ArticlePublisher preview available

Toward a Hybrid Model of Developmental Coordination Disorder

DOI:10.1007/s40474-017-0115-0
Authors:
Peter H Wilson at Australian Catholic University
Peter H Wilson
Bouwien Smits-Engelsman at University of Cape Town
Bouwien Smits-Engelsman
Karen Caeyenberghs at Deakin University
Karen Caeyenberghs
Bert Steenbergen at Radboud University
Bert Steenbergen
Read publisher preview
Download citation
To read the full-text of this research, you can request a copy directly from the authors.

Abstract and Figures

Purpose This paper discusses the merits of a hybrid model of developmental coordination disorder (DCD), one that integrates cognitive neuroscience and ecological systems approaches. More specifically, we present an integrative summary of recent empirical work on DCD that enlist behavioural and neuroimaging methods and propose a theoretical interpretation through the lens of a hybrid model. Findings The review identifies two current hypotheses of DCD that find consistent support: the internal modelling deficit (IMD) and mirror neuron system (MNS) accounts. However, motor performance and brain activation patterns are not expressed in a uniform way under these hypotheses—motor deficits are manifested variously as a function of specific task and environmental constraints and condition severity. Moreover, we see evidence of compensatory processes and strategies. Summary Taken together, results support the broad hypothesis that children with DCD show distinct motor control deficits and differences in neural structure and function compared with typically developing children. However, researchers still have difficulty ascribing causation. The proposed hybrid (multi-component) model of DCD can help researchers generate novel hypotheses about specific mechanisms, explaining the constellation of deficits that is shown experimentally and observed clinically. This model can be applied to cognate disorders of childhood that affect movement and design of intervention.
Figures - available from: Current Developmental Disorders Reports
This content is subject to copyright. Terms and conditions apply.
  • A preview of this full-text is provided by Springer Nature.
  • Learn more
Preview content only
Content available from Current Developmental Disorders Reports
This content is subject to copyright. Terms and conditions apply.
DISORDERS OF MOTOR (PH WILSON, SECTION EDITOR)
Toward a Hybrid Model of Developmental Coordination Disorder
Peter H. Wilson
1,2
&Bouwien Smits-Engelsman
3
&Karen Caeyenberghs
1,2
&
Bert Steenbergen
2,4
Published online: 27 June 2017
#Springer International Publishing AG 2017
Abstract
Purpose This paper discusses the merits of a hybrid model of
developmental coordination disorder (DCD), one that inte-
grates cognitive neuroscience and ecological systems ap-
proaches. More specifically, we present an integrative summa-
ry of recent empirical work on DCD that enlist behavioural
and neuroimaging methods and propose a theoretical interpre-
tation through the lens of a hybrid model.
Findings The review identifies two current hypotheses of
DCD that find consistent support: the internal modelling def-
icit (IMD) and mirror neuron system (MNS) accounts.
However, motor performance and brain activation patterns
are not expressed in a uniform way under these hypothe-
ses—motor deficits are manifested variously as a function of
specific task and environmental constraints and condition se-
verity. Moreover, we see evidence of compensatory processes
and strategies.
Summary Taken together, results support the broad hypothe-
sis that children with DCD show distinct motor control defi-
cits and differences in neural structure and function compared
with typically developing children. However, researchers still
have difficulty ascribing causation. The proposed hybrid
(multi-component) model of DCD can help researchers gen-
erate novel hypotheses about specific mechanisms, explaining
the constellation of deficits that is shown experimentally and
observed clinically. This model can be applied to cognate
disorders of childhood that affect movement and design of
intervention.
Keywords Developmental coordination disorder .Internal
modellingdeficit .Mirror neuronsystem .Disordersof motor .
Review
Introduction
Overview
Problems of motor skill learning in children (or developmental
coordination disorder—DCD) is a commonly occurring issue
that can have quite profound effects on academic achieve-
ment, participation and well-being [1,2]. While motor diffi-
culties are observed by parents and teachers from an early age,
they are not explained by known medical conditions such as
brain injury, muscular dystrophy and so on [3]. However, the
latest DSM-V now categorises DCD as a neurodevelopmental
disorder which opens up further debate on its causal roots.
While DCD continues to attract significant research, our ex-
planatory models of DCD have not developed in synchrony.
