children with dyspraxia - percieved interventions study

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O R I G I N A L A R T I C L E

Children with “Dyspraxia”: A Survey of Diagnostic

Heterogeneity, Use and Perceived Effectivenessof Interventions

Motohide Miyahara & G. David Baxter

Published online: 19 April 2011# Springer Science+Business Media, LLC 2011

Abstract A survey was distributed to parents at a conference organized by a

dyspraxia support group, and mailed twice to the members with the support group’s

newsletters. Of 118 respondents, 84% reported that their children were diagnosed

with dyspraxia, whereas 25% stated that their children’s diagnosis was develop-

mental coordination disorder. All respondents were using food supplements.Moreover, 69% of respondents sent their children to unconventional education or

therapy, and 57% provided their children with some form of complementary and

alternative medicine (CAM). In terms of perceived effectiveness of interventions,

about half of the parents (53%) reported improvement of physical skills and

attributed such progress to standard intervention in the mainstream health care and

education systems in New Zealand. Despite popular use, effectiveness of

unconventional education, therapy, or CAM was rarely considered. These findings

have important implications for parents, health and educational service providers,

policy makers, and funding bodies.

Keywords Survey . Dyspraxia . Developmental coordination disorder . Motor

coordination . Complementary medicine

Parents have great influence on decision-making for their children’s health and

choice of educational products and services. One of the key factors in the

J Dev Phys Disabil (2011) 23:439–458

DOI 10.1007/s10882-011-9239-z

M. Miyahara (*)

School of Physical Education, University of Otago, PO Box 56, Dunedin 9054, New Zealand

e-mail: [email protected]

G. D. Baxter

School of Physiotherapy, University of Otago, PO Box 56, Dunedin 9054, New Zealand


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decision-making is their beliefs about service and product benefits, or perceived

effectiveness of interventions in case of children with developmental disabilities.

One of the less explored developmental disabilities, collectively named dyspraxia

by parental support groups in Australia, New Zealand, and the UK is the focus of

our interest. Their broad definition of dyspraxia refers to a core movement disorder, and encompasses other developmental disorders and comorbid con-

ditions which cover almost all childhood disorders in the formal classification

manuals (Peters et al. 2001). Below we will outline the context to the present

study, including the reasons why a broad definition of dyspraxia came to be used,

and why it is timely and important to investigate diagnostic heterogeneity,

interventions that these children receive, and how parents perceive the effective-

ness of such interventions.

The term, motor dyspraxia has been traditionally used to refer to the problems of

motor sequencing and selection exhibited by adult patients with acquired brainlesions, despite their intact motor systems (Miyahara and Möbs 1995). Neuro-

psychologists originally defined and assessed dyspraxia in terms of a disorder of

gestural performance on verbal and imitation command (Dewey 1995; Hill 1998;

Miyahara, Leeder, Francis, & Inghelbrecht, 2008 ). The term has since been assigned

at least two new and extended meanings. First, it was used for children with dyslexia

when they evidenced motor learning difficulties (Orton 1925). Based on its

etymology, the term was also applied to the inability to execute a variety of

functional activities, such as dressing, drawing figures, and gait (Miyahara and Möbs

1995). Some therapists use dyspraxia for a broad range of sensory and motor disorders rather arbitrarily (Cummins 1991). Parents’ support groups follow this

trend to extend the meaning of dyspraxia, and use the term for all sorts of

developmental disorders (Peters et al. 2001). As the meaning of dyspraxia expands,

no single assessment process is capable of diagnosing dyspraxia, and therefore,

holistic individual assessment is recommended (Sweeney 2007). In sum, a specific

neuropsychological definition of dyspraxia refers to a disorder of motor sequencing

and selection, whereas the lay use of dyspraxia extends to a wide variety of

childhood disabilities.

Dyspraxia is the term preferred by parents (Miyahara and Register 2000; Peters et al.

2001). It is widely accepted that existing health care and educational systems do not

sufficiently recognize and manage such children’s difficulties, even in developed

countries, such as Australia (Hands and Larkin 2001), New Zealand (Miyahara 2001)

and the UK (Henderson et al. 1991). To address such limited services provision,

parents typically form groups to support each other by sharing information and

resources, promoting social awareness, and lobbying for better habilitation services.

