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) OT Amanda Connell PhD, MSc (Cog.Neuropsychol.), MCSP, MISCP

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Page 1: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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

Page 2: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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.

Page 3: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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.

Page 4: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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)

Page 5: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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.

Page 6: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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)

Page 7: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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).

Page 8: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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

Page 9: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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

Page 10: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

Social-environmental barriers to participation

Physical Environment

16%

Services & Supports

26%Access to

Information21%

People's Attitudes

19%

Transport18%

Page 11: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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

Page 12: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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

Page 13: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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

Page 14: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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

Page 15: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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.

Page 16: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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.

Page 17: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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.

Page 18: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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).

Page 19: What is the activity participation profile of Irish adolescents with Dyspraxia? Áine ODea MSc (Clinical Therapies), Bsc. (Hons) OT Amanda Connell PhD,

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.