Emerging Adulthood and Developmental Co-ordination Disorder

The interest in Developmental Co-ordination Disorder (DCD) in emerging adulthood has grown in recent years, and it is now acknowledged that the signs and symptoms of DCD persist into adolescence and adulthood. Nevertheless, the long-term impact of DCD is still poorly understood, and little is known about positive orientations of young adults with DCD. This review discusses some of the persisting features of DCD, with a particular emphasis on psychosocial difficulties, self-perception and the impact of comorbid developmental disorders. The role of the parent in emerging adulthood in DCD is an area that has received little research focus, but it seems likely that parents have a key role to play in positive outcomes. The need to provide appropriate assessment, intervention and support for young adults with DCD is discussed in terms of the need to provide comprehensive and continued support for all aspects of the disorder, which also takes into consideration the impact of DCD on the wider family unit.     

Driving Behaviour in Young Adults with Developmental Co-ordination Disorder

Between 30 and 70% of children with developmental co-ordination disorder (DCD) will have persistent daily functioning difficulties in adulthood (Cousins and Smyth 2003). However, few DCD studies have focussed specifically on the stage of emerging adulthood. Driving is an important rite of passage which marks the start of independence from parents. Delay, difficulty or avoidance in learning to drive may all have profound social, practical and psychological implications for the young adult with DCD. The driving experiences of 38 students with DCD and 77 typically developing students aged 17–25 years were examined using a semi-structured questionnaire. Quantitative measures indicate that fewer adults with DCD learn to drive compared to controls and that they show continuing difficulties with distance estimation and parking. Qualitative comments give a valuable insight into the learning and driving experiences of adults with DCD. Differences in the driving behaviour of adults with DCD and attention deficit hyperactivity disorder (ADHD) are discussed, as it is the need to consider guidance on driving skills when providing a package of care for young adults with DCD.     

A Preliminary Investigation of Quality of Life Satisfaction Reports in Emerging Adults With and Without Developmental Coordination Disorder

Developmental coordination disorder (DCD) affects around 5% of the population and is diagnosed on the basis of poor motor coordination. Although we know rather little about the lifetime consequences of this disorder, it is clear that significant difficulties remain through adolescence and into adulthood for the majority. It is also clear that significant psychosocial consequences exist for many individuals with DCD. In the current study, quality of life satisfaction was investigated in a group of emerging adults with and without DCD using the Quality of Life Satisfaction Questionnaire (Endicott et al. Psychopharmacology Bulletin, 29, 321–326, 1993). Overall, the group of adults with DCD reported significantly lower levels of quality of life satisfaction across all domains on the scale. This finding has important implications for consideration of early and later intervention for these individuals, as well as for studies to consider the risk and protective factors at play in long-term outcome with respect to both the motor skills and psychosocial aspects of this disorder.     

Level walking in adults with and without Developmental Coordination Disorder: An analysis of movement variability

Several studies have shown that Developmental Coordination Disorder (DCD) is a condition that continues beyond childhood. Although adults with DCD report difficulties with dynamic balance, as well as frequent tripping and bumping into objects, there have been no specific studies on walking in this population. Some previous work has focused on walking in children with DCD but variation in the tasks and measures used has led to inconsistent findings. The aim of the current study therefore was to examine the characteristics of level walking in adults with and without DCD. Fifteen adults with DCD and 15 typically developing (TD) controls walked barefoot at a natural pace up and down an 11 m walkway for one minute. Foot placement measures and velocity and acceleration of the body were recorded, as well as measures of movement variability. The adults with DCD showed similar gait patterns to the TD group in terms of step length, step width, double support time and stride time. The DCD group also showed similar velocity and acceleration to the TD group in the medio-lateral, anterior–posterior and vertical direction. However, the DCD group exhibited greater variability in all foot placement and some body movement measures. The finding that adults with DCD have a reduced ability to produce consistent movement patterns is discussed in relation to postural control limitations and compared to variability of walking measures found in elderly populations.     

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.     

Procedural learning,consolidation, and transfer of a new skill in Developmental Coordination Disorder

The aim of this study was to explore the differences in procedural learning abilities between children with DCD and typically developing children by investigating the steps that lead to skill automatization (i.e., the stages of fast learning, consolidation, and slow learning). Transfer of the skill to a new situation was also assessed. We tested 34 children aged 6–12 years with and without DCD on a perceptuomotor adaptation task, a form of procedural learning that is thought to involve the cerebellum and the basal ganglia (regions whose impairment has been associated with DCD) but also other brain areas including frontal regions. The results showed similar rates of learning, consolidation, and transfer in DCD and control children. However, the DCD children's performance remained slower than that of controls throughout the procedural task and they reached a lower asymptotic performance level; the difficulties observed at the outset did not diminish with practice.     