In contrast, developmental coordination disorder (DCD) has been more

specifically and exclusively defined in the Diagnostic and Statistical Manual of

Mental Disorder (DSM-IV-TR)(American Psychiatric Association 2000). Diagnostic

criteria stipulate the severity of poor motor coordination: it must significantly

interfere with activities of daily living and academic achievement after chronological

age and measured intelligence are taken into consideration. Performance levels are

often assessed with standardized motor performance tests and questionnaires, such

as the ones included in the Movement Assessment Battery for Children-Second

Edition(Henderson et al. 2007). Differential diagnosis is also used to distinguish

440 J Dev Phys Disabil (2011) 23:439–458


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DCD from medical conditions that cause motor incoordination (e.g., cerebral palsy,

muscular dystrophy), pervasive developmental disorders (PDD), and mental

retardation (MR). Hence, the diagnosis of the comorbid condition of DCD with

PDD or MR has been avoided. However, the exclusive criteria of PDD and MR are

no longer listed in the proposed DSM-5 (American Psychiatric Association, 2010). If the currently proposed changes are made in DSM-5, the comorbid condition of DCD

with PDD or MR will become acceptable.

Diagnostic heterogeneity and comorbidity of developmental disabilities thus

depend on diagnostic criteria that can be artificial and unstable, as in the case

of DCD. Nonetheless, comorbidity may be useful for indicating a full range of

treatment options (First 2005) and strategies (Miyahara, Yamaguchi, and Green

2008). For treatment of movement problems in children with DCD, for example,

the functional skill approach is considered legitimate if the intervention is

conducted to remediate functional motor tasks (Sugden and Dunford 2007). The principle of direct skill training has been also applied to the remediation of

various functional skills in intellectual and developmental disabilities in

educational and rehabilitation settings (Davis and Rehfeldt 2007). If a child has

dual diagnoses of attention deficit hyperactivity disorder (ADHD) and DCD for a

handwriting problem, the standard treatment of behavioral modification and

stimulant medication may be prescribed for ADHD, and handwriting training

may be arranged with a remedial education teacher, occupational or physical

therapist.

In addition to the standard treatment, children with dyspraxia may also be givencomplementary and alternative medicine (CAM). This is controversial, based upon

the lack of a sound theoretical base, the absence of evidence of effectiveness, the

possible waste of time and money, and potential harm (Ernst 2003; Golden 1984).

While empathizing with parents’ disappointment in conventional treatments, parental

stress (Gottlieb 1989), and health consumers’ empowerment in contemporary

postmodern society (Chan and Chan 2000; Vos et al. 2002), medical specialists

have issued warnings against the use of controversial treatments for ADHD (Gottlieb

1989), specific learning disabilities (Golden 1984; Gottlieb 1989), and behavioral

problems (Wolraich 1997). Health consumers have also been advised to be wary of

treatments that make claim to a broad range of effects (Golden 1984); for this

particular reason, sensory integration therapy and perceptual motor training have

been considered controversial (Sugden and Dunford 2007) and ineffective (Kaplan et

al. 1993; Kavale and Mattson 1983; Polatajko et al. 1991; Smith et al. 2005) in

improving learning disorders (Golden 1984), and behavioral problems (Gottlieb

1989; Wolraich 1997).

Investigation of the use of CAM for developmental disabilities has been

limited to autism spectrum disorder (75%) (Green et al. 2005; Hanson et al. 2007;

Liptak et al. 2006), ADHD (54%) (Chan et al. 2003), specific learning disabilities

(55%) (Bull 2009), and severe physical disabilities (Liptak et al. 2006; Rosenbaum

2003). No research has been conducted to survey the use and the perceived effect

of CAM interventions for children labeled as having dyspraxia. Bridging the gap in

the knowledge base is important because such information will useful for

stakeholders to understand the diagnoses that the concerned children receive and

the parents’ consumer behavior. The data on the parents’ perceived efficacy for

J Dev Phys Disabil (2011) 23:439–458 441441


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individual treatment would also help other parents to make informed decisions. To

produce such knowledge, this survey study aimed to answer the following research

questions:

& What kinds of diagnoses do such children receive?& What kinds of interventions do the children receive?

& What are parents’ perceptions of intervention effects with regard to academic

performance and problem domains?

Methods

Participants

Respondents ( N =118) for this survey were a purposive cluster sample of parents and

care givers who were affiliated with the Dyspraxia Support Group of New Zealand.

