ࡱ> {~tuvwxyz "bjbjss j-,X 8\U4 L  uBB B6~IASB"II $PPPI  PIPPџm@ Pv]yNdLyȽ<ݢ8N|B DvP!F,MGlBBBOBBBIIIIBBBBBBBBB :   Introduction Developmental Coordination Disorder (DCD) is a motor skills disorder that affects 5-9% of all children and their ability to perform activities of daily living (ADLs) including self care, academic tasks, and leisure activities. Children with DCD often appear lazy or clumsy in their attempts at ADLs due to delays in motor skill development or difficulties with coordinating movements. Over time, these children tend to participate in more sedentary activities with reduced physical activity and may suffer from poor self-esteem and sense of self-worth. DCD is generally not well understood and is felt to be significantly under-recognized. Obtaining a diagnosis for DCD has historically been a challenge due to the vagueness of the diagnostic criteria. The main purpose of this document is to provide an evidence-informed approach on why and how to properly assess children with possible DCD. Based on further interpretation of the European Academy of Childhood Disability Recommendations (EACD) and a review of the most current literature available, including the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), this paper reviews the updated diagnostic criteria and discusses the most up-to-date evidence related to best practices. Background Developmental Coordination Disorder (DCD) is a common but under-recognized movement skill disorder that significantly affects childrens everyday functioning (CanChild 2014). DCD does not have specific subtypes; however, children may have impairment in gross motor skills, fine motor skills, or both (Polatajko, 2006)). Regardless of which skills are affected, motor performance is usually slower, less accurate, and more variable in children with DCD than in their peers (Zwicker, Missiuna, Harris & Boyd, p. 574, 2012). DCD is more than just the lower end of typical development in motor skills (Polatajko, 1999); the motor impairment significantly impacts daily life and is not due to a neurological disorder or delayed cognitive development (Zwicker et al., p, 574, 2012). This condition consistently affects how a child learns and performs complex motor tasks and it affects activities such as self care, academic tasks, and leisure activities. DCD frequently co-occurs with other disorders such as Attention Deficit Hyperactivity Disorder (ADHD), speech language impairments, and learning disabilities. Early identification of DCD is crucial for optimal outcomes in this population. The consequences of developmental coordination disorder include reduced participation in team play and sports, poor self esteem and sense of self worth, emotional and behavioral problems, impaired academic achievement, poor physical fitness, and reduced physical activity and obesity (American Psychiatric Association, p 76, 2013). The sooner strategies and adaptations can be provided the more likely the child will experience success. DCD occurs in 5-9% of the population (Slater, Hillier, & Civetta, 2010). Although its etiology remains unclear, cerebellar dysfunction, mirror neurons, and other neurological mechanisms are noted in the research. Children born with low birth weight (under 1000g) or premature (29 weeks or less) are at a higher risk for DCD than their full-term peers. Males tend to be more affected than females by a ratio of 1.9:1.0 (Zwicker,Missiuna, Harris, & Boyd, 2012). Despite its frequency, the general awareness of this condition within health professions, education, and other community service providers is still very poor. For example, a 2012 Alberta study showed that 23-41% of physicians indicated knowledge about DCD and, of those, only 11-59% were aware of the psychological and secondary consequences of the condition (Wilson, Ruddock, Smits-Engelsman, Polatajko & Blank, 2011). As a result, many children and their families struggle through life without a diagnosis, with a misdiagnosis, or with the wrong assumption that the condition will be outgrown (Zwicker et al., 2012). DCD is a complex condition with a variety of factors to consider. The International Classification of Function (ICF) framework may be used to assess the impact of restrictions on day-to-day living and academic function of a child with DCD. A multidisciplinary team assessment is required to address all areas of concern (Blank, Smits-Engelsman, Polatajko & Wilson, 2011). A thorough history-taking enables the mapping of consistent patterns of behavior and the impact of motor difficulties on everyday functioning (Kirby, Sugden, & Purcell, p. 294, 2014). The assessment team may begin with history taking and questionnaires in order to gather information about a childs strengths and challenges in different environments. Based on this information, the team may decide to proceed with supporting the criteria in the DSM-5 (see Appendix A for a Quick Reference Guide). Literature Review and Recommendations The following information is a breakdown of how each component of the DSM-5 criteria can be met in order to assist a pediatrician in making a formal diagnosis. Please note that a diagnosis of DCD should not be given in any age group if motor performance cannot be assessed by a motor test because of low intellectual function, attention, or a medical disorder (Blank et al., 2011). See Appendix B for the complete DSM-5 description of DCD.  