COMMUNITY PERINATAL CARE STUDYfiles.ctctcdn.com/78b40a0d001/67b379f7-fe3e-448d-938d-58...A Calgary...

LITTLE MOVEMENTS ~ LOTS TO LEARN:

EARLY IDENTIFICATION OF DEVELOPMENTAL

COORDINATION DISORDER WITH A PARENT

QUESTIONNAIRE FOR PRESCHOOL CHILDREN

PROJECT

Final Report

July 31st 2013

Little Movements ~ Lots to Learn: Early Identification of Developmental Coordination Disorder with a Parent Questionnaire for Preschool Children 2

Report Prepared by

Brenda Wilson, MSc OT(C) Evidence Based Practice Facilitator, Alberta Health Services &

Research Assistant Professor, Paediatrics, Faculty of Medicine, University of Calgary

Dianne Creighton, Ph.D., R. Psych. Psychologist, Cardiorespiratory Services and Affiliate, , Alberta Health Services &

Research Assistant Professor, Paediatrics, Faculty of Medicine, University of Calgary

Investigators and Partners

Brenda Wilson, MSc OT(C), Evidence Based Practice Coordinator, Alberta Health Services & Research Assistant Professor, Paediatrics, Faculty of Medicine, University of Calgary

Dr. Dianne Creighton, Psychologist, , Alberta Health Services & Research Assistant Professor, Paediatrics, Faculty of Medicine, University of Calgary

Bethany Brewin, Occupational Therapist, Providence Children’s Centre Dr. Ben Gibbard, Developmental Paediatrician & Assistant Professor, Paediatrics, Faculty of

Medicine, University of Calgary Dr. Alice Holub, Psychologist. Alberta Health Services, Lisa Semple, Nurse & Assistant Professor, School of Nursing, Faculty of Health and

Community Studies, Mt Royal University,

Funder

Alberta Centre for Child, Family and Community Research

Institutional Supports

Alberta Health Services Alberta Children’s Hospital University of Calgary Mount Royal University Providence Children’s Centre Thornhill Day Care Preschool Intervention Program (PIP) Renfrew Educational Service


Acknowledgements

We extend our thanks to the families who generously agreed to be part of this study, and to the

therapists and staff who distributed our questionnaires:

Debra Busic (Providence)

Maria Valenti (Mt. Royal University)

Faith Campbell (Airdrie Preschool Intervention Program)

Carol Zwicker (Community Speech & Language Services)

Sharon Ness (University of Calgary Day Care)

Kevin VanEs (Renfrew Educational Services)

Christina Perrott (Thornhill Day Care)

Loralie Clark (PUF Preschools)

Karen McIntosh (IDEAS)

A special thanks to Loralie Clark for her contributions in both the clinical and research spheres.

The Little Movements ~ Lots to Learn Study Team

Our Full Study Team

Alice Holub

Ben Gibbard

Bethany Brewin

Jenny Heath

Kristine Neil

Lisa Semple

Loralie Clark

Melissa Wilson

Stacey Babcock

Susan Crawford

Heather Christianson

Community Partners

Kristine Neil

Dawne Clark

Research Assistants

Lindsay Burnett

Kristin Sabourin

Benjamin Tan

Kristen Hui


Table of Contents

Report Prepared by .................................................................................................................... 2 Investigators and Partners ......................................................................................................... 2 Funder ....................................................................................................................................... 2 Institutional Supports.................................................................................................................. 2 Acknowledgements .................................................................................................................... 3 The Little Movements ~ Lots to Learn Study Team .................................................................... 3

Our Full Study Team ........................................................................................................... 3 Community Partners ........................................................................................................... 3 Research Assistants ........................................................................................................... 3

Table of Contents ....................................................................................................................... 4 Executive Summary ................................................................................................................... 6

Background ............................................................................................................................ 6 Objectives .............................................................................................................................. 7 Methods ................................................................................................................................. 7 Highlighted Results................................................................................................................. 8 Key Conclusions ..................................................................................................................... 8 Next Steps .............................................................................................................................. 8

Introduction ................................................................................................................................ 9 Background ................................................................................................................................ 9

What Is DCD? ........................................................................................................................ 9 Relevance And Significance ..................................................................................................11

Objectives .................................................................................................................................12 Primary Objective ..................................................................................................................12 Secondary Objectives ............................................................................................................12

Study Design ............................................................................................................................12 Ethics Approval .....................................................................................................................12 Recruitment ...........................................................................................................................13

Recruitment Sites ...............................................................................................................13 Recruitment Rate ...............................................................................................................14

Selection Criteria ...................................................................................................................14 Participants ...........................................................................................................................15 Data Collection ......................................................................................................................15

Measures ...........................................................................................................................15 Data Collection Method ......................................................................................................16

Data Management and Analysis ............................................................................................17 Results ......................................................................................................................................17

Reliability ...............................................................................................................................17 Internal Consistency ..........................................................................................................18 Test-retest reliability ...........................................................................................................18

Factor Analysis ......................................................................................................................19 Construct Validity ..................................................................................................................19

Discussion ................................................................................................................................21 Timeline of This Project .........................................................................................................21 Further Research ..................................................................................................................21 Knowledge Translation ..........................................................................................................22

Publications and Presentations ..........................................................................................22


Grassroots education .........................................................................................................23 Awareness and Educational Outreach ...............................................................................23 Capacity Building ...............................................................................................................23 Cross-Cultural Collaboration ..............................................................................................24 Evaluation of Knowledge Utilization ...................................................................................24

Conclusion ................................................................................................................................25 Next Steps ................................................................................................................................25 Appendices ...............................................................................................................................26

References ............................................................................................................................26 Appendix I: Questionnaire Packet ..........................................................................................30 Appendix II: DCD-X Conference Poster .................................................................................39


Executive Summary

BACKGROUND

A Calgary mother of a 6 year-old boy came to us describing her experience in getting a diagnosis for her child with developmental coordination disorder, or DCD. This parent, a highly educated professional, went through a challenging 3&1/2 year process with many rounds of duplicate testing, to finally achieve an understanding and diagnosis of her child’s difficulty so that appropriate treatment could be activated. She felt that if there was better understanding and awareness of DCD among health professionals and the general public, the process of early identification and diagnosis would be improved.

We decided we wanted to develop a way to identify early signs of coordination difficulties in the preschool period, difficulties that interfere with the child’s ability to learn movement skills, participate in active play, and develop self confidence. We take for granted that our children can perform everyday activities at home and school. They learn to move their bodies in coordinated and smooth ways while they learn to use playground equipment, button their clothes, use a pencil, or eat with a fork. But one or more child in almost every classroom in Alberta is likely to have DCD. Prevalence rates of DCD are estimated at 5 to 6 percent of school-aged children, suggesting that a considerable number of children have movement difficulties. Children with DCD are intelligent, but struggle to put on their coat, open their milk carton without spilling, and pack their backpack in time to get to the school bus. The symptoms are sometimes subtle and often interpreted as laziness, silliness, or carelessness. However, the outcomes when unmanaged are much more pronounced. The psychological and social effects of having poor coordination skills, and the long term consequences that may accompany DCD into adolescence and adulthood highlight the need for early identification of difficulties for individual children, and the need for increased awareness of DCD among health professionals, child care providers, and in our community at large.

Social, emotional, and learning problems are frequently associated with DCD, impacting the children and their families’ daily lives. Children with DCD have higher rates of anxious and depressed symptoms, and have significantly lower activity levels, which in turn are associated with cardiovascular risk. Coordination difficulties often co-occur

with Attention Deficit/Hyperactivity Disorder and Speech and Language impairments, impacting early learning. Though they usually develop the fundamental skills of locomotion and hand use in their preschool years, children who are later identified as having DCD often do not have competent functional movements when they enter school. They fall behind their peers in academic tasks requiring coordinated motor skills such as printing and tool use.

“It took 6 speech tests, 3 OT assessments, 4 PT assessments, over a dozen psychological tests (including autism spectrum etc.), and finally a full cognitive/ psychological evaluation, blood work x 3, MRIs, you name it. We also bounced between dozens of professionals before getting to the bottom of it. At the end of the day, the administration cost versus the amount of funding that went towards actual therapy for [my son] is about a 95/5 split.”

