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.
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A pocket version of these guidelines is available as Appendix S1 (https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.14132#support-information-section)
•Findings extend support for the effectiveness of activity-oriented, as well as body function-oriented approaches when combined with activities.•An important new finding was the evidence of training ...effectiveness when programs were conducted in a small group format and for programs aiming at improved physical fitness.•Data suggest that active computer-assisted training can be a useful adjunct treatment, but the active ingredients are unknown.•Relatively short duration interventions still demonstrated positive treatment effects.•Comparison studies between approaches and groups (age, gender, severity, whether referred or selected and with co-occurring conditions) are needed.
As part of the process of creating an update of the clinical practice guidelines for developmental coordination disorder (DCD) (Blank, Smits-Engelsman, Polatajko, & Wilson, 2012), a systematic review of intervention studies, published since the last guidelines statement was conducted.
The aim of this study was to 1) systematically review the evidence published from January 2012 to February 2017 regarding the effectiveness of motor based interventions in individuals with DCD, 2) quantify treatment effects using a meta-analysis, 3) examine the available information on different aspects of delivery including use of group intervention, duration and frequency of therapy, and 4) identify gaps in the literature and make recommendations for future intervention research.
An electronic search of 5 databases (PubMed, Embase, Pedro, Scopus and Cochrane) was conducted for studies that evaluated motor-based interventions to improve performance for individuals with DCD.
Thirty studies covering 25 datasets were included, 19 of which provided outcomes on standardized measures of motor performance. The overall effect size (Cohen’s d) across intervention studies was large (1.06), but the range was wide: for 11 interventions, the observed effect was large (>0.80), in eight studies moderate (>0.50), and in five it was small or negligible (<0.50). Positive benefits were evident for activity-oriented approaches, body function-oriented combined with activities, active video games, and small group programs.
Results showed that activity-oriented and body function oriented interventions can have a positive effect on motor function and skills. However, given the varied methodological quality and the large confidence intervals of some studies, the results should be interpreted with caution.
•Ecological validity was strongest the more alike assessed skills were to daily tasks.•Bilateral Coordination and Balance were not linked to riding bicycle/scooter or sport.•Upper-Limb Coordination ...was linked to gross motor rather than fine motor skills.•Ecological validity of assessments should be considered for the diagnosis of DCD.
The diagnosis of Developmental Coordination Disorder (DCD) is based on poor motor coordination in the absence of other neurological disorders. In order to identify the presence of movement difficulties, a standardised motor assessment is recommended to determine the extent of movement problems which may contribute to deficits in daily task performance. A German version of the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (German BOT-2) was recently published. This study aimed to determine the ecological validity of the German BOT-2 by considering the relationship between assessment of fundamental motor skills with the BOT-2 and performance of everyday motor activities as evaluated by parents. This study used data obtained from the German BOT-2 standardisation study (n=1.177). Subtests were compared with theoretically corresponding tasks via parental ratings of overall fine and gross motor abilities and performance in six typical motor activities. Non-parametric Jonckheere Terpstra test was used to identify differences in ordered contrasts. Subtests reflecting ‘Strength’, ‘Running Speed and Agility’, ‘Upper-Limb Coordination’, ‘Balance’, and ‘Fine Motor Precision’ were associated with parental evaluation of gross motor skills (p<0.001). The subtest ‘Fine Motor Integration’ significantly correlated with parental ratings of females’ fine motor skills. Parental ratings of males’ fine motor skills were associated with three further subtests. Regarding everyday motor activities, the first three fine motor BOT-2 subtests were associated with parent evaluations of drawing, writing and arts and crafts (p<0.001). Gross motor subtests of ‘Bilateral Coordination’ and ‘Balance’ showed no relationship to bike riding or performance in sports. Subtests of ‘Upper-Limb Coordination’ and ‘Strength’ showed significant correlations with sports, ball games and cycling. The results of this study suggest that the closer the proximity in the nature of the motor skills assessed in the German BOT-2 to daily motor tasks, the stronger the relationship between the clinical test and parental report of everyday performance of their child. The body functions tested in the German BOT-2, and hypothesized to underpin certain skills, were not automatically relevant for specific activities undertaken by German children. Future research should investigate the relationships of the various BOT-2 constructs for diagnosis of DCD.
Purpose of Review
Support for the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach exists, but its specific evidence base for children and adults with developmental ...coordination disorder (DCD) is unclear. Accordingly, the objective of this study was to synthesize and critically assess the evidence regarding the use of the CO-OP approach with children and adults with DCD. A systematic review of four health-related databases was conducted to identify studies, published from 1998 to 2023, which reported on the effectiveness of the CO-OP approach or explored its components. Following data extraction and critical appraisal, the strength of the body of evidence for the outcomes extracted was assessed, and a meta-analysis of three of the studies was conducted.
Recent Findings
Thirty-one articles were selected. Findings consistently support CO-OP’s effectiveness with children having DCD, yielding positive outcomes for specific measures. However, characteristics of identified studies highlight the need for more rigorous research to bolster confidence in the evidence base.
Summary
This systematic review serves as a compelling call for an extended and diverse body of research aimed at deepening our understanding of the CO-OP approach. Exploration of its effectiveness across the lifespan, its adaptability, and its theoretical foundations is essential.
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