What is the activity participation profile
of Irish adolescents with Dyspraxia?
Áine O’Dea MSc (Clinical Therapies), Bsc. (Hons) OT
Amanda Connell PhD, MSc (Cog.Neuropsychol.), MCSP, MISCP
Study Aims
• To examine what challenges and barriers affect
participation in daily activities for Irish adolescents
with Dyspraxia; using a secondary analysis
methodology.
• To investigate if emotional difficulties are highlighted
by adolescents with Dyspraxia due to restricted
participation.
Objectives
1. Review the terminology of motor proficiency disorders.
2. Identify if social-environmental factors create barriers to
participation?
3. Identify what daily activities are restricted and how
performance skills influence participation for
adolescents with Dyspraxia.
4. Determine the emotional impact of participation
restrictions.
5. Highlight core health services accessed by adolescents
with dyspraxia.
Descriptive terminology of motor proficiency disorders
•
•
•
•
Clumsy Child Syndrome
Minimal Brain Dysfunction
Sensory Integration Disorder
Deficits in Attention, Motor Control & Perception
(DAMP)
• Dyspraxia
• Developmental Coordination Disorder (DCD) ( DSM-IV, APA
2000; European Academy for Childhood Disability ,2012) Sugden, 2005, Leeds
Consensus)
Diagnostic Criteria (DSM-IV-TR 2000)
A. Performance in daily activities that require motor coordination is
substantially below that expected, given the person’s
chronological age and measured intelligence.
B. Disturbance in Criterion A significantly interferes with academic
achievement or activities of daily living.
C. Disturbance is not due to a general medical condition (e.g.
cerebral palsy, or muscular dystrophy) and does not meet the
criteria for a Pervasive Developmental Disorder.
D. If mental retardation is present, the motor difficulties are in
excess of those usually associated with it.
DCD
• DCD is a major health problem for school age children (Green et al
2011)
• Internationally estimated prevalence rates: 6% -13% (Mandich et al
2001)
• Incidence rates: 2:1 boys: girls
• Heterogeneous presentation: Poor balance, coordination, manual
dexterity & low self-esteem. (Green et al 2008; Piek et al 2006)
Activity participation difficulties across the lifespan
• Children do not grow out of it (Cantell et al 2003; Kirby
et al 2011)
• Changing profile of socio-emotional, physical, &
vocational difficulties emerge with adolescence.
• Executive functioning difficulties; i.e. organisation,
planning and completion of complex daily tasks affect
participation (de Oliveria et al 2011; Kirby et al 2011).
Methodology
• Design: Secondary analysis: National Physical & Sensory
Disability Database (NPSDD).
• Inclusion Criteria: 16-19 year olds with DCD/ Dyspraxia
• Sample: N=141 Adolescents with Dyspraxia; N=< 5
Adolescents with DCD
• Research Tool: NPSDD Interview form
• Data Analysis: Descriptive Statistics
Results
Total sample: 146 participants
• 5 DCD participants excluded
• 141 Dyspraxia participants included
MAP Section of NPSDD qualitative interview N =
40/141
• ‘barriers & challenges to participation’,
• ‘participation restrictions in areas of daily living’
• ‘WHODAS II’
Data on access to services 141/141
Social-environmental barriers to participation
Physical
Transport Environment
18%
16%
People's
Services &
Attitudes
Supports
19%
26%
Access to
Information
21%
Activity Participation
Restrictions
 Education & Training:
• 20% Mild; 15% Moderate
 Socialising:
• 20% Mild; 12% Moderate
 Family Life:
• 17% Mild; <12.5%
Moderate
Emotional Impact
 Education & Training:
• 30% affected a little; < 12.5%
affected a lot
 Socialising:
• 17.5% = affected a little; 12.5%
affected a lot
 Family Life:
• 20% affected a little; <12.5%
affected a lot
Performance Skill Difficulties
Area of Participation Restriction
Mild
Difficulty
Moderate Severe
Extreme
Difficulty Difficulty Difficulty
Concentration on doing something
for ten minutes?