The team should consider the child and the environment when deciding which assessment tool to use in each category. There are other widely used tests (e.g. Bruininks-Oseretsky Test of Motor Proficiency 2nd Edition) in practice; however, when considering recent literature, the EACD recommendations, and information from other sources, the tools listed below are considered best practice. Motor Assessment (ages five and over) Movement Assessment Battery for Children-2nd Edition (MABC-2) - measures the motor capability of children between the ages of 3 and 16 years Includes qualitative descriptors of motor behavior and a behavioral checklist that looks at the influence of motivation and compliance on assessment results Should not be used in isolation for diagnosis or referral of children between 4 and 8 years of age, as it does not provide sufficiently detailed information about their motor performance (Watter et al, p 348, 2008) 15th percentile cutoff is recommended (Blank et al., 2011). Domain specific DCD is possible (Blank et al., 2011) (e.g., if a child scores below the fifth percentile in fine motor tasks but performs above the 15th percentile on other domains, the child could be considered to have a domain specific DCD as long as the other criteria for diagnosis are met) MABC-2 does not: Consider restrictions in activity and participation (Watter et al., 2008) Identify handwriting abilities (Geuze, Jongmans, Schoemaker, & Smits-Engelsman, 2001) Identify kinesthetic abilities (Smyth & Mason, 1998) Identify motor planning, bilateral integration, or sequencing abilities (High, Gough, Pennington, & Wright, 2000) Printing Assessment Children with DCD often have difficulty with fine motor skills affecting their ability to print and write, which adversely influences academic achievement (Blank et al., 2011). McMaster Handwriting Assessment Protocol-2nd Edition Comprehensive, functional examination of all aspects of printing and writing for children between Kindergarten and grade 6 Encourages evaluation of environment, postural control, endurance, attention and motivation, writing from memory, near and far point copying, dictation and composition, grasp, pressure, paper positioning, cursive, and speed Provides grade expectations Available on the CanChild (2014) website Based on the deficits identified in the McMaster Handwriting Assessment Protocol 2nd Edition, the following standardized tools can be used for further assessment. Evaluation Tool of Childrens Handwriting (ETCH) Criterion-referenced tool for evaluation of printing and cursive skills of children in grades 1-6 Evaluates legibility, pencil grasp, hand pressure, pencil pressure, and manipulative skills Detailed Assessment of Speed of Handwriting (DASH) For children between the ages of 9 and 17 years that exclusively measures speed of handwriting DASH17+ is for people between the ages of 17 and 25 years Handwriting fluency test for older children may be useful for diagnosing a writing disorder (Blank et al., 2011).  Gathering information from all of the childs environments is crucial for satisfying Criterion B. Information can be obtained from: Detailed child and parent interview Observation of the child in natural environments Parent, child, and teacher questionnaires described below: Parent Questionnaires Developmental Coordination Disorder Questionnaire-2007 (DCDQ-07) - designed to screen for coordination disorders in children aged 5 to 15 years (Wilson & Crawford, 2007) Examines postural control during movement, fine motor/handwriting, and general coordination Three age groups with cutoff scores to help identify children with probable DCD (Wilson et al., 2009) Strong correlations found with the Movement Assessment Battery for Children (MABC) (Cairney, Missiuna, Veldhuizen, & Wilson, 2008) Significant differences noted by gender (Rivard, Missiuna, Pollock, & Steyer-David, 2012) Boys tend to have stronger gross motor skills while girls tend to develop better fine motor skills; therefore, girls could be under-identified and those identified may have more severe difficulties while boys may be over-identified (Rivard et al., 2012) Movement Assessment Battery for Children-2nd Edition Checklist (MABC-2 Checklist) focuses on how children aged 5 to 12 years manage everyday tasks at home and at school Strongly correlates with the DCDQ-07 and the MABC-2 (Schoemaker, Niemeijer, Flapper, & Smits-Engelsman, 2012) Teacher may need to provide some information Vineland Adaptive Behavior Scale-2nd Edition (VABS-II) - measure of adaptive behaviors in individuals from birth to 90 years of age Useful tool for measuring participation in self care, productivity, and leisure (Blank et al., 2011). VABS-II is unnecessary if a psychologist has provided information from the Adaptive Behavior Assessment Scale-2nd Edition (ABAS-II) Child Questionnaires Childrens Self-Perceptions of Adequacy in and Predilection toward Physical Activity (CSAPPA) for children between 9 and 16 years of age DCDQ-07 and