Calgary mother of a 6 year-old boy recently diagnosed with DCD


OBJECTIVES

The Developmental Coordination Disorder Questionnaire (2007) (DCDQ ‘07) is a parent questionnaire to identify subtle motor problems in school aged children, aged 5 to 14 years. It is considered to be a valid, reliable, and convenient screening instrument. It is used by clinicians and researchers worldwide, but now they would like a way to identify motor problems in preschool children, aged 3 and 4. Could we develop a similar practical and useful tool for preschoolers?

Our co-primary investigator, Brenda Wilson, the developer of the DCDQ, worked with researchers in Israel who were creating a downward extension of the DCDQ, modifying the questions to reflect the motor coordination skills of 3 and 4 year-olds. The Israeli research group is continuing work on their Hebrew version, while we have adapted it into an English translation with items relevant in the Canadian culture and context. The result was a 15-item parent questionnaire designed with the purpose of identifying children showing early signs of developmental coordination difficulties, which quickly became called “The Little DCDQ”.

Developing a useful screening questionnaire includes establishing that it is both reliable and valid. A reliable measure is one that gives the same results each time. It needs to have items that are consistent in how they contribute to the total score. It may also have sets of items that go together to measure certain sub-factors relevant to the overall dimension being assessed. In the case of a movement questionnaire, the sub-factors could be a set of items relating to precision movements of the hands, and another set of items relating to total body movements.

The question of whether a questionnaire is valid can only be answered by comparing the scores to something else that is thought to be a meaningful measure or indicator of what you are trying to assess – some “gold standard” against which to evaluate the questionnaire. For this component of our test development, we used membership in a group of likely typically developing children versus membership in a group of children showing or at-risk of developmental difficulties (according to preschool attendance and parent report of services), as the standard against which to measure the validity of the Little DCDQ.

We have additional funding from the Alberta Children’s Hospitals Research Institute (ACHRI) to measure the validity of the instrument against standardized assessments, and to develop cut-off scores.

METHODS

After we received ethical approval for the study, we engaged preschools, day cares, community agencies and health services in Calgary and surrounding area to help us recruit participants. Teachers, therapists, and child care providers distributed packages to families of 3, 4, and 5 year-old children who met inclusion criteria. The packages included the Little DCDQ, the Strengths and Difficulties Questionnaire (SDQ, a standardized questionnaire about the child’s behaviour) and a short demographic survey. Included was an envelope to ensure confidentiality when the forms were returned. Parents had the option of remaining anonymous, or, if they wanted to be involved in other stages of the research, they could provide their contact information.

We recruited both children who were expected to be typically developing and children who were presenting with functional movement impairments and/or language impairments, or who were born very prematurely, placing them at risk of DCD. This latter group we call our “At-Risk” group. For the main analyses, we focused on the 3 and 4 year-olds.


HIGHLIGHTED RESULTS

We had parents of 315 children participate: 181 boys and 134 girls. Of the sample, 99 were in the “Typically Developing” group and 216 were in the “At-Risk” group. For parents who agreed to be contacted, we sent out a second Little DCDQ after a few weeks to see if the questionnaire gave the same results a second time. In this way, we established that test-retest reliability was strong (r = 0.83, p <0.001, n = 22).

The internal consistency of the items making up the Little DCDQ was measured by calculating Cronbach’s Alpha Co-efficient. An alpha of .70 is considered evidence of adequate internal consistency. Cronbach’s alphas did not decrease significantly if items were deleted, and ranged from .93 to .94. This means that all of the items are fairly equally important to the total score.

Factor analysis showed that the Little DCDQ items may be grouped into two factors accounting for 62% of the variance in the scores. The first factor includes items related to gross motor skills and the second factor is represented by fine motor items. This shows that the questionnaire make sense, conceptually, as children’s development is often measured by gross and fine motor skills.

Finally, we looked at construct validity. To be valid, our measure would have to give higher scores to children in the “Typically Developing” group than to those in the “At-Risk” group. We found that the mean Little DCDQ score for the “Typically Developing” group was 67, and for the “At-Risk” group was 62. The difference in mean scores between the two groups was highly significant (F(1, 88) = 27.25, p < .001). This means the questionnaire is able to discriminate between groups of children who may be at risk of developmental coordination difficulties.

KEY CONCLUSIONS

We continue to analyze the data to ensure that the Little DCDQ is equally reliable and valid for boys and girls, and for 3 year-olds and 4 year-olds. We are looking at whether it is also useful for 5 year-olds, so that it could be used in a classroom of preschool children whose ages range up to 5. As part of a subsequent study funded by ACHRI, we are also doing definitive motor testing for a subgroup of the children, to allow us to determine what the best cut-off scores are to indicate a likely motor impairment.

There is much more to do, but we are excited about our success so far in moving this questionnaire closer to publication as a reliable and valid screening tool. Utilizing the report of parents of preschool children, younger children with motor difficulties can be identified earlier, when interventions, supports, and guidance can be provided to optimize outcomes.

NEXT STEPS

Conduct a targeted recruitment of parents of 3 and 4 year-old children to ensure adequate sample size for further analysis

Complete Part III of the study to ensure validation of the instrument and develop cut-off scores

When the Little DCDQ is demonstrated to be psychometrically strong, make it available through www.dcdq.ca

Complete a short report for participating centers and for families

Complete a manuscript for publication

../../../../../../../Documents%20and%20Settings/bwilson/Local%20Settings/Temporary%20Internet%20Files/Content.IE5/GHMJKPIZ/www.dcdq.ca


Introduction

There are three distinct parts to the development of a preschool parent questionnaire to identify DCD.

The first part is the preliminary assessment of the face validity of the Little DCDQ. This was completed prior to the present study.

The second part of the research involves collecting data in Calgary to assess the reliability of the questionnaire with English-speaking families, as will be reported here.

The third part involves direct assessment of children’s motor skills using standardized testing in order to assign membership to a typical developing group vs. a group at risk of DCD. This will allow development of cut-off scores and full assessment of the construct, concurrent, criterion and predictive validity of the measure in the future.

The data in this paper reflect the results of the second part of the questionnaire development.

Background

WHAT IS DCD?

Developmental Coordination Disorder (DCD) is characterized by difficulties performing a range of movement tasks, evident from early childhood and often persisting into adulthood. The DSM-IV-TR1 diagnostic criteria stipulate that there is a marked impairment in performance of motor skills (Criterion A) and that these difficulties impact the performance of daily activities (Criterion B). Children with DCD are intelligent but struggle to put on their coat, open their milk carton without spilling, and pack their backpack in time to get to the school bus. The symptoms are sometimes subtle, and often misinterpreted as laziness, silliness, or carelessness. However, the outcomes when unmanaged are much more pronounced.2 The psychosocial effects of having poor coordination skills and the long-term sequelae that accompany DCD into adolescence and adulthood have been reported for over 20 years,3 yet the condition remains relatively unrecognized and under funded. One or more children in almost every classroom in Alberta is likely to have DCD; prevalence rates of DCD are estimated at 5 to 6 percent of school-aged children,1 suggesting that a considerable number of children have movement difficulties affecting many areas of life.

Social, emotional and learning problems are frequently associated with DCD, impacting the children and their families’ daily lives.4 Higher rates of depressive symptoms in children aged 6 to 17 with DCD, compared to their identical twins without DCD, has been reported,5 and a relationship between anxious/depressed behavior and poor motor coordination in preschool children, aged 3 years 9 months to 5 years 4 months has been found.6 In a recent population based study, Lingam et al.7 noted a higher impact on social and emotional development than previously thought. In the largest epidemiological study to date which investigated children selected on the basis of


motor impairment, Missiuna et al.8 found that children with both DCD and Attention Deficit/Hyperactivity Disorder (ADHD) (which commonly co-occur) are significantly more anxious and depressed than typically developing children. The long-term risks of DCD to physical health are also well known: significantly lower activity levels9 associated with cardiovascular risk.10-12

From 40-90% of school-age children with speech-language delays also have motor coordination problems.13 Between 45 and 75% of children identified with speech/language impairments as toddlers also showed motor impairments at the ages of 5 to 6 years.14 Although speech/language pathologists are increasingly aware of coordination issues, they are lacking a convenient and valid tool, and the children they serve are not formally screened for DCD.14

Experts in the field of DCD believe that referral and identification at an earlier age may significantly improve the health, psychosocial and educational outcomes of these children.15 Although children who have DCD usually develop the fundamental skills of locomotion and hand use in their preschool years, competent functional movements may not be developed when they enter school.16, 17 They are at an immediate disadvantage and fall behind their peers in academic tasks requiring coordinated motor skills, such as printing and tool use. They are not just un-athletic children; they are the group who are not included in play activities at recess. Adults who had DCD report that they accommodate for their coordination issues, but remain affected by their inability to participate fully in community and social activities, and the self-esteem, social and mental health problems that arise from this.18 Seeing this repeatedly, clinicians and researchers feel a growing need for earlier identification of children who have movement difficulties. A diagnosis of DCD is not usually made with 3 to 5 year-olds15, 19 but it is suggested that children identified in this age range should be monitored.