Navigating through apertures: perceptual judgements and actions of children with Developmental Coordination Disorder

Passing through a narrow gap/aperture involves a perceptual judgement regarding the size of the gap and an action to pass through. Children with DCD are known to have difficulties with perceptual judgements in near space but whether this extends to far space is unknown. Furthermore, in a recent study it was found that adults with DCD do not scale movements when walking through an aperture in the same way as their peers. The current study, therefore, considered perceptual judgements and motor behaviour of children with DCD while looking at or walking through apertures. Twenty‐nine children with DCD and 29 typically developing (TD) children took part. In Experiment 1, participants completed a perceptual task, where they made passability judgements. Children with DCD showed a significantly smaller critical ratio (aperture size at which a participant first rotates the shoulders to pass through) compared to their TD peers. In Experiment 2, participants completed an action task where they walked through the same apertures. Children with DCD showed a significantly larger critical ratio than TD peers when body size alone was accounted for. Taken together these results suggest that perception within a static context is different from that within a dynamic context for children with DCD. However, despite this difference we have demonstrated a clear relationship between perception and action in children with DCD. A video abstract of this article can be viewed at: https://youtu.be/SABXFrAJtF8     

Developmental coordination impairments in adulthood

The aim of this study was to extend the understanding of Developmental Coordination Disorder (DCD) into adulthood. We recruited 19 adults aged between 18 and 65 who had received diagnoses of DCD or dyspraxia or who self-reported as having motor impairments consistent with a history of DCD, together with age- and gender-matched controls. Participants were given tests of manual dexterity, handwriting, construction, obstacle avoidance, dynamic balance, static balance, dual task performance, ball skills, reaction time, movement time and sequencing. As a group, adults with DCD performed more poorly than controls across all tasks. Slowness and variability of movement was a pervasive feature of their performance and many individuals had considerable problems with sequencing and with dual task performance. A discriminant function analysis conducted using six performance measures correctly classified participants as car drivers or non-drivers. Adults do retain motor difficulties and these can exclude them from important activities of daily living.     

Dissecting online control in Developmental Coordination Disorder: a kinematic analysis of double-step reaching

In a recent study, children with movement clumsiness (or Developmental Coordination Disorder-DCD) were shown to have difficulties making rapid online corrections when reaching, demonstrated by slower and less accurate movements to double-step targets (Hyde & Wilson, 2011). These results suggest that children with DCD have difficulty using predictive estimates of limb position when making rapid adjustments to movement, in-flight. However, chronometric data alone does not provide strong evidence for this hypothesis: it remains unclear whether early (and rapid) control parameters or post-correction stages of the movement trajectory are affected. Thus, the overarching aim of this study was to conduct a kinematic analysis of double-step reaching in order to isolate the different control parameters that might explain the slower and less accurate double-step reaching performance of children with DCD. Participants were a new sample of 13 children with DCD aged between 8-12 years and 13 age-matched controls. Children were required to reach and touch one of three possible targets presented at the coordinates -20°, 0° and 20° on a 17 in. LCD touch-screen. For most trials (80%) the target remained stationary for the duration of movement (non-jump trials), while for the remainder (20%), the target jumped randomly to one of two peripheral locations at movement onset (jump trials). Consistent with earlier work, children with DCD were slower to initiate reaching compared to controls and showed longer MT and more errors on jump trials. Kinematic data showed that while the two groups did not differ on time to peak velocity or acceleration, children with DCD were slower to correct reach trajectory on jump trials. No group differences were observed on late kinematic markers, e.g., post-correction time. The pattern of results support and extend earlier work showing deficits in ROC in DCD. From a computational perspective, delayed corrections to the reach trajectory suggests some difficulty integrating information about the target perturbation with a predictive (or forward) estimate of limb position relative to the initial target. These conclusions are discussed, along with directions for future research.     

Comparing Attention to Socially-Relevant Stimuli in Autism Spectrum Disorder and Developmental Coordination Disorder

Difficulties with social interaction have been reported in both children with an autism spectrum disorder (ASD) and children with developmental coordination disorder (DCD), although these disorders have very different diagnostic characteristics. To date, assessment of social skills in a DCD population has been limited to paper-based assessment or parent report. The present study employed eye tracking methodology to examine how children attend to socially-relevant stimuli, comparing 28 children with DCD, 28 children with ASD and 26 typically-developing (TD) age-matched controls (aged 7–10). Eye movements were recorded while children viewed 30 images, half of which were classed as ‘Individual’ (one person in the scene, direct gaze) and the other half were ‘Social’ (more naturalistic scenes showing an interaction). Children with ASD spent significantly less time looking at the face/eye regions in the images than TD children, but children with DCD performed between the ASD and TD groups in this respect. Children with DCD demonstrated a reduced tendency to follow gaze, in comparison to the ASD group. Our findings confirm that social atypicalities are present in both ASD and to a lesser extent DCD, but follow a different pattern. Future research would benefit from considering the developmental nature of the observed findings and their implications for support.     

