sharon tuppeny, college of occupational therapists (cot) carolyn dunford, the children’s trust,...
TRANSCRIPT
Sharon Tuppeny, College of Occupational Therapists (COT)Carolyn Dunford, The Children’s Trust, Tadworth,
Christine Owen, NHS Lothian
Facilitating the diagnosis of Developmental Coordination Disorder (DCD) can enable children to participate in their chosen occupations (Missiuna et al, 2008)
• Enable parents to advocate for their child, through increasing their understanding
(Ahern 2000) • Ease the process of gaining extra support in school and
assisting teachers in understanding a child's potential (Missiuna et al 2006)
Parents perceptions of the challenge of getting a diagnosis are well understood (Stephenson et al. 1991; Pless et al. 2001; Cermak & Larkin 2002; Rodger & Mandich 2005; Missiuna et al. 2006)
Occupational therapists‘ (OT) in children's community services have a long history of involvement with children with difficulties consistent with a diagnosis of DCD(Tuppeny, Dunford & Owen 2012)
OT’s have a significant role to play in diagnosis, as applying the DSM IV criteria has a specific focus on the impact on activities of daily living(Tuppeny, Dunford & Owen 2012)
The College of Occupational Therapists briefing is intended as a guide for occupational therapists contributing to the multidisciplinary diagnosis for clients who are thought to have DCD
DSM IV TR. Diagnostic Criteria for
Developmental Coordination Disorder
(American Psychiatric Association, 2000 p58)
Criterion B: academic & daily living
Criterion B: academic & daily living
Criterion A: motor coordination Criterion A: motor coordination
Criterion C:absence of existing medical condition
Criterion C:absence of existing medical condition
Criterion D: absence of a generalised
learning difficulty
Criterion D: absence of a generalised
learning difficulty
Individually administered, culturally appropriate and norm-referenced test of general motor competence is required
Establish developmental history from parents/carers and/or the child/young person of their motor skill acquisition to provide additional information about the child's motor coordination (APA, 2000).
Where there is no norm referenced test available then a developmental history can provide information for applying Criterion A
Occupational therapists have a key contribution to make in applying this criterion (Missiuna et al 2008)
Consults the child, parent/carer and/or teacher to identify which activities of daily living are presenting difficulties to the child to identify difficulties in a range of tasks including schoolwork, self-care, play and leisure tasks requiring motor skills (Dunford et al 2005)
particular attention should be given to assessing handwriting asthis frequently impacts on the child's academic achievement (Sugden 2006)
It is essential that a medical doctor is involved in the diagnostic process to rule out other possible diagnoses
Occupational therapists need to be aware of a number of known conditions that commonly co-occur with DCD, and assess or refer to other professionals as appropriate
If the child meets DCD criteria but there is no local access to medical assessment the OT can recommend that the child's difficulties are consistent with the criteria for DCD but this would need to be confirmed by medical examination
A collaborative approach is required to identify the most appropriate professionals and process for applying criterion D
Where IQ testing is not possible or deemed inappropriate, a child's ability to follow a mainstream curriculum and their teacher's opinion that their cognitive ability falls within the normal range can suffice
Where it is thought that learning disabilities are the main obstacle todevelopment and learning, the level of motor co-ordination should be below that expected for the child's developmental stage (Sugden 2006)
“It is inappropriate to exclude the possibility of a dual diagnosis of DCD and a Pervasive Developmental Disorder, and both should be given if appropriate” (Sugden 2006)
• DSM IV TR states that the diagnoses cannot be jointly given (APA 2000)
• ICD-10 does not specifically address the issue
EACD state that a dual diagnosis of DCD and other developmental or behavioural disorders should be given if appropriate
Collaborative process
Multidisciplinary process
Ensure full knowledge and understanding of diagnostic criteria and reachagreement with colleagues as to the local diagnostic pathwayhttp://www.healthcareimprovementscotland.org/programmes/reproductive,_maternal_child/programme_resources/dcd_review_response.aspx
Work with doctors to ensure that other possible diagnoses are excluded, if a medical opinion is not available a full diagnosis should not be given
Familiarise themselves with “access to community occupational therapy within developmental coordination disorder Services” (COT 2011)http://www.cot.co.uk/position-statements/access-ot-children-and-young-people-developmental-co-ordination-disorder
Ensure they maintain their knowledge regarding diagnostic criteria and the relevant assessments
Base subsequent intervention approaches on best available evidence
Consider the implications for their practice of emerging guidelines regarding DCD including the EACD UK specific guidelines to be released 2011/12
http://www.cot.co.uk/docs/briefings/children-young-people-and-families