A pilot trial of a cognitive treatment for children with developmental coordination disorder

This pilot study compared a new treatment approach, the Cognitive Orientation to daily Occupational Performance (CO-OP) to the Contemporary Treatment Approach (CTA) to treating children with Developmental Coordination Disorder (DCD). CO-OP emphasises problem-solving strategies and guided discovery of child and task specific strategies. CTA encompasses a variety of approaches, such as neuromuscular, multi-sensory, and biomechanical, focusing on motor aspects of skill acquisition. Twenty children with a mean age of 9.05 years (S.D. = 1.23) participated in the study. All children had normal intelligence, scored below the 15th percentile on a standardised test of motor ability, and demonstrated motor difficulties significant enough to warrant referral for treatment. Pre- and post-measures included the Canadian Occupational Performance Measure (COPM), the Vineland Adaptive Behavior Scales (VABS), the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), the Developmental Test of Visual-Motor Integration-Revised (VMI), the motor items of the Self-Perception Profile for Children (SPPC), and the Performance Quality Rating Scale (PQRS). In both groups, treatment goals were child-chosen. Both treatments lead to improved COPM self-ratings of performance and satisfaction; however, improvements in the CO-OP group were greater than those in the CTA group. These results were paralleled by PQRS scores, and the Motor scores on the VABS, but not on the BOTMP measures. This outcome still needs replication as no control group was involved and because of the occurrence of pre-treatment differences between the CO-OP and CTA groups on relevant measures. Follow-up data indicated that children who received CO-OP tended to experience greater long-term maintenance of their motor goals and acquired strategies; follow-up parent-report rated CO-OP treatment as more useful than CTA treatment. Self-report, observer report, standardised assessment, and follow-up all demonstrated the effectiveness of the CO-OP approach, supporting the use of CO-OP and suggesting further investigation of this new cognitive intervention.     

Motor skill learning in children with and without Developmental Coordination Disorder

ObjectiveThe question whether children with DCD have motor learning deficits is difficult to answer based on the current body of knowledge. The aim of this study was to examine the impact of practice on motor skill acquisition, retention and transfer in children with and without DCD using a variety of games in a virtual environment.MethodPerformance on a criterion task (Wii ski game) and MABC-2 balance subscore was compared between children with DCD (n = 33) and TD children (n = 28) following 10 weeks of playing active video games. Repeated measures ANOVA was used to compare changes in the two groups.ResultsThe children with DCD demonstrated lower performance on the criterion task than the TD group (p = 0.031). A time by group interaction indicated that the difference in performance on the criterion task became larger over time (p = 0.039). No differences were found in retention between groups. Large improvement (Cohen d 1.11) was observed for the children with DCD on the MABC-2 balance subscore.ConclusionBased on the criterion task results, typically developing children seem more proficient in learning new skills compared to children with DCD. More research is needed to confirm that children with DCD have a problem to transfer skills to other contexts.     

End-state comfort planning after explicit goal instructions in children with and without probable developmental coordination disorder

BackgroundWhen completing grip-selection tasks, healthy adults generally plan for the most comfortable end-posture which is termed the end-state comfort (ESC) effect. Children with and without developmental coordination disorder (DCD) are less likely to plan for ESC which begs the question as to whether they are not able to perform this type of planning or whether they prioritize other aspects of the task.Aims(1) Examine if children with and without probable DCD (pDCD) are able to plan for ESC if they are explicitly instructed to and (2) if this transfers to another similar task. (3) Examine if children with and without pDCD perceive the level of comfort of the grips that they use differently and if this relates to ESC planning.MethodsTwelve children with and 12 children without probable DCD (pDCD) (aged 5–9 years) received a 10-min training session in which children were explicitly instructed to end their movement in ESC, after which they formulated their own plan to reach this goal. The study consisted of a pre-post-test design in which changes in the proportion of ESC were analyzed on the task that was trained as well as on an untrained transfer-task. Furthermore, the perceived level of comfort was examined.ResultsBoth groups of children showed a higher proportion of ESC on the post-test compared with the pre-test, on the task that was trained as well as on the transfer-task. There were no group differences regarding the perceived level of comfort of the different grip postures.ConclusionThe majority of the children with and without pDCD seems to be able to adjust their planning strategy and prioritize ESC if they are explicitly instructed to.     