Handwriting Difficulties and Their Assessment in Young Adults with DCD: Extension of the DASH for 17-to 25-Year-Olds

Handwriting difficulties are common in children with developmental coordination disorder (DCD) and frequently continue into adulthood. In spite of increased computer use, handwriting remains an essential everyday life skill. The Detailed Assessment of Speed of Handwriting (DASH) provides an objective measure of handwriting performance for students aged 9–16 years. No equivalent test for adults exists. The aim of this study is to explore developmental trends beyond the age of 16 on the five tasks included in the DASH and to describe the employment of these data in an extension of the test for 17-to 25-year-olds (DASH 17+). A case study is included to illustrate its use in the assessment of young adults with DCD. Three hundred and ninety-three students between the ages of 17 and 25 completed the test. The sample was selected to represent the population of UK students in post-16 education. Statistically significant, but overall modest developmental trends in handwriting performance were found for all tasks. Depending on the task, the year-on-year average increase in performance followed a linear or non-linear trend. Gender effects were generally small. DASH 17+ will provide useful information on any individual whose handwriting is causing concern, including those with, or suspected of having DCD.     

Oculomotor atypicalities in Developmental Coordination Disorder

Children with Developmental Coordination Disorder (DCD) fail to acquire adequate motor skill, yet surprisingly little is known about the oculomotor system in DCD. Successful completion of motor tasks is supported by accurate visual feedback. The purpose of this study was to determine whether any oculomotor differences can distinguish between children with and without a motor impairment. Using eye tracking technology, visual fixation, smooth pursuit, and pro‐ and anti‐saccade performance were assessed in 77 children that formed three groups: children with DCD (aged 7–10), chronologically age (CA) matched peers, and a motor‐match (MM) group (aged 4–7). Pursuit gain and response preparation in the pro‐ and anti‐saccade tasks were comparable across groups. Compared to age controls, children with DCD had deficits in maintaining engagement in the fixation and pursuit tasks, and made more anti‐saccade errors. The two typically developing groups performed similarly, except on the fast speed smooth pursuit and antisaccade tasks, where the CA group outperformed the younger MM group. The findings suggest that children with DCD have problems with saccadic inhibition and maintaining attention on a visual target. Developmental patterns were evident in the typically developing groups, suggesting that the pursuit system and cognitive control develop with age. This study adds to the literature by being the first to systematically identify specific oculomotor differences between children with and without a motor impairment. Further examination of oculomotor control may help to identify underlying processes contributing to DCD. A video abstract of this article can be viewed at: https://youtu.be/NinXa2KlB4M . [Correction added on 27 January 2017, after first online publication: The video abstract link was added.]     

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.     

Y-Balance Test Performance and Leg Muscle Activations of Children with Developmental Coordination Disorder

This study compared Lower Quarter Y-Balance Test (YBT-LQ) performance and leg muscle kinetics between children with and without developmental coordination disorder (DCD), and investigated the association between YBT-LQ performance and muscle kinetics in children with DCD. Forty-eight children with DCD and 51 children without DCD participated in the study. Leg muscle kinetics were measured using surface electromyography when performing YBT-LQ. Children with DCD exhibited an overall lower YBT-LQ scores than controls. They had a lower peak gastrocnemius medialis activation for YBT-LQ posteromedial direction and shorter duration for the muscle to reach peak torque for YBT-LQ anterior direction. No relationship was found between YBT-LQ performance and leg muscle activations in children with DCD. Children with DCD exhibited a less competent YBT-LQ performance with atypical neuromuscular control.     

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.     

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.     

Online corrections in children with and without DCD

Human arm movements need 'online' corrections due to noise in perception and action. A Step-Perturbation paradigm explored online corrections in control children and children with DCD aged between 7 and 13 years. Control children found the task straightforward: a distracter had no effect and they managed to stop relatively quickly. Children with DCD found the task difficult and the apparatus was modified accordingly (decreased postural and force production demands). The distracter affected some children with DCD and some found it difficult to stop. All of the DCD population showed poorer performance in both the perturbation and non-perturbation condition. Nevertheless, there was no interaction between group and condition. Thus, this study found no evidence for specific deficits in online correction mechanisms in DCD. We suggest that: (i) fundamental problems in generating basic movements can account for the documented difficulties in correcting on-going movements, and (ii) such fundamental difficulties make it very difficult to pinpoint specific mechanism deficits.     

Increased associated movements: influence of attention deficits and movement difficulties

This study was designed to examine whether increased associated movements (AMs) reflect motor difficulties or the symptoms associated with attention disorders. Four groups of male children (N=51) aged 6-8 years participated: Group 1 consisted of 13 children diagnosed with developmental coordination disorder (DCD); Group 2 consisted of 13 children diagnosed with attention deficit hyperactivity disorder (ADHD); Group 3 consisted of 10 children diagnosed with co-occurring DCD and ADHD, and Group 4 was a control sample of 15 children, with no known movement or attention difficulties. Various AM tasks were selected from established assessments and previous research to measure AM severity. The results supported the hypothesis that increased severity of AMs reflect movement difficulties with children in the DCD and DCD/ADHD groups displaying significantly more AMs than children in the ADHD and control groups (p<.001). No differences were found between the ADHD only and control groups (p=.67) or the DCD and DCD/ADHD groups (p=.81) suggesting that AM severity is not influenced by the neurodevelopmental symptoms associated with ADHD.     

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.     

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.