CSAPPA look at motor coordination issues from different perspectives (i.e., parent vs. child) (Cairney et al., 2008) Advantages of the CSAPPA (Cairney et al., 2007): Can be administered to groups of children Can be completed in approximately 15-20 minutes Easy to score Can be administered by teachers or researchers Optimal cutoff scores for diagnosing DCD in males and females using the CSAPPA have been determined (Hay, Hawes, & Faught, 2004) Considerations: Literature suggests that awareness of physical competence is a strength for young children (Damon & Hart, 1982) Children under the age of eight years tend to have difficulty with accurate self-evaluation (Rodger, Watter, Marinac, Woodyatt, & Ziviani, 2007) Teacher Questionnaires School Function Assessment (SFA) measures level of participation, adaptation and assistance needed, as well as performance in the academic and social aspects of school Evaluates individual and contextual factors and defines function by the outcome of the performance rather than by the methods used Distinguishes between children who differ in functional tasks that require cognitive abilities versus those that require physical abilities Wang, Tseng, Wilson, & Hu (2009) concluded that childrens motor performance is not always consistent in different contexts, especially when there are differences in time pressures between home and school; in addition, perceptions of parents as primary caregivers may be quite different from the judgment of teachers, who may value independence more than direct care..children with DCD are a heterogeneous group, and those who have poor functional performance at home may not necessarily experience limitations at school, or vice versa (p. 823). Although the SFA has not been referenced specifically to the DCD population, there is a moderately high correlation between the related parts of the SFA and the VABS (Hwang, Davies, Taylor, & Gavin, 2002) Motor Observation Questionnaire for Teachers (MOQ-T) helps identify children in the 6-11 year old range with possible DCD Evaluates qualitative descriptors of motor performance Significantly correlates with the DCDQ-07 and M-ABC (Schoemaker, Flapper, Reinders-Messelink, & de Kloet, 2008) Teacher Estimation of Activity Form (TEAF) - measures a students general aptitude for and enjoyment of physical activity Supports physical education teachers in differentiating between children with and without DCD The impacts of DCD do not limit themselves only to participation in physical activities but rather influence participation in other leisure activities, which is important to consider when planning for intervention (Engel-Yeger, Hanna-Kassis, & Rosenblum, p. 1012, 2012) Teachers were less likely to observe motor impairments in children with disruptive behavior (Rivard, Missiuna, Hanna, & Wishart, 2007) Teachers assess motor skills differently depending on the type of motor task, reporting more concern for gross motor problems than fine motor problems (Rivard et al., 2007) Academic Performance Emerging evidence suggests that some children with deficits in manual dexterity may have compromised academic achievement in school (Sartori, Lamp, Von Baranov, Goncalves, & Brauner, 2013). If the child is not functioning at grade level, further investigation of intellectual ability is warranted.  Theoretically, DCD is present from birth; however, it is not recommended that a diagnosis be given to children under the age of five due to wide variability in: Stability of testing results for intellectual and motor functioning (Blank et al., 2011). Motor development (Blank et at., 2011). Cooperation and motivation (Blank et at., 2011). Performance between environments Performance from day to day Early developmental milestones may develop spontaneously and may not be impacted or delayed. At school age, delays become more apparent with learned skills such as handwriting, kicking a ball, and independent dressing. When tasks require adaptation in speed, timing, force or distance of movement, delays become more observable. Deficits in the early developmental period are subtle yet apparent. Watch for the following (adapted from Missiuna, Rivard, & Barlett, 2003): Awkward gait Fixing joints Slowness of movement Frequent tripping Bumping into others and obstacles Restricted repertoire of play Rigid and jerky movements Fatiguing quickly Heavy reliance on vision Repeating motor tasks in the same way regardless of success Inability to generalize skills across settings Avoidance of motor tasks Messy eating Lack of independence in ADLs The Peabody Developmental Motor Scale-2nd Edition (PDMS-2) is a good tool for describing and evaluating change over time of motor skills in young children under the age of 72 months (Rivard, Missiuna, Pollock, & Steyer-David, 2012). Considerations for Criterion C: Although developmental milestones are not necessarily delayed in children with DCD, the quality of the movement may be impacted and should be observed  A comprehensive physical assessment should be completed by all professionals involved in order to rule out other possible causes of motor difficulties (Adah, 2011, Callanen, 2012). Intellectual Function If the child is not functioning