Motor Skill Interventions in Children With Developmental Coordination Disorder: A Systematic Review and Meta-Analysis

doi:10.1016/j.apmr.2017.12.009

Archives of Physical Medicine and Rehabilitation

Volume 99, Issue 10, October 2018, Pages 2076-2099

https://doi.org/10.1016/j.apmr.2017.12.009 Get rights and content

Abstract

Objectives

To determine the characteristics and effectiveness of motor skill interventions in children with developmental coordination disorder (DCD) and to identify potential moderators of training effects using meta-analysis.

Data Sources

A search was conducted in 6 databases (CINAHL Plus, Cochrane Library, Embase, ERIC, PsycINFO, and PubMed) for articles published between 1995 and August 2017 using search items which were grouped into 3 components (motor skill interventions, DCD, and age group of interest).

Study Selection

Studies were included if they recruited children 3 to 17 years of age with DCD, reported performance of motor-related skills as outcomes, were published in peer-reviewed journals, and were written in English. Qualitative synthesis was conducted for all included studies. Quantitative synthesis (meta-analysis) was only conducted for studies using a (quasi) randomized controlled trial design.

Data Extraction

Methodology, participant characteristics, intervention components, outcomes, and statistically significant training effects of each included study were extracted.

Data Synthesis

Sixty-six studies met the inclusion criteria with 18 of the studies eligible for meta-analysis. Motor performance and cognitive, emotional, and other psychological factors were the most common outcomes. Other 3 outcome categories included perceptions and/or satisfaction regarding the children's improvement from significant others, physical fitness, and physical activity and participation. Immediate and moderate training effects were found for motor performance (Hedges g=.63; 95% confidence interval [CI], .31–.94; P<.001) and cognitive, emotional, and other psychological factors (Hedges g=0.65; 95% CI, 0.25–1.04; P=.001). Additionally, dose (minutes in total) and frequency of the intervention were significant moderators of training effect on motor performance.

Conclusions

Motor skill interventions are effective in improving motor competence and performance on cognitive, emotional, and other psychological aspects in children with DCD in the short term. These effects are more robust in interventions using a large training dose and a practicing schedule of high frequency.

Section snippets

Methods

The conduct and reporting of this review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement.²²

Results

The initial literature search (1995–2015) yielded 4691 unique and potentially eligible studies, of which 4622 studies were excluded based on the screening of their titles and abstracts. Twenty-two studies were further excluded based on review of their full texts. The interrater reliability between the 2 reviewers for both abstract screening (κ=.88) and full-text screening (κ=.86) was considered to be excellent. A total of 47 studies met the inclusion criteria for qualitative synthesis through

Discussion

The main aims of this systematic review were to identify the characteristics of motor skill interventions designed for children with DCD and to determine whether such interventions are effective in remediating motor impairments and secondary problems caused by DCD. It was found that the characteristics of interventions varied in terms of participant recruitment, setting, approach, and treatment components, and that the motor performance and cognitive, emotional, and psychological factors were

Conclusions

This systematic review is the first, to our knowledge, to generate a quantitative summary that supports the beneficial effects of motor skill interventions on motor performance and cognitive, emotional, and other psychological factors in children with DCD. It is concluded that motor skill interventions are effective in improving motor competence and performance of cognitive, emotional, and other psychological factors in children with DCD; however, this is only over the short term. The

Supplier

a.
Comprehensive Meta-Analysis v.3; Biostat, Inc.

Acknowledgments

We thank Wan Yu Kwok, BSc, and Caren Lau, PhD, for their assistance in screening eligible studies.

