Activities of daily living in children with developmental coordination disorder: Dressing, personal hygiene, and eating skills

Abstract

In order to understand how age, culture, and problems in motor coordination impact the performance of activities of daily living, we used focus groups and in-depth interviews with Australian and Canadian parents to examine activities of daily living of younger (5–7 years of age) and older (8–9 years of age) children with and without DCD. By comparison with their typically developing age group, children with DCD had more difficulty with dressing, personal hygiene, and eating skills. Difficulties with postural control and fine-motor skills were reported to contribute to poorer performance of activities of daily living. As expected, competence in the performance of activities of daily living improved in the older children with and without DCD and there were few differences in the performance of daily living tasks between typical children in Australia and Canada. Overall, the motor difficulties of children with DCD had a significant impact on performance of a wide range of daily activities.

Introduction

Movement allows us to meet our basic needs, to communicate and to learn. It allows us to participate in the everyday activities of daily living. When movement is impaired, children’s participation in the activities of daily living can be compromised. Difficulties in movement are a significant problem for approximately 6–13% of school age children (American Psychiatric Association, 1994, Kadesjö and Gillberg, 1999). These movement difficulties have been labeled Developmental Coordination Disorder (DCD; American Psychiatric Association, 1994). By definition, children with DCD display a marked impairment in the development of motor coordination that significantly interferes with academic achievement or activities of daily living.

Children with DCD manifest motor deficits in virtually every motor domain. They tend to work more slowly than their typically developing peers (Missiuna and Pollock, 1995, Schoemaker et al., 2001) and display deficits in gross-motor (i.e., balance, gait) (Deconinck et al., 2006, Geuze, 2005) and fine-motor skills (Rodger et al., 2003, Smits-Engelsman et al., 2001). Intuitively, one would expect that there would be a link between these motor skill difficulties and the performance of activities of daily living. Case-Smith (1995), however, failed to find a strong relationship between motor impairment and performance of self-maintenance activities on standardized measures. In contrast, other research has reported that children with DCD have difficulties with daily living skills like dressing, personal hygiene, and eating (Mandich et al., 2003, May-Benson et al., 2002, Missiuna et al., 2007, Rosenblum, 2006). Rodger et al. (2003) suggested that this lack of consistency could be due to differences between parents’ perceptions and children’s performance on more standardized evaluations, differences in the context in which the activities of daily living were performed, and cultural differences. They suggested that investigation of children with DCD in ecologically valid contexts such as the family was needed to improve our understanding of children’s participation in activities of daily living.

To explore the specific impact of motor impairment on the performance of daily living skills, knowledge of typical children’s performance at various ages is required. Significant changes occur in children’s motor skills throughout childhood (Roncesvalles et al., 2005, Smits-Engelsman et al., 2006, Smyth et al., 2004) that influence the performance of activities of daily living. However, our knowledge regarding the development of activities of daily living in typical children in the context of the family is limited (Gesell & Ilg, 1946). For example, based on the current literature we do not know whether typical six-year-old children dress themselves independently or need assistance. Further, if they need assistance, what type of assistance do they require and from whom?

There is a growing body of literature that argues that human performance cannot be isolated from the environmental context in which it occurs (Bronfenbrenner, 1979, Davis and Burton, 1991, Dewey and Wilson, 2001, Dunn et al., 1994, Gibson, 1977, Newell, 1986). Weisner (1984) refers to each contextual setting (e.g., home, school) as an ecocultural niche, and suggests that each should be studied separately and compared within and across cultures. These theories support the view that performance of activities of daily living is contingent on multiple factors, which include the unique attributes of the individual, the context of the physical, socio-cultural environment and the specific demands of the task (Law et al., 1996). Different approaches can be taken to understand the interrelationship of the individual, environment, and task on human performance. One in relation to motor performance put forward by Newell (1986) argues that movement is constrained by factors within the individual, the environment, and the task. Others describe “affordances” (Gibson, 1977) or supports (Dunn, 1993) that enable performance. Dunn et al. (1994) consider that the person–environment interaction affects all human behavior, therefore, performance cannot be understood outside of its context.

The view that an individual’s performance of activities of daily living is the result of person–environment–task interactions guided this study. This framework allowed us to examine activities of daily living in younger and older children with DCD in the context of their family and their family’s country of residence (Australia and Canada). To better understand how problems in motor coordination impacted activities of daily living in these contexts, knowledge of typical children’s performance was obtained and differences between typically developing children and children with DCD were examined.