We see several hypotheses about the underlying basis of the
motor issues, but it is fair to say that a unifying account of
DCD has been elusive. In Kuhnian terms, it cannot be said that
new methods from cognitive neuroscience have seen a full
paradigm shift [4]; rather, a tension still exists between neuro-
science and ecological approaches (see Wade and Kazeck
2017 [5•]; Wilson et al. 2017). This paper is designed to
This article is part of the Topical Collection on DisordersofMotor
*Peter H. Wilson
peterh.wilson@acu.edu.au
1
School of Psychology, Australian Catholic University (ACU),
Melbourne, Australia
2
Centre for Disability and Development Research (CeDDR) | Faculty
of Health Sciences, Australian Catholic University (ACU), 115
Victoria Parade, Melbourne, VIC 3450, Australia
3
University of Cape Town, Cape Town, South Africa
4
Behavioural Science Institute, Radboud University,
Nijmegen, The Netherlands
Curr Dev Disord Rep (2017) 4:64–71
DOI 10.1007/s40474-017-0115-0
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Evidence-based activity-and participation oriented interventions (Smits-Engelsman et al., 2018), such as Neuromotor Task Training (NTT) or Cognitive Orientation to daily Occupational Performance (CO-OP), are underpinned by theories of motor learning and motor control (Blank et al., 2019;Missiuna et al., 2001;Schoemaker et al., 2003). Both approaches are child-centered, and based on the theoretical foundation that motor performance is the result of interactions between characteristics of child, task, and environment as described by the Dynamic Systems Theory (Kamm et al., 1990;Missiuna et al., 2001;Schoemaker et al., 2003;Thelen, 2005;Wilson et al., 2017). Furthermore, motor learning strategies derived from motor learning research are addressed to enhance motor performance by manipulating the interaction of child, task and environment (Levac et al., 2009;Missiuna et al., 2001;Schoemaker et al., 2003). ...
... The selection process focused on segments that provided rich data or showed unique elements of motor learning. Because instructions and feedback are adapted to the child and task (Kleynen et al., 2016;MacWilliam et al., 2021;Wilson et al., 2017), and are shaped differently depending on the type of motor learning (Kleynen et al., 2015), it was important to select segments with different tasks and labels. In Phase 2, Step 4, all observable actions of the therapist that might enhance the motor learning process of the child in the selected segments were coded, using an inductive strategy. ...
... Furthermore, it was observed that therapists changed the focus of attention and/or modality when the child encountered complex challenges in performing a task. These findings support previous research showing that characteristics of the individual and of the task influence therapists' use of motor learning strategies (Kleynen et al., 2015;MacWilliam et al., 2021), which is considered important in interventions with children with DCD (Wilson et al., 2017). ...
Therapists' Use of Instructions and Feedback in Motor Learning Interventions in Children with Developmental Coordination Disorder: A Video Observation Study
Article
Aim: This qualitative study explored therapists' use of instructions and feedback when teaching motor tasks to children with developmental coordination disorder (DCD) as a first step in developing practical recommendations. Methods: A conventional content analysis approach was used to analyze videotaped treatment sessions of physical therapists using a newly developed analysis plan. Inductive coding was used to code purposively selected video segments. The codes were sorted into categories to identify key themes. Analyses were performed independently by two researchers until data saturation was reached. Results: Ten video-taped sessions were analyzed and 61 segments were coded. Three key themes were identified: (1) therapists' intention with the instructions and feedback was to motivate or to provide information; (2) the preferred therapists' teaching style was either direct or indirect; and (3) parameters to shape specific instructions and feedback were the focus of attention, modality, information content, timing and frequency. Conclusion: Therapists used numerous instructions and feedback with different information content, often shaped by multiple focuses and/or modalities to motivate children or to provide specific information about task performance. Although therapists adapted instructions and feedback to child and task, future research should explore how characteristics of child and task can guide therapists' clinical decision-making.
View
... Kinder mit Entwicklungskoordinationsstö rungen Die Prävalenz dieser Entwicklungsstörung beträgt bei Kindern im Alter von 5-11 Jahren ca. 5-6 %, wobei die Schätzungen je nach Messinstrumenten und Grenzwerten von 1,8 % für schwere Fälle bis zu Kindern mit höherem Risiko um 4 % variieren (Wilson et al. 2017a). Jungen zeigen tendenziell eine höhere Prävalenz, die je nach Tests und Kriterien zwischen 2,1 % und 7,1 % liegt (Lingam et al. 2009). ...
... B. die Aktivitäten verschiedener Effektoren koordiniert werden. So werden beispielsweise bei der Generierung eines internen Vorwärtsmodells sensorische Informationen aus der Umgebung genutzt, um den Ausgang von Bewegungen vorherzusagen und bei Bedarf Abb. 5 Mehrkomponenten-Constraints-Modell der Entwicklung der motorischen Fertigkeiten bei Personen mit DCD (MNS: Spiegelneuronensystem; IMD: internal mo-delling deficit hypothesis; WMN: Vernetzung der weißen Hirnsubstanz; EF: exekutive Funktionen; modifiziert nach Wilson et al. 2017a) schnelle Korrekturen dieser Bewegungen zu ermöglichen, z. B. in einer Situation, in der die Hand eines Individuums sich bewegt, um einen Ball zu fangen, der Ball jedoch aufspringt und seine Flugbahn schnell ändert. ...
