children with suspected motor difficulties were provided with more assistance (verbal and/or physical) by SLPs during therapy sessions. They also demonstrated particular behavioural characteristics that were seen more often than in typically developing children (Missiuna, Gaines & Pollock, 2002).
  • Services provided at other OACRS centres are varied; many centres would like to facilitate earlier identification of children with DCD.
  • Research is currently underway through other projects at CanChild to look at early identification of preschool children with DCD.
  • Research is ongoing in other locations such as the University of Western Ontario examining the efficacy of cognitive interventions with young children with DCD.

What was developed?

  • Service delivery models were developed which proposed tools for identification, assessment and intervention for preschool and school aged children with DCD.
  • Service delivery models emphasized a more active intervention approach and included the potential for participation by parents and teachers.
  • A research report was generated for the funding agency that summarizes the DCD literature and these models.
  • The findings of this project were presented at the 2002 OACRS Conference (Rivard, Johal and Missiuna, 2002).

How is this information useful?

  • Information gathered may assist speech language pathologists in the early identification and referral of children with suspected movement difficulties to occupational therapy and/or physiotherapy for further assessment.
  • Parents and teachers may be able to recognize coordination difficulties and may seek out further information about their child’s development.
  • Occupational therapists and physical therapists will be more likely to accurately identify, assess and provide effective intervention for children with motor coordination difficulties.

What’s next?

  • Proposed service delivery models need to be evaluated for effectiveness.
  • More research is needed regarding the early indicators of children with DCD and the provision of service to preschool children with coordination difficulties.
  • Click here for list of references

    American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th Ed., Text Revision). Washington, DC: Author.

    Cantell, M., & Kooistra, L. (2002). Long-term outcomes of developmental coordination disorder. In S. Cermak & D. Larkin (Eds.), Developmental coordination disorder (pp. 23-38). Albany, NY: Delmar.

    Mandich, A., Polatajko, H., Macnab, J., & Miller, L. (2001). Treatment of children with developmental coordination disorder: What is the evidence? Physical and Occupational Therapy in Pediatrics. 20: 2/3, 51-68.

    Miller, L., Polatajko, H., Missiuna, C., Mandich, A., Macnab, J. & Malloy-Miller, T. (2001). A pilot trial of a cognitive treatment for children with developmental coordination disorder. Human Movement Science. 20, 183-210.

    Missiuna, C., Gaines, B., & Pollock, N. (2002). Recognizing and referring children at risk for developmental coordination disorder: Role of the speech-language pathologist. Journal of Speech-Language Pathology and Audiology.26, 172-179.

    Revie, G., & Larkin, D. (1993). Task specific intervention with children reduces movement problems. Adapted Physical Activity Quarterly, 10, 29-41.

    Rivard, L., Johal, H., & Missiuna, C. (2002). Early identification of children with developmental coordination disorder. Workshop presented at the Ontario Association of Children’s Rehabilitation Services Conference, Richmond Hill, Ontario.

We would like to thank…

  • the children and parents
  • service providers of the Rotary Children’s Centre
  • the students at McMaster University

…who participated in the pilot study and in this project.

  • We also acknowledge and thank Eric Goldberg and Patricia Usher of the Rotary Children’s Centre for their support and guidance.

This research project was funded by the Cloverleaf Foundation and by support provided to C. Missiuna by the Canadian Institutes of Health Research.

Where can I get an information package regarding this project?

Please contact C. Seftel at (519) 886-8886, ext. 216. An administration cost will apply.

For further inquiries, please contact:

Herdip Johal, BHScOT, OTReg(Ont)
Rotary Children’s Centre
250 Hespeler Road
Cambridge, Ontario N1R 3H3
(519) 621-7580 ext. 257