This was formed in 1992 to help parents support each other by sharing information

and resources, and increasing awareness and understanding of dyspraxia. Member-

ship was over 800, including parents, care givers, and professionals in New Zealand,

Australia, and other countries, of which 260 members subscribed to the group’s

newsletter, named Connection.

Materials

Survey Questionnaire Development After reviewing all available CAM survey

studies on developmental disabilities (Chan et al. 2003; Green et al. 2005; Hanson

et al. 2007; Liptak et al. 2006; Weber et al. 2008), we decided to use a

questionnaire previously used by Quinn et al. (2008) as a template for our study

because we found the format of the questionnaire (Table 1) most suitable for the

purposes of our study, and for the nature of our sample. We adapted the questions

about demographic information on the basis of New Zealand Census (Table 2),

developmental disabilities (Table 3), and included all interventions appeared in the

existing CAM survey studies on developmental disabilities (Chan et al. 2003;

Green et al. 2005; Hanson et al. 2007; Liptak et al. 2006; Weber et al. 2008) in our

prototype questionnaire. Although perceptual motor program (PMP) and sensory

integration are controversial (Sugden and Dunford 2007), PMP, sensory integra-

tion, and specific learning disorder lessons/remedial training conducted by

occupational therapists, physiotherapists, psychologists, and resource teachers are

an integral part of the mainstream educational system in New Zealand, and

therefore, included in the section of therapy and education instead of the CAM

section.

A list of prescribed medication (Table 5) was based on the list in the survey

conducted by Hanson et al. (2007). The US brand names for prescription

medications were converted to New Zealand trade names by an experienced child

psychiatrist who had worked in both USA and New Zealand; he also suggested

additions and deletions of medications possibly used by children with dyspraxia.



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Pilot Prior to the main survey, the prototype questionnaire was reviewed by the

International Scientific Committee members of the Developmental Coordination Disorder

Research Group, and the president of the Dyspraxia Support Group of New Zealand who

had over a decade of experience in consulting the group members. The latter person had

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Table 1 Questionnaire outline and exemplary questions. Excerpts from the instruction: You are invited to

complete all of the following questions about yourself and your child’s intervention…This survey is

entirely voluntary…There are no right or wrong answers…Your response will only be used for the

purposes of this research and will be treated in the strictest confidence


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improvement because of multiple factors involved in the timing, such as the ages of

children, time durations after interventions, and the accuracy of memory. Instead, we

aimed to assess the parents’ subjective impression of improvement from each

intervention.

Procedures

Questionnaires were distributed through the Dyspraxia Support Group of New

Zealand. The survey of group members was completed in two phases: the first phase

Table 3 Percentage of respondents whose children received single or dual diagnoses

Diagnosis n %

Dyspraxia (incl. apraxia) 99 84

Developmental coordination disorder (DCD) 29 25

Specific learning disabilities/disorders 26 22

Attention deficit hyperactivity disorder 22 19

Pervasive developmental disorders (incl. autism, Asperger) 20 17

Dyslexia 13 11

Dysgraphia 6 5

Mental retardation/intellectual disabilities 7 6

Oppositional defiant disorder 6 5

Dyscalculia 5 4

Epilepsy 3 3

Cerebral palsies 2 2

Conduct disorder 1 1

Comorbid condition with dyspraxia

Dyspraxia and DCD 23 19

Dyspraxia and specific learning disabilities/disorders 23 19

Dyspraxia and pervasive developmental disorders 16 14

Dyspraxia and dyslexia 11 9

Dyspraxia and mental retardation/intellectual disabilities 5 4Dyspraxia and oppositional defiant disorder 5 4

Dyspraxia and dyscalculia 5 4

Dyspraxia and attention deficit hyperactivity disorder 3 3

Dyspraxia and dysgraphia 3 3

Dyspraxia and cerebral palsies 2 2

Comorbid condition with DCD

DCD and specific learning disabilities/disorders 8 7

DCD and attention deficit hyperactivity disorder 7 6

DCD and dyslexia 4 3DCD and dysgraphia 4 3

DCD and dyscalculia 2 2

DCD and oppositional defiant disorder 1 1



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during the New Zealand Dyspraxia conference, and the second phase through the

group’s newsletter distribution.

