DCE

Question 1

Define DCD

Answer 1

motor coordination markedly below expected levels for the child’s chronological age and intelligence which sig interferes with ADLs and school

Question 2

T/F: DCD is typically due to a medical condition

Answer 2

FALSE

it is not due to a general medical condition

does not meet criteria for a pervasive developmental disorder

Question 3

is it possible to have intellectual disability along with DCD?

Answer 3

YES

but if present, the motor difficulties are in excess of those usually associated with intellectual disability

Question 4

What are the exclusion criteria for a dx of DCD?

Answer 4

1. motor impairment must not be caused by, or have the symptoms of an identifiable neurological problem
2. the child must not have disturbances in tone (ataxia or spasticity), sensory loss, or involuntary movements

Question 5

List previous terms associated with DCD

Answer 5

1. Developmental clumsiness
2. clumsy child
3. developmental apraxia
4. perceptual motor difficulties

Question 6

list frequently encountered comorbidities to DCD

Answer 6

1. ADHD
2. learning disability

Question 7

what is the prevalence of DCD?

Answer 7

• 5-8% of all school-aged children
• boys > girls
• usually ID between 6-12 years of age

Question 8

what is the pathology of DCD?

Answer 8

• heterogenous disorder → difficult to isolate cause
• several theories exist
  
  • continuum of CP → but neuronal damage is at the cellular level or neurotransmitter-receptor level
  • neuronal processing deficit → disorder of complex interaction of various levels of the CNS

Question 9

List common impairments in DCD

Answer 9

1. poor strength and coordination
2. jerky movements
3. poor visual perception
4. joint laxity
5. poor spatial organization
6. inadequate info processing
7. poor sequencing
8. poor feedback and feedforward motor control
9. poor short and long term memory

Question 10

list common activity limitations in DCD

Answer 10

1. awkward, slow gait
2. delayed and poor quality of fine and gross motor skills
   
   1. hopping
   2. jumping
   3. ball skills
   4. writing
3. delayed oral motor skills

Question 11

List participation restriction in DCD that are environmental factors

Answer 11

1. doors too heavy to open
2. PE is competitive and skills oriented
3. late to class b/c passing time is too short
4. time to dress and undress reduces participation in recess and readiness for home and community activities
5. slow and messy written communication in class limits academic performance
6. peers don’t want to try to understand conversations

Question 12

list participations restrictions in DCD that are personal factors

Answer 12

1. depression
2. quit trying to participate, unmotivated
3. low self-esteem
4. poor fitness
5. activities performed w/o concern for time restrictions
6. vocational anxiety

Question 13

list soft neurological signs of DCD

Answer 13

1. hypotonia
2. persistence of primitive reflexes
3. immature balance reactions

Question 14

what are possible early indicators of DCD?

Answer 14

1. difficulty managing a spoon, manipulating a toy, pedaling a tricycle, scribbling
2. difficulty with self care skills such as putting on and taking off clothes, tying shoes, managing zippers, snaps

Question 15

T/F: children can outgrow DCD

Answer 15

FALSE

they can learn to compensate

Question 16

Give some examples of interview questions for the parent when trying to ID DCD

Answer 16

1. how does your child feel about physical activity?
2. how does your child feel about participating in group physical activities?
   
   1. are there particular group activities he/she dislikes?
3. does your child often trip, fall down, or bump into things?

Question 17

Give some examples of interview questions for a child you suspect has DCD

Answer 17

1. what do you like/dislike about PE?
2. what is your fav type of physical activity?
3. do you participate in any of these activities with your friends/family?
   
   1. do you think you are good at them?
4. do you think you are as good at physical activities as other children your age?
5. do you ever get frustrated when participating in physical activity with your friends?

Question 18

List assessment tools to include in your eval of a child who may have DCD

Answer 18

1. PDMS-2
2. BOT
3. MABC
4. Canadian Occupational performance measure
5. School function assessment

Question 19

things to keep in mind with the BOT

Answer 19

• appropriate for children over 4
• caution → may miss some children with DCD as it does not look at quality of movement just completion

Question 20

things to keep in mind with MABC

Answer 20

Movement Assessment battery for Children

• for children 4-12 years old
• included qualitative descriptors of motor behavior
• gold standard for this population

Question 21

what is a bottom-up approach to intervention?

Answer 21

focuses on remediating underlying deficits though selective transmittal of sensory info, which the CNS interprets and organizes into the development of an appropriate movement strategy

ie sensory system impaired lets beef it up

Question 22

give some examples of bottom-up interventions

Answer 22

1. SI therapy
2. process-oriented treatment
3. perceptual motor training

Question 23

what is a top-down approach to intervention?

Answer 23

emphasis on cognitive or problem-solving skills to select and implement the most appropriate strategies for successful task performance

Question 24

give some examples of top-down interventions

Answer 24

1. task-specific intervention
2. cognitive approaches

Question 25

which approach has more research support?

Answer 25

Top Down

Question 26

what is a task specific intervention?

Answer 26

focuses on direct teaching of a skill motor tasks are broken down into steps

Question 27

what are cognitive approaches to intervention?

Answer 27

emphasize active problem solving child uses verbal guidance

Question 28

what the benefit of a task specific and cognitive approach to intervention?

Answer 28

* provide repetition and practice of specific motor skills * cognitive approach has added advantage of promoting independent problem solving * both require attention to task and working memory

Question 29

what types of modifications to the home can we encourage in a child with DCD?

Answer 29

1. encourage participation in sports/activities that are interesting to the child 2. physical activity and enjoyment should be emphasized rather than proficiency or competition 3. try introducing child to new sport or playground on individual basis before being in a group 1. private lessons may help 2. ask simple questions to ensure comprehension 4. during functional tasks prompt problem solving (ask “what do you need to do first?") 5. select clothing the child can independently manage

Question 30

what types of modifications to school should we encourage in children with DCD?

Answer 30

1. make sure child is properly positioned 2. set realistic short term goals 3. provide child with extra time to complete fine motor activities 4. introduce computers early 5. adapted pencil grips, markers

Question 31

what types of modifications to PE should we make for children with DCD?

Answer 31

1. break down gym activity into smaller parts, while ensuring that each part is meaningful and achievable 2. try to choose activities that will ensure success for the child at least 50% of the time 3. reward effort not skill 4. try to incorporate activities which require a coordinated response from arms and/or legs

Question 32

other things we should keep in mind in children with DCD

Answer 32

1. encourage children to develop skills using their hands in a dominant/assistant fashion 1. baseball, hockey 2. keep the environment predictable when teaching a new skill 3. make participation, not competition the major goal

Question 33

Briefly describe ADHD

Answer 33

* frequently involve motor problems as well * 30-50% have DCD * core symptoms: * inattention * impulsivity * hyperactivity

Question 34

Briefly describe ADHD

Answer 34

* frequently involve motor problems as well * 30-50% have DCD * core symptoms: * inattention * impulsivity * hyperactivity