... Die Forschung zu den meisten Aspekten der DCD hat zugenommen, aber es gibt Hinweise darauf, dass die motorische Koordination, der Kern der Störung, nicht im gleichen Maße untersucht wurde wie andere Aspekte. Beispielsweise untersuchen viele Studien die kognitiven Aspekte dieser Entwicklungsstörung, wie die Studien über die exekutiven Funktionen und andere interne Mechanismen zeigen Wilson et al. 2017a Die zugrunde liegenden theoretischen Erklärungen der motorischen Entwicklung sind aber für alle Personen gleich, unabhängig von Alter, Geschlecht oder Entwicklungseinschränkungen bzw. -störungen. ...
Motorische Entwicklung über die Lebensspanne
Chapter
  • Mar 2023
Der erste Teil dieses Beitrages zur motorischen Entwicklung über die Lebensspanne ist der Darstellung von zentralen Begriffen, Theorien, Konzepten und wichtigen historischen Aspekten gewidmet, gefolgt von der Darstellung der Entwicklung der zentralnervösen, sensorischen und motorischen Systeme. Daran schließt sich die Beschreibung ausgewählter lokomotorischer, ballistischer und manipulativer Fertigkeiten an. Die Entwicklung aus der Perspektive einer motorisch-kognitiven Interaktion wird anhand von Forschungsarbeiten dargestellt, die einerseits Studien zum Einfluss von körperlicher Aktivität auf die kognitive Leistungsfähigkeit umfassen und anderseits das Feld „Embodied Cognition“ berücksichtigen. Anstatt die motorische Entwicklung durch kognitive Prozesse zu erklären, wird aus dieser Perspektive die motorische Entwicklung als treibende Kraft und mit untermauerndem Einfluss auf die Entwicklung der kognitiven Prozesse verstanden. Der Einfluss der motorische Entwicklung auf andere Entwicklungsbereiche, wie z. B. soziale und kognitive Fähigkeiten wird zunehmend auch bei Kindern, die sich atypisch entwickeln, in den Fokus genommen. Diese motorischen (und auch kognitiven Defizite) werden am Beispiel der umschriebenen Entwicklungskoordinationsstörung (Developmental Coordination Disorder) dargestellt. Dieser Beitrag ist Teil der Sektion Sportmotorik, herausgegeben von den Teilherausgebern Alfred Effenberg und Gerd Schmitz, innerhalb des Handbuchs Sport und Sportwissenschaft, herausgegeben von Arne Güllich und Michael Krüger.
View
... Accumulating research highlights the psychological effects of DCD symptoms still remain unclear (e.g., Zwicker et al., 2018;Kirby et al., 2013;Tal Saban & Kirby, 2018). Yet, psychological and other aspects of DCD, such as the presence of executive functioning deficits (e.g., Tal Saban et al., 2014;Purcell et al., 2015;Licari et al., 2015;Wilson et al., 2017;Zwicker et al., 2018;Bernardi et al., 2018;Sartori et al., 2020). Furthermore, there is a lack of established gold standard diagnostic procedure for adults with DCD despite increasing evidence that motor symptoms and psychosocial consequences continue into adulthood in most cases (Kirby et al., 2011;Tal Saban & Kirby, 2018;Purcell et al., 2015). ...
... Notably, research in the last decade has provided increasing evidence that symptoms of DCD extend beyond motor coordination. More specifically, impaired executive functions (i.e., inhibition, cognitive control, working memory, and related processes such as attention) can be recognized as a prominent feature of DCD (Bernardi et al., 2018;Leonard & Hill, 2015;Tal Saban et al., 2014;Purcell et al., 2015;Licari et al., 2015;Wilson et al., 2017;Zwicker et al., 2018;Bernardi et al., 2018;Sartori et al., 2020). However, neither the DSM-5 nor the ICD-11 consider these as potential symptoms of DCD (Purcell et al., 2015; see Table 1). ...
... However, neither the DSM-5 nor the ICD-11 consider these as potential symptoms of DCD (Purcell et al., 2015; see Table 1). Furthermore, the specific symptom profiles and the extent to which executive function impairments in DCD can be attributed to comorbid conditions (e.g., attention and inhibition difficulties typical to ADHD) remains unclear (Wilson et al., 2017;Blank et al., 2019). ...
Developmental Coordination Disorder (DCD): Relevance for Clinical Psychologists in Europe
Preprint
Full-text available
  • Feb 2022
**Advanced Author Manuscript available on PsychArchives. For upcoming publication in Clinical Psychology in Europe** Background: Developmental Coordination Disorder (DCD) is a common neurodevelopmental disorder primarily characterized by fine and gross motor coordination difficulties. Yet, many aspects remain unclear regarding the clinical presentation of secondary symptoms and their implications for Clinical Psychology. Therefore, the purpose of this review is to provide an update about the current understanding of DCD for clinical psychologists and psychotherapists across Europe, particularly based on new insights stemming from the last decade of research. Method: We provide a narrative review of articles published in the last decade on the topic of DCD, and relevant aspects to clinical psychologist, including lesser known aspects of DCD (e.g., executive functions, psychological consequences, and adult DCD). Results: DCD is a highly prevalent, disruptive, and complex disorder, which should be investigated further in many areas (e.g., comorbidity to ADHD). Existing evidence points toward a key role of executive functioning difficulties at all ages. Most patients report secondary psychological problems, but little headway has been made in examining the effectiveness of psychotherapy for DCD. Conclusions: Insights and remaining research gaps are discussed. It is critical for psychologists and clinical researchers to raise awareness for DCD, take note of the growing literature, and foster continued interdisciplinary approaches to research and treatment of DCD.