Gaze behaviour during walking in young adults with developmental coordination disorder

BackgroundIndividuals with Developmental Coordination Disorder (DCD) experience difficulty with motor coordination and this affects their daily functioning. Research indicated inferior visuospatial processing and oculomotor control in DCD. As visual information is essential for locomotor control, more insight in the gaze behaviour of this population during walking is required and crucial for gaze training interventions as a possible means to improve daily functioning of children and adults with DCD.AimThis study explored differences and similarities in gaze behaviour during walking between typically developing young adults and those with DCD.Methods and proceduresTen young adults with DCD (age: 22.13 ± 0.64) and ten typically developing individuals (age: 22.00 ± 1.05) completed a walking task in which they had to place their feet on irregularly placed targets wearing eye tracking glasses.Outcomes and resultsIndividuals with DCD walked slower and demonstrated a different gaze strategy compared to their neurotypical peers as they fixated almost each and every target sequentially. Typically developing individuals, on the other hand, directed gaze further along the path and often fixated areas around the targets.Conclusions and implicationsDespite adequate walking performance in daily situations in young adults with DCD, fundamental control deficits persist into adulthood.What this paper adds?This paper is the first to demonstrate differences in gaze behaviour between young adults with DCD and typically developing individuals in a task that resembles a task of daily living, as previous research focused on laboratory tasks. This is a valuable finding as DCD has a clear impact on the daily life. Furthermore, this study demonstrated that the fundamental control deficits of DCD persist into adulthood despite frequent performance and practice of these daily tasks. Lastly, these findings might contribute to the therapeutic potential of gaze training interventions to improve the daily functioning of children and adults with DCD.     

Rites of passage: understanding participation of children with developmental coordination disorder

Children with developmental coordination disorder (DCD) experience difficulty participating in the typical activities of childhood and are known to have a more sedentary pattern of activities than their peers. Little research has been done to investigate the impact of these deficits on the lives of children with DCD and the importance of their participation in the typical activities of childhood. This qualitative study explored the impact of the disorder and the importance of participation for children with DCD from the perspective of the parent. Twelve in-depth interviews were conducted with parents of children with DCD who attended a university clinic specializing in using the Cognitive Orientation to daily Occupational Performance (CO-OP) approach, a cognitive-based intervention. Findings revealed that incompetence in everyday activities had serious negative effects for the children. Conversely, intervention that was focused on enablement at the activity and participation level had a significant positive impact on the children's quality of life. Emerging themes highlighted the notion that performance competency played an important role in being accepted by peers and being able "to be part of the group". As well, parents reported that successful participation built confidence in their children and allowed them to try other new activities. The World Health Organization's International Classification of Functioning, Disability, and Health provides a unique framework for analyzing and understanding the impact of the physical disability on the lives of families with children with DCD. Results illustrate how intervention that focuses on enabling children to choose their own functional goals in the area of physical activity has important implications for enabling participation and building the social networks of children with DCD.     

Perceptual skills of children with developmental coordination disorder

The aim of this study was to investigate whether children with a Developmental Coordination Disorder (DCD) experience problems in the processing of visual, proprioceptive or tactile information. Different aspects of visual perception were tested with the Developmental Test of Visual Perception (DTVP-2), tactile perception was assessed with the Tactual Performance Test (TPT), and a manual pointing task was employed to measure the ability to use visual and proprioceptive information in goal-directed movements. Nineteen children with DCD and nineteen age and sex-matched controls participated in this study. Differences between groups were most pronounced in the subtests measuring visual-motor integration of the DTVP-2, and in two subtests measuring visual perception (visual closure and position in space). On average the children with DCD performed slightly below the norm for tactile perception, with only three children failing the norm. On the manual pointing task, children with DCD made inconsistent responses towards the targets in all three conditions (visual, visual-proprioceptive and proprioceptive condition). No significant differences between groups were found for absolute error. Inspection of the individual data revealed that only two children failed on the majority of perceptual tasks in the three modalities. Across tasks, no consistent pattern of deficits appeared, illustrating the heterogeneity of the problems of children with DCD.     

Do motor ability and handwriting kinematic measures predict organizational ability among children with Developmental Coordination Disorders?

