Aim
These international clinical practice recommendations (CPR) for developmental coordination disorder (DCD), initiated by the European Academy of Childhood Disability (EACD), aim to address key ...questions on the definition, diagnosis, assessment, intervention, and psychosocial aspects of DCD relevant for clinical practice.
Method
Key questions in five areas were considered through literature reviews and formal expert consensus. For recommendations based on evidence, literature searches on ‘mechanisms’, ‘assessment’, and ‘intervention’ were updated since the last recommendations in 2012. New searches were conducted for ‘psychosocial issues’ and ‘adolescents/adults’. Evidence was rated according to the Oxford Centre for Evidence‐Based Medicine (level of evidence LOE 1–4) and transferred into recommendations. For recommendations based on formal consensus, two meetings of an international, multidisciplinary expert panel were conducted with a further five Delphi rounds to develop good clinical practice (GCP) recommendations.
Results
Thirty‐five recommendations were made. Eight were based on the evidence from literature reviews (three on ‘assessment’, five on ‘intervention’). Twenty‐two were updated from the 2012 recommendations. New recommendations relate to diagnosis and assessment (two GCPs) and psychosocial issues (three GCPs). Additionally, one new recommendation (LOE) reflects active video games as adjuncts to more traditional activity‐oriented and participation‐oriented interventions, and two new recommendations (one GCP, one LOE) were made for adolescents and adults with DCD.
Interpretation
The CPR–DCD is a comprehensive overview of DCD and current understanding based on research evidence and expert consensus. It reflects the state of the art for clinicians and scientists of varied disciplines. The international CPR–DCD may serve as a basis for national guidelines.
What this paper adds
Updated international clinical practice guidelines on developmental coordination disorder (DCD).
Refined and extended recommendations on clinical assessment and intervention for DCD.
A critical synopsis of current research on mechanisms of DCD.
A critical synopsis of psychosocial issues in DCD, with implications for clinical practice.
The first international recommendations to consider adolescents and adults with DCD.
Resumen
Recomendaciones internacionales para la práctica clínica sobre la definición, diagnóstico, evaluación, intervención y aspectos psicosociales del trastorno del desarrollo de la coordinación
Objetivo
Estas recomendaciones internacionales para la práctica clínica (RPC) sobre el trastorno del desarrollo de la coordinación (TDC), iniciadas por la Academia Europea de Discapacidad Infantil (EACD), tienen como objetivo abordar preguntas clave sobre la definición, diagnóstico, evaluación, intervención y aspectos psicosociales de TDC relevantes para la práctica clínica.
Método
Las preguntas clave en cinco áreas fueron tratadas a través de revisiones bibliográficas y consenso formal de expertos. Para las recomendaciones basadas en la evidencia, las búsquedas en la literatura sobre “mecanismos”, “evaluación” e “intervención” se actualizaron desde las últimas recomendaciones en 2012. Se realizaron nuevas búsquedas para “problemas psicosociales” y “adolescentes / adultos”. La evidencia se calificó de acuerdo con la gradación del Centro de Oxford para Medicina Basada en la Evidencia (nivel de evidencia LOE 1–4) y en ello se basaron las recomendaciones. Para recomendaciones basadas en el consenso formal, se llevaron a cabo dos reuniones de un panel multidisciplinario internacional de expertos con cinco rondas Delphi adicionales para desarrollar recomendaciones de buena práctica clínica (BPC).
Resultados
Se realizaron 35 recomendaciones. Ocho de ellas se basaron en la evidencia de las revisiones de la literatura (tres en “evaluación”, cinco en “intervención”). Veintidós fueron actualizadas a partir de las recomendaciones de 2012. Las nuevas recomendaciones se relacionan con el diagnóstico y la evaluación (dos BPC) y las cuestiones psicosociales (tres BPC). Además, una nueva recomendación (LOE) trata acerca de los videojuegos activos como complemento de las intervenciones más tradicionales orientadas a la actividad y la participación, y se hicieron dos nuevas recomendaciones (una BCP, una LOE) para adolescentes y adultos con TDC.
Interpretación
Estas recomendaciones internacionales para la práctica clínica sobre TDC aportan una visión general completa sobre TDC y el conocimiento actual basado en evidencia de investigación y consenso de expertos. Brinda actualización para clínicos y científicos de diversas disciplinas. Las recomendaciones internacionales para la práctica clínica TDC pueden servir como base para recomendaciones nacionales.