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Literature searches were conducted in PubMed, Cochrane Central, Web of Science, Medline, SPORTDiscus, and PsychInfo from January 1, 2010, to May 6, 2022. Meta-analyses of randomized and quasi-randomized studies investigating the efficacy of PA interventions for psychosocial outcomes in children and adolescents were included. Summary effects were recalculated using common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small study effects, and whether the results of the observed positive studies were greater than expected due to chance. On the basis of these calculations, strength of associations was assessed using quantitative umbrella review criteria, and credibility of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Quality was assessed using the AMSTAR 2 tool. This study is registered with the Open Science Framework, https://osf.io/ap8qu.
A total of 112 studies from 18 meta-analyses generating 12 new meta-analyses comprising 21,232 children and adolescents in population groups including attention-deficit/hyperactivity disorder, cancer, cerebral palsy, chronic respiratory diseases, depression, neuromotor impairment, and obesity and in general populations were included. PA interventions were efficacious in reducing psychological symptoms in all meta-analyses across the different population groups using random-effects models. However, umbrella review criteria suggested a weak strength of association for this outcome, and GRADE credibility of evidence ranged from moderate to very low. For psychological well-being, 3 out of 5 meta-analyses identified significant effects, but the strength of these associations was weak, and GRADE credibility of evidence ranged from moderate to very low. Similarly, for social outcomes, meta-analyses reported a significant summary effect, but the strength of association was weak, and GRADE credibility of evidence ranged from moderate to very low. For self-esteem, one meta-analysis in children with obesity failed to show any effect.
Even though existing meta-analyses suggested a beneficial effect of PA interventions on psychosocial outcomes across different population groups, the strength of associations was weak, and the credibility of evidence was variable depending on the target population, outcome, and condition or disability. Randomized studies of PA interventions in children and adolescents with and without different physical and psychological conditions or disabilities should always include psychosocial outcomes as an important dimension of social and mental health.
Prenatal Maternal Infection and Adverse Neurodevelopment: A Structural Equation Modelling Approach to Downstream Environmental Hits; https://osf.io/; ap8qu.
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Children with Developmental Coordination Disorder (DCD) are at high risk for mental health disorders, stemming from challenges participating in motor activities. Parents of children with DCD report increased caregiver burden exacerbated by insufficient support and services for their child. A paucity of literature exists on parent and child mental health associated with a DCD diagnosis.
To explore parent perceptions of their child’s mental health, and the impact of DCD on family and parental mental health.
Implementation of a secondary analysis using the impACT for DCD, a cross-sectional online survey of parents of children with self-reported suspected or confirmed diagnosis of DCD living in British Columbia, Canada. Data analysis included descriptive and inferential statistics and content analysis.
Of the 237 participants, more than one third of parents (36%) rated their own mental health to be fair or poor, and the majority (90%) expressed concern for their child’s mental health. Themes emerged on the impact of DCD on child, parent, and family, influenced by access to resources.
Standard of care for DCD needs to include services and supports that address caregiver burden and mental health of children with DCD and their families.
This paper explores parent perceptions of their child(ren)'s and their own mental health when raising a child with DCD in British Columbia (BC). In BC, there is a lack of research on the mental health challenges families face when their child has a diagnosis of DCD. Amongst health care providers, there tends to be a focus on DCD as a motor disorder, with limited understanding and acknowledgement of the mental health component for children and their families. Thus, this study will inform health-care providers, parents, educators, and policy makers on parent-identified mental health needs and the essential services and supports. Unique to this study was the inclusion of a descriptive and exploratory content analysis, providing a holistic understanding of parents’ perceptions regarding the impact of DCD on their children and themselves. Our results revealed that parents perceive significant inter-connected impacts of DCD on the child, parents, and family, leading to poor mental health for parents and their child(ren). Limited access to resources and supports results in a negative trajectory for family mental health and well-being. Study results indicate the critical importance of addressing mental health, in addition to motor challenges. Healthcare providers need to adopt a family-centred approach to address the physical and psychosocial impairments associated with DCD, ensuring positive outcomes for children and their families.
Effect of a motor skill-based intervention in the relationship of individual and contextual factors in children with and without Developmental Coordination Disorder from low-income families