View
... Based on this body of research, a (hybrid) multicomponent ecological systems theory model of performance and advancements in cognitive neuroscience will be developed. The three essential components of the paradigm are based on systems theory, and motor performance is judged by the interplay of person, task, and environmental constraints [6]. Individually, there is an interaction set of restrictions that skew our reaction capacities at every particular stage of development [7]. ...
Handwriting Evaluation in School-Aged Children With Developmental Coordination Disorder: A Literature Review
Article
Full-text available
  • Mar 2023
Despite widespread computer use, legible handwriting remains an important common life skill that requires more attention from schools and health professionals. Importantly, instructors and parents typically attribute the difficulties to laziness or a lack of effort, causing the youngster anger and disappointment. Handwriting issues are a public health concern in terms of both prevalence and consequences. Writing is a tough and diverse activity that requires cognitive, perceptual-motor, mental, and emotional talents. It is largely a motor process involving an effective level of motor organization that results in exact movement synchronization. Handwriting problems have been connected to developmental disorders such as developmental coordination disorder. For the affected youngsters, forming letters takes more work, and the kid may forget what he or she planned to write. School children's primary handwriting issues include illegible writing, slow handwriting, and strained writing. Handwriting problems may lead to scholastic underachievement and low self-esteem. Because of this complication, some school-aged children develop handwriting difficulties, which cause psychological distress and learning impairments. In the treatment of children with bad handwriting, the therapeutic intervention has been demonstrated to be successful. We aimed to determine how efficient tools and scales are which assess handwriting in school-aged children having developmental coordination disorder. Keyword searches were conducted on Google Scholar and PubMed, yielding 45 results, eight of which met the inclusion requirements. We concluded that there are a lot of scales and tools to date but no scale focuses on the temporal and spatial parameters for handwriting evaluation.
View
... Contemporary literature conceptualises DCD as a motor learning disorder, which suggests that motor learning theory and ecological models would provide more appropriate guidance for practitioners working with these children (Wilson et al., 2017). The past dominance of sensory integration and neurodevelopmental treatments in DCD has likely contributed to the under-use of motor learning theories in current practice (Zwicker & Harris, 2009). ...
Assessing children to identify developmental coordination disorder: A survey of occupational therapists in Australia
Article
  • Feb 2023
Background: Developmental coordination disorder (DCD), a prevalent neurodevelopmental disorder with motor and psychosocial consequences, can significantly impact children's quality of life. In Australia, most children with diagnosed/suspected DCD have received occupational therapy services, more so than any other health service. As such, occupational therapists are key in identification and treatment and require a sound knowledge of diagnostic criteria and the best evidence for practice. This study explored current occupational therapy services for children with DCD. Areas for development are identified to improve the identification of, and subsequent intervention for, children with DCD. Methods: In this cross-sectional study, an online survey was completed in September and October 2020 by 175 occupational therapists working in Australia. Results: Although all therapists worked with children who met the criteria for DCD diagnosis, 70% worked with children with no specific diagnosis and 50% worked with children with outdated diagnostic labels. Australian occupational therapists used similar models/frameworks (commonly a multisensory/sensory processing approach) to guide practice with children with DCD, regardless of therapist characteristics, practice setting (clinic/community, rural/urban), how therapy is funded, or the state where the therapists completed their training/currently practiced. Although assessment practices did not differ significantly, therapists with greater years of paediatric practice and those who studied and/or practiced in Western Australia were more likely to assess to identify DCD. Half of the therapists did not assess to identify DCD; however, 60% of assessing therapists reported best practice methods in assessment for DCD, indicating emerging best practices in the Australian context. Conclusion: The findings from this study suggest that small adaptations to current occupational therapy practice may enhance the early identification of children with DCD in Australia. The existing gaps in evidence to practice must be addressed to improve current Australian practice and increase access to appropriate services and ultimately improve the quality of life for children with DCD.
View
... However, it is also important to consider the impact that anxiety itself might have on movement. The constraints-based approach to understanding motor control can be helpful in describing and understanding motor control in DCD [2,15,16]. It posits that any emerging movement is constrained by the individual, the task and the environment [17]. ...
Moving With Confidence: How Does Anxiety Impede Performance in Individuals With Developmental Coordination Disorder (DCD)?