Background and aimChildren with Developmental Coordination Disorders (DCD) exhibit deficient daily performance concealed in their perception–action mechanism. The aim of this study was to analyze behavior organization of children with DCD, in varied tasks that require generating and monitoring mental representations related to space and time inputs/requirements, for achieving better insight about their perception–action mechanism.MethodParticipants included 42 children aged 7–10, half of whom were defined with DCD and half were typically developing (TD). The children were matched for age, gender and school. They were evaluated using the Movement–ABC and performed three handwriting tasks on an electronic tablet that is part of a computerized system (ComPET – Computerized Penmanship Evaluation Tool). In addition, their teachers completed the Questionnaire for Assessing Students’ Organizational Abilities-Teachers (QASOA-T) to assess the children’s daily organizational ability.ResultsSignificant group differences (DCD versus controls) were found for all handwriting kinematic measures across the three handwriting tasks and for the children’s organizational abilities. Motor ability predicted a considerable percentage of the variance of the kinematic handwriting measures (30–37%), as well as a high percentage of the variance of their organizational abilities (67%). The coefficient of variance of the pen tilt added an additional 3% to the prediction of their organizational abilities.ConclusionsThe results of this study exhibited deficient ability among children with DCD in organizing their behavior in varied real-world tasks requiring generation and monitoring representation related to space and time. The significance of the results to understanding the performance mechanism and implication to the clinical field are discussed.     

The influence of task paradigm on motor imagery ability in children with Developmental Coordination Disorder

Children with Developmental Coordination Disorder (DCD) have difficulty imagining movements such that they conform to the customary temporal constraints of real performance. We examined whether this ability is influenced by the choice of task used to elicit motor imagery (MI). Performance of typically developing (TD) (n = 30) and children with DCD (n = 30) was compared on two tasks: the Visually Guided Pointing Task (VGPT) and the Computerized Virtual Radial Fitts Task (C-VRFT). Since the VGPT places higher demands on executive functions like working memory but requires less spatial planning, we reasoned that the C-VRFT would provide a purer measure of motor imagery (or simulation). Based on our earlier work, we predicted that imagery deficits in DCD would more likely manifest on the C-VRFT. Results showed high correlations between tasks in terms of executed and imagined movement time suggest that both tasks measure MI ability. However, group differences were more pronounced in the imagined condition of the radial Fitts’ task. Taken together, the more spatially complex C-VRFT appears to be a more sensitive measure of motor imagery, better discriminating between DCD and TD. Implications for theory and practice are discussed.     

Intervention in children with Developmental Coordination Disorder: The role of parents and teachers

Background: Children with Developmental Coordination Disorder (DCD) are a heterogeneous group who have a marked impairment in the performance of functional skills. Provision for these children is usually made via a paediatrician through occupational or physiotherapy though, with a prevalence rate of 5%, regular provision is not possible due to limited professional resources. Aims: The study aimed to determine the extent to which parents and teachers, with guidance, can assist in the management of children with DCD; whether children with DCD are helped in this way and how this may contribute to our understanding of the condition. Sample: Thirty‐one children with DCD aged 7 to 9 years participated in the study. Methods: Following assessment, individual profiles were developed and each week teachers and parents were given guidelines for working with the children and each child had three to four sessions a week lasting approximately for 20 minutes. In Phase 1, one group of children worked with teachers and the other group worked with parents. In Phase 2, the two groups of children swapped over. The children were assessed regularly throughout the project using the Movement ABC, together with diaries and comments from teachers and parents. Results: At the end of the 40‐week study, 27 children showed significant improvement in their motor skills. Conclusions: Both teachers and parents were able to provide effective intervention for the majority of the children. It is possible that the children who did not improve have difficulties that are of a more complex type which require more specialist therapy to meet their need.     

Effect of dual tasking on a dynamic balance task in children with and without DCD

The purpose of this study was to compare performance of children with Developmental Coordination Disorder (DCD) and typically developing (TD) children in a dual task paradigm with a dynamic balance task on the Wii Fit as primary task and a concurrent cognitive (counting) or a concurrent bimanual fine motor task as secondary tasks.Using a cross-sectional design, 25 children with DCD and 38 TD children were assessed with the Movement Assessment Battery for Children, 2nd edition (MABC-2) and Divided Attention (DA) task of the KiTAP. Next, the single- and dual-tasks were performed and the level of interference or facilitation of the dual tasks was calculated. Regression analysis determined the predictive value of the DA and MABC-2 component balance outcomes on the dual task performance. On the motor and attentional tasks, the group of children with DCD scored significantly below the level of the TD children. The dual task effect showed similar interference and facilitation of tasks in the different dual-task conditions in both groups.In the dual task-cognitive condition, the divided attention abilities and the MABC-2 balance score predicted 25% of the Wii Fit dynamic balance task performance, whereas in the dual task-motor condition this was higher (31.6%). In both conditions, DA was a stronger predictor than MABC balance score and appears to be an important factor to consider when developing motor task training for children with DCD.     