As part of the first phase, questionnaires along with self-addressed stamped

envelopes were included in conference bags and distributed to all participants

(n=250) at the registration desk of the Fourth National Dyspraxia Conference held

in Christchurch, New Zealand from 5th-7th October, 2007. During the conference,

participants were encouraged to respond to the survey by announcements and posters,

and a drop box was placed at the registration desk. A total of 54 parents (22% of

attendees) either returned the forms via the dropbox, or mailed the forms to theresearchers using the attached self-addressed envelopes by the end of October 2007.

In December, 2007 and April, 2008, questionnaires were mailed with the group’s

newsletter Connection to all subscribers (n =260). The instruction for the

questionnaire asked the subscribers to respond to the questionnaire only if they

have not responded before. By the end of January, 2008, 24 forms (9%) were

Table 4 Use of food supplement, modified diet, and herbal remedies

Used intervention n %

Food supplements

Fish oil 44 37

Omega 3 fatty acids 42 36

Evening primrose oil 9 8

Pycnogenol 1 1

Blue green algae 1 1

Other food supplements 6 5

Modifieddiet

Removal of foodadditives 15 13

Wheat free 12 10

Megavitamins 8 7

Sugar free 3 3

Feingold 2 2

Mineral therapy 2 2

Vegan 0 0

Otherdiet 17 14

Herbal remedies

St. John’sWort 3 3

Valerian 1 1Kava 1 1

Ginseng 1 1

Gingkobiloba 1 1

Chamomile 1 1

Wild OatSeed 0 0

Skullcap 0 0

Other Herbal Remedies 8 7



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returned, and a further 40 forms (15%) were returned by the end of April, 2008. The

final sample consisted of 118 respondents. Because of two different sources of

samples, member attrition and initiating new members, we were unable to determine

the overall response rate.

Statistical Analysis

In keeping with previous CAM surveys on developmental disabilities (Chan et al.

2003; Green et al. 2005; Hanson et al. 2007; Liptak et al. 2006; Weber et al. 2008),

only descriptive statistics were performed using frequencies and percentages.

Percentage data were not included for the questions as to perceived effectiveness

because low and variable response rates in this section could create confusions

between percentages of the total respondents ( N =118), and varying numbers of

respondents to different questions. Inferential statistics were not performed due to

the descriptive nature of this study. Because of a large number of intervention items

in the survey questionnaire and the focus of the present study, the multivariate

frequency distributions of different interventions are not analyzed, but noteworthy

observations are described in the Results section.

Results

Sample Characteristics

Characteristics of the sample are presented in Table 2 in comparison with data from

the census of New Zealand population in 2006. All respondent parents were 25 years

of age or older, and mothers constituted 93% of the sample. A relatively large

proportion consisted of European descendants educated at university levels and

earning upper middle to high personal income compared to the general New Zealand

population.

Table 5 Use of prescribed medication

Medication (Brand name) n %

Paroxetine (Aropax, Loxamine) 7 6

Clonidine (Dixarit, Catapres) 5 4

Dexamphetamine 5 4

Fluoxetine (Fluox, Prozac) 4 3

Sodium Valproate (Epilim) 4 3

Carbamazepine (Tegretol) 3 3

Risperidone (Risperdal) 2 2

Methylphenidate (Concerta, Ritalin, Rubifen) 1 1

Other a 11 9

a Other medication consisted ofcitalopram (Celapram), Melatonin, Lactose, Flixotide, microlax,

ibuprophen (Rubiprofen), and Lithium



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Diagnosis

Characteristics of the sample by diagnosis are summarized in Table 3. Of the

children represented by parents in the sample, dyspraxia is the most common

diagnosis (84%), followed by DCD (25%), specific learning disabilities/disorder

(22%), ADHD (19%), pervasive developmental disorder (PDD) (17%), and dyslexia

(10%). Diagnoses of both dyspraxia and DCD have been given to 23 children, 19%

of the sample. Consistent with the exclusion criteria of the current DSM, children