at grade level, further investigation of intellectual ability is warranted. Academic achievement can be evaluated by a psychologist or a teacher (level B trained) using an assessment of learning such as the Wechsler Individual Achievement Test-3rd Edition (WIAT-III). Emerging evidence of a cognitive profile specific to DCD includes deficits in processing speed, perceptual reasoning, language, attention, working memory, and executive function (Biotteau, Albaret, Lelong, & Chaix, 2013). Cognitive function can be measured by a psychologist using the Wechsler Intelligence Scale for Children 4th Edition (WISC-IV) or screened by a trained rehabilitation professional using the Kaufmann Brief Intelligence Test 2nd edition (KBIT-2). KBIT-2: Estimates a childs verbal versus nonverbal intelligence and can be helpful in identifying children who require a more comprehensive evaluation Neither the WIAT-III nor the KBIT-2 identify memory or processing speed deficits which are integral to determining a full scale IQ The authors of the KBIT-2 also caution against using the screen for labeling and placement based on the IQ standard score and when using the KBIT-2 as the only IQ measurement in a reading disability evaluation (Chin et al., 2001). In the past, children scoring less than 70 on IQ testing were excluded from a diagnosis of DCD. However, if the motor impairment fits the criteria for DCD and the history and examination preclude any other cause for a motor impairment, then a DCD diagnosis should be given (Blank et al., 2011). Since these recommendations, preliminary research has emerged that provides parameters to guide reasoning to determine the point at which motor difficulties are in excess of those usually associated with cognitive deficits: for each standard deviation lower IQ, a mean loss of 10 percentile motor points would be expected (Smits-Engelsman & Hill, p. 954, 2013). The confidence interval is wide and must be taken into account (Figure 1). This Smits-Engelsman and Hill study applies to children with an intellectual disability and an IQ of <80.  Figure 1. Relationship between motor percentile and IQ scores: expected motor percentile score based on 10-point IQ bands (n = 460) (From: Smits-Engelsman & Hill, p 954, 2013) Visual Function The DSM-5 (American Psychiatric Association, 2013) indicates that visual impairments must be ruled out as a cause of motor skill deficits. Prior to assessing for DCD, both visual acuity and ocular motor skills need to be screened by trained therapists (Coetzee & Pienaar, 2013, Piquette & Boulet 2013,). Screening includes: Horizontal and vertical pursuits Vertical pursuits are significantly impaired relative to children without DCD (Robert et al., p 597, 2014) Saccades Convergence Suppression significant strabismus was three times more common in severe DCD than in typically developing children (Creavin, Lingam, Northstone and Williams, p 166, 2014) Ocular mobility These results should be report to the pediatrician and included in a referral to an optometrist for a comprehensive evaluation. Neurological Status Evidence is emerging that indicates that neurological soft signs (NSS) may provide insight into a childs neurological condition. Van Hoorn, Maathuis, Peters, Lieke, & Hadders-Algra, 2010 found a strong correlation between impaired handwriting, visual-motor integration, and NSS. The Quick Neurological Screening Test 3rd Edition (QNST-3) is a screening tool of NSS that looks at how a person plans and executes motor movements. As a child matures, the motor system becomes more finely tuned and the soft signs that had been apparent earlier disappear.The persistence of soft signs beyond early childhood can indicate atypical neurological development.Thus, soft signs provide a window into the structural and functional integrity of the neural pathways that govern motor planning and execution (Mutti, Martin, Sterling, & Spalding, p. 11, 2012). Contains four of the items to evaluate cerebellar function, which is implicated in DCD (Zwicker, Missiuna and Boyd, 2012) - tandem walk, finger-nose test, one legged stance, and rapidly alternating forearm rotations Although not required for a diagnosis, the presence of NSS should be recorded and reported to the pediatrician. Dyspraxia (Sensory Integrative Dysfunction and Praxis) The definitions for dyspraxia and DCD are often similar; however, whether they are distinct diagnoses has been a controversial debate in the literature. Sanger et al., (2006) and Kimball (2002) both agree that dyspraxia is distinct from DCD and that dyspraxia may or may not be present in children with DCD. Kimball states that DCD includes deficits in motor planning and execution, whereas dyspraxia is defined as deficits in sensory function (tactile, proprioceptive, and vestibular input) that may cause poor ideation and planning, which can in turn impact motor performance. When treating children with dyspraxia, the emphasis is on ideation, concept formation, and planning, while intervention for a neuro-motor problem is on motor execution (Kimball, pg 210, 2002). To help differentiate DCD and dyspraxia, observe a childs ideation, planning, and execution abilities: If deficits in processing