Increased visual bias in children with developmental coordination disorder: Evidence from a visual-tactile temporal order judgment task

BackgroundPrevious studies have suggested that children with developmental coordination disorder (DCD) rely heavily on vision to perform movements, which may contribute to their clumsy movements. However, few studies have objectively and quantitatively investigated the perceptual biases of children with DCD.MethodsA visual-tactile temporal order judgment (TOJ) task was used to measure and compare the perceptual biases of 19 children with DCD and 19 age- and sex-matched typically developing children. The point of subjective equality, which demonstrates when “visual first” and “tactile first” judgment probabilities are equal (50%), obtained by analyzing the results of the visual-tactile TOJ task, was used as an indicator of perceptual biases. Further, variables (age and manual dexterity in all participants; motor function, autism spectrum disorder and attention-deficit hyperactivity disorder traits, and depressive symptoms in children with DCD) associated with perceptual biases were examined with correlation analysis.ResultsChildren with DCD had significantly stronger visual bias than typically developing children. Overall correlation analysis showed that increased visual bias was significantly correlated with poor manual dexterity.ConclusionChildren with DCD had a strong visual bias, which was associated with poor manual dexterity.     

Computerized Progressive Attentional Training (CPAT) Program: Effective Direct Intervention for Children with ADHD

We tested the efficacy of a pioneering intervention program grounded in a contemporary theoretical framework of attention and designed to directly improve the various attentional functions of children with ADHD. The computerized progressive attentional training (CPAT) program is composed of four sets of structured tasks that uniquely activate sustained attention, selective attention, orienting of attention, and executive attention. Performance was driven by tight schedules of feedback and participants automatically advanced in ordered levels of difficulty contingent upon performance. Twenty 6- to 13-year-old children with ADHD were assigned to the experimental group and received the CPAT sessions twice a week over an 8-week period. Sixteen age-matched control children with ADHD were assigned to the control group and participated in sessions of the same frequency, length, and format except that instead of performing the training tasks they played various computer games during the session. The experimental participants showed a significant improvement in nontrained measures of reading comprehension, and passage copying as well as a significant reduction of parents' reports of inattentiveness. No significant improvements were observed in the control group. We thus concluded that the above academic and attentional improvements were primarily due to the CPAT.     

Does subtype of developmental coordination disorder count: is there a differential effect on outcome following intervention?

It is well known that developmental coordination disorder (DCD) is a heterogeneous condition in which children frequently present with co-occurring conditions in addition to their motor difficulties. This study considered whether there would be a differential effect of a group treatment program on subtypes of perceptual and movement problems or associated co-occurring conditions. A subset of children (n=43) from a larger clinical sample (n=100) with DCD participated in a 214 year cross-over intervention study which followed the cognitive orientation to daily occupational performance (CO-OP) approach. Original subtypes were determined by contrasting the current sample with previously published subtyping studies in DCD [Hoare, D. (1994). Subtypes of developmental coordination disorder. Adapted Physical Activity Quarterly, 11, 158-169; Macnab, J. J., Miller, L. T., & Polatajko, H. J. (2001). The search for subtypes of DCD: Is cluster analysis the answer? Human Movement Science, 20, 49-72]. No advantage was conferred to any subtype although children with more profound and complex difficulties at initial assessment, despite progress following intervention, were most likely to have continuing difficulties at the end of the project.     

