Summary of the article: Is treating motor problems in DCD just a matter of practice and more practice? (2015) - Schoenmaker et. al.

What is DCD?

Developmental coordination disorder (DCD) is a motor learning deficit, referring to children whose acquisition and execution of motor skills is substantially below their age and opportunities for learning. This includes the ability to perform daily activities, participate in sports, and occupy oneself with leisure activities.

Some important processes in learning these skills is being able to learn through observation, detect one's own errors, and change one's behaviour according to this self-monitoring. This paper discusses whether improvement of motor skills is just a matter of mere practice.

It is reported that the children with DCD are delayed in reaching the level of automaticity – a part of the DSM-5 diagnostic criteria is that the child must have had enough opportunities for earning these skills. Recent theory also acknowledges that con- textual factors may play a large role in mediating developmental outcomes and should be taken into consideration early on. To date, not much interventional research has been done in the field.

Decreased Participation in Motor Activities

Several studies suggest that children with DCD have an activity deficit, as they show lower levels of participation in activities of daily living (ADL) and in both organized (eg: participating in organised sports) and non-organized (eg: going outside for recess) physical activities. In these instances, children with CDC often take on the role of observer, or occupy themselves with other tasks, such as going to the toilet. While limitations obviously affect their level of participation in these activities, it has been proposed that children with DCD may also be trying to avoid failure experiences. These children are often aware of their lack of competence in motor skills, which affects their self-perception; in turn, affecting their willingness to participate. However, when parents of children with DCD were asked, it was found that these children participate in ADL as much as their peers, implying that mere participation is not enough to improve motor skills.

Problem-Solving Abilities

In order to improve performance, it is necessary that children with DCD develop the right problem-solving skills, such as the ability to identify and correct errors, which has been demonstrated to be lacking in children with DCD. This often means that they focus on less relevant aspects or incorrect causes of an incorrect motor activity in the process of self-monitoring. Children with DCD were also found to plan, monitor, and evaluate their performance less often than their peers without DCD. Thus, one important aspect of treating DCD is giving these children the opportunities to practice motor skills and teaching them how to monitor and correct their own performance.

Intervention Methods and Their Effectiveness

Most intervention methods of the last 40 years can be categorised into 2 categories:

Process-oriented treatment approaches assume that a deficit in a body structure or sensory process is responsible for the motor skill problems, eg: sensory integration therapy. Meta-analyses show, however, that these methods are not particularly effective.

Task-oriented treatment approaches are designed to improve functional outcomes and focus on teaching motor skills that are difficult for the child with DCD. One example is Neuromotor Task Training (NTT), which identifies problems with particular motor skills and participation. Additionally, environmental factors, such as the size of the button that needs to be pushed, are also identified. The child is then taught how to manipulate these environmental factors and has a feedback session. By using motor teaching strategies, therapists guide children through the different phases of motor skill learning by gradually increasing task demands.

Another well-known task-oriented therapy is Cognitive Orientation to daily Occupational Performance (C)-OP). Developed by Meichenbaum, CO-OP is a child-centered approach based upon cognitive behavior modification theories, in particular the verbal self- instruction strategy. Children choose skills they want to learn and is taught how to identify why the performance was not successful and to invent and execute plans to correct their performance

Both of these task-oriented methods have been shown to be useful int he treatment of DCD.

New Intervention Development

Practicing motor skills during intervention sessions is often not enough to increase motor skill performance, and children undergoing therapy are encouraged to practice at home. However, due to both a lack of motivation and a lack of their perceived ability to perform well, children often do not engage in practice at home.

One method of increasing motivation is to introduce serious games as part of the intervention. A serious game is the application of an inter- active game that can be used for purposes other than mere entertainment, such as rehabilitation. One example that may work in DCD intervention is the use of a Wii Fit, which has shown to improve not only skills measuring balance, but also fine motor precision and visuo-motor integration in children with DCD.

Another study investigated the use of the PlayStation 2 EyeToy, which was shown to improve balance skills and daily motor activities.

Conclusion

Although the evidence is scarce, the results of several studies confirm that virtual reality games enhance the motivation to engage in practice. Motivation is particularly enhanced when playing against an opponent. Players were found to perform better in a rehabilitation setting when they played in competition. Despite the effectiveness of serious games, practicing serious games is ultimately not as effective as a regular task-oriented intervention, such as NTT. Regular intervention techniques provide a more explicit style of learning, while in serious games, learning is rather implicit. Children with DCD, therefore, must also undergo regular therapy, as this focuses on skills in self-monitoring an problem-solving (as described above.)