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.

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International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder

Aim
To better understand the neural and performance factors that may underlie developmental coordination disorder (DCD), and implications for a multi-component account.

Method
A systematic review of the experimental literature published between June 2011 and September 2016 was conducted using a modified PICOS (population, intervention, comparison, outcomes, and study type) framework. A total of 106 studies were included.

Results
Behavioural data from 91 studies showed a broad cluster of deficits in the anticipatory control of movement, basic processes of motor learning, and cognitive control. Importantly, however, performance issues in DCD were often shown to be moderated by task type and difficulty. As well, we saw new evidence of compensatory processes and strategies in several studies. Neuroimaging data (15 studies, including electroencephalography) showed reduced cortical thickness in the right medial orbitofrontal cortex and altered brain activation patterns across functional networks involving prefrontal, parietal, and cerebellar regions in children with DCD than those in comparison groups. Data from diffusion-weighted magnetic resonance imaging suggested reduced white matter organization involving sensorimotor structures and altered structural connectivity across the whole brain network.

Interpretation
Taken together, results support the hypothesis that children with DCD show differences in brain structure and function compared with typically developing children. Behaviourally, these differences may affect anticipatory planning and reduce automatization of movement skill, prompting greater reliance on slower feedback-based control and compensatory strategies. Implications for future research, theory development, and clinical practice are discussed.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/dmcn.13530

Cognitive and neuroimaging findings in developmental coordination disorder: new insights from a systematic review of recent research

Children born early (<37 weeks of gestation) are at high risk of a range of motor impairments due to a variety of biological and environmental risk factors. Cerebral palsy occurs more frequently in those children born preterm, with the risk increasing with decreasing gestational age. Mild and moderate motor impairments, consistent with developmental coordination disorder, occur in almost half of those children born preterm and include difficulties with balance, manual dexterity and ball skills. All forms of motor impairment are associated with comorbidities, which may have a greater effect on quality of life, academic achievement and participation in extracurricular activities than the motor impairment itself. Infants at risk of motor impairment can be identified in early infancy with a combination of clinical assessment tools and perinatal risk factors. However, the reliable diagnosis of motor impairment requires follow-up into early childhood and it is important to ensure that the appropriate intervention is implemented.

Cerebral palsy and developmental coordination disorder in children born preterm.

Introduction Paediatric occupational therapy seeks to improve children's engagement and participation in life roles. A wide variety of intervention approaches exist. Our aim was to summarise the best-available intervention evidence for children with disabilities, to assist families and therapists choose effective care. Methods We conducted a systematic review (SR) using the Cochrane methodology, and reported findings according to PRISMA. CINAHL, Cochrane Library, MEDLINE, OTSeeker, PEDro, PsycINFO were searched. Two independent reviewers: (i) determined whether studies met inclusion: SR or randomised controlled trial (RCT); an occupational therapy intervention for children with a disability; (ii) categorised interventions based on name, core components and diagnostic population; (iii) rated quality of evidence and determined the strength of recommendation using GRADE criteria; and (iv) made recommendations using the Evidence Alert Traffic Light System. Results 129 articles met inclusion (n = 75 (58%) SRs; n = 54 (42%)) RCTs, measuring the effectiveness of 52 interventions, across 22 diagnoses, enabling analysis of 135 intervention indications. Thirty percent of the indications assessed (n = 40/135) were graded 'do it' (Green Go); 56% (75/135) 'probably do it' (Yellow Measure); 10% (n = 14/135) 'probably don't do it' (Yellow Measure); and 4% (n = 6/135) 'don't do it' (Red Stop). Green lights were: Behavioural Interventions; Bimanual; Coaching; Cognitive Cog-Fun & CAPS; CO-OP; CIMT; CIMT plus Bimanual; Context-Focused; Ditto; Early Intervention (ABA, Developmental Care); Family Centred Care; Feeding interventions; Goal Directed Training; Handwriting Task-Specific Practice; Home Programs; Joint Attention; Mental Health Interventions; occupational therapy after toxin; Kinesiotape; Pain Management; Parent Education; PECS; Positioning; Pressure Care; Social Skills Training; Treadmill Training and Weight Loss 'Mighty Moves'. Conclusion Evidence supports 40 intervention indications, with the greatest number at the activities-level of the International Classification of Function. Yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions could be discontinued because effective alternatives existed.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/1440-1630.12573

Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review.

The impact of Wii Fit intervention on dynamic balance control in children with probable Developmental Coordination Disorder and balance problems

Aim The aim of this study was to review systematically evidence about the efficacy of motor interventions for children with developmental coordination disorder (DCD), and to quantify treatment effects using meta-analysis.

Method  Included were all studies published between 1995 and 2011 that described a systematic review, (randomized) clinical trial, or crossover design about the effect of motor intervention in children with DCD. Studies were compared on four components: design, methodological quality, intervention components, and efficacy. Twenty-six studies met the inclusion criteria for the review. Interventions were coded under four types: (1) task-oriented intervention, (2) traditional physical therapy and occupational therapy, (3) process-oriented therapies, and (4) chemical supplements. For the meta-analysis, effect sizes were available for 20 studies and their magnitude (weighted Cohen’s d [dw]) was compared across training types.

Results  The overall effect size across all intervention studies was dw=0.56. A comparison between classes of intervention showed strong effects for task-oriented intervention (dw=0.89) and physical and occupational therapies (dw=0.83), whereas that for process-oriented intervention was weak (dw=0.12). Of the chemical supplements, treatment with methylphenidate was researched in three studies (dw=0.79) and supplementation of fatty acids plus vitamin E in one study (no effect). The post hoc comparison between treatment types showed that the effect size of the task-oriented approach was significantly higher than the process-oriented intervention (p=0.01) and comparison (p=0.006). No significant difference in the magnitude of effect size between traditional physical and occupational therapy approaches and any of the other interventions emerged.

Interpretation  In general, intervention is shown to produce benefit for the motor performance of children with DCD, over and above no intervention. However, approaches from a task-oriented perspective yield stronger effects. Process-oriented approaches are not recommended for improving motor performance in DCD, whereas the evidence for chemical supplements for children with DCD is currently insufficient for a recommendation.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/dmcn.12008

Efficacy of interventions to improve motor performance in children with developmental coordination disorder: a combined systematic review and meta-analysis.

Anne-Claire Van Der Kaay

Papers

Efficacy of interventions to improve motor performance in children with developmental coordination disorder: a combined systematic review and meta-analysis.