Table 6 Use of therapy and education

Used intervention n %

Occupational therapy

Sensory integration 62 53

I don’t know the detail 39 33

Cognitive orientation too ccupational performance (COOP) 10 8

Bobath 2 2

Other occupational therapy 19 16

Physiotherapy


Sensory integration 23 19

Bobath 4 3

Doman-Delacato patterning 1 1

Kabat 0 0

Other physiotherapy 8 7

Psychology

Specific learning disorder lessons/remedial training 27 23

Behavior therapy (Applied behavior analysis) 11 9

Clinical psychology 11 9

Cognitive behavior therapy 8 7


Psychotherapy 2 2

Behavior therapy (TEACCH) 1 1

Other psychology 8 7

Alternativetherapy and education

Brain gym (applied kinesiology) 42 36

Optometric training 23 19

Musictherapy 12 10

Chiropractic 9 8

Dance/movement therapy 9 8Art therapy 7 6

Dore 7 6

Conductiveeducation 4 3

Mindfulness training 0 0



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Table 8 The breakdowns of frequency (n=69) for responses to the question: Did your child’s physical

coordination improve? and the descriptions to the question: Which intervention do you think helped the

improvement?

Response Frequency Response Frequency

Yes 62 No 7

Intervention used Intervention used

Occupational therapy 15

Physiotherapy 5

Sensory integration 4

PMP 3

Brain gym 2

School education 1

Optometric training 1

Brain gym 1

Cranial osteopathy 1

Movement clinic 1

No description 28 No description 7

Subtotal 62 Subtotal 7

PMP Perceptual motor programme

Table 7 Use of complementary and alternative medicine (CAM)

Intervention used n %

Osteopathy 23 19

Homeopathy 20 17

Massage/bodywork 12 10

Craniosacraltherapy 8 7

Meditation/Relaxation response 6 5

Hypnotherapy (guidedimagery) 6 5

Faith/Spiritual Health 5 4

Aromatherapy 5 4

Reflexology 3 3

Healer/healingtouch 3 3

Biofeedback 3 3

Yoga 2 2

Alexander Technique 2 2

Shiatsu/Acupressure 1 1

Prayer/shaman 1 1

Acupuncture 1 1

Tai Chi/Qui Gongs 0 0

Rolfing 0 0



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with DCD have not been diagnosed with PDD or MR. In contrast, 16 children withdyspraxia received the dual diagnoses of PDD, and 5 children with dyspraxia also

had MR.

Table 10 The breakdowns of frequency (n=61) for responses to the question: Did your child’s

achievement in physical education improve? and the descriptions to the question: Which intervention do

you think helped the improvement?


Yes 52 No 9



Physiotherapy 8


No specific intervention 2

PMP 2

School education 2

Brain gym 1


Movement clinic 1



PMP Perceptual motor program

Table 9 The breakdowns of frequency (n=68) for responses to the question: Did your child’s hand

writing improve? and the descriptions to the question: Which intervention do you think helped the

improvement?


Yes 58 No 10



School education 5

Typing 3

Physiotherapy 2


Brain gym 2


PMP 1


Educational psychology 1



PMP Perceptual motor program



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Interventions

As shown in Table 4, food supplements were more popular than modified diet and

herbal remedies. More than one third of the sample used fish oil and Omega 3 fatty

acids. Supplements reported in the ‘other food supplements’

category includedcalcium, cod liver oil, flax seed oil, garlic, horseradish, multivitamin, and vitamin C.

Approximately 10% of the sample removed food additives and wheat from

children’s diet. Under ‘other diet ’, organic, dairy free, dietician monitoring fat

content, Effalex, Failfree diet and gluten free diet were reported. Few used herbal

remedies; several listed Bryophyllum Argento Cult, homeopathy, unknown Oriental


achievement in math improve? and the descriptions to the question: Which intervention do you think

helped the improvement?


Yes 22 No 12


School education 5 Cranial osteopathy 1

No specific internvention 3


Number works 2

Kumon 2

Physiotherapy 1

Speech therapy 1




achievement in music improve? and the descriptions to the question: Which intervention do you think

helped the improvement?


Yes 31 No 14


Music lesson/therapy 4


No specific internvention 2

School education 2

Physiotherapy 1







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herbs, rescue remedy, Rocket tablets, and sleep remedy under ‘other herbal

remedies’. Though not possible to deduce from Table 4, it caught our attention,

when we browsed the raw data, that all 118 respondents had reported their use of at

least one food supplement.

