Developmental coordination disorder: Associated problems in attention, learning, and psychosocial adjustment
Introduction
Deficits in motor skills have been labelled in many ways over the centuries (e.g., neurological soft signs, clumsiness), but the current, dominant term is developmental coordination disorder (DCD). As defined by the American Psychiatric Association, DCD is “… a marked impairment in the development of motor coordination … (which) significantly interferes with academic achievement or activities of daily living …”. The prevalence of DCD is estimated to be about 6–10% in school age children (American Psychiatric Association, 1994, p. 53).
Gillberg and colleagues have extensively examined the overlap of attention and motor problems, referring to it as DAMP: deficits in attention, motor control and perception (Gillberg & Rasmussen, 1982; Gillberg, Rasmussen, Carlstrom, Svenson, & Waldenstrom, 1982; Hellgren, Gillberg, & Gillberg, 1994a; Kadesjo & Gillberg, 1998; Landgren, Kjellman, & Gillberg, 1998). Piek, Pitcher, and Hay (1999) also examined motor coordination in children with attention deficit/hyperactivity disorder (ADHD) and found that children with ADHD displayed motor coordination problems that were consistent with DCD. However, the type and degree of movement difficulty differed between children with ADHD-predominantly inattentive (ADHD-PI) and ADHD-combined (ADHD-C). Children with ADHD-PI had significantly poorer fine motor (FM) skills, whereas children with ADHD-C had significantly greater difficulty with gross motor (GM) skills. Further, they noted a strong association between inattention and movement difficulties with higher levels of inattention predictive of more severe difficulties in motor coordination. Other investigators have shown that children with learning disabilities, or dyslexia, have a high rate of motor difficulties (Dewey, Wilson, Crawford, & Kaplan, 2000; Fawcett and Nicolson, 1994, Fawcett and Nicolson, 1995; Gottesman, Hankin, Levinson, & Beck, 1984; Nicolson & Fawcett, 1994) and that children with language impairments also display significant difficulties with motor tasks (Dewey & Wall, 1997; Hill, 1998; Hill, Bishop, & Nimmo-Smith, 1998). Powell and Bishop (1992) investigated the hypothesis that children with specific language impairment (SLI) might be particularly impaired on motor skills that involved rapidly changing movements. In fact, they found that the children with SLI were impaired on all 19 measures of motor function included in their test battery, not just those that reflected slow processing rates.
The above research has shown that children with attention, learning and language problems display difficulties in motor skills. Studies have also reported developmental problems in children with motor impairments. Dewey and colleagues (Dewey & Kaplan, 1994; Dewey et al., 2000; Kaplan, Dewey, Crawford, & Wilson, 2001; Kaplan, Wilson, Dewey, & Crawford, 1998) found that children with motor problems displayed significant difficulties in language, reading, arithmetic and visual perceptual skills compared to comparison children. Kadesjo and Gillberg (1999) found that DCD was strongly associated with ADHD, with approximately half of the children with DCD displaying ADHD. They also reported that DCD was associated with reading comprehension problems at 10 years of age. It has been suggested that the association of motor deficits with reading deficits may reflect an inherited subtype. Two family studies that have supported this notion have demonstrated an unexpectedly strong relationship between reading disabilities and DCD in some, but not all, families with strong familial dyslexia (Regehr & Kaplan, 1988; Wolff, Melngailis, Obregon, & Bedrosian, 1995).
Recent studies have begun to investigate the associations among DCD, and behavioural and emotional problems. Longitudinal outcome studies have reported that children with DCD are more immature, socially isolated and passive than comparison children (Ahonen, 1990; Cantell, 1998; Cantell, Smyth, & Ahonen, 1994). In addition, feelings of lower self-worth, higher levels of anxiety and somatic symptoms have been reported to be more common in the children with DCD (Cantell, 1998; Schoemaker & Kalverboer, 1994; Skinner & Piek, 2001). Studies that have followed children with DCD and ADHD (i.e., DAMP) report that these children are at risk for a number of psychiatric and personality disorders. Hellgren, Gillberg, Bagenholm, and Gillberg (1994b) found that more than half of the adolescents with DAMP had psychiatric or personality disorders compared to only one-tenth of the control group. The psychiatric symptoms displayed by these adolescents ranged from affective and anxiety disorders to personality disorders. Follow-up of these individuals at 22 years of age revealed that 58% of the ADHD/DCD group had a poor outcome and that antisocial personality disorder, alcohol abuse, criminal offending, reading disorders and low educational level were overrepresented in this group (Rasmussen & Gillberg, 2000).