In Southern Alberta, there is a gap between the demand for service and the resources for diagnosis, intervention and management of this chronic condition. The scenario in the text box on the left is a very typical diagnosis journey.4 The average cost of assessment from recognition of the problem to diagnosis was estimated to be $2,387.29 in 2004, not including the cost of return visits to the physician for referrals.20 Children face

lengthy waitlists and, even after identified, they are usually seen only a few times and then discharged. No one is consistently following the issues that may arise, nor linking them back to DCD.

Although there are several valid measures to screen for broad developmental delay (e.g. the Brigance21 and the PEDS22), few screening tools are available that focus on the specific motor skills relevant to DCD. The Movement Assessment Battery for Children (MABC)23, 24 includes children as young as 3 years but is a therapist-

“It took 6 speech tests, 3 OT assessments, 4 PT assessments, over a dozen psychological tests (including autism spectrum etc.), and finally a full cognitive/ psychological evaluation, blood work x 3, MRIs, you name it. We also bounced between dozens of professionals before getting to the bottom of it. At the end of the day, the administration cost versus the amount of funding that went towards actual therapy for [my son] is about a 95/5 split.”

Calgary mother of a 6 year-old boy recently diagnosed with DCD


administered full length assessment battery. Even fewer measures are available to ascertain the impact of these movement problems (Criterion B) on functional tasks measured within the context of the situation. Several instruments have been developed for identification of DCD by teachers25-27 but parents are often overlooked and underutilized in the identification of problems28-30. Parents of children with DCD experience a lot of uncertainty and self-doubt about identifying the subtle differences they see in their children at an early age.4, 31 However, these parents noticed differences at about 4 years and were later able to connect the lack of risk-taking early on, for example, with difficulty in learning to use complex playground equipment later.

Parents may not know exactly what they are seeing, but they seem to know when something is wrong. The Developmental Coordination Disorder Questionnaire32 (DCDQ) is a parent questionnaire used to identify subtle motor problems in school aged children (5 to 14.6 years), and is considered to be a valid, reliable and convenient screening instrument.33, 34 Clinicians and researchers world-wide are identifying the need for assessment tools to identify motor problems in preschool children. Revising an established questionnaire for a younger age group, is more practical and economical than developing a new tool.35 Local and international collaborations afford the ideal opportunity in Calgary to develop and assess the reliability and validity of a parent questionnaire for preschoolers at risk of DCD.

RELEVANCE AND SIGNIFICANCE

The field of study of DCD is growing and the results of population based studies show that the impact of DCD, especially when unrecognized in the early years, is much greater than previously thought.4, 7 A condition which is associated with anxious and depressed behavior at as early an age as 3 years 9 months6 should be ‘on our radar’, yet there are no validated screening tools for DCD in preschoolers, no studies on the factors present before school entry specifically for risk of DCD, and poor

awareness and knowledge of DCD among child care personnel, educators, and health professionals. This is especially relevant in Alberta since there is no universal developmental screening between the ages of 18 months and 4 years. Parent opinion is therefore even more important and needs to be supported. Evaluation of the use of the Little DCDQ in Calgary would enable parents to have a valid measurement of their concerns when talking with their pediatrician or family doctor.


Objectives

PRIMARY OBJECTIVE

To examine the reliability of the Little DCDQ with 3 to 5 year-old children, specifically: a. Item consistency b. Item-total correlations c. Test-retest reliability

To examine the factor structure of the Little DCDQ.

SECONDARY OBJECTIVES

Secondary objectives included:

To examine the association of the Little DCDQ with teacher reports of motor skill.

To examine the level of agreement of the Little DCDQ and the DCDQ’07 (developed for 5-15 year-olds) when used with 5 year-olds, to ascertain the compatibility of the two instruments and to provide preliminary evidence on which is the best instrument to use with 5 year-olds.

Study Design

ETHICS APPROVAL

Approval was obtained from the CHREB of the University of Calgary prior to initiation of the study. We requested that parents’ assent to participate be demonstrated through their completion and return of the questionnaires, without the need to provide identifying or contact information, and that a consent form will only be requested if teacher participation is involved or if the child is involved in an assessment of their motor skills. It was reported by parents and professionals, and by other researchers, that the receipt of a large envelope containing a 1 or 2 page questionnaires and a 4 to 6 page consent form is a deterrent to consenting to participate. For this reason, assent was assumed if the questionnaire is returned to us. This was first approved by CHREB and participating agencies.

After we received ethical approval for the study, we engaged preschools, day cares, community agencies and health services to help us recruit participants. Children were recruited from universal, integrated and targeted (specialized services) programs, both private and public, in Calgary and surrounding areas. Teachers, therapists, and

Participating Centers

Mount Royal University Daycare University of Calgary Daycare Thornhill Day Care Preschool Intervention Program (PIP) Providence Children’s Centre Renfrew Educational Services Program Unit Funded Preschools Perinatal Follow-up Clinic Community Speech and Language Services IDEAS


child care providers distributed packages to families of 3, 4, and 5 year-old children who met inclusion criteria. The packages included the Little DCDQ, the Strengths and Difficulties Questionnaire (SDQ, a standardized questionnaire about the child’s behaviour) and a short demographic survey in a 2 page, legal-sized folded booklet (see Appendix 1 for the portrait view, which is much longer). Included was an envelope to ensure confidentiality when the forms were returned. Parents had the option of remaining anonymous, or, if they wanted to be involved in other stages of the research, they could provide their contact information.

If parents provided contact information, we asked for formal consent to obtain a questionnaire from their child’s teacher and/or be involved in motor testing of their child.

RECRUITMENT

We actively encouraged recruitment by timing the distribution of the questionnaires to coincide with a school staff meeting, where active involvement of the teachers and child care providers could be sought and their questions answered. We also attempted to maximize recruitment rates by sending reminder cards to staff and parents (or posting a poster at the Centre) 2 weeks after distribution of the questionnaires. Gift certificates for $50 to $100 for a Teachers Store were given to each Center at Christmas as a ‘thank you’ and as encouragement to continue their participation.

Recruitment Sites

Families were recruited from universal, integrated and targeted (specialized services) programs, both private and public, in Calgary and surrounding areas:

Universal Programs Mount Royal University Daycare University of Calgary Daycare – Main University of Calgary Daycare – West Thornhill Day Care – North Thornhill Day Care – Dover-Marlborough Day Care Specialized Programs Preschool Intervention Program (PIP) (Cochrane and Airdrie) Providence Children’s Centre Renfrew Educational Services Program Unit Funded (PUF) Preschools Integrated Developmental Educational Assessment Services (IDEAS) Clinical Programs Alberta Children’s Hospital /Alberta Health Services: Perinatal Follow-up Clinic Community Speech and Language Services


Recruitment Rate

Tracking our recruitment rate has been a challenge due to the need to collect all un-used quesionniares from each site, to create the denominator. Sometimes un-used ones were not returned to us but, to the best of our knowledge, we believe our recrutiment rate has varied from 8% to 61.8%, averaging 33.4%. This is an acceptable rate for community-based research:

Providence Children’s Centre: 27.4% Mount Royal University Day Care: 23.6% University of Calgary Main Campus: 36.4% University of Calgary West Campus: 41.4% Preschool Intervention Program: 30% Perinatal Follow-Up Clinic (AHS): ~50% Community Speech and Language Services (AHS): 8% to date Renfrew Educational Services: 22.1% Thornhill Day Care: 61.8%

SELECTION CRITERIA

Not all of the children whose parents returned questionnaires were eligible for our study. Selection criteria included: Inclusion criteria for Both Groups

Children between 3 years 0 months and 5 years 11 months.