Recomendações internacionais para a prática clínica na definição, diagnóstico, avaliação, intervenção e aspectos psicossociais do transtorno do desenvolvimento da coordenação
Objetivo
Essas recomendações internacionais para a prática clínica (RPC) no transtorno do desenvolvimento da coordenação (TDC), iniciadas pela Academia Européia de Deficiência Infantil (EACD), objetiva direcionar questões chave na definição, diagnóstico, avaliação, intervenção e aspectos psicossociais do TDC relevantes para a prática clínica.
Métodos
Questões chave em cinco áreas foram consideradas através de revisões da literatura e consensos formais de especialistas. Para recomendações baseadas em evidências, buscas na literatura em “mecanismos”, “avaliação” e “intervenção” foram atualizadas desde as últimas recomendações de 2012. Novas buscas foram conduzidas para “problemas psicossociais” e “adolescentes/adultos”. Evidências foram classificadas de acordo com o Centro Oxford para Medicina Baseada em Evidência (nível de evidência NE 1‐4) e transferidas em recomendações. Para recomendações baseadas em consensos formais, dois encontros de um painel de especialistas internacional e multidisciplinar foram conduzidos com posteriormente cinco sessões Delphi para desenvolver recomendações de boa prática clínica (BPC).
Resultados
Trinta e cinco recomendações foram feitas. Oito foram baseadas em evidências de revisões da literatura (três em “avaliação”, cinco em “intervenção). Vinte e duas foram atualizadas das recomendações de 2012. Novas recomendações são relacionadas com diagnóstico e avaliação (duas BPC) e problemas psicossociais (três BPCs). Adicionalmente, uma nova recomendação (NE) se refere a jogos de videogame ativos como adjuntos à mais tradicional terapia orientada à tarefa e intervenção orientada à participação, e duas novas recomendações (uma BPC, um NE) foram feitas para adolescentes e adultos com TDC.
Interpretação
A RPC‐TDC apresenta uma visão geral do TDC e o conhecimento atual baseado em evidências de pesquisas e consenso de especialistas. Reflete o estado de arte dos clínicos e cientistas de disciplinas variadas. A RPC‐TDC internacional deverá servir como uma base para as diretrizes nacionais.
What this paper adds
Updated international clinical practice guidelines on developmental coordination disorder (DCD).
Refined and extended recommendations on clinical assessment and intervention for DCD.
A critical synopsis of current research on mechanisms of DCD.
A critical synopsis of psychosocial issues in DCD, with implications for clinical practice.
The first international recommendations to consider adolescents and adults with DCD.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
A pocket version of these guidelines is available as Appendix S1 (https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.14132#support-information-section)
Current models of writing do not sufficiently address the complex relationship between the 2 transcription skills: spelling and handwriting. For children with dyslexia and beginning writers, it is ...conceivable that spelling ability will influence rate of handwriting production. Our aim in this study was to examine execution speed and temporal characteristics of handwriting when completing sentence-copying tasks that are free from composing demands and to determine the predictive value of spelling, pausing, and motor skill on handwriting production. Thirty-one children with dyslexia (Mage = 9 years 4 months) were compared with age-matched and spelling-ability matched children (Mage = 6 years 6 months). A digital writing tablet and Eye and Pen software were used to analyze handwriting. Children with dyslexia were able to execute handwriting at the same speed as the age-matched peers. However, they wrote less overall and paused more frequently while writing, especially within words. Combined spelling ability and within-word pausing accounted for over 76% of the variance in handwriting production of children with dyslexia, demonstrating that productivity relies on spelling capabilities. Motor skill did not significantly predict any additional variance in handwriting production. Reading ability predicted performance of the age-matched group, and pausing predicted performance for the spelling-ability group. The findings from the digital writing tablet highlight the interactive relationship between the transcription skills and how, if spelling is not fully automatized, it can constrain the rate of handwriting production. Practical implications are also addressed, emphasizing the need for more consideration to be given to what common handwriting tasks are assessing as a whole.
Physician work hours are an underexplored facet of the physician workforce that can inform policy for the rapidly changing health care labor market.
To examine trends in individual physician work ...hours and their contribution to clinical workforce changes over a 20-year period.