22.5%
25.0%
<12.5%
15.0%
Learning a new task
20.0%
27.5%
<12.5%
0.0%
Taking care of your household
responsibilities
12.5%
20.0%
<12.5%
0.0%
<12.5%
15.0%
12.5%
0.0%
Maintaining a friendship
12.5%
15.0%
<12.5%
<12.5%
Your day to day work/school
20.0%
<12.5%
<12.5%
0.0%
How much of a problem did you
have in joining in community
activities
25.0%
<12.5%
<12.5%
<12.5%
Dealing with people who you do
not know
Day Services
Day
Currently receiving services
Requiring Services
(N=110)
(N=56)
Mainstream primary school
20
<5
78
14
<5
<5
<5
<5
Mainstream secondary school
Specialist day primary school
Specialist day secondary school
Third Level Education
17
Vocational Training
7
Access to Health Services
Occupational Therapy
Psychology
 58: receiving service but  57: receiving service but
18 awaiting further
12 were awaiting
enhanced Service.
further enhanced
service
 83: not receiving any
service but 45 of these
 84: not receiving any
adolescents were
service but 36 of these
awaiting an assessment
adolescents were
waiting an assessment
Summary
1. Review terminology of motor proficiency disorders.
Ireland is not yet in line with European recommendations.
2. To identify if social-environmental factors create barriers to
participation?
Services & supports, Access to information & People’s attitudes.
3. To identify what daily activities are restricted and how
performance skills influence participation.
Education & Vocational Activities → Executive functioning
difficulties
Socialising Activities → Difficulties maintaining a friendship &
meeting new people.
Summary
4. Determine the emotional impact of participation restrictions.
Academic, vocational & social participation restrictions were
linked to difficulties with emotional well-being.
5. To highlight what are the core health services accessed by
adolescents with dyspraxia.
Occupational Therapy
Psychology services.
Conclusion
Health services are crucial to support this population
group.
Research involving a larger sample size, including
adolescents with a diagnosis of DCD is necessary.
NPSDD a valuable resource for secondary analysis
research; further research into this diagnostic group
with transition across the lifespan is necessary.
References
• Cairney, J., Hay, J. A., Faught, B.E., Mandigo, J. & Flouris, A. (2005)
‘Developmental Coordination Disorder, Self-efficacy towards physical activity
and play: Does gender matter?’ Adapted Physical Activity Quarterly, 22, 6782.
• Cantell, M.H., Smyth, M. M. & Ahonen, T.P. (2003) ‘Two distinct pathways for
developmental coordination disorder: Persistence and resolution’, Human
Movement Science, 22, 413-431.
• de Oliveira, R. F. & Wann, J.P. (2011) ‘Driving skills of young adults with
developmental coordination disorder: Regulating speed and coping with
distraction’, Research in Developmental Disabilities, 32,1301-1308.
• Health Research Board (HRB), Health Information and Evidence, National
Physical and Sensory Disability Database (NPSDD) (Online) available:
http://www.hrb.ie/health-information-in-house-research/disability/npsdd/
(accessed 9 April 2012).
References
•
Hessell, S., Hocking, C., & Graham Davies, S. (2010). ‘Participation of boys
with developmental coordination disorder in gymnastics’, New Zealand
Journal of Occupational Therapy, 57(1), 14-21.
• Kirby, A., Edwards, L. & Sugden, D. (2011) ‘Emerging adulthood in
developmental coordination disorder: Parent and young adult
perspectives’, Research in Developmental Disabilities, 32(4), 1351-1360.
• O’Brien, J. C., Williams, H.G., Bundy, A., Lyons, J. & Mittal, A. (2008)
‘Mechanisms that underlie coordination in children with developmental
coordination disorder’, Journal of Motor Behavior, 40(1), 43–61.
• World Health Organisation. ‘International classification of functioning,
disability and health: Short version’, Geneva: World Health Organisation;
2001.