Helping Students with DCD / Dyspraxia in the classroom
•Download as PPTX, PDF•
1 like•842 views
How to identify and support students with DCD / Dyspraxia in schools. An occupational therapy perspective with useful information and resources.
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Similar to Helping Students with DCD / Dyspraxia in the classroom
Similar to Helping Students with DCD / Dyspraxia in the classroom (20)
Recently uploaded
Recently uploaded (20)
Helping Students with DCD / Dyspraxia in the classroom
- 1. OTs4Schools CIC Skills for Learning, Living and Leisure Occupational Therapy Services for Children and Young People www.ots4schools.com
- 2. *Session plan *What does it look like? *Identify and assess *Support, services and best practice
- 3. *
- 4. *
- 5. *
- 6. * SIGNIFICANT IMPACT IN: *Academic tasks *Self-care *Organisation *Attention *Leisure activities *Social relationships and self-esteem *PARTICIPATION IN DAILY LIFE
- 7. * •Clumsy child syndrome •Developmental dyspraxia •Gross/ fine motor challenges •Sensory based motor disorder •Motor coordination difficulties DEVELOPMENTAL COORDINATION DISORDER •International Consensus (1994) •Leeds Consensus (2006) •EACD Guidelines (2012)
- 8. * * A disorder characterised by an impairment in the development of an individual’s motor coordination skills *It is not due to a medical condition *Interferes with Activities of Daily Living
- 9. * 1. Learning and execution of coordinated motor skills is below expected level of age, given opportunity for learning. 2. Motor skills deficit significantly and persistently interferes with activities of daily living appropriate to chronological age and impacts academic/school productivity, prevocational and vocational activities, leisure and play 3. Onset of symptoms is in the early developmental period 4. The motor skills deficits are not better explained by intellectual disability, visual impairment and or other neurological condition that affect movement
- 10. * *ADHD *ASD / PDD *Dyslexia *Specific Language Impairments *Social, emotional, behavioural needs *Other: hypermobility, prematurity, low birth weight, etc.
- 11. * • Affects around 5-6% of school-aged children (APA, 2013) • 1.7% UK Population • Psychological and social concerns • Negative impact on physical fitness • Secondary consequences (anxiety, depression, self- esteem) • Poor long term outcomes Early identification and intervention is crucial
- 12. * No clear answer. Distinct Neuro-developmental Disorder. Differences in: *Processing information *Motor learning *Repeated errors – don’t learn from it or others *Poor Generalisation Life long difficulties
- 13. * *Standardised assessments (including Medical) *Questionnaires *Family / School professionals interview *Observation / Analysis of functional activities
- 14. * *NHS – multidisciplinary services *Allied Health Professionals (OT/PT/SLT) *CAMHS *Private practices *Specialist teachers *Online information and leaflets
- 15. *
- 16. *Best Practice Interventions Training and Partnership Integration through accommodations Task-oriented approaches
- 18. *Accommodations to facilitate integration: M.A.T.C.H. *Modify the task *Alter your expectations *Teaching Strategies *Change the Environment *Help by understanding MATCH leaflets on DCD for educators on different school years: http://tinyurl.com/zv7u9ea
- 19. *What about all those OT gadgets?