Article
Full-text available
  • Sep 2022
Purpose of Review It is well-established that anxiety levels are higher among people with developmental coordination disorder (DCD) compared to their peers. However, it is unclear whether this anxiety influences movement and behaviour. The purpose of this paper is to review studies demonstrating the influence of anxiety on movement and/or behaviour in non-DCD and DCD populations. Recent Findings When considering non-DCD literature, many studies have illustrated the influence of anxiety on movement. Only two papers were found which explicitly aimed to consider the influence of anxiety on movement in a DCD population. These findings are described and explored against a backdrop of the wider research field. Summary This paper has highlighted the potential role of anxiety in constraining movement patterns in DCD. While a great deal more evidence is needed before definitive conclusions, there is emerging evidence that motor behaviour may be related to task-specific anxiety in children with DCD.
View
... While there appears to be no single causal agent in the etiology of DCD, a variety of factors has been implicated in earlier research and highlighted in the most recent international consensus reviews of the DCD literature. Those factors identified include deficits in predictive motor control and skill automaticity (aka internal modeling deficit hypothesis-IMD) (Tsai et al., 2009;Wilson et al., 2013Wilson et al., , 2017aAdams et al., 2014), perceptualmotor coupling, executive function, atypical neural structure and function in networks that support motor planning and imitation, including the mirror neuron system (MNS) (Brown-Lum and Zwicker, 2015;Biotteau et al., 2016), and atypical interhemispheric communication (Sigmundsson et al., 1999;Tallet et al., 2013). More specifically, the IMD account of DCD posits a core deficit in the ability to implement predictive models of action, which impacts the online adjustment of movements in response to external perturbations and impairs movement automatization Adams et al., 2014). ...
Foot strike determines the center of pressure behavior and affects impact severity in heel-toe running
Article
Full-text available
This study assessed the centre of pressure (COP) behaviour and the relationship with impact severity during heel-toe running in conventional athletic footwear. We hypothesized that the COP behaviour depends on its location at foot strike, which would be associated with the vertical loading rate and peak tibial accelerations in heel-toe running. Ground reaction force and tibial acceleration were measured in 104 distance runners running level at ~3.2 m/s. High-speed plantar pressure captured at high temporal resolution (500 Hz) and spatial resolution (7.62 · 5.08 mm/sensor) allowed for localization of the COP directly in the footprint during running in self-selected athletic footwear. More lateral X-coordinates of the COP at first foot contact had, in general, more anterior Y-coordinates (adj.R2 = 0.609). In heel-toe running, a more anterior foot strike had a greater refined strike index, which was associated with a quicker roll-over in the rearfoot zone. This strike index contributed to greater maximum vertical loading rates (R2 = 0.121), and greater axial (R2 = 0.047) and resultant (R2 = 0.247) peak tibial accelerations. These findings indicate that (1) the COP progression is dependend on the COP location at foot strike; (2) more anterior rearfoot strikes are more likely to have greater impact severity than posterior rearfoot strikes.
View
... While there appears to be no single causal agent in the etiology of DCD, a variety of factors has been implicated in earlier research and highlighted in the most recent international consensus reviews of the DCD literature. Those factors identified include deficits in predictive motor control and skill automaticity (aka internal modeling deficit hypothesis-IMD) (Tsai et al., 2009;Wilson et al., 2013Wilson et al., , 2017aAdams et al., 2014), perceptualmotor coupling, executive function, atypical neural structure and function in networks that support motor planning and imitation, including the mirror neuron system (MNS) (Brown-Lum and Zwicker, 2015;Biotteau et al., 2016), and atypical interhemispheric communication (Sigmundsson et al., 1999;Tallet et al., 2013). More specifically, the IMD account of DCD posits a core deficit in the ability to implement predictive models of action, which impacts the online adjustment of movements in response to external perturbations and impairs movement automatization Adams et al., 2014). ...
Behavioral and Neuroimaging Research on Developmental Coordination Disorder (DCD): A Combined Systematic Review and Meta-Analysis of Recent Findings
Article
Full-text available
  • Jan 2022
Aim The neurocognitive basis of Developmental Coordination Disorder (DCD; or motor clumsiness) remains an issue of continued debate. This combined systematic review and meta-analysis provides a synthesis of recent experimental studies on the motor control, cognitive, and neural underpinnings of DCD. Methods The review included all published work conducted since September 2016 and up to April 2021. One-hundred papers with a DCD-Control comparison were included, with 1,374 effect sizes entered into a multi-level meta-analysis. Results The most profound deficits were shown in: voluntary gaze control during movement; cognitive-motor integration; practice-/context-dependent motor learning; internal modeling; more variable movement kinematics/kinetics; larger safety margins when locomoting, and atypical neural structure and function across sensori-motor and prefrontal regions. Interpretation Taken together, these results on DCD suggest fundamental deficits in visual-motor mapping and cognitive-motor integration, and abnormal maturation of motor networks, but also areas of pragmatic compensation for motor control deficits. Implications for current theory, future research, and evidence-based practice are discussed. Systematic Review Registration PROSPERO, identifier: CRD42020185444.