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Contextual opportunities facilitate skill acquisition, and the interaction between individual and contextual factors is fundamental to enhancing health and social parameters in children with DCD. This study examined (1) the influence of Mastery Motivational Climate (MMC) and Exercise Play Climate (EPC) interventions on motor performance, physical activity, self-perceptions, BMI, engagement in the lessons, playtime, and screen time of children without and with DCD, (2) the relationship between motor performance, self-perceptions, BMI, engagement in the physical education lessons, playtime, and screen factors in the children's physical activity levels in the lessons (PA) pre-and post-test. Children (N = 255, 98 children with Developmental Coordination Disorder - DCD; 157 children without DCD) were randomly assigned to MMC and EPC. Physical Activity levels in the lessons, motor performance, self-perceptions of physical competence, body mass indexes, appropriate motor engagement with success in the lessons, and active play and screen time were assessed. Regarding intervention impact, from pre-to post-tests, the results showed increases (1) PA in children with DCD in the EPC group and without DCD in the MMC group; (2) locomotor and ball skills for children with DCD in both climates; (3) locomotor and ball skills for children without DCD in the MMC group; (4) self-perceptions of competence for children with DCD in the MMC group; and (5) engagement with success for all children in both climates. A slight decrease in BMI for children with DCD in both climates was found. Regarding the associations, at post-test, engagement with success explained (1) PA levels for children with DCD in the MMC group and children without DCD in the EPC group; (2) active playtime explained PA for children with DCD in the EPC group; (3) ball skills explained PA for children without DCD in the MMC group. The intervention promoted overall increases in motor performance and children’s engagement in the lesson. The intervention strengthened the role of ball skills performance, engagement with success, and active play; however, these relationships were different across groups.
Learning a novel rhythmic stepping task in children with probable developmental coordination disorder
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Developmental coordination disorder affects approximately 6% of children, interfering with participation in physical activity and can persist through adulthood. However, no studies have investigated the neuromotor mechanisms of learning of a novel task with rhythmic cueing.
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In recent years, the usage of technology has grown in popularity (Blank, Smits‐Engelsman, Polatajko, & Wilson, 2012; Kwan et al., 2016; Neto et al., 2019). Active video games (AVG) incorporate greater scale body movements in an interactive environment, as opposed to more traditional (sedentary) electronic games (Hocking et al., 2019; Jane, Burnett, & Sit, 2018; Mentiplay et al., 2019). When compared to traditional motor skill interventions such as physiotherapy, occupational therapy, cognitive orientation to daily occupational performance (CO-OP), or Neuro-motor Task Training (NTT), AVG had more therapeutic engagement and enjoyment.
This paper elucidated the influence of Wii Fit training on visual perception and executive function in boys with developmental coordination disorders (DCD).
50 school boy with DCD (Mean Age = 9.55 ± 2.24) were randomly assigned to one of two groups, Wii Fit training (intervention; n = 25) or usual school program (control; n = 25). Visual perception and executive function were measured pre-, post- (8 weeks, 3 sessions per week, 30 minute per session), using Cognitive Assessment System (CAS) and Test of Visual-Perceptual Skills–Revised (TVPS-R), respectively. Pre- and post-test changes in executive function and visual perception were calculated using one-way ANCOVA, with pre-test values as covariate and post-test values as dependent variables.
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As in many areas of developmental disabilities, there is no gold standard for assessing DCD, so not surprisingly, a significant number of studies have explored the concurrent validity of different tests of motor proficiency and impaired coordination for identifying children with this condition and to plan treatment [42]. Moreover, most tests are only validated and normed for Western countries (mainly USA and UK) and not specifically developed for other cultures [7,43–45]. As mentioned before, a child's movement skills are determined by how well the child utilizes his/her personal attributes and information about the environment and task demands to create the desired movement outcomes.
This paper adopts a method of narrative critical review based on a non-systematic search of the literature to provide insights into the trends of developmental coordination disorder (DCD) treatment and to point out some future alternative approaches to prevent secondary health implications in children with DCD. The cause of DCD is unknown, but evidence suggests that these children have atypical brain structure and function. Interventions to help children cope with their activity limitations are effective in improving motor competence and motor skill related fitness in the short term. Although activity-orientated interventions can improve motor outcomes in children with DCD, high quality intervention trials and evaluation of long-term effects are urgently needed. Importantly, motor coordination problems associated with DCD extend to exercise-related activities leading to reduced participation in play and sports, which causes secondary problems in muscular fitness and body composition. Hence, treatment goals should not be limited to the improvement of motor skills (in ADL), but should also focus on health-related quality of life. We therefore propose when noticing motor problems in a child, already before enrolling but also during intervention, to explore ways to adapt everyday physical activities to optimally match the child's skill level. Hence, such activities will not only train the skills and improve physical fitness but will lead to positive engagement, thereby preventing the child from opting out of active play and sports. This provides the child with chances for exercise-dependent learning and will also positively impact social-emotional well-being.