A comparison of the performance of Persian speaking children who do and do not stutter on three nonwords repetition tasks

PurposeThe purpose of the study was to examine the performance of Persian speaking children who stutter (CWS) and children who do not stutter (CWNS) on three nonword repetition tasks, while also focusing on which task and scoring method best differentiates the two groups of children.MethodThirty CWS and 30 CWNS between the ages of 5;0 to 6;6 completed three nonword repetition tasks that varied in complexity. Each task was scored using two methods: nonwords correct and phonemes correct. Between-group differences in performance on each task were examined, along with disfluencies for CWS and the task and scoring method that best differentiated the CWS and CWNS.ResultsThe findings revealed that, across all three nonword repetition tasks, the CWS consistently produced fewer nonwords correct and phonemes correct than the CWNS group at virtually all syllable lengths. The CWS produced more disfluencies on longer nonwords than shorter nonwords in all three nonword repetition tasks. The nonword repetition task with lower wordlikeness and more phonologically complex items best differentiated the two groups of children. Findings further revealed that discriminative accuracy was highest for scoring based on the number of phonemes produced correctly.ConclusionFindings provide further evidence to suggest that CWS may have difficulty with phonological working memory and/or phonological processing.     

Movement Control Strategies in a Dynamic Balance Task in Children With and Without Developmental Coordination Disorder

Abstract

Our study aimed to analyze movement control strategies using predefined criteria for amplitude and differences in these strategies between children with and without DCD. Children with (n?=?28) and without DCD (n?=?15) were included. A video-observation-tool was used to score the moving body parts during a Wii Fit slalom task over multiple time points. Two-step cluster analysis was used to extract distinct movement strategies. Two different movement strategies were identified that were independently validated by a measure of task performance and a subjective mark of quality of the movement. Initial differences between groups and changes over time toward the more successful strategy were found in both groups, albeit in a different percentage. This study shows that the more efficient movement strategy is seen in the majority of the TD children and only in a small number of children with DCD, even after practice.     

A comparison of characteristics,developmental disorders and motor progression between children with and without developmental coordination disorder

Background and aimChildren with Developmental Coordination Disorder (DCD) have difficulty in the development of motor coordination and with learning new motor skills. Studies demonstrate that children with DCD differ in terms of the nature and severity of their motor difficulties, the incidence of co occurring conditions and family background. However, little is known whether these profiles may relate to motor progression over time. The aim of this study was to describe the profiles of children with and without DCD and track motor progression over time.MethodThe characteristics of thirty-four 7–14 year old children (M = 10.07, 85.3% boys) with and without DCD were compared and their motor progression monitored over a two academic years. DCD was identified using DSM5 criteria. The Movement Assessment Battery for Children-2 (MABC-2) was used to classify children as TD (≥25th percentile), having moderate motor coordination difficulties (6-16th percentile) or severe motor coordination difficulties (≤ 5th percentile). The Kaufman Brief Intelligence Test – 2 (KBIT-2) was used to measure full scale IQ. Parent questionnaires were used to gather information on socio economic status and co occurrence of other developmental disorders. We used ANOVA to assess whether there were differences in characteristics between the TD children, children with severe motor coordination difficulties and children with moderate motor coordination difficulties. Linear mixed effect modelling was used to estimate any change in motor performance over time and whether this differed between the three groups of children.ResultsChildren with severe motor coordination difficulties had distinct profiles in motor and non-motor domains, lower IQ and a greater likelihood of having associated characteristics of 2 or more developmental disorders. We found significant differences between the poor motor performance of the severe group compared to the other two groups. Longitudinal analyses revealed stable, persistent and lower motor competence for the severe group. The rate of change in motor proficiency for the typical and severe groups was similar. However, the group with moderate motor difficulties gained on average more points per week compared to the typical group and achieved motor scores in the typically developing range over time.ConclusionsThis is one of the first studies to compare the characteristics and rate of motor progression of children with and without DCD using different motor proficiency cut off scores. The children with severe motor coordination difficulties progressed at the same rate as typically developing peers but remained in the severe group over time, whereas the children with moderate motor coordination difficulties caught up to TDC. The results indicate that different intervention may be required according to the nature and severity of the characteristics in both the motor and non-motor domains of children with DCD.     

