Developmental coordination disorder DCD. Overview. Gross & fine motor skill. Elisabeth Hill The importance of motor development

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1 Developmental coordination disorder Overview The importance of motor development Elisabeth Hill DCD Developmental coordination disorder: Diagnosis Behaviour, brain & Intervention Gross motor development Gross motor development: 0-24 months roll sit unassisted stand assisted hands-knees crawling walk assisted stand walk unassisted unassisted WHO Multicentre Growth Reference Study (2006) Gross & fine motor skill Gross motor: posture, reaching, locomotion Fine motor: grasping, object exploration, manual dexterity 1

2 ENVIRONMENT environment Importance of motor skill Limb and body movements are crucial for: learning about the world, gaining object knowledge development of skilled interaction, social relations, language (e.g. Campos et al. 2000; Bremner et al. 2008; Karasik et al. 2009; Iverson 2010) activities of daily living, general health, mental health (e.g. Cairney et al. 2010; Ekornås et al. 2010; Emck et al. 2011; Hill et al. 2011) good academic achievement and employment outcome (e.g. Kirby et al. 2008; Piek et al. 2008; Hansen et al. 2010) From to (via ) Behaviour [MOTOR] How we measure DCD Cognition Mechanisms that link to Biology Genes, proteins neurotransmitters... Morton (2004) Introducing ENVIRONMENT Diet, maternal drug abuse, orthography, social environment, parenting, teaching style, deprivation, trauma, attachment patterns... Morton (2004) Most children develop motor control fast and effortlessly some have difficulty BUT: despite adequate ability despite adequate environment despite adequate teaching despite adequate motivation Developmental coordination disorder Motor coordination No medical condition; Below expected for age and intelligence; Delayed motor milestones (e.g. crawling); Impact on activities of daily living; academic achievement % prevalence American Psychiatric Association (1994) 2

3 ENVIRONMENT ADL, education Draw as quickly as you can between the two lines of the star... Draw as quickly as you can between the two lines of the star... Draw as quickly as you can between the two lines of the star... with your nonwriting hand without looking at your hand & looking at the star in a mirror Draw as quickly as you can between the two lines of the star... DCD: with your nonwriting hand without looking at your hand & looking at the star in a mirror Behaviour what we measure Hopping, balancing Moving pegs, writing Throwing, catching 3

4 ENVIRONMENT ENVIRONMENT DCD: DCD: Cognition Timing? Motor planning? Visual perception? Kinaesthetic perception? Biology Genes? Motor cortex? Neural connectivity? Neurotransmitters? Biology Does brain based electrical activity (ERP) differ between DCD and typical adults when visual attention is combined with movement? Forward movement Cross movement** Control DCD Cued hand Cued target Cued Hand Cued Target Opposite Cued Hand Opposite Cued Target Brown, van Velzen & Hill (in prep.) Distribution of N1 elicited by probes near GOAL Biology Control DCD Control DCD frontal central posterior Brain based electrical activity differs between DCD and typical adults when visual attention is combined with movement to target, in cross movements Control DCD DCD = Control Brown, van Velzen & Hill (in prep.) Control: expected enhancement DCD: enhancement greatest at irrelevant goal Brown, van Velzen & Hill (in prep.) 4

5 Intervention Motor based interventions Co-op: individual/group MOTOR skill weakness Task-oriented: task breakdown Technology?? Practice, practice, practice The WiiFit Study The WiiFit Study 10 minutes, 3x week Wii Fit vs. Jump Ahead WiiFit Jump Ahead vs. Motor outcome improved following WiiFit intervention Hammond, Jones, Green, Hill & Male (under rev.) Hammond, Jones, Green, Hill & Male (under rev.) Non-motor consequences Independent living Employment Well-being Depression Anxiety Self-esteem DCD is: Conclusions a developmental disorder diagnosed from BEHAVIOUR MOTOR difficulty is the core DIFFERING profiles, and outcomes are seen SIGNIFICANT long-term consequences Long-term economic & well-being implications 5

6 Pause for thought How will this influence your practice? What do need to know about a child s motor difficulties to support their needs? What support would you provide? 6