Efficacy of the Cognitive Orientation to Daily Occupational Performance (CO-OP) Intervention for Children With Developmental Coordination Problems

PURPOSE: Developmental coordination disorder (DCD), seen in 6% of children, interferes with academic achievement and activities of daily living in school-age children (Kirby & Sugden, 2007). Additionally, children with DCD often display difficulties with multistep verbal directions, poor athletic ability, increased time to complete tasks, poor handwriting, and difficulties with dressing (Banks, Rodger, & Polatajko, 2008). Evidence suggests that motor challenges may persist into adolescence and beyond, leading to the development of secondary mental health and educational issues, including poor social competence, academic problems, behavioral problems, and low self-esteem. Occupational therapists work with children with DCD to ultimately enhance their motor and cognitive skills to ensure success in daily pursuits.

Cognitive Orientation to daily Occupational Performance (CO-OP) is a verbally based, highly individualized program focused on using problem-solving techniques to help the child generate his or her own solutions to resolve a difficult aspect of task performance (Banks et al., 2008). CO-OP focuses on teaching children to use a four-step self-instructional problem-solving strategy called Goal–Plan–Do–Check. It targets self-regulatory skills in goal setting, planning, self-monitoring, and evaluation by encouraging the child to consciously reflect on performance and to select, enact, evaluate, and adapt their performance strategies (Jokic, Polatajko, & Whitebread, 2013). While an adult initially guides the child through this strategy, the intention is for the child to gradually become proficient in the problem-solving technique and use it to complete everyday tasks individually. Limited evidence exists on the efficacy of this intervention.

DESIGN AND METHOD: This quasi-experimental pretest–posttest quantitative study recruited 11 children to participate in a pilot investigation to determine the efficacy of the CO-OP intervention. Goal attainment scaling (GAS) allowed individualized goals to be used as outcome measures. GAS provides a mechanism to develop individualized client-centered goals that can be used as an outcome measure (Graham, Rodger, & Ziviani, 2010).

RESULTS: Following completion of the CO-OP program, all children made statistically significant improvements in their individualized goals as measured by GAS scores.

References

Banks, R., Rodger, S., & Polatajko, H. J. (2008). Mastering handwriting: How children with developmental coordination disorder succeed with CO-OP. OTJR: Occupation, Participation and Health, 28, 100–109. https://doi.org/10.3928/15394492-20080601-01

Graham, F., Rodger, S., & Ziviani, J. (2010). Enabling occupational performance of children through coaching parents: Three case reports. Physical and Occupational Therapy in Pediatrics, 30, 4–15. https://doi.org/10.3109/01942630903337536

Jokic, C. S., Polatajko, H., & Whitebread, D. (2013). Self-regulation as a mediator in motor learning: The effect of the Cognitive Orientation to Occupational Performance approach on children with DCD. Adapted Physical Activity Quarterly, 29, 103–126. https://doi.org/10.1123/apaq.30.2.103

Kirby, A., & Sugden, D. A. (2007). Children with developmental coordination disorders. Journal of the Royal Society of Medicine, 100, 182–186. https://doi.org/10.1258/jrsm.100.4.182

McDougall, J., & Wright, V. (2009). The ICF–CY and goal attainment scaling: Benefits of their combined use for pediatric practice. Disability and Rehabilitation, 31, 1362–1372. https://doi.org/10.1080/09638280802572973