Effet de la thérapie des schémas sur la dépression de la personne âgée institutionnalisée : 3 études de cas uniques de type AB en lignes de bases multiples

IntroductionSchema therapy has confirmed its effectiveness in caring for depression. However, few studies have evaluated its effectiveness of an institutionalized elderly population.ObjectiveThe aim of this pilot study is to evaluate the efficiency of this therapy for the treatment of depression in 3 elderly people, with no neurocognitive disease, living in a nursing home.MethodClinician conducted a single case experimental protocol AB with multiple baseline for 3 participants who were experiencing depressive symptoms. Participants were randomized in 3 baselines and performed respectively 8, 7, and 6 intervention sessions.ResultsThe results highlight progressive effectiveness for two of the three residents. From baseline to the end of the therapeutic sessions (11 weeks), the improvement was significant and clinically observable for the activation of the schemas (–1.4 and –2 points on average) as well as for the level of depression (–8 and –9 points to the GDS).ConclusionThis pilot study indicates the effectiveness and replicability of schema therapy as therapeutic intervention for depression in elderly people.     

Action planning and position sense in children with Developmental Coordination Disorder

The present study examined action planning and position sense in children with Developmental Coordination Disorder (DCD). Participants performed two action planning tasks, the sword task and the bar grasping task, and an active elbow matching task to examine position sense. Thirty children were included in the DCD group (aged 6–10 years) and age-matched to 90 controls. The DCD group had a MABC-2 total score ⩽5th percentile, the control group a total score ⩾25th percentile. Results from the sword-task showed that children with DCD planned less for end-state comfort. On the bar grasping task no significant differences in planning for end-state comfort between the DCD and control group were found. There was also no significant difference in the position sense error between the groups. The present study shows that children with DCD plan less for end-state comfort, but that this result is task-dependent and becomes apparent when more precision is needed at the end of the task. In that respect, the sword-task appeared to be a more sensitive task to assess action planning abilities, than the bar grasping task. The action planning deficit in children with DCD cannot be explained by an impaired position sense during active movements.     

Identifying play characteristics of pre-school children with developmental coordination disorder via parental questionnaires

Motor coordination deficits that characterize children with Developmental Coordination Disorder (DCD) affect their quality of participation. The aim of the current study was to identify play characteristics of young children with DCD, compared to those of children with typical development in three dimensions: activity and participation, environmental factors and children’s impairments.MethodSixty-four children, aged four to six years, participated. Thirty were diagnosed as having DCD; the remaining 34 children were age, gender and socioeconomic level matched controls with typical development. The children were evaluated by the M-ABC. In addition, their parents completed a demographic questionnaire, the Children’s Activity Scale for Parents (CHAS-P), the Children’s Leisure Assessment Scale for preschoolers (CLASS-Pre), and My Child’s Play Questionnaire (MCP).ResultsChildren with DCD performed significantly poorer in each of the four play activity and participation domains: variety, frequency, sociability, and preference (CLASS-Pre). Furthermore, their environmental characteristics were significantly different (MCP). They displayed significantly inferior performance (impairments) in interpersonal interaction and executive functioning during play, in comparison to controls (MCP). Moreover, the children’s motor and executive control as reflected in their daily function as well as their activities of daily living (ADL) performance level, contributed to the prediction of their global play participation.DiscussionThe results indicate that the use of both the CLASS-Pre and the MCP questionnaires enables the identification of unique play characteristics of pre-school children with DCD via parents’ reports. A better insight into these characteristics may contribute to theoretical knowledge and clinical practice to improve the children’s daily participation.     

Visual perceptual and handwriting skills in children with Developmental Coordination Disorder

ObjectiveChildren with Developmental Coordination Disorder demonstrate a lack of automaticity in handwriting as measured by pauses during writing. Deficits in visual perception have been proposed in the literature as underlying mechanisms of handwriting difficulties in children with DCD. The aim of this study was to examine whether correlations exist between measures of visual perception and visual motor integration with measures of the handwriting product and process in children with DCD.MethodThe performance of twenty-eight 8–14 year-old children who met the DSM-5 criteria for DCD was compared with 28 typically developing (TD) age and gender-matched controls. The children completed the Developmental Test of Visual Motor Integration (VMI) and the Test of Visual Perceptual Skills (TVPS). Group comparisons were made, correlations were conducted between the visual perceptual measures and handwriting measures and the sensitivity and specificity examined.ResultsThe DCD group performed below the TD group on the VMI and TVPS. There were no significant correlations between the VMI or TVPS and any of the handwriting measures in the DCD group. In addition, both tests demonstrated low sensitivity.ConclusionClinicians should execute caution in using visual perceptual measures to inform them about handwriting skill in children with DCD.