- 20. *Task-oriented Approaches *Cognitive Orientation to Occupational Performance (Co-Op) (Polataijko & Mandich, 2004; Mandich, Missiuna et al. 2001)
- 21. *Co-Op *Client-centred *Problem-solving *Skill/ Strategy Use *Guided Discovery/ coaching
- 22. *Co-Op objectives *Acquire news skills or improving the quality of a current activity (Skill acquisition) *Become a strategy user (Strategy use) *Apply the learned strategy in daily activities (Generalization) *Apply the learnt skills to new tasks (Transfer)
- 23. *CO-OP intervention Pre intervention Setting two to three goals - Diary - PEGS and or COPM Determine baseline of the performance (PQRS) Dynamic Performance Analysis (DPA) Interventions sessions (up to 12) Use of cognitive strategies via guided discovery - Session 1: Teach Goal-Plan-Do-Check - The following sessions: apply Goal-Plan-Do-Check and use domain specific strategies with own goals Homework Carry out tasks, using what has been learned, at home, in school, at work and during leisure time. (Generalisation and transfer) Post intervention Evaluation of the goals (PQRS and COPM)
- 24. *Helpful strategies to support task knowledge 1. Body position 2. Attention to doing 3. Task specification/ modification 4. Supplementing task knowledge 5. Feeling the movement 6. Verbal motor Mnemonic 7. Verbal rote script
- 25. *Guided discovery Therapist might say: “Where should you be standing, in the middle of the rope or near the ends?” (skipping rope) ‘What do your hands look like at the beginning/end (catching a ball)? ‘What do the laces look like in the next step?’ (shoe- laces) Student might say: “bounce, bounce, pause… shoot” (football) ‘I need to use my ‘chatty fingers’ (holding a pencil) ‘ eyes on the ball’ (waiting to bat a ball)
- 26. *What Co-op looks like
- 27. *
- 28. * *Thank you! *Contact: Patricia Terrer-Perez, MScOT Consultant and Clinical Specialist OT www.OTs4Schools.com admin@ots4schools.com
- 29. * *EACD guidelines – http://edu.eacd.org/node/34 * Missiuna, C., et al (2002). Partnering for Change: An Innovative school-based occupational therapy service delivery model for children with developmental coordination disorder: http://tinyurl.com/zx8mm4d *Can Child, a Canadian site with a wealth of information, research and resources related to DCD: https://www.canchild.ca/en/diagnoses/developmental- coordination-disorder *Co-Op: http://www.ot.utoronto.ca/coop/research/introduction.html And Co-Op Academy: http://www.ot.utoronto.ca/coop/
Editor's Notes
- Gets up, bangs foot on the bed Takes longer to dress Spills food trying to make breakfast – gets told off by mum Gets to school late often – gets told off by office lady / teacher Gets told off for messy writing by teacher – writes little compared to peers Struggles to organise his work on the page for Maths –teacher tells him he is not trying hard enough. Finishes work later than others, misses play time. Does not join the others in games during breaks – previous experience of failure, pretends not to care, aloof. Trips in the playground and falls over. Drops food down his front at lunch time. Spills his drink while carrying his tray. Does not stay for afterschool clubs – claims not to like them. Goes back home with dirty clothes – gets told off again by mum. Tries to do homework but does as little as possible as he’s physically/mentally tired. Plays video games or does social media to relax – he’s good at computers / video games. Goes to sleep worried about little homework done and PE tomorrow, which he hates.
- Video: https://www.youtube.com/watch?v=jupa59OgZcs - cha cha slide Shoe laces/ cutting food videos – MH baseline shoelaces Sitting in class video: http://elearning.canchild.ca/dcd_workshop/sitting-in-class.html
- Handwriting sample for 6/7 year olds. Awkward movements Seems clumsy and poorly coordinated Frequently trips or drops things Prints or writes poorly and with much effort Has trouble with daily activities such as handling utensils, catching a ball, cutting with scissors, tying shoe-laces. Avoids participation in physical or motor-based activities Has difficulty learning and transferring new motor skills
- Children with DCD may have barriers to forming and maintaining relationships with others – poor self-esteem and confidence, sometimes communication problems Performance impairment in daily tasks – ‘activities’ getting dressed, domestic chores, washing dishes, preparing food, eating during mealtimes Self-organisation – remembering PE kit, books for school, thinking about next steps of a plan Barriers to participation – not wanting to play ball games, football, indoor climbing, avoiding tasks, not being able to keep up with running, coming last
- Different groups have had different ideas of how to define these children In the past definitions have depended on the country you are from or your profession. Developmental Dyspraxia was widely used initially in the UK, but now DCD is more common. In 1994 an international consensus in Ontario, Canada, decided on DCD as a unifying term. (11 professions from 8 countries, 43 expert opinions). This was later ratified by Leeds consensus and EACD guidelines (2012). SDDMF –Specific Developmental Disorder of Motor Functions – was left as an ICD-10 Diagnosis DSM- V agrees with DCD as unifying definition. Dyspraxia UK are still strong advocators of Developmental Dyspraxia as a condition part of the wider DCD umbrella, but this has not been agreed by experts at EACD. Confusion at times about what diagnosis to give is more correct, but Dr’s are using more DCD at present. Dyspraxia still valid as well to describe similar motor coordination difficulties in childhood.