View
Experts' perspectives on how to promote implicit and explicit motor learning in children: A mixed-methods study
Article
Background: Little is known about how motor learning strategies (MLSs) can promote implicit and explicit motor learning processes. This study aimed to explore experts' perspectives on therapists' use of MLSs to promote specific learning processes in children with and without developmental coordination disorder (DCD). Methods: In this mixed-methods study, two consecutive digital questionnaires were used to ascertain the opinions of international experts. Questionnaire 2 explored the findings of Questionnaire 1 in greater depth. In order to reach a certain level of agreement about the classification of MLSs as promoting either (more) implicit or (more) explicit motor learning, 5-point Likert scales were used in addition to open-ended questions. The open-ended questions were analysed with a conventional analysis approach. Open coding was performed by two reviewers independently. Categories and themes were discussed within the research team, taking both questionnaires as one dataset. Results: Twenty-nine experts from nine different countries with different backgrounds in research, education and/or clinical care completed the questionnaires. The results of the Likert scales showed large variation. Two themes emerged from the qualitative analyses: (1) Experts found it difficult to classify MLSs as promoting either implicit or explicit motor learning, and (2) experts stressed the need for clinical decisionmaking when choosing MLSs. Conclusions: Insufficient insight was gained into how MLSs could promote (more) implicit or (more) explicit motor learning in children in general and in children with DCD specifically. But this study demonstrated the importance of clinical decisionmaking to model and adapt MLSs to child, task and environment, with therapists' knowledge of MLSs being an important prerequisite. Research is needed to better understand the various learning mechanisms of children and how MLSs can be used to manipulate these mechanisms.
View
Fine motor skill automatization and working memory in children with and without potential fine motor impairments: An explorative study
Article
Aims The present study explored fine motor skill automatization and working memory in kindergarten children with and without potential fine motor impairments. For both groups, lower performance was expected in a cognitive-motor dual-task compared to single-tasks. Children with potential fine motor impairments were expected to show higher dual-task costs (indicating lower automatization) and lower working memory performance compared to children without potential fine motor impairments. Methods The sample included 18 kindergarten children (mean age M = 67.17 months, SD = 4.34 months) with potential fine motor impairments (scoring at or below the 9th percentile of the manual dexterity scale of the Movement ABC-2; Petermann, 2011) and 36 children scoring above the 9th percentile of the manual dexterity scale of the Movement ABC-2 (mean age M = 67.56 months; SD = 3.74). All children completed a fine motor task (trail drawing) and a working memory task (digit span backwards) in single- and dual-task conditions. Results Results showed an overall lower cognitive but not fine motor performance in the dual-task condition compared to the single-task condition. Overall, the group scoring above the 9th percentile showed a lower error-to-length ratio and higher working memory performance than the group with potential fine motor impairments. The dual-task costs did not differ between the groups. Conclusions Although the potential fine motor impaired children did not show an automatization deficit, they might be at risk of academic problems due to their lower fine motor and working memory performance. Implications for school and interventions are discussed.
View
Cognitive and neuroimaging findings in Developmental Coordination Disorder: New insights from a systematic review of recent research
Article
Full-text available
Aim: To better understand the neural and performance factors that may underlie developmental coordination disorder (DCD), and implications for a multi-component account. Method: A systematic review of the experimental literature published between June 2011 and September 2016 was conducted using a modified PICOS (population, intervention, comparison, outcomes, and study type) framework. A total of 106 studies were included. Results: Behavioural data from 91 studies showed a broad cluster of deficits in the anticipatory control of movement, basic processes of motor learning, and cognitive control. Importantly, however, performance issues in DCD were often shown to be moderated by task type and difficulty. As well, we saw new evidence of compensatory processes and strategies in several studies. Neuroimaging data (15 studies, including electroencephalography) showed reduced cortical thickness in the right medial orbitofrontal cortex and altered brain activation patterns across functional networks involving prefrontal, parietal, and cerebellar regions in children with DCD than those in comparison groups. Data from diffusion-weighted magnetic resonance imaging suggested reduced white matter organization involving sensorimotor structures and altered structural connectivity across the whole brain network. Interpretation: Taken together, results support the hypothesis that children with DCD show differences in brain structure and function compared with typically developing children. Behaviourally, these differences may affect anticipatory planning and reduce automatization of movement skill, prompting greater reliance on slower feedback-based control and compensatory strategies. Implications for future research, theory development, and clinical practice are discussed.