Use of prescribed medication is summarized in Table 5. Approximately 9% of thesample reported that their children used serotonin reuptake inhibitors (SSRI) for

anxiety and depression (i.e., Paroxetine, Fluoxetine). A combined total of 9% used

medication for ADHD (i.e., Clonidine, Dexamphetamine, Methylphenidate). A

combined total of 6% of the sample reported use of medication commonly

prescribed to control epilepsy, mood changes, and aggression (e.g., Sodium

Valproate, Carbamazepine). Medication for the management of psychosis and

aggression (i.e., Risperidone) was used by 2% of the sample. Under the heading of

“Other medication” a subtotal of 9% of the sample listed the following medications:

another SSRI called Celapram, melatonin (commonly used for insomnia), lactoseand microlax to ease constipation, Flixotide to control asthma, ibuprofen for pain

control, and lithium, a mood stabilizer.

Table 6 shows therapies and educational interventions ranging from conventional

to non-conventional with the numbers of respondents who used these. Among the

conventional therapies, occupational therapy was most popular, and more than half

of the sample reported that the therapists had used sensory integration. One third of

the sample was uncertain about the specific approach of occupational therapy. With

regard to physiotherapy, sensory integration was jointly ranked first (19%) with “I

don’t know the detail

” response. Among the orthodox psychological interventions,specific learning disorder lessons/remedial training (23%), behavior therapy (applied

behavior analysis) (9%), clinical psychology (9%), and cognitive behavior therapy

(7%) were the most commonly used interventions.

Among the alternative therapy and education interventions in Table 6, those that

are considered controversial, namely Brain Gym (Educational Kinesiology) (36%)

and optometric training (19%) were most widely used. Expressive art therapies, such

as music therapy (10%), dance/movement therapy (8%) and art therapy (6%) are an

integral part of standard medical care in the USA, but are not yet part of standard

health care in New Zealand; these were therefore used by minorities in the sample.

Overall, 69% of respondentssent their children to at least one of the unconventional

education or therapy.

The popularly used forms of CAM were osteopathy (19%), homeopathy (17%), and

massage/body work (10%), followed by craniosacral therapy (7%), meditation and

relaxation response (5%), and hypnotherapy and guided imagery (5%). A wide variety

of other CAM was also used by a small number of the sample as detailed in Table 7.

Some form of CAM was provided by 57% of the respondents to their children.

Perceived Efficacy

In response to the question as to whether or not any intervention improved physical

coordination, 62 parents (53%) answered in the affirmative, 7 (6%) in the negative,

and the other 49 (42%) made no response or chose the “not applicable” response

(Table 8). Among those 62 parents who answered in the affirmative, 15 parents

thought occupational therapy helped their children’s physical coordination, 5 parents



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mentioned physiotherapy, and 4 parents listed sensory integration (which is

administered by occupational therapists or physiotherapists). This response pattern

indicates that those interventions that are perceived as most effective are conducted

by therapists working in the mainstream health care system in New Zealand. The

seven parents who answered in the negative did not specify which intervention failedto improve their children’s physical coordination. Some of the parents who made no

response or chose the “not applicable” response reported in Section D that their

combined use of different intervention methods made it impossible for them to

determine which one was working.

To be more specific, improved handwriting was reported by 58 parents (49%) and

ascribed most frequently to occupational therapy (16 respondents) and school

education (5 respondents) (Table 9). With regard to the school subjects with strong

physical components, enhanced achievement in physical education was reported by

52 parents (44%) who most commonly attributed the improvement to occupationaltherapy (14 respondents), physiotherapy (8 respondents), and sensory integration

(3 respondents) that was presumably conducted as part of occupational therapy and

physiotherapy (Table 10). Music is another subject that demands physical

coordination, especially when children play musical instruments. Improved music

achievement was reported by 52 parents (44%), most commonly as a result of music

lesson/therapy (14 respondents) and physiotherapy (8 respondents) (Table 11). By

contrast, school subjects with little physical component, such as math, improved in

22respondents (19%), most frequently from school education (5 respondents)

(Table 12) and reading improved in 55 respondents (47%), most commonly due toschool education (9 respondents), occupational therapy (5 respondents), and

optometric training (5 respondents) (Table 13).

In summary, about half of the parents (53%) reported improvement of physical

skills and attributed such progress to occupational therapy, physiotherapy, and

school education which are all part of the mainstream health care and education

systems in New Zealand. Progress in physical and non-physical domains indicated

Table 13 The breakdowns of frequency (n=63) for responses to the question: Did your child’s reading

improve? and the descriptions to the question: Which intervention do you think helped the improvement?


