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College of Occupational Therapists Annual
Conference Glasgow 2003
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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
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Structure of presentation
• DCD - Terminology
• Background
• Aims of project
• DCD clinic and assessment procedure
• Method
• Results
• Implications and issues
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Terminology and definition
• More than 20 terms exist
• Definition is inconsistent
• Heterogeneity of DCD group
• Problems for research
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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
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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
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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.
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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
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Aspects of research
Research includes clinical and non-clinical elements:
Clinical• assessment• screening
One stop clinicsNon-clinical• parental views
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Research to date regarding children with DCD
High volume Low volume
- Assessment (incl tools) - Screening
- Cause - One stop clinics
- Treatment - Outcomes
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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
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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
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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
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Basic screening procedure
• History
• Clinical observance
• Drawing and writing
• Posture imitation
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Further assessment
• Additional screening tests: motor performance items; visual-motor skill and visual perception
• Fuller assessment: Movement ABC; VMI; MVPT/TVPS (sensory profile)
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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.
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Areas examined
• Accuracy of Clinical Observations
• Further tests following screening
• Diagnosis - sub-typing
• Intervention required
• Resource need: clinical/educational
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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
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Concordance
Highest levels: Clinical observations
(at least 0.80)
Lowest levels: Intervention required
(0.08)
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Concordance cont.
Clinical observations
Highest levels of concordance between:
Clinician & Assessor 1 on neck reflexes
Clinician & Assessor 2
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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
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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
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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)
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Implications
• For clinical practice
• For future research
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Issue raising
• Clinical settings
• Resources