Parents have adequate proficiency in written English to be able to complete the questionnaire independently or with assistance from clinic or program staff, research staff or student researchers.

Inclusion criteria for At-Risk Children:

Children referred for or receiving treatment for a motor developmental concern or a speech/language concern (a diagnosis of DCD is not required; a general complaint of developmental problems is sufficient).

Exclusion criteria for Typically Developing Children:

Children referred for or in treatment for a motor development concern.

History of speech and language delay evidenced through previous speech and language therapy.

Exclusion criteria for Both Groups

Children with diagnosed mental retardation, autism spectrum disorder, neuromotor disorder (muscular dystrophy, cerebral palsy, etc.), or sensory loss (blindness, etc).

Parents do not have adequate proficiency in written English to be able to complete the questionnaire even with assistance.

A total of 466 questionnaires were returned; 315 met selection criteria and had

complete data. The most common reason for exclusion was the presence of an autism spectrum disorder (ASD).


PARTICIPANTS

The mean ages (with standard deviation) and gender distributions of the sample of 315 children (181 boys, 134 girls) are presented in Table 1. Of the sample, 99 children were typically developing preschoolers who had never been referred for any developmental delay in the past and who were not being treated at the time of the study (including occupational, speech or physical therapy) (Typically Developing). In total, 216 children had been referred or were being treated for some form of developmental delay at the time of the study (At-Risk).

Table 1: Age and Gender Distribution with mean ages and standard deviations (SD) in years

Age Gender

At risk Typical Total

Mean Age

n = SD Mean Age

n = SD Mean Age

n = SD

3-3.99yrs

Male 3.67 82 0.36 3.73 31 0.46 3.69 113 0.39

Female 3.53 47 0.36 3.59 34 0.40 3.56 81 0.38

Total 3.62 129 0.37 3.66 65 0.43 3.63 194 0.39

4-4.99yrs

Male 4.43 53 0.27 4.47 15 0.31 4.44 68 0.28

Female 4.42 34 0.21 4.42 19 0.26 4.42 53 0.23

Total 4.43 87 0.25 4.44 34 0.28 4.43 121 0.26

Total

Male 3.97 135 0.50 3.97 46 0.54 3.97 181 0.51

Female 3.91 81 0.54 3.89 53 0.54 3.90 134 0.54

Total 3.94 216 0.51 3.93 99 0.54 3.94 315 0.52

DATA COLLECTION

Measures

Little DCDQ (Appendix I): As described above, the Little DCDQ is a parent questionnaire adapted for preschool children from the DCDQ’07. It was developed for children, aged 3 years to 4 years 11 months. For this study, it was used for children from 3 years to 5 years 11 months in order to assess the degree of agreement between the Little DCDQ and the DCDQ’07 in 5 year-olds. The DCDQ’07 (www.dcdq.ca):

The DCDQ is used extensively in population-based studies,36, 37 in clinical screening,38 and to satisfy Criterion B of the DSM-IV DCD diagnosis.1 It demonstrates high internal consistency (alpha=.94). Logistic Regression Modeling was used to generate separate cut-off scores for three age groups (overall sensitivity=85%, specificity=71%). Differences in scores between children with and without DCD (p<.001) provide evidence of construct validity. Correlations between DCDQ scores and


Movement Assessment Battery for Children (MABC, r=.55) and Test of Visual Motor Integration (r = .42) scores support concurrent validity. There were no significant associations between age group and gender (χ2

(2) = 0.32, p = .85), and girls and boys did not differ on their total (F(1,230) = 0.72, p .40), indicating that the scale is valid for use with both genders when age-specific cut-off scores are used. The results provide evidence that the DCDQ’07 is a valid clinical screening tool for DCD. Strengths and Difficulties Questionnaire (SDQ; Appendix 1): The SDQ, for children age 4 and up, has questions covering 25 emotional and behavioural attributes of the child, 10 of which are considered to be strengths, 14 represent difficulties and one is a neutral item. The SDQ39, 40 was used to control for possible emotional and behavioural problems which may influence participation in movement activities and subsequent skill development. Parent report of attention/hyperactivity problems and/or poor peer relations were incorporated in the Logistic Regression analysis to adjust for these factors. Demographic Survey (Appendix 1): A short demographic survey was included, which had been developed collaboratively with other international researchers, to ensure that common data was collected across all countries.

Data Collection Method

Parents received packages that included the Little DCDQ, the Strengths and Difficulties Questionnaire (SDQ, a standardized questionnaire about the child’s behaviour) and a short demographic survey in a 2 page, legal-sized folded booklet (see Appendix 1 for the portrait view, which is much longer). Included was an envelope to ensure confidentiality when the forms were returned. Parents were invited to provide their phone number, home or email address to give us permission to contact them: if questions about their responses or their evaluation of the individual questions arose,

or if further involvement in the study, including teacher completion of questionnaires or

completion of another questionnaire for re-retest reliability, or to receive a copy of the final report or to be contacted for a possible follow-up study

(for motor assessment in the next part (Part III) of this study).

Parents who consented to being contacted were phoned and the process of obtaining teacher questionnaire(s) or being contacted for motor assessment was explained. If they agreed, a consent form was delivered to the preschool or mailed with a stamped, addressed envelope, signed and returned. Some parents were sent a second copy of the Little DCDQ a few weeks after the first copy, in order to compute test-retest reliability. In order to examine the performance of the Little DCDQ in relation to other measures, some teachers were asked to complete another questionnaire.


DATA MANAGEMENT AND ANALYSIS

Privacy of individual information was protected. All forms in hard copy were stored in locked cabinets in a secure office. Subject numbers, not names, were used in the database. Electronic data was password protected. Access to data was available only to study personnel. Published reports did not contain identifying information.

The data analyses followed the same approach as for the original DCDQ32 and its recent revision.41 The reliability of the Little DCDQ was assessed in a number of ways. Internal consistency was assessed using Cronbach’s alpha. Item-to-total correlations was calculated, and the alpha coefficient of the test when each item is deleted was examined. An overall alpha coefficient of .70 was used as the criterion for this study as per Bland and Altman.42 Any items with coefficients below .3 were not strongly related to the Little DCDQ as a whole and may not be making a strong contribution to the test. These items were removed and Cronbach’s alpha recalculated.

A factor analysis was done to explore the relationship among items on the Little DCDQ. The factor structure of the Little DCDQ was compared to that of the DCDQ’07. For the subgroup of parents who completed the Little DCDQ at two different times, test-retest reliability was assessed using intra-class correlations.

The validity of the Little DCDQ was examined with the methods used in developing the original DCDQ and DCDQ’07. Total scores of children in the At-Risk group was compared to scores of children who were Typically Developing, using analysis of variance or its nonparametric counterpart, where necessary.

Results

RELIABILITY

Our primary objectives were:

(1) to examine the reliability of the Little DCDQ with 3 to 5 year-old children, specifically internal consistency (item and item-total correlations) and test-retest reliability

(2) to examine the factor structure of the Little DCDQ.

Other objectives included examining the association of the Little DCDQ with teacher reports of motor skills, and examining the level of agreement between the Little DCDQ and the DCDQ’07 (developed for 5-15 year-olds) when used with 5 year-olds. At this time, our sample sizes are too small for these specific secondary analyses, but we will endeavor to continue to augment this data while completing Part III of the study (funded by ACHRI).


Internal Consistency

The internal consistency of the items making up the Little DCDQ was measured by calculating Cronbach’s Alpha Co-efficient. Cronbach’s alphas did not decrease significantly if items were deleted, and ranged from .93 to .94. The results are presented in Table 2, and indicate that all of the items are fairly equally important to the total score.

