Developmental coordination disorder : risk and resilience

Aim The aim of this study was to analyse the impact of Developmental Coordination Disorder (DCD) on the lives of young people and identify factors that promote resilience to mental health difficulties within this population. Methods The study used a mixed methods approach. Results from the analysis of data from a longitudinal population-based birth cohort, the Avon longitudinal Study of Parents and Children {n=6,902) were synthesised with qualitative data from a purposive sample of 11 young people with clinically diagnosed DCD aged 11 to 16 years. Findings from the qualitative study highlighted areas that were important in the lives of the young people interviewed. These areas, such as the importance of friendship groups, bullying and a positive sense of self, were added to the final analytical model as explanatory mediators in the relationship between DCD and mental health difficulties. Findings In total, 123 young people (1.8% of the eligible cohort aged seven years), met all four diagnostic criteria for DCD using strict (5th centile) cut-offs (severe DCD). In addition, 346 young people met wider inclusion criteria (15th centile of a motor test and activity of daily living scales) and were defined as having moderate or severe DCD. These young people with moderate or severe DCD had increased odds of difficulties in attention, short-term memory, social communication, non-verbal skills, reading and spelling. They also had increased odds of self-reported depression, odds ratio: 2.08 (95% confidence interval (Cl) 1.36 to 3.19) and parent reported mental health difficulties, odds ratio: 4.23 (95% Cl 3.10 to 5.77) at age nine to ten years. The young people interviewed did not see themselves as disabled. Factors that increased a positive sense of self were inclusion in friendship groups, information that helped them understand their difficulties and being understood by parents and teachers. These findings were mirrored in the quantitative analysis which showed that the odds of mental health difficulties reduced after accounting for social communication difficulties, bullying, lower verbal intelligence and self-esteem. Conclusions Developmental Coordination Disorder is a common developmental disorder in childhood. The difficulties seen in these young people are complex and assessment needs to be multidisciplinary and consider neurological causes of poor motor coordination, the presence of coexisting developmental difficulties and associated mental health difficulties. Due to the high prevalence of the condition, ongoing one-to-one therapeutic interventions are not feasible. School based interventions, using therapists as trainers, working within a socio-medical model of disability, could work to promote resilience within the individual and improve the acceptance of differences in abilities within the school.