tactile, proprioceptive, and vestibular information are suspected, complete the Observations of Sensory Processing (Blanche 2002) If more detailed information is required, complete a Sensory Integration and Praxis Test (SIPT) (requires certification) See Appendix C for other considerations regarding Criterion D. Discussion and Summary The diversity of deficits in DCD warrants investigation and early identification by a multidisciplinary team to provide the most comprehensive assessment possible and to further determine optimal intervention planning and support for the child and family. This paper has provided evidence-based information on best practices for the evaluation and assessment necessary for supporting the diagnosis of Developmental Coordination Disorder. Further clinical reference papers will include information on co-morbidities and conditions commonly associated with DCD, best practice for intervention, and the long-term outcomes associated with DCD. Further resources can be found on the CanChild (2014) website. Additional Recommendations Use Appendix A to guide your assessment Use Appendix A as a resource for available tools References Adah, C., (2011, December 16). Developmental Coordination Disorder (Physical Therapy). In the Clinical Review Series. Glendale, CA: CINAHL Information Systems. Retrieved from:  HYPERLINK "http://search.ebscohost.com/login.aspx?authtype=uid&profile=rrc&user=ns011560&password=password" http://search.ebscohost.com/login.aspx?authtype=uid&profile=rrc&user=ns011560&password=password American Psychiatric Association (2012) Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. (DSM-5) Washington, DC, USA. pages.74-77 Amundson, S.J. (1995) Evaluation Tool of Childrens Handwriting (ETCH). Homer, AK Ayres, A.J. (1989). Sensory Integration and Praxis Tests. Los Angeles. Western Psychological Services Barnett, A, Henderson, S.E., Scheib, B. and Schulz. C. (2007). The Detailed Assessment of Speed of Handwriting (DASH). London, UK Biotteau, M., Albaret, J.M., Lelong, S., & Chaix, Y. (2013). Cognitive Profile on the WISC-IV of children with developmental coordination disorder and or developmental dyslexia.[Abstract] Brazilian Journal of Motor Behavior, 7, 104 Blanche, E.I. (2002)Observations based on Sensory Integration Theory. Los Angeles. Western Psychological Services Blank, R., Smits-Engelsman, B., Polatajko, H., & Wilson, P. (2012). European Academy for Childhood Disability (EACD), Recommendations on the Definition, Diagnosis and Intervention of Developmental Coordination Disorder. Developmental Medicine and Child Neurology, 54(1), 54- 93. Bruininks, R., & Bruininks, B., (2005). Bruininks-oseretsky test of motor proficient (2nd ed). Circle Pines, MN: AGS Publishing (American Guidance Services) Bruininks, R., & Bruininks, B., (2005). Bruininks-oseretsky test of motor proficient (2nd ed) Checklist. Circle Pines, MN: AGS Publishing (American Guidance Services) Cairney, J., Veldhuizen, S., Kurdyak, P., Missiuna, C., Faught, B.E., & Hay, J. (2007). Evaluating the CSAPPA subscales as potential screening instruments for developmental coordination disorder. Archives of Disease in Childhood, 92(11), 987-991. Cairney, J., Missiuna, C., Veldhuizen, S., & Wilson, B. (2008). Evaluation of the psychometric properties of the Developmental Coordination Disorder questionnaire for parents (DCD-Q): Results from a community based study of school-aged children. Human Movement Science, 27(6), 932-940. CanChild needs to be on here see Julie Ps explanation on how to reference Callanen, A., (2012, November 30). Developmental Coordination Disorder (Occupational Therapy). Clinical Review Series. Retrieved from:  HYPERLINK "http://search.ebscohost.com/login.aspx?authtype=uid&profile=rrc&user=ns011560&password=password" http://search.ebscohost.com/login.aspx?authtype=uid&profile=rrc&user=ns011560&password=password Chin, C.E., Ledesma, H.M., Cirino, P.T., Sevcik, R.A., Morris, R.D., Frijters, J.C, (2001). Relation between Kaufman Brief Intelligence Test and WISC-III scores of children with RD. Journal of Learning Disabilities, 34(1), 2-8. Coetzee, D., &Pienaar, A., (2013). The effect of visual therapy on the ocular motor control of seven- to eight-year-old children with Developmental Coordination Disorder. Research in Developmental Disabilities, 34, 4073-4084 Coster, W., Deeney, T., Haltiwanger, J., & Haley, S. (1998).School Function Assessment. Boston, MA: Boston University Creavin, A., Lingam, R., Northstone, K., & Williams, C., (2014) Ophthalmic abnormalities in children with developmental coordination disorder. Developmental Medicine &Child Neurology 56:164-170 Damon, W., & Hart, D. (1982). The development of self-understanding from infancy through adolescence. Child Development 53, 841-864 Dunn, W. (1999). Sensory Profile Caregiver. University of Kansas, Lawrence, KS Dunn, W., (2002) Sensory Profile Adolescent/Adult Caregiver. University of Kansas, Lawrence, KS Dunn, W. (2006). Sensory Profile School Companion. University of Kansas, Lawrence, KS Engel-Yeger, B., Hanna-Kassis, A., & Rosenblum, S. (2012). Can gymnastic teacher predict leisure activity preference among children with developmental coordination disorder (DCD)? Research in Developmental Disabilities, 33, 1006-1013. Faught, B., Cairney, J., Hay, J., Veldhuizen, S., Missiuna, C., & Spironello, C., (2008). Screening for motor coordination challenges in children using teacher ratings of physical ability and activity. Human Movement Science, 27, 177-189 Folio, M.R & Fewell. R.R. (2000). Peabody Developmental Motor Scale 2nd Edition. Austin, TX: Geuze, R., Jongmans, M., Schoemaker, M., & Smits-Engelsman, B. (2001). Developmental coordination disorder. Human Movement Science, 20, 1-5. Harrison, K., Cantin, N., & Stipanicic, A. (2013). Is there a neuropsychological profile associated with developmental coordination disorder? [Abstract] Brazilian Journal of Motor Behavior, 7, 68 Hay, J., Hawes, R., & Faught, B.E. (2004). Evaluation of a screening instrument for developmental coordination disorder. Journal of Adolescent Health, 34(4), 308-313. Henderson, S.E., Sugden, D.A. and Barnett A. L., (2007). The Movement Assessment Battery for Children 2nd Edition London, UK. High, J., Gough, A., Pennington, D., & Wright, C. (2000). Alternative assessments for sensory integration dysfunction. British Journal of Occupational Therapy, 63, 2-8. Hwang, J., Davies, P.L., Taylor, M.P., & Gavin, W.J. (2002). Validation of School Function Assessment with elementary school children. OTJR: Occupation, Participation and Health, 22(2), 48-58. Kaufman, A.S., Kaufman, N.L. (2004). Kaufman Brief Intelligence Test 2nd Edition. Yale University Child Study Center, New Haven, CN. Kimball, J., (2002) Developmental Coordination Disorder. By: Cermak, S., & Larkin, D. (Eds.). (2002). New York: Delmar Thomson. 210-20 Kirby, A., Sugden, D., & Purcell, C. (2014). Diagnosing developmental coordination disorders. Arch Dis Child, 99, 292-296. Missiuna, C., Rivard, L., & Bartlett, D. (2003). Early identification and risk management of children with developmental coordination disorder. Pediatric Physical Therapy, 15(1), 32-38. Mutti, M., Martin, N.A., Sterling, H.M., & Spalding, N.V. (2012). Quick Neurorological Screening Test 3rd Edition. Novato, CA: ATP Assessment Division of Academic Therapy Publications. Piquette, N., & Boulet C., (2013) Visual Impediments to Learning. Optometry and Visual Performance, 1 (4):118-24 Polatajko, H., & Cantin, N., (2006) Develpmental Coordination Disorder (Dyspraxia): an Overview of the State of the Art. Seminars in Pediatric Neurology, 12: 250-58 Pollock, N., Lockhart, J., Blowes, B., Semple, K., Webster, M., Farhat, L., Jacobson, J., Bradley, J., Brunetti, S., (2009) The McMaster Handwriting Assessment Protocol (2nd ed.). McMaster University, Hamilton, Ontario: CanChild 2014 Rivard, L., Missiuna, C., McCauley, D., & Cairney, J. (2012). Descriptive and factor analysis of the Developmental Coordination Disorder Questionnaire (DCDQ07) in a population-based sample of children with and without Developmental Coordination Disorder. Child: care, health and development, 40(1), 42-49. Rivard, L., Missiuna, C., Pollock, N., & Steyer-David, K., (2012). Development Coordination Disorder. Physical Therapy for Children 4th Edition. By Campbell Suzann K., Palisano, Robert J., Orlin, Margo. Elsevier Saunders, St. Louis, Missouri. 16, 498-538. Rivard, L.M., Missiuna, C., Hanna, S., & Wishart, L. (2007). Understanding teachers perceptions of the motor difficulties of children with developmental coordination disorder (DCD). British Journal of Educational Psychology, 77, 633-648. Robert, M., Ingster-Moati, I., Albuison, E., Cabrol, D., Golse, B., Vaivre-Douret, L., (2014) Vertical and horizontal smooth pursuit eye movements in children with developmental coordination disorder. Developmental Medicine & Child Neurology.56:595-600 Rodger S., Watter P., Marinac J., Woodyatt G., & Ziviani J. (2007). Assessment of children with Developmental Coordination Disorder (DCD): Motor, functional, self-efficacy, and communication abilities. New Zealand Journal of Physiotherapy, 35(3). 99-109 Sanger, T., Chen, D., Delgado, M., Gaebler-Spire, D., Hallet, M., & Mink, J. (2006). Definition and Classification of Negative Motor Signs in Childhood. Pediatrics, 118(5), 2159-2167. Sartori, R.F., Lamp, L.G., Von Baranov, S., Goncalves, M.B., & Brauner, V.L.P. (2013). Motor performance and academic achievement. [Abstract] Brazilian Journal of Motor Behavior, 7, 126 Schoemaker, M.M., Flapper, B.C.T., Reinders-Messelink, H.A., & de Kloet, A. (2008). Validity of the motor observation questionnaire for teachers as a screening instrument for children at risk for developmental coordination disorder. Human Movement Science, 27(2), 190-199. Schoemaker, M.M., Niemeijer, A.S., Flapper, B.C., & Smits-Engelsman, B.C. (2012). Validity and reliability of the Movement Assessment Battery for Children-2 Checklist for children with and without motor impairments. Developmental Medicine & Child Neurology, 54(4), 368-375. Slater, L.M., Hillier, S.L., & Civetta, L.R. (2010). The clinimetric properties of performance-based gross motor tests used for Children with developmental coordination disorder: A systematic review. Pediatric Physical Therapy, 22(2), 170-179. Smits-Engelsman, B., & Hill, E.L. (2013). The Relationship between Motor Coordination and Intelligence