- 2017 Called Specific Developmental Disorder of Motor Function (SDDMF) Excludes: abnormalities of gait and mobility, lack of coordination secondary to intellectual disabilities
- Unlike the ICD-10, the DSM-5 (APA, 2013), which was released in May 2013, has made substantial changes to the diagnostic criteria for DCD compared with its predecessor (DSM-IV-TR, APA, 2000) in an attempt to address the increasing body of evidence that has demonstrated that DCD persists throughout the lifespan. Below the expected - we need to have motor norms to understand that motor skills are below the chronological age. Motor skills – child could be seen as clumsy – dropping things, bumping into things and slowness and poor accuracy in motor movements – e.g. Catching a ball, learning to ride a bike, kicking a football **Consider environment and opportunity – children not exposed to writing or never used scissors or do self-care tasks from an early age. Significantly and persistently interferes with daily life – a child may score terribly on a mvt ABC or 1 leg balance tests, but can be functioning and managing well day to day – not impact on the daily skills= no DCD Cannot be explained by another motor deficit Diagnosis is from the age of 5 years – earlier signs can still be recognised and treated in a similar way (but not diagnosed until 5). Motor milestones are often not delayed; the delay is usually in the acquisition of new motor skills.
- Leeds (2006) Consensus: Co-exist with ASD, ADHD, developmental dyslexia ADHD most frequent – 50% co-exist 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 (from EACD guidelines) A dual diagnosis of DCD (SDDMF) and other developmental or behavioural disorders (e.g. ASD, learning disorders, ADHD) should be given if appropriate. Co-morbid disabilities increase the risk of long-term difficulties. At times separate treatment may be required for the associated condition – i.e. medication for ADHD, behavioural management approaches for SBE needs, ASD specific approaches, etc.
- Why should we care about this? UK population study 1.7% More prevalent in males than females (4 times) Make up between 40 – 60% of community OT’s caseload (Green et al. 2005). Although low priority for OT intervention as at times seen as less crucial than more significant motor disabilities (i.e. CP, muscular dystrophy) BODY OF RESREACH around secondary consequences COT position statement Under achievers in school, subsequent long term unemployment – decreased self-esteem Passive lifestyle – leads to physical health problems and obesity Impact on psychological and social well being (Rossman and Gilberg 200) Emotional and social isolation **Poor physical fitness: Rivilis et al (2011) children have more difficulty with running, jumping and skipping. Systematic review found cardio, muscle strength, power and over physical fitness was negatively impacted upon for children with DCD. Anxiety and depression: (Missiuna et al. 2007), which include increased risk of depression, anxiety and childhood obesity, and decreased self-esteem (Cocks et al. 2009; Cairney et al. 2010a,b; Engel-Yeger & Hanna Kasis 2010; Piek et al. 2010; Missiuna et al. 2011). Early identification - consider diagnosis around 5 years old however picking problems up early to begin to problem solve and adapt tasks in the child’s environment.
- Different reasons, not a single factor. Possible link to cerebellum? Problems with automatic movement control and ongoing monitoring of movement. Some dysfunction in neurological networks? They keep trying again, making same mistake, don’t learn from others, don’t learn through trial and error, but they can learn skills if coached in the right way. Poor generalisation to other tasks. That’s why sometimes they are good at specific activities but not others (i.e; might play football well, but not able to record his own work in the classroom).
- The European Academy of Childhood Disability consensus project suggested two pathways (one for assessment and diagnosis, and one for intervention). Medical assessment should always be present (to rule out other conditions). Must have ax of motor function and also of motor performance. EACD adopted guidance around ax: Be clear that it is the diagnosis that fits the best – not something else - Use a validated questionnaire to collect information on the DCD-Q or Mvt ABC-2 checklist -appropriate, valid, reliable, and standardized motor test (norm-referenced) should be used. There are numerous tests on motor functions but only a few tests have been designed and tested for the assessment of the diagnosis DCD Concerning criterion II: the complete assessment should include consideration of activities of daily living (e.g. self-care and self-maintenance, academic ⁄ school productivity, prevocational and vocational activities, leisure and play) and the views of the child, parents, teachers, and relevant others. The diagnosis of DCD however, should not be made only on the basis of a standardized motor test. It requires careful history taking, clinical examination and confirmation using valid tests and questionnaires EACD guidelines: The diagnosis of DCD (SDDMF) should be made within a diagnostic setting by a professional who is qualified to examine the specific criteria. This may require a multidisciplinary approach
- Not all NHS services will see DCD children, it varied in every borough. Paediatrician input – overall health promotion, obesity, diet, sleep, sexual health, toileting, emotional and mental health. Training and education of child’s environment is KEY.