This cross-sectional study focused on active US physicians between January 2001 and December 2021 who were included in the Current Population Survey. Outcomes for physicians, advanced practice professionals (APPs), and nonphysician holders of doctoral degrees were compared, and generalized linear models were used to estimate differences in time trends for weekly work hours across subgroups.
Physician and APP workforce size, defined as the number of active clinicians, 3-year moving averages of weekly work hours by individual physicians, and weekly hours contributed by the physician and APP workforce per 100 000 US residents.
A total of 87 297 monthly surveys of physicians from 17 599 unique households were included in the analysis. The number of active physicians grew 32.9% from 2001 to 2021, peaking in 2019 at 989 684, then falling 6.7% to 923 419 by 2021, with disproportionate loss of physicians in rural areas. Average weekly work hours for individual physicians declined by 7.6% (95% CI, -9.1% to -6.1%), from 52.6 to 48.6 hours per week from 2001 to 2021. The downward trend was driven by decreasing hours among male physicians, particularly fathers (11.9% decline in work hours), rural physicians (-9.7%), and physicians aged 45 to 54 years (-9.8%). Physician mothers were the only examined subgroup to experience a statistically significant increase in work hours (3.0%). Total weekly hours contributed by the physician workforce per 10 000 US residents increased by 7.0%, from 13 006 hours in 2001 to 2003 to 13 920 hours in 2019 to 2021, compared with 16.6% growth in the US population over that time period. Weekly hours contributed by the APP workforce per 100 000 US residents grew 71.2% from 2010 through 2012 to 2019 through 2021.
This cross-sectional study showed that physician work hours consistently declined in the past 20 years, such that physician workforce hours per capita lagged behind US population growth. This trend was offset by rapid growth in hours contributed by the APP workforce. The gap in physician work hours between men and women narrowed considerably, with diverging potential implications for gender equity. Increasing physician retirement combined with a drop in active physicians during the COVID-19 pandemic may further slow growth in physician workforce hours per capita in the US.
•The HLS gives an easy-to-use, holistic assessment of handwriting legibility.•It discriminates well between good and poor handwriting.•The HLS has potential for use across languages and scripts.
...Demands for the production of legible handwriting produced in a timely manner increase as children progress through school. Despite the considerable number of children faced with handwriting difficulties, there is no quick and practical tool to assess legibility in this population.
The aim of this study was to develop the Handwriting Legibility Scale (HLS) and to establish the scale’s reliability and validity.
The HLS is a non-language dependent scale which assesses global legibility, based on five criteria applied to samples of ‘free writing’. Content validity, inter-rater reliability and internal consistency were initially examined using scripts from 20 children aged 8–14 years. Construct validity was established by Principal Component Analysis (PCA) of data from 150 school children aged 9–14 years, with an additional examination of gender effects. Discriminant validity of the HLS score was examined in 29 children with Developmental Coordination Disorder (DCD) and 29 typically developing (TD) children.
The results indicated high internal consistency (α=0.92). The inter-rater reliability was acceptable but indicates the need to refine the scoring instructions. PCA of the five components revealed a one factor solution explaining 61% of the variance. In the discriminant analysis, 86.2% of the children with DCD and 89.7% of the TD children were correctly classified to their groups based on the total HLS score.
The overall findings suggest that the HLS may be a useful tool to identify poor handwriting legibility, with application across different languages and writing scripts.
It is commonly assumed that children with dyslexia are slower at handwriting than other children. However, evidence of slow handwriting in children with dyslexia is very mixed. Thirty-one children ...with dyslexia, aged 9 years, were compared to both age-matched children and younger spelling-ability matched children. Participants completed an alphabet-writing task and a composition task on the surface of a digital writing tablet. Children with dyslexia wrote the same amount of letters per minute in the alphabet task but wrote fewer words per minute when composing their texts than children of the same age. Crucially, no differences were found between children with dyslexia and their same age peers for speed of handwriting execution, measured by the tablet, when writing the alphabet or composing their texts. However, children with dyslexia were found to pause within their compositions as often as the spelling ability matched group. Thus handwriting execution is not impaired in children with dyslexia. The slow writing that is typical of children with dyslexia is due to pausing more often when composing and is related to spelling ability. This may reflect processing problems in response to high cognitive load through having to contend with spelling and composing concurrently.