Across the IQ Range. Pediatrics, 130, 950-956. Smyth, M.M., & Mason, U.C. (1998). Use of proprioception in normal and clumsy children. Developmental Medicine and Child Neurology, 40, 672-681 Sparrow S.S., Cicchetti D. V. and Balla D.A., (2005) Vineland Adaptive Behavior Scales 2nd Edition. Bloomington, Min. Sugden, D.A. and Henderson, S.E., (2007). Movement Assessment Battery for Children-2 Edition (MABC-2), London, UK Sugden, D.A. and Henderson, S.E., (2007). Movement Assessment Battery for Children- 2 Edition Checklist (MABC-2 Checklist), London, UK Van Dellen, T, and Kalverboer, A.F. (1987); revised Schoemaker, M.M. (2003) Motor Observation Questionnaire for Teachers. Netherlands Van Hoorn, J., Maathuis, C., Peters, Lieke., Hadders-Algra, M., (2010). Handwriting, Visuomotor Integration, and Neurological condition at school age. Developmental Medicine and Child Neurology , 52:941-947. Wang, T., Tseng, M., Wilson, B., and Hu, F., (2009). Functional performance of children with developmental coordination disorder at home and at school. Developmental Medicine and Child Neurology, 51:817-825. Watter, P., Rodger, S., Marinac, J., Woodyatt, G., Ziviani, J., & Ozanne, A. (2008). Multidisciplinary Assessment of Children with Developmental Coordination Disorder: Using the ICF Framework to Inform Assessment. Physical and Occupational Therapy in Pediatrics, 28(4), 331-352. Wechsler, David. (2010) Wechsler IndividualAchievement Test 3rd Edition: Canadian. London, UK. Wechsler, David (2010) Wechsler Intelligence Scale for Children 4th Edition: Canadian. London, UK. Wilson, P.H., Ruddock, S., Smits-Engelsman, B., Polatajko, H., & Blank, R. (2012). Understanding performance deficits in developmental coordination disorder: A meta-analysis of recent research. Developmental Medicine and Child Neurology, 55(3), 217-228 Wilson, B.N., Crawford, S.G., Green, D., Roberts, G., Aylott, A., & Kaplan, B.J. (2009). Psychometric properties of the Revised Developmental Coordination Disorder Questionnaire. Physical & Occupational Therapy in Pediatrics, 29(2), 182-202 Wilson, B., Crawford., The Developmental Coordination Questionnaire 2007. Administration manual for DCDQ07 with psychometric properties. Calgary, Alberta Zwicker, J.G.,Missiuna, C.,Harris, S.R.,and Boyd, L.A. (2012). Developmental coordination disorder: A pilot diffusion tensor imaging study. Pediatric Neurology, 46(3), 162-167. Zwicker, J.G.,Missiuna, C.,Harris S.R., and Boyd, L.A. (2012).Developmental coordination disorder: A review and update. European Journal of Pediatric Neurology, 16(6), 573-581. Appendix A Quick Reference Guide for Assessment in DCD Clinical examination to determine the presence of DCD should include the following areas. Based on the childs challenges and on the environment, choose the appropriate tools to support your assessment. History taking Motor status Parent/Teacher and Child Perspective Children 3 and over: Movement ABC-2nd Edition Children under 5: Peabody Developmental Motor Scales-2nd Edition (PDMS-2) Developmental Coordination Disorder Questionnaire-2007 (DCDQ-07) HYPERLINK "http://www.dcdq.ca"www.dcdq.ca Printing; McMaster Handwriting Assessment Protocol-2nd Edition  HYPERLINK "http://www.canchild.ca/en/aboutcanchild/resources/HandwritingProtocolAugust2009FINAL.pdf" www.canchild.ca/en/aboutcanchild/resources/HandwritingProtocolAugust2009FINAL.pdf Evaluation Tool of Childrens Handwriting (ETCH) Detailed Assessment of Speed of Handwriting (DASH) ADLs, productivity, and leisure Parent/Child/Teacher interviews and questionnaires Vineland Adaptive Behavior Scales-2nd Edition (VABS-2) Neurological status Quick Neurological Screening Test -3rd Edition (QNST-3) Sensory status Visual screen Observations of Sensory Processing Sensory Integration and Praxis Testing (SIPT) Emotional/behavioral status Parent/teacher interview Psycho-educational reports Vineland Adaptive Behavior Scales-2nd Edition (VABS-2) Cognitive function Psycho-educational assessment and/or reports Wechsler Individual Achievement test 3rd Edition (WIAT-III) Kaufmann Brief Intelligence Test -2nd Edition (KBIT-2) Wechsler Intelligence Scale for Children 4th Edition (WISC-IV) Parents will contribute information by providing or completing: Family history of: DCD, co-morbidities, neurological, mental, or medical conditions, sleep disturbances, and the environmental/social factors specific to the family Personal history of their child: prenatal and birth history, medical history and current diagnoses, developmental milestone acquisition, school achievements, and function within all environments Current supports and challenges in all environments: ADLs, participation, etc. Questionnaires Developmental Coordination Disorder Questionnaire-2007 (DCDQ-07) Movement ABC-2nd Edition (MABC-2) Vineland Adaptive Behavior Scales-2nd Edition (VABS-2) Child will contribute information by completing: Questionnaires: Childrens Self-perceptions of Adequacy in and Predilection toward Physical Activity (CSAPPA) Teachers will provide information on: Academic achievement Wechsler Individual Achievement test 3rd Edition (WIAT-III) School based behaviors (attention, self-esteem, etc.) Motor function, activities and