- Before moving on we need to frame what we do in the ICF ICF offers classifications to help structure multi-agency working, and foster working together with schools Important to mention that in the past that research has focussed on body functions – now more consideration around activity and participation Contextual factors (Environment) is also crucial for success – person’s attitudes and believes and those of the people around them.
- TRAINING AND PARTNERSHIP Goals of P4C: Early identification for students with SEND Build capacity to help educators and parents understand children’s needs – knowledge translation Improve ability to participate in school and home Facilitate self management to prevent secondary consequences Training and Partnership: Some authors have argued that scant therapy resources might be used more strategically to build capacity among parents and teachers, rather than providing direct services to a smaller number of children (Stephenson & Chesson 2008). Missiuna 2013 - target at population level, creating an environment for all to learn motor skills, function and participation European countries (EACD 2011a,b, 2012; Blank et al. 2012) propose an algorithm for interventions that provides information and support to parents and teachers before moving to group or individual interventions The literature also supports the use of a consultative model for children with DCD in occupational therapy school-based services (Reid et al. 2006; Wehrmann et al. 2006). These approaches move away from a medical model and consider the holistic needs of children with DCD, and not only health-related needs (Kirby & Sugden 2007; Sugden 2007). Partering for change study (2012): OT interventions in partnership with schools focus on building capacity through collaboration and coaching in schools for students with DCD. Shift from remediation of impairment to chronic desease management.
- In their meta-analysis of intervention approaches, Pless and Carlsson194 reported the highest effect size for this group of task-oriented approaches. Task-oriented approaches work on teaching essential activities of daily living and thereby stimulate participation in the child at home, school, leisure, and sports M – Change aspects of the activity that are too difficult for the child. Let them experience success if they make an effort to join in . A – flexibility with goals. Allow extra time or alternate methods of completing a task. T – different teaching approaches – guided discovery; show, don’t tell; use visual supports; guided problem-solving and other coaching methods. C – minimise environmental factors that make it difficult for the child (noise, visual distractions, level of activity, business on worksheets) H- help the child feel supported and understood, problem solve together. Video: https://www.youtube.com/watch?v=_qRP0CJgyMg MATCH in Secondary School
- Use with caution. Equipment can be helpful in the classroom but it is not the substitute of appropriate interventions and support. It must always be agreed upon by the student. Not one size fits all. Every student is unique and is worth trying a range of things. Don’t forget the role of technology as well as the student gets older, as a compensatory strategy.
- COOP Neuro motor task training – NTT Netherlands.164 It is a task-oriented training programme for children with DCD (SDDMF) originally developed to be used by physical therapists. Skills are taught through task analysis, which breaks down a task into its component parts and will enable focus on the main problems. Challenge, planning, execution and evaluation, environment. Within the task-oriented approach are task-specific training (Revie, 1993), cognitive motor approach (Henderson, 1992), cognitive orientation to daily occupational performance (CO-OP) (Missiuna 2001), neuromotor task training (NTT) (Schoemaker 2003), and ecological intervention (Sugden, 2007). Assumption that learning and skill acquisition is strongest when the learner understands the meaning of the training, and finds the task to be useful or relevant to his or her life. You capture the motivation of the child.
- Shift away from process orientated approaches, Co-op approach has superior to any other top down intervention approaches (Chen et al 2003) More research evidence - access co-op web page Smits-Engelsman and colleagues (2013) meta analysis (review of all systematic analysis) found interventions using task-oriented approaches had a significantly higher effect size than process-oriented interventions addressing children’s impairments.
- What it can look like – individual or in a group situations. Importance of child-centred goal-setting (as opposed to parent/teacher goal setting)
- Task Specification/Modification – Discussions regarding the specifics or modification of the task or parts of the task that facilitate motor performance
- Videos – before and after, if possible Cutlery Shoe-laces Catching a ball Skipping Riding a bike Parent video
- Explain that know what is not the same as knowing how – information is easy and widely available online and is a good starting point. Trial and error of given ideas (like the ones in this presentation) is the next logical step. However, if we want to make an impact on this population, help from OTs on how to implement these approaches will be really beneficial. Collaboration and partnership with school professionals and families is essential to obtain good outcomes for these students.