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

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.

Objectives Review the terminology of motor proficiency disorders. Identify if social-environmental factors create barriers to participation? Identify what daily activities are restricted and how performance skills influence participation for adolescents with Dyspraxia. Determine the emotional impact of participation restrictions. Highlight core health services accessed by adolescents with dyspraxia.

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)

Diagnostic Criteria (DSM-IV-TR 2000) Performance in daily activities that require motor coordination is substantially below that expected, given the person’s chronological age and measured intelligence. Disturbance in Criterion A significantly interferes with academic achievement or activities of daily living. 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. If mental retardation is present, the motor difficulties are in excess of those usually associated with it.

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)

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).

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

Results Total sample: 146 participants 5 DCD participants excluded 141 Dyspraxia participants included MAP 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

Social-environmental barriers to participation

Activity Participation Restrictions Emotional Impact Education & Training: 20% Mild; 15% Moderate Socialising: 20% Mild; 12% Moderate Family Life: 17% Mild; <12.5% Moderate 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

Performance Skill Difficulties

Day Services Mainstream primary school Mainstream secondary school Currently receiving services Requiring Services   (N=110) (N=56) Mainstream primary school 20 <5 Mainstream secondary school 78 14 Specialist day primary school < 5 Specialist day secondary school Third Level Education 17 Vocational Training 7

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

Summary 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 difficulties Socialising Activities → Difficulties maintaining a friendship & meeting new people.

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.

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.

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).

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.