View
Executive Functions, Time Organization and Quality of Life among Adults with Learning Disabilities
Article
Full-text available
Purpose This study compared the executive functions, organization in time and perceived quality of life (QoL) of 55 adults with learning disabilities (LD) with those of 55 matched controls (mean age 30 years). Furthermore, relationships and predictive relationships between these variables among the group with LD were examined. Methods All participants completed the Behavioral Rating Inventory of Executive Functions (BRIEF-A), the Time Organization and Participation (TOPS, A-C) and the World Health Organization Quality of Life (WHOQOL) questionnaires. Chi-square tests, independent t-tests and MANOVA were used to examine group differences in each of the subscales scores and ratings of each instrument. Pearson correlations and regression predictive models were used to examine the relationships between the variables in the group with LD. Results Adults with LD had significantly poorer executive functions (BRIEF-A), deficient organization in time abilities (TOPS A-B), accompanied with negative emotional response (TOPS- C), and lower perceived QoL (physical, psychological, social and environmental) in comparison to adults without LD. Regression analysis revealed that Initiation (BRIEF-A) significantly predicted approximately 15% of the participants' organization in time abilities (TOPS A, B scores) beyond group membership. Furthermore, initiation, emotional control (BRIEF-A subscales) and emotional responses following unsuccessful organization of time (TOPS-C) together accounted for 39% of the variance of psychological QoL beyond the contribution of group membership. Conclusions Deficits in initiation and emotional executive functions as well as organization in time abilities and emotional responses to impairments in organizing time affect the QoL of adults with LD and thus should be considered in further research as well as in clinical applications.
View
Integrating New Technologies into the Treatment of CP and DCD
Article
Full-text available
  • Jun 2016
This paper examines how current understandings of childhood participation and motor development provide opportunities for using new technologies (such as virtual reality—VR) for children with neurodevelopmental disorders. Specifically, the International Classification of Functioning, Disability and Health is used to conceptualize the role of technology in treatment across body structures and body function, activity performance, and participation (WHO 2007, 2012). First, we review the particular motor control and learning mechanisms that have been implicated in children with atypical motor development, like DCD. This section will highlight avenues for targeted remediation. Next, VR-based rehabilitation systems are reviewed in relation to neurodevelopmental disorders, focusing first on CP and second on more recent applications for children with DCD. We describe the evolution of particular design innovations in virtual rehabilitation including recent advances using tangible interfaces, as well as other methods targeting cognitive function more specifically. Benefits of these various treatments will be viewed through the lens of current theory and evaluated at the level of child and family outcomes. Finally, we consider the broader aspects of the potential for technological innovation in rehabilitation and its impact on brain function, activity competence, and longer-term participation.
View
View
Genome-wide association study of motor coordination problems in ADHD identifies genes for brain and muscle function
Article
  • Apr 2011
Objectives. Motor coordination problems are frequent in children with attention deficit/hyperactivity disorder (ADHD). We performed a genome-wide association study to identify genes contributing to motor coordination problems, hypothesizing that the presence of such problems in children with ADHD may identify a sample of reduced genetic heterogeneity. Methods. Children with ADHD from the International Multicentre ADHD Genetic (IMAGE) study were evaluated with the Parental Account of Children's Symptoms. Genetic association testing was performed in PLINK on 890 probands with genome-wide genotyping data. Bioinformatics enrichment-analysis was performed on highly ranked findings. Further characterization of the findings was conducted in 313 Dutch IMAGE children using the Developmental Coordination Disorder Questionnaire (DCD-Q). Results. Although none of the findings reached genome-wide significance, bioinformatics analysis of the top-ranked findings revealed enrichment of genes for motor neuropathy and amyotrophic lateral sclerosis. Genes involved in neurite outgrowth and muscle function were also enriched. Among the highest ranked genes were MAP2K5, involved in restless legs syndrome, and CHD6, causing motor coordination problems in mice. Further characterization of these findings using DCD-Q subscales found nominal association for 15 SNPs. Conclusions. Our findings provide clues about the aetiology of motor coordination problems, but replication studies in independent samples are necessary.
View
Developmental coordination disorder and its cause: The road less travelled
Article
  • Nov 2016
We critically review the research literature that seeks to focus on the possible cause of children diagnosed with developmental coordination disorder (DCD). In so doing we contrast the traditional information processing (IP) approach as a model to explain the causal factors that account for the motor deficits present in children with DCD, with a dynamical systems (DS) account which argues that coordination deficits in children with DCD is less to do with problems of poor internal models (a cornerstone of IP theory) and more with a degrading of perception-action coupling. We review and comment on the extant empirical data and conclusions of both approaches. We conclude that the data for an IP explanation is weak and a reconsideration of DCD is in order with respect to the underlying cause of this issue.
