what is the activity participation profile of irish adolescents with dyspraxia? Áine odea msc...
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What is the activity participation profile of Irish adolescents with
Dyspraxia?
Áine O’Dea MSc (Clinical Therapies), Bsc. (Hons) OTAmanda 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 includedMAP 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 Environment
16%
Services & Supports
26%Access to
Information21%
People's Attitudes
19%
Transport18%
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
Area of Participation Restriction Mild Difficulty
Moderate Difficulty
Severe Difficulty
Extreme 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%
Dealing with people who you do not know
<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%
Performance Skill Difficulties
Day ServicesDay
Currently receiving services Requiring Services
(N=110) (N=56)Mainstream primary school
20 <5Mainstream secondary school
78 14Specialist day primary school
<5 < 5Specialist day secondary school
<5 <5Third Level Education
17Vocational Training
7
Access to Health Services
Occupational Therapy 58: receiving service but
18 awaiting further enhanced Service.
83: not receiving any service but 45 of these adolescents were awaiting an assessment
Psychology 57: receiving service but
12 were awaiting further enhanced service
84: not receiving any service but 36 of these adolescents were waiting an assessment
Summary1. 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
difficultiesSocialising 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, 67-82.
• 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.