Cronbach’s Alpha co-efficient was also calculated separately for the typically developing group and the at-risk group. Cronbach’s alpha did not decrease significantly if items were deleted for each group:

at-risk sample: range of .93 to .94

typically developing sample: range of .90 to .91. Table 2: Cronbach Alpha values for items and total scores for entire sample:

Item-Total Statistics

Scale Mean if

Item Deleted

Scale Variance

if Item Deleted

Corrected Item-

Total

Correlation

Cronbach's

Alpha if Item

Deleted

Item 1 Throw 59.68 97.94 0.77 0.93

Item 2 Catch 60.14 96.24 0.71 0.93

Item 3 Kick 59.56 98.83 0.74 0.93

Item 4 Run 59.58 97.11 0.75 0.93

Item 5 Move place 59.27 102.67 0.64 0.93

Item 6 Drinks 59.43 103.51 0.56 0.94

Item 7 Cutlery 59.47 101.94 0.64 0.93

Item 8 Pencil 59.83 98.65 0.71 0.93

Item 9 Thread 59.96 98.64 0.63 0.93

Item 10 Stickers 59.59 99.21 0.72 0.93

Item 11 Building 59.51 99.86 0.68 0.93

Item 12 Imitate 59.65 97.35 0.79 0.93

Item 13 Playground equipment

59.22 104.29 0.67 0.93

Item 14 Coordination 59.63 99.87 0.69 0.93

Item 15 Sits upright 59.58 101.33 0.58 0.94

Test-retest reliability

Twenty-two parents completed a second Little DCDQ after a few weeks to see if the questionnaire gave the same results a second time. Test-retest reliability was strong (r = 0.83, p <0.001, n = 22).


FACTOR ANALYSIS

Factor analysis using varimax rotation showed that the Little DCDQ items may be grouped into two factors accounting for 61.6% of the variance in the scores. As shown in Table 3, the first factor includes items related to gross motor skills and the second factor is represented by fine motor items. This shows that the questionnaire make sense, conceptually, as children’s development is often measured by gross and fine motor skills.

Table 3: Factor Loadings by Item

Component

Gross Motor Factor

Fine Motor Factor

Item 1 Throw 0.76

Item 2 Catch 0.58

Item 3 Kick 0.70

Item 4 Run 0.83

Item 5 Move place 0.74

Item 6 Drinks 0.57

Item 7 Cutlery 0.66

Item 8 Pencil 0.74

Item 9 Thread 0.74

Item 10 Stickers 0.81

Item 11 Building 0.76

Item 12 Imitate 0.62

Item 13 Playground equipment 0.71

Item 14 Coordination 0.75

Item 15 Sits upright 0.54

CONSTRUCT VALIDITY

Finally, we looked at construct validity. To be valid, our measure would have to give higher scores to children in the “Typically Developing” group than to those in the “At-Risk” group.

We found that the mean Little DCDQ score for the “Typically Developing” group was 67.27, and for the “At-Risk” group was 62.30. The difference in mean scores between the two groups was highly significant overall (F(1, 313)=15.38, p<.001), and for the 3 year-old age group (F(1, 192)=14.66, p<.001). However, the difference between the scores for “Typically Developing” and for “At-Risk” in 4 year-old children was not significant (F(1, 119)=2.52, p=.115).


This means the questionnaire shows potential to discriminate between groups of children who may be at risk of developmental coordination difficulties, but that the sample size for 4 year-olds (especially those assumed to be “Typically Developing”) is inadequate to answer this question fully. Fortunately, with the funding received for Part III of the study, we will be able to compare the Little LDCQ to standardized tests of motor skills and address this objective in a more psychometrically strong manner.

Table 4: Means and Standard Deviations for the Little DCDQ Score by Age and Designation of “At Risk” and “Typically Developing”

Age

At Risk Typically Developing Total

Total Score

Gross motor score

Fine motor score

Total Score

Gross motor score

Fine motor score

Total Score

Gross motor score

Fine motor score

3-3.99 yrs

Mean 61.59 37.10 24.49 67.48 40.52 26.95 63.56 38.25 25.31

n = 129 129 129 65 65 65 194 194 194

Std. Deviation

11.48 7.42 4.81 6.56 4.30 2.96 10.46 6.73 4.43

4-4.99 yrs

Mean 63.36 38.30 25.06 66.88 40.18 26.71 64.35 38.83 25.52

n = 87 87 87 34 34 34 121 121 121

Std. Deviation

11.50 7.31 4.94 9.51 5.89 4.19 11.05 6.97 4.78

Total

Mean 62.30 37.58 24.72 67.27 40.40 26.87 63.86 38.47 25.39

n = 216 216 216 99 99 99 315 315 315

Std. Deviation

11.49 7.38 4.86 7.66 4.88 3.41 10.68 6.82 4.56


Discussion

Questionnaires are still being distributed and we will continue to collect and analyze the data to ensure that the Little DCDQ is equally reliable and valid for boys and girls, and for 3 year-olds and 4 year-olds. We will look at whether the Little DCDQ is also useful for 5 year-olds, so that it could be used in a classroom of preschool children whose ages range up to 5

There is more to do – instrument development is never complete after one study. We are excited about our success so far in moving this questionnaire closer to publication as a reliable and valid screening tool. Utilizing the report of parents of preschool children, younger children with motor difficulties can be identified earlier, when interventions, supports, and guidance can be provided to optimize outcomes.

TIMELINE OF THIS PROJECT

This study, conceived in 2008 and funded in 2010, has required several extensions. Three factors contributed to the delays. First, the increased prevalence and diagnosis of the condition of ASD resulted in many of our recruited families being excluded, and the need for more recruitment activities. Secondly, both of our Research Coordinators left after one year for more permanent, full-time positions, as is often the case with skilled individuals. We were grateful for their achievements, but it entailed further hiring and training, and we need to re-hire again in order to continue research on this instrument. Lastly, and most significantly, one Investigator (B. Wilson) experienced an orthopedic condition that required several months off of work prior to diagnosis, followed by surgery, and then a 6 month recovery period.

We would like to take this opportunity to sincerely thank our funder and partner, the ACCFCR, for their understanding and patience during these delays and the need to make changes to our conference travel plans. It was very much appreciated and contributed greatly to the success of this phase and to further research

FURTHER RESEARCH

As part of a subsequent study, we are also completing definitive motor testing for a subgroup of the children to determine what the best cut-off scores are to indicate a likely motor impairment. We base our classification of Motor Impairment (MI) on a child having at least 1 score at or below the 5th percentile, or 3 to 6 scores below the 15th percentile, on the Movement Assessment Battery for Children-II (MABC-II) total and subscale scores, and the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI) total and motor coordination standard scores.

Preliminary analysis with a sample of 91 children who have received motor testing to date shows that there is a significant difference in scores of children classified as MI versus Non-MI (F(1,88) = 27.25; p < 0.001).


There was no correlation between the Little DCDQ score and age (r = 0.089; p = 0.383). A Discriminant Function Analysis revealed an overall significant model (X2(15) = 38.89; p=0.001), with 13 of the 15 items demonstrating strong discriminating ability between MI and Non-MI children.

The total Little DCDQ score, its Gross Motor Factor and its Fine Motor Factor correlated significantly with each component of the MABC -II and the VMI, except for two correlations of the 18 correlations.

Logistic Regression Modeling showed that a low total score on the Little DCDQ (p < 0.001) and being male (p = 0.022) were significant predictors of motor impairment on standardized testing (p < 0.001), but that behavior as measured by the SDQ was not a predictor. Even with this small sample size, sensitivity and specificity range from 62% to 79%; data collection and analysis are continuing.

These results are shown in a poster in Appendix II:

Wilson, B.N., Creighton, D., Babcock, S., Brewin, B., Melissa, B., Crawl, S., Gibbard, B., Heath, J.A., Holub, A., Neil, K., Semple, L., Tan, B. Development of the Little DCDQ – Canadian for Preschool Children: Preliminary Findings. The 10th International Conference on Developmental Coordination Disorder, Ouro Preto, Brazil (June 2013)

KNOWLEDGE TRANSLATION

Publications and Presentations

An article on the Hebrew version of the Little DCDQ has been published: Rihtman, T., Wilson, B.N., Parush, S. (2011) Development of the Little Developmental

Coordination Disorder Questionnaire for Preschoolers and Preliminary Evidence of its Psychometric Properties in Isreal. Research in Developmental Disabilities. 32: 1378–1387

Posters have been presented at the:

Canadian Psychological Association Convention (June 2010)

9th International Conference on Developmental Coordination Disorder, Lausanne, Switzerland (June 2011)

Centre of Child Well-Being, Mount Royal University, Calgary, Advisory Meeting (January 2012)

2nd Annual Registered Nursing Professional Practice Conference (August 2012)

the 10th International Conference on Developmental Coordination Disorder, Ouro Preto, Brazil (June 2013) – see Appendix II An oral presentation was made at the Canadian Association of Occupational

Therapists Conference (June 2011). Following completion of the validation study, a one- to two-page report suitable

for the public will be prepared and given to all preschools and agencies who participated and to parents who request it.

