College of Occupational Therapists Annual

Conference Glasgow 2003

Children with developmental co-

ordination disorder (DCD): Is screening assessment

effective?Elizabeth Stephenson,Clinical Specialist Occupational Therapist, Royal Aberdeen Children’s Hospital

Rosemary ChessonProfessor of Health Services ResearchThe Robert Gordon University

Structure of presentation

• DCD - Terminology

• Background

• Aims of project

• DCD clinic and assessment procedure

• Method

• Results

• Implications and issues

Terminology and definition

• More than 20 terms exist

• Definition is inconsistent

• Heterogeneity of DCD group

• Problems for research

Developmental co-ordination disorder

(DCD)• Performance in daily activities requiring motor co- ordination substantially below that expected for age and cognitive ability.

• Motor difficulty affects academic learning and activities of daily living.

• Not due to a medical condition such as CP, nor meeting the criteria for PDD

• Where cognitive delay exists, motor difficulty must be in excess of it

The study

• Investigation of assessment efficacy part of a wider study

• Study included survey of parent and referrer satisfaction

• Extension of study examines outcome for children with DCD

Collaborative working

• collaboration both between departments and staff in Royal Aberdeen Children’s Hospital & the Robert Gordon University (RGU)

• long term collaboration - grown over the years.

• joint working with OT department and Health Services Research Group, RGU.

Features of collaborative workingDifferent perspectives

- health services researcher (non clinician) and clinician- child specific focus vs broad age spectrum- different organisational contexts

Common objectives- commitment to improve patient care- help establish evidence-based practice

Outcomes- publications- future research

Aspects of research

Research includes clinical and non-clinical elements:

Clinical• assessment• screening

One stop clinicsNon-clinical• parental views

Research to date regarding children with DCD

High volume Low volume

- Assessment (incl tools) - Screening

- Cause - One stop clinics

- Treatment - Outcomes

Outcome Studies• Few longitudional studies.

• Main emphasis on motor & academic outcome.

• Some work on associated emotional/behavioural problems.

• Effects on family neglected- none longitudinal- very few studies- earliest and largest (Chesson, McKay & Stephenson 1990) 31 children

Aims of the project

Evaluation of the accuracy and efficacy of the occupational therapy screening within a one stop clinic procedure for children with DCD

Establishing the DCD clinic

• Increasing demand on occupational therapy service

• ‘One stop’ clinic implemented trial

• Medical and occupational therapy screening on same day

• After 3 years (1995-1997) evaluation required

Basic screening procedure

• History

• Clinical observance

• Drawing and writing

• Posture imitation

Further assessment

• Additional screening tests: motor performance items; visual-motor skill and visual perception

• Fuller assessment: Movement ABC; VMI; MVPT/TVPS (sensory profile)

Method

• Two independent assessors recruited

• Records of 36 children scrutinised (15% of three year study group)

• Data entered into SPSS-PC

• Kappa values calculated to establish degrees of concordance in 5 areas.

Areas examined

• Accuracy of Clinical Observations

• Further tests following screening

• Diagnosis - sub-typing

• Intervention required

• Resource need: clinical/educational

ResultsOverall high levels of concordance between clinician screening & two external assessors

Extent of concordance established using Kappa

poor <or = 0.21

fair 0.21 - 0.40

Moderate 0.41 - 0.60

Sustantial 0.61 - 0.80

Good >0.80

Concordance

Highest levels: Clinical observations

(at least 0.80)

Lowest levels: Intervention required

(0.08)

Concordance cont.

Clinical observations

Highest levels of concordance between:

Clinician & Assessor 1 on neck reflexes

Clinician & Assessor 2

Additional Tests

Tests indicated to supplement basic screening (selection from list)

None considered ‘good’ & none ‘poor’

Highest agreement between C & Assessor 1 regarding visual motor test

Types of dysfunction & diagnosis

Types of dysfunction• considerable range in degrees of concordance

Primary diagnosis

• 20/36 cases of complete agreement on dx

• 11 cases of 2 way agreement

• 5 cases where there was no agreement

Intervention

Intervention C/A1 C/A2

Therapy 0.11 0.49 Therapy ideas 0.08 0.45 Referral to an. agency 0.05 0.60

reflected also in resource needed (educational or clinical)

Implications

• For clinical practice

• For future research

Issue raising

• Clinical settings

• Resources