Yes 55 No 8


School education 9 Cranial osteopathy 1



No specific intervention 3

Brain gym 1

Davis method 1

Kyp McGrath lessons 1





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the domain-specific nature of perceived intervention effects. The effect of alternative

education, therapy, or medicine was rarely reported.

Discussion

This study surveyed parents who were affiliated with a dyspraxia support group. It

turned out that many of their children were not only diagnosed with dyspraxia or

DCD, but also with other comorbid developmental disorders. About a half of the

parents perceived conventional therapies and school education as effective, and

some parents were unaware of the specific intervention methods used in

occupational therapy, physiotherapy, and psychology. Despite their controversial

nature, and reported ineffectiveness, over half of the sample used alternative

interventions. A discussion of the possible relation between the comorbid conditionsand the parental definition of dyspraxia, the limitations of the study and future

research directions follows.

Diagnostic heterogeneity among children with dyspraxia is present in the lists of

diagnoses and prescription medications given. This finding echoes and substantiates

the statement by Peters et al. (2001) that the parental definition of dyspraxia seems to

cover a wide variety of childhood disorders. Frequency of the diagnosis of dyspraxia

was three times more than the frequency of the diagnosis of developmental

coordination disorder (DCD). This may be due to the stringent criteria of DCD

(American Psychiatric Association 2000) which excludes mental retardation (MR), pervasive developmental disorders (PDD), and cerebral palsies. Except for the

accepted comorbidity of DCD with ADHD for example, movement problems may

not be specifically acknowledged and attended in children with MR or PDD, for

instance. This may be why the term dyspraxia is used to allow comorbidity of

movement difficulties with MR and PDD, thus drawing attention to the motor

domain of the children with MR and PDD.

It is noteworthy that some of the children with dyspraxia or DCD seem to have

neuropsychiatric disorders, ranging from ADHD, oppositional defiant disorder,

epilepsy, depression, aggression, and mood disorders. Because the present survey

did not ask when medications were first prescribed, it is difficult to determine

whether these disorders started during childhood, adolescence, or adulthood. It

would be an interest of future research to investigate the onsets of neuropsychiatric

disorders in relation to the timing of movement disorder. These seemingly unrelated

disorders may share common underlying processes, and the identification of one

disorder may help the prediction, early identification, and management of the other.

High prevalence of CAM use revealed in our study is consistent with other

disability groups, such as autism spectrum disorder (Green et al. 2005; Hanson et al.

2007; Liptak et al. 2006), ADHD (Chan et al. 2003; Weber et al. 2008), severe

physical disabilities (Liptak et al. 2006; Rosenbaum 2003), and a recent study in

Christchurch, New Zealand (Wilson et al. 2007) that reported a high prevalence of

CAM use (70%) among the child patients of general practice surgeries and a

paediatric diabetes clinic. The study also found that female parents accompanying

the children, increased household income, higher parental education, parental use of

CAM, and stronger beliefs about the general harm of conventional medicines, were



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conditions. Indeed, comorbidity may reflect the current limitation in understand-

ing the underlying processes linked to multiple disorders (First 2005). Frequent

use of sensory integration and the perceived effect of the sensory integration

therapy and occupational therapy, where sensory integration therapy often takes

place, may be affected by such an orientation of the support group. For instance,the group members may be encouraged to visit health care professionals who tend

to diagnose children with dyspraxia and to treat dyspraxia with sensory integration

therapy.

Conclusion

The present study provided the first data on diagnostic heterogeneity and the

interventions for children whose parents are affiliated with a dyspraxia support

group. Parents tend to perceive conventional and free-of-charge interventions asmore effective than alternative interventions. This finding would be useful for the

parents, health and educational service providers, policy makers, and funding bodies

to make informed decisions. Future theory-driven research needs to explore the

mechanisms involved in decision-making.

Acknowledgements We thank the Dyspraxia Support group of New Zealand for contributing to this

study, and gratefully acknowledge the support of Ms. Brigid Ryan through the Centre for Physiotherapy

Research, School of Physiotherapy, Ms. Kate Heveldt through Movement Development Clinic, School of

Physical Education in assisting with the survey and in proofing the paper, and Dr. Juan García at the Child,

Adolescence, and Family Service for pharmacological information.

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