When adequate psychometric properties are demonstrated for the Little DCDQ, the questionnaire will be posted on the DCDQ website for free access (www.dcdq.ca). Other clinical groups, research communities and web sites interested in DCD will be informed of its development.

A manuscript describing this study, together with the validation Study (Part III), is in preparation.

http://www.dcdq.ca/


Grassroots education

End users of the Little DCDQ have already been engaged in this project.

A Clinical Advisory Committee (CAC) consisting of end users of the DCDQ and the Little DCDQ has met in 2009 and 2010 to discuss the need for earlier identification of preschool children who are at risk for DCD and to assist in establishing content validity of the Little DCDQ. Their experiences have informed the design of this project and assisted in developing the research questions to ensure that their clinical needs in working with children with developmental problems are more likely to be met by this research. This group has also begun to identify the barriers to the use of evidence on early identification of DCD in their practice, which may facilitate new strategies to overcome some of these issues and ensure greater knowledge utilization.

Communities of Practice (CoP) have been shown to be one of the most successful strategies for knowledge dissemination and utilization. The CoP on Understanding DCD has met monthly since 2004 and involves rehabilitation and educational professionals from health services and the community.

Team members are exploring ways to provide family physicians, community pediatricians and pediatric residents with information about identification of DCD, the impact of risk for DCD in the preschool years, and the use of parent report in a collaborative relationship with families.

Kristine Neil, former VP at Vision Critical/Angus Reid, with the support of two of our investigators (SB and BW), led a public opinion survey to measure awareness of DCD with a sample of almost 1300 participants, including over 500 physicians. Results were presented at the 9th International Conference on DCD in Europe at the same time as a media release was successfully held in Calgary. An article was published outlining the poor awareness of DCD, with recommendations: Wilson, B.N., Neil, K., Kamps, P.H., & Babcock, S. (2012) Awareness and

knowledge of Developmental Coordination Disorder Among Physicians, Teachers, and Parents. Child: Care, Health and Development. doi:10.1111/j.1365-2214.2012.01403.x/ 39:2, 296–300

Awareness and Educational Outreach

Awareness of DCD by students and child care providers has been fostered through the research team's collaboration with three programs within the Faculty of Health and Community Studies at MRU. This may influence future curriculum-based education, as well as influence the knowledge of child care providers through MRU’s connection with the majority of child care centres in Calgary.

Capacity Building

We have invited five junior investigators to join our study (for Part II or Part III, or both Parts of the study). This has enabled them to participate in research activities and presentations, while facilitating recruitment, assessment processes and questionnaire development.


Similarly, we engaged three students from the University of Calgary (Kinesiology and Nursing) and the University of Alberta (Medicine) in various parts of the study; one student attended the DCD-X Conference in Brazil to present this study’s findings, when the Investigator was unable to travel that distance (see Appendix II). We have also employed two new kinesiology graduates as Research Coordinators for this study.

Cross-Cultural Collaboration

Since 2006, B. Wilson has been collaborating with researchers in Israel to develop a screening instrument to identify motor difficulties in young preschoolers. After a presentation on this collaboration was made at the DCD-VIII Conference in 2009, several other countries asked to join us to collaboratively develop the Little DCDQ and to ensure numerous psychometrically sound, comparable versions of the tool. This will enable the analysis and comparison of different patterns of motor delay in different cultures. Tanya Rihtman took the lead role as part of her PhD studies.

Since then, over 10 countries have adapted the Canadian version of the instrument to their local cultures and languages, and followed a similar protocol for psychometric assessment. During the next planned phase, each collaborator will use their local version of the Little DCDQ to assess 40 children between the ages of 3 years to 4 years 11 months (20 typically developing and 20 with suspected motor difficulties), and the data will be compared to assess motor development across cultures.

Results of this collaborative effort were presented on 10 occasions at the recent DCD-X Conference (http://www.eeffto.ufmg.br/DCD/material/conference_book.pdf). B. Wilson was an author on two of the oral presentations:

Rihtman, T., Wilson, B. N., et. al. Can a Little instrument make a big noise? A cross-

cultural collaboration for identifying motor delay in young preschoolers. Jover, M., Albaret, J‐M, Ray‐Kayser, S., Parush, S., Rihtman, T., Wilson, B.N. European

French adaptation of the Little DCDQ questionnaire (Little DCDQE-French).

Evaluation of Knowledge Utilization

Success of knowledge utilization will be best measured during and after the final part of the research (Part III), when the validity of the Little DCDQ has been established. The success of knowledge utilization methods could be measured by:

the number of peer-reviewed publications and lay reports

the number of presentations to parents, teachers, early childhood studies students, early intervention personnel, child care centres, health services and community agencies

the number of presentations prepared by junior investigators and students supported by the research team

eliciting feedback from the Clinical Advisory Committee on changes to organization, policy or practice which were influenced by the results of this project

the number of unique visits to the DCDQ web site after the Little DCDQ is posted

sustained knowledge exchange over time, through feedback from researchers and clinicians

http://www.eeffto.ufmg.br/DCD/material/conference_book.pdf


Conclusion

DCD is a common childhood condition which may have serious consequences, especially if not identified and acknowledged at an early age. Through ongoing collaboration with researchers in the field of DCD and with clinicians in Calgary, the Investigators are well positioned to contribute to the development of a questionnaire which has the potential to contribute to earlier and more accurate identification of preschool children who are at risk of DCD. In future, this project will also enable cross cultural comparison of the expression of motor coordination difficulties in preschool children in several countries.

Next Steps

Conduct a targeted recruitment of parents of 3 and 4 year-old children to ensure adequate sample size for further analysis

Complete Part III of the study to ensure validation of the instrument and develop cut-off scores

When the Little DCDQ is psychometrically strong, make it available through www.dcdq.ca

Complete a short report for participating centers and for families

Compete a manuscript for publication


Appendices

REFERENCES

(1) American Psychiatric Association. DSM-IV-TR. Diagnostic and statistical manual

of mental disorders. 4th Ed. text revision ed. Washington, DC: APA; 2000.

(2) Wann J. Current approaches to intervention in children with developmental coordination disorder. Dev Med Child Neurol 2007 June;49(6):405.

(3) Gubbay SS. The Clumsy Child: A Study in Developmental Apraxia and Agnosic Ataxia. London: W.B. Saunders; 1975.

(4) Missiuna C, Moll S, Law M, King S, King G. Mysteries and mazes: parents' experiences of children with developmental coordination disorder. Can J Occup Ther 2006 February;73(1):7-17.

(5) Martin NC, Piek JP, Hay D. DCD and ADHD: a genetic study of their shared aetiology. Hum Mov Sci 2006 February;25(1):110-24.

(6) Piek JP, Bradbury GS, Elsley SC, Tate L. Motor coordination and social-emotional behaviour in preschool-aged children. International Journal of Disability, Development and Education 2008;55(2):143-51.

(7) Lingam R, Hunt L, Golding J, Jongmans M, Emond A. Prevalence of developmental coordination disorder using the DSM-IV at 7 years of age: a UK population-based study. Pediatrics 2009 April;123(4):e693-e700.

(8) Missiuna C, Cairney J, Pollock N, Cousins M, Macdonald K. Exploring psychological distress in children with DCD and/or Attention Deficit Hyperactivity Disorder: A population-based study. Paper presented at: 8th International Conference on Developmental Coordination Disorder; June 23-26, 2009; Baltimore, MD.

(9) Baerg S, Cairney J, Hay J, Rempel L, Faught BE. Physical Activity of Children with Developmental Coordination Disorder in the Presence of Attention Deficit Hyperactivity Disorder: Does Gender Matter? Paper presented at: 8th International Conference on Developmental Coordination Disorder; June 23-26, 2009; Baltimore, MD.

(10) Cantell M, Crawford SG, Tish Doyle-Baker PK. Physical fitness and health indices in children, adolescents and adults with high or low motor competence. Hum Mov Sci 2008 April;27(2):344-62.

(11) Cairney J, Hay J, Veldhuizen S, Missiuna C, Faught B. Trajectories of Cardiovascular Risk in Children with and without Developmental Coordination Disorder: Results from a large, prospective cohort of children. Paper presented at: 8th International Conference on Developmental Coordination Disorder; June 23-26, 2009; Baltimore, MD.


