A SYSTEMATIC REVIEW OF INTERVENTIONS FOR CHILDREN WITH DEVELOPMENTAL COORDINATION DISORDER (DCD)

1. A SYSTEMATIC REVIEW OF INTERVENTIONS FOR CHILDREN WITH DEVELOPMENTAL COORDINATION DISORDER (DCD) Henn P Medical Education, School of Medicine, UCC. Results Thirty-eight publications were identified using the search strategy. Eleven studies met the criteria for inclusion: 6 randomised control trials1,2,3,4,5,-6 ; 3 randomised trials 7,8,9 ;2 studies in the format of a meta-analysis10,11 No previous published systematic review was identified Aim To carry out a systematic review of the literatureto determine whether the evidence exists to support current practice or indicates that a change of practice should be considered for therapeutic interventions for children with DCD Summary 5 studies reported on process orientated intervention1,2,4,7,9 3 studies reported on task orientated intervention 3,8,5 2 studies were meta-analyses10,11 1 study was a pharmacological based intervention 6 All reported on the primary outcome measure 2 studies reported on the secondary outcome measures6,8 On the primary outcome, the studies reviewed do not  support  any form of therapy over another in any meaningful way. This is primarily due to flaws in study design. The evidence for Le Bon Départ therapy, motor imagery training therapy and task orientated approach is weak. Sensory integration therapy, kinaesthesis and dietary supplementation with omega fatty acids have not been shown to be of benefit, though the latter did show benefits for secondary outcome measures Conclusions The implication for clinical practice is that therapists will have to deliver intervention based on their best clinical judgement for each child with DCD The implication for children and their parents is uncertainty in choosing interventions The implication for those who plan and budget for health service provision is that there is not much evidence on which to base new strategies for interventions The implications for researchers are many: There is need for clarity around diagnostic criteria and a requirement that children included in trials meet these criteria There is the need for a new assessment instrument to measure motor skill development across a wider age range, and one that has good psychometric properties In order to improve the evidence base for therapeutic intervention all intervention studies should be designed with the following in mind: the heterogeneous nature of DCD; an appropriate sample size; limitation of the effect of systematic seasonal variation and the placebo effect; the use of randomised control trials with good subject matching; blinding of assessor to treatment; and subjects followed up for sustained effect Background DCD is a developmental disorder of childhood characterised by a deficit in the development of age appropriate motor skills and a deficit in the performance of these motor skills that is sufficient to impede a child in performing everyday motor tasks in the home, play and school environments It is not due to an underlying medical or neurological disorder, a general intellectual disability, or autistic spectrum disorder. The cause is unknown, the prevalence is reported at 6% of children between the ages of 5 to 12 years. It persists into adulthood Good motor skill development is a prerequisite for pre academic, academic, social and emotional development. Children with DCD experience significant difficulties in these areas Interventions for children with DCD for the acquisition of and improvement of motor skills have varied from the so called process orientated treatment e.g. sensory integration, perceptual motor training, to the so called cognitive approaches which emphasise a problem solving approach ? ? ? ? ? Methods Subjects: children diagnosed with DCD or an equivalent condition Therapeutic interventions: the process orientated approach; the task orientated approach; the cognitive orientated approach; and pharmacological interventions Studies: randomised controlled trials, quasi-randomisation trials, randomised trials where the participants are allocated to different types of intervention and any meta-analysis of or systematic reviews of such studies Sources searched electronically: Cochrane Collaboration for systematic reviews, DARE, the Cochrane Central Trials Register, MEDLINE, CINAHL, PsychINFO, ERIC, OTDBASE, EMBASE, OVID, National Research Register and Papers First Hand search: references of appropriate studies, important review articles and appropriate textbooks Forward citation searches: conducted on appropriate studies in the electronic citation index SCISEARCH Primary outcome: change in motor performance Secondary outcomes: changes in psychological functioning, social functioning, academic achievement and quality of life measures • References • Polatajko HJ, Macnab JJ, Anstett B, Murphy K, Noh S. A clinical trial of the process orientated treatment approach for children with Developmental Coordination Disorder. Developmental Medicine and Child Neurology. 1995; 37: 310-319 • Sims K, Henderson SE, Hulme C, Morton J. The remediation of clumsiness. 11 Is kinaesthesis the answer? Developmental Medicine and Child Neurology. 1996b; 38:988-997 • Pless M, Carlsson M, Sundeli C, Persson K. Effects of group motor skill intervention on five-to-six-year-old children with developmental coordination disorder. Pediatric Physical Therapy 2000 Winter; 12(4): 183-9 • Wilson PH, Thomas PR, Maruff P. Motor imagery training ameliorates motor clumsiness in children. Journal of child Neurology 2002; 17:7491-8 • Shoemaker MM, Niemeijer AS, Reynders K, Smits-Engelsman BC. Effectiveness of neuromotor task training for children with developmental coordination disorder. Neural Plasticity 2003; 10(1- 2): 155-63 • Richardson AJ, Montgomery P. A randomized control trial of dietary supplementation with fatty acids in children with developmental coordinationdisorder. Pediatrics 2005; 115: 1360-1366. • Leemreijse C, Meijer OG, Vermeer A, Arder HJ, Diemel S. The efficacy of Le Bon Depart and Sensory Integration treatment for children with developmental coordination disorder: a randomized study with six single cases. Clinical Rehabilitation 2000; 14 (3): 247-59 • Miller LT, Polatajko HJ, Missiuna C, Mandich AD, Macnab JJ. A pilot trial of a cognitive treatment for children with developmental coordination disorder. Human Movement Science. 2001; 20:183-210 • Sugden DA, Chambers ME. Intervention in children with Developmental Coordination Disorder: the role of parents and teachers. British Journal of Educational Psychology. 2003 Dec; 73(Pt4): 545-61 • Miyahara M. A meta-analysis of intervention studies in children with developmental coordination disorder. Corpus, Psyche et Societas. 1996; 3(1): 11-18 • Pless M, Carlsson M. Effects of motor skill intervention on developmental coordination disorder: a meta-analysis. Adapted Physical Activity Quarterly 2000; 17:381-401