The above research suggests that DCD is associated with the co-occurrence of a number of disorders of development. Few studies, however, have investigated the co-occurrence of these various problems in one population of children. Thus, the main purpose of the present study was to examined the co-occurrence of problems in attention, learning and psychosocial adjustment in school age children with DCD.
One of the major issues in research on DCD is that there is no “gold standard” for the assessment of motor skills, and hence the identification of DCD (Crawford, Wilson, & Dewey, 2001; Dewey & Wilson, 2001; Henderson & Barnett, 1998). It has also been shown that it is not uncommon for children to score within the average range on one test of motor function, but to be impaired on others (Crawford et al., 2001; Dewey & Wilson, 2001). Therefore, different measures of movement ability may identify different children as displaying motor impairment. Another problem with motor assessment in general is that there is no universally established criteria regarding the amount of impairment necessary for a child to be categorized as having DCD. On the Movement Assessment Battery for Children (MABC) (Henderson & Sugden, 1992), children with motor difficulties fall into two groups, those with definitive movement problems (i.e., total impairment scores below the 5 percentile) and those with borderline movement problems (i.e., total impairment scores between the 5 and 15 percentile). Other measures of motor functioning (e.g., Bruininks–Oseretsky Test of Motor Impairment, McCarron Assessment of Neuromuscular Development) have established different criteria for the identification of impaired motor performance. As a result, in the research literature children classified with DCD may display varying level of movement problems.
No research studies have specifically investigated the co-occurrence of problems in attention, learning and psychosocial adjustment in children with different degrees of movement impairment. Kadesjo and Gillberg (1999) found however, that children with severe and moderate DCD did not differ from each other on attention deficit symptoms, Asperger’s disorder symptoms, and school dysfunction scores, although both groups were clearly different from children without DCD on these measures. To further investigate whether degree of movement impairment was related to the co-occurrence of problems, the current study examined two groups of children: one group who met our criteria for a diagnosis of DCD, and whose motor impairments were severe, and a second group who met our criteria as being suspect for DCD, and who displayed less severe motor impairments. Consistent with the findings of Kadesjo and Gillberg (1999), it was hypothesized that children with movement problems (i.e., DCD, suspect for DCD) would display more difficulties in attention, reading and psychosocial adjustment compared to children without DCD. It was also hypothesized that the children with DCD and the children suspect for DCD would display similar levels of difficulty.
Section snippets
Participants
This project was part of a larger study that investigated learning and attention problems in children. Participants were recruited from public and private schools in Calgary. The original sample consisted of 430 children who presented as typically developing or as displaying learning and attention difficulties. None of the children were referred specifically because of problems in motor skills. Children with a diagnosis of autism, development delay, a genetics disorder or a history of
Attention problems
An ANOVA revealed significant group differences on the Attention Problems subscale of the CBCL, F(2,68)=27.21; p<0.001. Post-hoc group comparisons showed that the DCD group and the suspect group score significantly higher than the comparison group on this scale, indicating more attention problems.
χ2 analysis was used to investigate group differences on the ASQ. Scores on the ASQ were standardized for age and sex, and the proportion of children in each of the three groups scoring at least one
Discussion
Previous research has suggested that children with DCD are at a higher risk for problems in attention and learning (Gillberg & Rasmussen, 1982; Gillberg et al., 1982; Hellgren et al., 1994a; Kadesjo & Gillberg, 1998). In fact, Kadesjo and Gillberg, 1998, Kadesjo and Gillberg, 1999 found that as many as half of the children with DCD displayed significant problems in attention and that DCD was associated with problems in reading comprehension at 10 years of age. Further, Piek et al. (1999)
Acknowledgements
Support for this research was provided by the Alberta Mental Health Research Fund and the Alberta Children’s Hospital Foundation.
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