(12) Cairney J, Hay JA, Veldhuizen S, Missiuna C, Faught BE. Developmental coordination disorder, sex, and activity deficit over time: a longitudinal analysis of participation trajectories in children with and without coordination difficulties. Dev Med Child Neurol 2009 December 9; url: 20015253.

(13) Missiuna C, Gaines BR, Pollock N. Recognizing and Referring Children at Risk for Developmental Coordination Disorder: Role of the Speech-Language Pathologist. Journal of Speech-Language Pathology and Audiology 2002;26(4):172-9.

(14) Gaines R, Missiuna C. Early identification: are speech/language-impaired toddlers at increased risk for Developmental Coordination Disorder? Child Care Health Dev 2007 May;33(3):325-32.

(15) Leeds Consensus Statement (LCS). Developmental Coordination Disorder as a specific learning difficulty. Leeds: University of Leeds; 2006.

(16) Chambers M, Sugden D. Early Years Movement Skills. Description, Diagnosis and Intervention. London: Whurr Publishers Ltd; 2006.

(17) Chambers ME, Sugden DA. The Identification and Assessment of Young Children with Movement Difficulties. International Journal of Early Years Education 2002;10(3):157-76.

(18) Cantell MH, Smyth MM, Ahonen TP. Two distinct pathways for developmental coordination disorder: persistence and resolution. Hum Mov Sci 2003 November;22(4-5):413-31.

(19) Jongmans M. Early identification of children with Developmental Coordination Disorder. In: D.A.Sugden, M.E.Chambers, editors. Children with Developmental Coordination Disorder.London: Whurr; 2005. p. 155-67.

(20) Missiuna C, Gaines R. PHCT Fund Final Report. 2006. Unpublished Work

(21) Brigance Inventory of Early Development. North Billerica, MA: 2002.

(22) Glascoe FP. Parents' Evaluation of Developmental Status (PEDS). Nashville, TN: Ellsworth & Vandermeer Press, LLC; 2006.

(23) Henderson SE, Sugden DA, Barnett AL. Movement Assessment Battery for Children-2. 2nd ed. London, U.K.: Pearson; 2007.

(24) Cairney J, Hay J, Veldhuizen S, Missiuna C, Faught BE. Comparing probable case identification of developmental coordination disorder using the short form of the Bruininks-Oseretsky Test of Motor Proficiency and the Movement ABC. Child Care Health Dev 2009 May;35(3):402-8.

(25) Hay JA, Hawes R, Faught BE. Evaluation of a screening instrument for developmental coordination disorder. Journal of Adolescent Health 2004;34(4):308-13.


(26) Rosenblum S. The development and standardization of the Children Activity Scales (ChAS-P/T) for the early identification of children with Developmental Coordination Disorders. Child Care Health Dev 2006 November;32(6):619-32.

(27) Schoemaker MM, Flapper BC, Reinders-Messelink HA, Kloet A. Validity of the motor observation questionnaire for teachers as a screening instrument for children at risk for developmental coordination disorder. Hum Mov Sci 2008 April;27(2):190-9.

(28) Bois JE, Sarrazin PG, Brustad RJ, Trouilloud DO, Cury F. Elementary school children's perceived competence and physical activity involvement: The influence of parents' role modelling behaviours and perceptions of their child's competence. Psychology of Sport and Exercise 2005;64(4):381-97.

(29) Glascoe FP. Using parents' concerns to detect and address developmental and behavioral problems. J Soc Pediatr Nurs 1999 January;4(1):24-35.

(30) Saigal S, Rosenbaum PL, Feeny D et al. Parental perspectives of the health status and health-related quality of life of teen-aged children who were extremely low birth weight and term controls. Pediatrics 2000 March;105(3 Pt 1):569-74.

(31) Missiuna C, Moll S, King S, King G, Law M. A trajectory of troubles: parents' impressions of the impact of developmental coordination disorder. Phys Occup Ther Pediatr 2007;27(1):81-101.

(32) Wilson BN, Kaplan BJ, Crawford SG, Campbell A, Dewey D. Reliability and validity of a parent questionnaire on childhood motor skills. Am J Occup Ther 2000 September;54(5):484-93.

(33) Albaret JM, de Castelnau P. Diagnostic procedures for Developmental Coordination Disorder. In: Reint H.Geuze, editor. Developmental Coordination Disorder: A review of current approaches.Marseille, France: Solal; 2007. p. 27-82.

(34) Barnett A, Peters J. Motor proficiency assessment batteries. In: D.Dewey & D.E.Tupper, editor. Developmental motor disorders: A neuropsychological perspective.New York: Guilford Press; 2004. p. 66-109.

(35) The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med 1995 November;41(10):1403-9.

(36) Cairney J, Missiuna C, Veldhuizen S, Wilson B. Evaluation of the psychometric properties of the developmental coordination disorder questionnaire for parents (DCD-Q): results from a community based study of school-aged children. Hum Mov Sci 2008 December;27(6):932-40.

(37) Schoemaker MM, Flapper B, Verheij NP, Wilson BN, Reinders-Messelink HA, de KA. Evaluation of the Developmental Coordination Disorder Questionnaire as a screening instrument. Dev Med Child Neurol 2006 August;48(8):668-73

(38) Civetta LR, Hillier SL. The developmental coordination disorder questionnaire and movement assessment battery for children as a diagnostic method in Australian children. Pediatr Phys Ther 2008;20(1):39-46.


(39) Goodman R. The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry 1997 July;38(5):581-6.

(40) Goodman R, Scott S. Comparing the Strengths and Difficulties Questionnaire and the Child Behavior Checklist: is small beautiful? J Abnorm Child Psychol 1999 February;27(1):17-24.

(41) Wilson BN, Crawford SG, Green D, Roberts G, Aylott A, Kaplan BJ. Psychometric properties of the revised Developmental Coordination Disorder Questionnaire. Phys Occup Ther Pediatr 2009;29(2):184-204.

(42) Bland JM, Altman DG. Statistics notes: Cronbach's alpha. BMJ 1997;314:572.


APPENDIX I: QUESTIONNAIRE PACKET

The package included the Little DCDQ, the Strengths and Difficulties Questionnaire

(SDQ, a standardized questionnaire about the child’s behaviour) and a short

demographic survey in a 2 page, legal-sized folded booklet.

The portrait view seen here is much longer and ‘clumsier’ than the version the parents

received.


Little Movements ~ Lots To Learn

Information for Parents

Some young children have difficulties learning to move their bodies in coordinated

and

smooth ways while they learn to use playground equipment, button their clothes, or

eat neatly. This kind of problem may affect many parts of their life, including how

well they

play with other children and how they feel about themselves. That is why early

identification of any problems with their movement skills is so important.

We are developing ways to listen to parents’ opinions of their children’s

motor skills.

Our goal is to improve our ability to find and help children with motor

problems.

We need 15-30 minutes of your time….

If you have seen these questionnaires before, there is no need

to do them again, but please return this booklet.

~Thanks


Little Movements ~ Lots To Learn

Why participate? Although your child probably has no difficulty with motor coordination, there are many children who find it hard to play on playground equipment, to handle puzzles and toys, or to eat neatly.

Your participation will help us achieve the goal of

assisting these children as early as possible. What are we asking of you? You are under no obligation to complete these questionnaires – it is voluntary. One is about how your child moves and the other lets us know if there are any social or behavioural problems that might be affecting movement skills. Some questions are very similar, but please answer each one. By filling out these questionnaires and returning them, you are agreeing to share this information with us. If you would like to learn more about the study or participate further, you may fill in your name and phone number and someone from the study will call you. Again, your involvement is completely voluntary. If we call or see you in person to ask further questions or to see your child, we will ask for your written consent at that time. Who will see your answers? All information will be kept private and confidential. Only the research people conducting this study will see your answers. Your responses will not be shared with the teacher, the school or entered into your child’s health records. No names or other identifying information will be used in any publications or presentations. This research has been approved by the Conjoint Health Research Ethics Board at the University of Calgary and the Child Health Research Office. This project is supported by the Integrated Developmental Education Assessment Services. If you still prefer that your response to this questionnaire be anonymous, please write “no name” on the questionnaire(s) but tell us your child’s birth date and sex. If you are unsure about how to mark an item or how you would answer it to best describe your child, please call our research team at 403-955-2769 for assistance. Thank you for helping! Sincerely,

Brenda N. Wilson, MSc Dianne Creighton, PhD Occupational Therapist Psychologist Alberta Health Services Alberta Children’s Hospital Tel: 403-944-3563 Tel: 403-955-7963

Ethics ID: 23418: Little Movements ~ Lots to Learn PI: Creighton and Wilson Date: 2010/11/09


Little Movements ~ Lots to Learn Developed by T. Rihtman and Professor S. Parush, University of Jerusalem

Adapted with permission of B.N. Wilson

Name of Child: ________________________________________

Year

Mon

Day

Child’s gender: Male Female Today’s Date:

Person completing Questionnaire: _________________________ Birth Date:

Relationship to child: ___________________________________ Child’s Age:

This questionnaire asks about activities that children do when moving their body and using their hands.