participation, environmental factors, support systems, and relevant strengths and challenges seen at school Questionnaires: School Function Assessment (SFA) Motor Observation Questionnaire for Teachers (MOQ-T) Teacher Estimation of Activity form (TEAF) Appendix B DSM-5 (2012) criteria for Developmental Coordination Disorder: Diagnostic Criteria: The acquisition and execution of coordinated motor skills is substantially below that expected given the individuals chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness (e.g. dropping or bumping into objects) as well as slowness and inaccuracy of performance of motor skills (e.g. catching an object, using scissors or cutlery, handwriting, riding a bike, or participation in sports). The motor skills deficit in Criterion A significantly and persistently interferes with activities of daily living appropriate to chronological age (e.g. self care and self maintenance) and impacts academic/school productivity, prevocational and vocational activities, leisure and play. Onset of symptoms is in the early developmental period The motors skills deficits are not better explained by intellectual disability intellectual developmental disorder) or visual impairment and are not attributable to a neurological condition affecting movement (e.g. cerebral palsy, muscular dystrophy, degenerative disorder) Diagnostic Features: The diagnosis of developmental coordination disorder is made by a clinical synthesis of the history (developmental and medical), physical examination, school or workplace report, and individual assessment using psychometrically sound and culturally appropriate standardized tests. Criterion A: Young children may be delayed in achieving motor milestones Movement execution may appear awkward, slow or less precise Criterion B: The motor impairment must significantly interfere with the performance of, or participation in daily activities in family social, school or community life Activities such as getting dressed, eating meals with age appropriate utensils and without mess, engaging in physical games with others, using specific tolls in class such as rulers and scissors and participating team exercise activities at school.. Not only is ability to perform impaired, but also marked slowness in execution is common. Handwriting competence is frequently affected, consequently affecting legibility and or speed of written output and affecting academic achievement Criterion C: Typical not diagnosed before age 5 years because there is considerable variation in the age of acquisition of many motor skills or lack of stability of measurement Criterion D: Visual function examination and neurological examination must be included in the diagnostic evaluation If intellectual disability is present, the motor difficulties are in excess of those expected for the mental age, however no IQ cutoff is specified Appendix C Developmental Coordination Disorder Differential Diagnosis Coordination difficulties are likely not due to DCD when a history of any of the following is reported: Recent head injury or trauma Deterioration in previously learned or acquired skills Global developmental delays Increased muscle tone, fluctuating tone, or significant hypotonia Asymmetrical/ fluctuating tone or strength Gait abnormalities (e.g., ataxia, wide based, prolonged toe walking) Musculoskeletal abnormality Neuro-cutaneous lesion (e.g., tuberous sclerosis, neurofibromatosis) Gowers sign Dysarthria , swallowing, or feeding difficulties Absence of deep tendon reflexes Dysmorphic features Headaches, eye pain, blurred vision Untreated visual impairments (e.g., strabismus) Adapted from: Missiuna, Gaines, & Soucie (2006) and Kirby, Sugden, & Purcell (2013)      PAGE \* MERGEFORMAT 1 Developmental Coordination Disorder What information does a multi-disciplinary team require for consistent, evidence-based evaluation and assessment to support the diagnosis of Developmental Coordination Disorder? Prepared by: DCD Resource Team Childrens Rehabilitation Central Zone September 2014 Criterion A: The acquisition and execution of coordinated motor skills is substantially below that expected given the individuals chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness (e.g. dropping or bumping into objects) as well as slowness and inaccuracy of performance of motor skills (e.g. catching an object, using scissors or cutlery, handwriting, riding a bike, or participation in sports (American Psychiatric Association, p 74, 2013) Criterion B: The motor skills deficit in Criterion A significantly and persistently interferes with activities of daily living appropriate to chronological age (e.g. self care and self maintenance) and impacts academic/school productivity, prevocational and vocational activities, leisure and play (American Psychiatric Association, p 74, 2013). 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5ɹlmuu~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u'4AߟKnq,,ա]Y~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u?*=r{ nO\ 5ɹlmuu~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u'4AߟKnq,,ա]Y~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u~{ߺ^׽u?*=r{ nO\ 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