View
View
Copy-number variations are enriched for neurodevelopmental genes in children with developmental coordination disorder
Article
  • Aug 2016
Background Developmental coordination disorder is a common neurodevelopment disorder that frequently co-occurs with other neurodevelopmental disorders including attention-deficit hyperactivity disorder (ADHD). Copy-number variations (CNVs) have been implicated in a number of neurodevelopmental and psychiatric disorders; however, the proportion of heritability in developmental coordination disorder (DCD) attributed to CNVs has not been explored. Objective This study aims to investigate how CNVs may contribute to the genetic architecture of DCD. Methods CNV analysis was performed on 82 extensively phenotyped Canadian children with DCD, with or without co-occurring ADHD and/or reading disorder, and 2988 healthy European controls using identical genome-wide SNP microarrays and CNV calling algorithms. Results An increased rate of large and rare genic CNVs (p=0.009) was detected, and there was an enrichment of duplications spanning brain-expressed genes (p=0.039) and genes previously implicated in other neurodevelopmental disorders (p=0.043). Genes and loci of particular interest in this group included: GAP43, RBFOX1, PTPRN2, SHANK3, 16p11.2 and distal 22q11.2. Although no recurrent CNVs were identified, 26% of DCD cases, where sample availability permitted segregation analysis, were found to have a de novo rare CNV. Of the inherited CNVs, 64% were from a parent who also had a neurodevelopmental disorder. Conclusions These findings suggest that there may be shared susceptibility genes for DCD and other neurodevelopmental disorders and highlight the need for thorough phenotyping when investigating the genetics of neurodevelopmental disorders. Furthermore, these data provide compelling evidence supporting a genetic basis for DCD, and further implicate rare CNVs in the aetiology of neurodevelopmental disorders.
View
Motor imagery difficulties in children with Cerebral Palsy: A specific or general deficit?
Article
  • Jul 2016
Aim: The aim of this study was to examine the specificity of motor imagery (MI) difficulties in children with CP. Method: Performance of 22 children with CP was compared to a gender and age matched control group. MI ability was measured with the Hand Laterality Judgment (HLJ) task, examining specifically the direction of rotation (DOR) effect, and the Praxis Imagery Questionnaire (PIQ). Results: In the back view condition of the HLJ task both groups used MI, as evidenced by longer response times for lateral compared with medial rotational angles. In the palm view condition children with CP did not show an effect of DOR, unlike controls. Error scores did not differ between groups. Both groups performed well on the PIQ, with no significant difference between them in response pattern. Conclusion and implication: The present study suggests that children with CP show deficits on tasks that trigger implicit use of MI, whereas explicit MI ability was relatively preserved, as assessed using the PIQ. These results suggest that employing more explicit methods of MI training may well be more suitable for children with CP in rehabilitation of motor function.
View
Neural signature of developmental coordination disorder in the structural connectome independent of comorbid autism
Article
Children with autism spectrum disorders (ASD) often exhibit motor clumsiness (Developmental Coordination Disorder, DCD), i.e. they struggle with everyday tasks that require motor coordination like dressing, self-care, and participating in sport and leisure activities. Previous studies in these neurodevelopmental disorders have demonstrated functional abnormalities and alterations of white matter microstructural integrity in specific brain regions. These findings suggest that the global organization of brain networks is affected in DCD and ASD and support the hypothesis of a 'dys-connectivity syndrome' from a network perspective. No studies have compared the structural covariance networks between ASD and DCD in order to look for the signature of DCD independent of comorbid autism. Here, we aimed to address the question of whether abnormal connectivity in DCD overlaps that seen in autism or comorbid DCD-autism. Using graph theoretical analysis, we investigated differences in global and regional topological properties of structural brain networks in 53 children: 8 ASD children with DCD (DCD+ASD), 15 ASD children without DCD (ASD), 11 with DCD only, and 19 typically developing (TD) children. We constructed separate structural correlation networks based on cortical thickness derived from Freesurfer. The children were assessed on the Movement-ABC and the Beery Test of Visual Motor Integration. Behavioral results demonstrated that the DCD group and DCD+ASD group scored on average poorer than the TD and ASD groups on various motor measures. Furthermore, although the brain networks of all groups exhibited small-world properties, the topological architecture of the networks was significantly altered in children with ASD compared with DCD and TD. ASD children showed increased normalized path length and higher values of clustering coefficient. Also, paralimbic regions exhibited nodal clustering coefficient alterations in singular disorders. These changes were disorder-specific, and included alterations in clustering coefficient in the isthmus of the right cingulate gyrus and the pars orbitalis of the right inferior frontal gyrus in ASD children, and DCD-related increases in the lateral orbitofrontal cortex. Children meeting criteria for both DCD and ASD exhibited topological changes that were more widespread from those seen in children with only DCD, i.e. children with DCD+ASD showed alterations of clustering coefficient in (para)limbic regions, primary areas, and association areas. The DCD+ASD group showed changes in clustering coefficient in the left association cortex relative to the ASD group. Finally, the DCD+ASD group shared ASD-specific abnormalities in the pars orbitalis of right inferior frontal gyrus, which was hypothesized to reflect atypical emotional-cognitive processing. Our results provide evidence that DCD and ASD are neurodevelopmental disorders with a low degree of overlap in abnormalities in connectivity. The co-occurrence of DCD+ASD was also associated with a distinct topological pattern, highlighting the unique neural signature of comorbid neurodevelopmental disorders.
View