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Review article (meta-analysis)Motor Skill Interventions in Children With Developmental Coordination Disorder: A Systematic Review and Meta-Analysis

Abstract

Objectives

Data Sources

Study Selection

Data Extraction

Data Synthesis

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Supplier

Acknowledgments

Gait Posture

Res Dev Disabil

Res Dev Disabil

Res Dev Disabil

Hum Mov Sci

Eur J Paediatr Neurol

Control Clin Trials

Res Dev Disabil

Disabil Health J

Hum Mov Sci

Hong Kong J Occup Ther

Res Dev Disabil

Hum Mov Sci

Res Dev Disabil

Res Dev Disabil

Res Dev Disabil

Res Dev Disabil

Hum Mov Sci

Hum Mov Sci

Res Dev Disabil

Hum Mov Sci

Hum Mov Sci

Res Dev Disabil

Hum Mov Sci

Res Dev Disabil

Hum Mov Sci

Res Dev Disabil

Brain Cogn

Res Dev Disabil

Diagnostic and statistical manual of mental disorders, 5th edition

Understanding performance deficits in developmental coordination disorder: a meta-analysis of recent research

Dev Med Child Neurol

An international consensus on children with developmental coordination disorder

Can J Occup Ther

Functional performance of children with developmental coordination disorder at home and at school

Dev Med Child Neurol

Developmental coordination disorder and overweight and obesity in children: a systematic review

Obes Rev

Mental health difficulties in children with developmental coordination disorder

Pediatrics

Fundamental movement skills proficiency in children with developmental coordination disorder: does physical self-concept matter?

Disabil Rehabil

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

Dev Med Child Neurol

European Academy for Childhood Disability (EACD): recommendations on the definition, diagnosis and intervention of developmental coordination disorder (long version)

Dev Med Child Neurol

Intervention for children with developmental coordination disorder: a systematic review

The Internet Journal of Allied Health Science and Practice

Efficacy of interventions to improve motor performance in children with developmental coordination disorder: a combined systematic review and meta-analysis

Dev Med Child Neurol

Examining the evidence for interventions with children with developmental coordination disorder

Br J Occup Ther

Exploring assessment tools and the target of intervention for children with developmental coordination disorder

Phys Occup Ther Pediatr

Effects of motor skill intervention on developmental coordination disorder: a meta-analysis

Adapt Phys Activ Q

Practitioner review: approaches to assessment and treatment of children with DCD: an evaluative review

J Child Psychol Psychiatry

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement

PLoS Med

The association between developmental coordination disorder and other developmental traits

Pediatrics

Getting the fundamentals of movement: a meta-analysis of the effectiveness of motor skill interventions in children

Child Care Health Dev

Quality of life domains affected in children with developmental coordination disorder: a systematic review

Review article (meta-analysis)
Motor Skill Interventions in Children With Developmental Coordination Disorder: A Systematic Review and Meta-Analysis