Children with Developmental Coordination Disorder (DCD) have been shown to have different coordination patterns on some tasks compared to their typically developing peers. However, it is unclear ...whether these differences are driven by the fact that typically developing children tend to be more practiced at the task on which coordination is being measured. The current study used a novel pedalo task to measure coordination in order to eliminate any practice differences. Thirty children (8 years −16 years), 15 with DCD and 15 without were recruited for this study. Children pedalled along an 8 m line 20 times. Movement of the 7th Cervical Vertebra, shoulders, elbows, wrists, hips, knees, ankles and toes was recorded. In terms of outcome measures, pedalling speed was not different between the groups but the coefficient of variation of speed was higher in the children with DCD indicating a less smooth movement. Coordination was measured by calculating angles at the shoulder, elbow, hip, knee and ankle. A higher correlation coefficient (more tightly coupled movement) and a greater variation in joint angle was seen in the typically developing children for specific joint segments. The relationship between group and movement outcome (smoothness of movement) was mediated by inter-limb coordination variability. Therefore, the poor coordination and slower learning generally reported in children with DCD could be due to a slower or less optimal exploration of motor solutions.
•Children with DCD and their TD peers completed a novel pedalo task•Movement outcome and inter-limb coordination was different in children with DCD•Inter-limb variability of the upper body was higher in TD children•The relationship between group and movement outcome was mediated by inter-limb variability•Movement difficulties in DCD may be due to a less optimal exploration of motor solutions.
Handwriting difficulties are frequently mentioned in descriptions of developmental coordination disorder (DCD). Recent studies have shown that children with DCD pause more and produce less text than ...typically developing (TD) peers. This temporal dysfluency indicates a lack of automaticity in handwriting production. One possible contributing factor is the accuracy and consistency of letter formation. The aim of this study was to gain a better understanding of handwriting dysfluency by examining the accuracy and consistency of letter production both within and across different writing tasks. A total of 28 children aged 8 to 15 years with DCD participated in the study with 28 TD age- and gender-matched control participants. They completed the alphabet writing and copy fast tasks from The Detailed Assessment of Speed of Handwriting on a digitizing writing tablet. The accuracy and consistency of letter production were examined. The DCD group had a higher percentage of errors within their letterforms than did the TD peers. Letter production was also less consistent between tasks. Children with DCD appear to have difficulties with the “allograph” (motor program) aspect of handwriting and may require explicit teaching of letter formation.
The nature of handwriting difficulties have been explored in children with specific developmental disorders. The aim of this study was to investigate the nature of handwriting difficulties in ...children with dysgraphia, a less studied group who have significant handwriting difficulties in the absence of motor control or cognitive difficulties. The performance of a dysgraphia group aged 8-14 years was compared to a group with Developmental Coordination Disorder and to typically developing (TD) controls. Participants completed two handwriting tasks on a digitizing writing tablet. The amount and accuracy of the handwriting product was measured, plus various temporal and spatial features of the writing process. There were no significant differences in performance between the two groups with handwriting difficulties but both performed more poorly than the TD group. Individual differences in the type and severity of handwriting impairments suggest the need for a range of classroom assessments to tailor intervention appropriately.
During everyday life we move around busy environments and encounter a range of obstacles, such as a narrow aperture forcing us to rotate our shoulders in order to pass through. In typically ...developing individuals the decision to rotate the shoulders is body scaled and this movement adaptation is temporally and spatially tailored to the size of the aperture. This is done effortlessly although it actually involves many complex skills. For individuals with Developmental Coordination Disorder (DCD) moving in a busy environment and negotiating obstacles presents a real challenge which can negatively impact on safety and participation in motor activities in everyday life. However, we have a limited understanding of the nature of the difficulties encountered. Therefore, this current study considered how adults with DCD make action judgements and movement adaptations while navigating apertures. Fifteen adults with DCD and 15 typically developing (TD) controls passed through a series of aperture sizes which were scaled to body size (0.9-2.1 times shoulder width). Spatial and temporal characteristics of movement were collected over the approach phase and while crossing the aperture. The decision to rotate the shoulders was not scaled in the same way for the two groups, with the adults with DCD showing a greater propensity to turn for larger apertures compared to the TD adults when body size alone was accounted for. However, when accounting for degree of lateral trunk movement and variability on the approach, we no longer saw differences between the two groups. In terms of the movement adaptations, the adults with DCD approached an aperture differently when a shoulder rotation was required and then adapted their movement sooner compared to their typical peers. These results point towards an adaptive strategy in adults with DCD which allows them to account for their movement difficulties and avoid collision.
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