A child’s coordination skills may change as they grow and develop. That is why it will be easier for you to answer the questions if you think about other children that you know who are the same age and sex as your child.

Please compare your child’s coordination with that of other children the same age and sex. For each item, circle the number which best describes your child.

Not at all like your child

1

A bit like your

child 2

Moderately like your

child 3

Quite a bit like your child

4

Extremely like your

child 5

1…is able to throw a large (soccer size) ball to another child or adult

1 2 3 4 5

2…catches a large ball with both hands when it is thrown towards the center of his or her body from a distance of 1.5m (ages 3-4 years) or 2m (ages 4-5 years)

1 2 3 4 5

3…kicks a ball rolled towards him or her 1 2 3 4 5

4…runs fast and in a manner similar to other children 1 2 3 4 5

5…is able to move from place to place and from one body position to another (for example, climbs up and down stairs, climbs onto and off the bed, gets into the bath independently and with ease, on and off chairs, can play musical chairs)

1 2 3 4 5

6…drinks from an open cup or glass without spilling 1 2 3 4 5

7…uses cutlery independently (spoon, fork) to bring food towards his or her mouth

1 2 3 4 5

8...holds a pencil or crayon the same way as other children, and scribbles or draws with it (age 3) or copies simple lines and shapes (age 4) with it

1 2 3 4 5

Think about other children the same age and sex as your child. Compared to them, your child…


Not at all like your

child 1

A bit like your child

2

Moderately like your

child 3

Quite a bit like your

child 4

Extremely like your

child 5

9…is able to thread large beads (3 years old) or small beads (4 years old) onto a string

1 2 3 4 5

10…is able to peel stickers from a sheet of stickers, and stick them onto a defined place or space on a sheet of paper

1 2 3 4 5

11…succeeds at building activities (puzzles, Lego™, building a block tower)

1 2 3 4 5

12…is able to imitate the body positions of others during movement or sports activities (Simon Says, Follow the Leader, dance, gymnastics)

1 2 3 4 5

13...uses playground equipment (climbs ladders, slides down the slide)

1 2 3 4 5

14…seems to be coordinated (does not fall often during the day and does not often bump into people or objects)

1 2 3 4 5

15…remains sitting upright when required to sit for a period of time (does not tire easily, does not slouch as if falling out of the chair)

1 2 3 4 5

THANK YOU VERY MUCH! WE MAY WISH TO CONTACT YOU IN THE

FUTURE. PLEASE CHECK THE BOX OR BOXES IF WE HAVE

PERMISSION TO CONTACT YOU FOR: We may have questions about how you completed the questionnaire, or about how you rate the clarity of the wording of the questions. Calling or emailing you will enable us to create the best questionnaire we can. We would like your child’s teacher to complete a similar questionnaire. We would like to explain more about this and get your consent for the teacher to share this information with us. If you are willing to be contacted again, we may ask you to fill in the Questionnaire again in a few weeks’ time, in order to see if we get the same results after a short period of time. We will provide your child’s program with a summary report of this research. If you would also like to receive your own copy of this report, please check here and provide your address: Address: __________________________________________________________________ We may want to follow up with some children to do motor testing. We would like to explain more about this.

If you are willing to be contacted for any of these purposes, please provide your phone number or email address, and the best time of day to reach you: Phone number:________________ email: _________________________________________ The best time to reach you is: -______________________________________________________


The following information will help us know more about the children in our study.

Week of pregnancy at which your child was born: Child’s weight at birth:

YES NO

Did the child have a difficult birth (have fetal distress, require medical intervention)?

If yes, please explain:

Language spoken at home:

Additional language spoken at home:

YES

NO

Does your child receive regular medical treatments of any sort?

Has your child been referred to or received treatment from a developmental pediatrician or a pediatric neurologist?

Has your child been referred for or received treatment for speech or language difficulties?

Has your child been referred for or received treatment for gross or fine motor difficulties, or sensory processing issues (physical therapy, occupational therapy)?

Has your child been referred to or received treatment from a psychologist?

Has your child been referred for possible autism or PDD?

Has your child received a diagnosis of autism or PDD?

Does your child have a neurological disorder, such as cerebral palsy or muscular dystrophy?

Does your child have a sensory loss, such or blindness or deafness?

Does your child receive any form of educational support?

If you answered yes to any of these questions, please give details: ___________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________


The development of motor coordination is related to play skills.

Please tell us more about your child.

Strengths and Difficulties Questionnaire

For each item, please mark the box for Not True, Somewhat True or Certainly True. It would

help us if you answered all items as best you can even if you are not absolutely certain. Please

give your answers on the basis of your child's behavior over the last six months.

Not True Somewhat True

Certainly True

Considerate of other people's feelings

Restless, overactive, cannot stay still for long

Often complains of headaches, stomach-aches or sickness

Shares readily with other children, e.g. toys, treats, pencils

Often loses temper

Rather solitary, prefers to play alone

Generally well behaved, usually does what adults request

Many worries or often seems worried

Helpful if someone is hurt, upset or feeling ill

Constantly fidgeting or squirming

Has at least one good friend

Often fights with other children or bullies them

Often unhappy, depressed or tearful

Generally liked by other children

Easily distracted, concentration wanders

Nervous or clingy in new situations, easily loses confidence

Kind to younger children

Often argumentative with adults

Picked on or bullied by other children

Often offers to help others (parents, teachers, other children)


Not True Somewhat

True Certainly

True

Can stop and think things out before acting

Can be spiteful to others

Gets along better with adults than with other children

Many fears, easily scared

Good attention span, sees work through to the end

Overall, do you think that your child has difficulties in one or more of the following areas:

emotions, concentration, behavior or being able to get on with other people?

If you have answered "Yes", please answer the following questions about these difficulties:

How long have these difficulties been present?

Do the difficulties upset or distress your child?

Do the difficulties interfere with your child's everyday life in the following areas?

Do the difficulties put a burden on you or the family as a whole?

No Yes- minor

difficulties

Yes- definite

difficulties

Yes- severe

difficulties

Less than a

month

1-5 months 6-12 months Over a year

Not at all Only a little Quite a lot A great deal

Not at

all

Only a

little

Quite a

lot

A great

deal

Home Life

Friendships

Learning

Leisure Activities

Not at all Only a little Quite a lot A great deal


On behalf of our partners, we want to

Thank you for participating in the project

Little Movements ~ Lots to Learn

Please return by mail in the pre-paid postage envelope enclosed OR

by putting it in the blue survey box at your child’s program

We are grateful for the financial support of the Alberta Center for Child, Family and Community Research, and

the Alberta Children’s Hospital Foundation

Ethics ID: 23418: Little Movements ~ Lots to Learn PI: Creighton and Wilson Date: 2010/11/09


APPENDIX II: DCD-X CONFERENCE POSTER

Wilson, B.N., Creighton, D., Babcock, S., Brewin, B., Melissa, B., Crawl, S., Gibbard, B.,

Heath, J.A., Holub, A., Neil, K., Semple, L., Tan, B. Development of the Little DCDQ – Canadian for Preschool Children: Preliminary Findings. The 10th International Conference on Developmental Coordination Disorder, Ouro Preto, Brazil (June 2013)

COMMUNITY PERINATAL CARE STUDYfiles.ctctcdn.com/78b40a0d001/67b379f7-fe3e-448d-938d-58...A Calgary...

Documents

Transcript of COMMUNITY PERINATAL CARE STUDYfiles.ctctcdn.com/78b40a0d001/67b379f7-fe3e-448d-938d-58...A Calgary...