Written Communication in School Children With Developmental Coordination Difficulties: An Interprofessional Study

PURPOSE: Written communication is an important occupation necessary for school performance. Developmental coordination disorder (DCD) is a motor skills disorder that results in a child being challenged in performance of everyday tasks including written communication (Ferguson et al., 2014; Prunty et al., 2016). These problems can have long-term effects on academic, psychosocial, and vocational outcomes (Harrowell et al., 2017; Tal-Saban et al., 2012). The purpose of this pilot study was to evaluate the effect of a two-group comparison 9-wk (27 sessions) interprofessional, team-based intervention program consisting of fine and gross motor muscle strengthening, coordination, and balance training on motor skills and handwriting ability and output in children with documented coordination difficulties.

METHOD: In this quasi-experimental design study, participants were 18 students (9 girls, 9 boys; M age = 9 yr, 2 mo) with documented coordination difficulties recommended by teachers and with parent permission to participate. Inclusion criteria were scores below the 22nd percentile on the Movement Assessment Battery for Children Version 2 (MABC–2) and parent or teacher report that motor problems significantly impaired the child’s daily living or school activities beyond what would be anticipated given their age and intellectual ability. Exclusion criteria were cognitive impairment and evidence of comorbidities that would affect motor skills.

Participants were stratified for age and MABC–2 scores and randomly assigned to an intervention (n = 9) or control group (n = 9). The control group received no intervention, participating in typical after-school program activities. Intervention group participants rotated, in groups of three, every 15 min among three stations: (1) core strengthening and balance; (2) hand strengthening, in-hand manipulation, coordination, and sensorimotor, and (3) writing. Intervention took place in a quiet classroom in the participants’ school and was implemented by physical therapy, occupational therapy, and special education students supervised by a faculty team member using a predetermined protocol.

The MABC–2, Beery–Buktenica Developmental Test of Visual–Motor Integration, Test of Handwriting Skills (THS), and free writing assessments were used to measure intervention effectiveness. Pre- and postintervention testing was administered by experienced professionals who were blinded to group assignment.

RESULTS: Although both groups improved in overall MABC–2 scores, the intervention group demonstrated greater improvement at 9 wk than the control group. Significant improvements were found only in the intervention group for the ball skills (p = .01) and balance (p = .013) subcomponents of the MABC–2 and for the THS (p = .04). Children increased writing output as seen in more complete and readable documents produced in the free writing sessions. Parents reported that the intervention improved their child’s confidence, social behaviors, and ability to sustain attention and complete homework assignments.

CONCLUSION: Findings suggest that an interprofessional intervention program approach was effective in improving motor ability, handwriting skills and output, and behavior among children with developmental coordination difficulties and that the program addressed critical development and transition issues for children with DCD, a key research priority of the American Occupational Therapy Foundation.

IMPACT STATEMENT: Interprofessional group programs that are relevant to school participation can increase the output and quality of written communication in children with DCD. Such programs suggest innovative models of practice to improve academic performance, home and school behavior, and future work performance and social inclusion.

References

Ferguson, G. D., Jelsma, J., Versfeld, P., & Smits-Engelsman, B. C. M. (2014). Using the ICF framework to explore the multiple interacting factors associated with developmental coordination disorder. Current Developmental Disorders Reports, 1, 86–101. https://doi.org/10.1007/s40474-014-0013-7

Harrowell, I., Hollén, L., Lingam, R., & Emond, A. (2017). Mental health outcomes of developmental coordination disorder in late adolescence. Developmental Medicine and Child Neurology, 59, 973–979. https://doi.org/10.1111/dmcn.13469

Prunty, M. M., Barnett, A. L., Wilmut, K., & Plumb, M. S. (2016). The impact of handwriting difficulties on compositional quality in children with developmental coordination disorder. British Journal of Occupational Therapy, 79, 591–597. https://doi.org/10.1177/0308022616650903

Tal-Saban, M., Zarka, S., Grotto, I., Ornoy, A., & Parush, S. (2012). The functional profile of young adults with suspected developmental coordination disorder (DCD). Research in Developmental Disabilities, 33, 2193–2202. https://doi.org/10.1016/j.ridd.2012.06.005