What is the Relationship between Self-efficacy and Occupational Performance in Children with DCD? Elisa Agnoletto Christine Charlebois Amanda Garnett Iris Lazaro Behdin Nowrouzi Colleen Ross Eugenia Wong

Outline of Presentation Introduction to DCD & self-efficacy Research process & Model 1 Critical appraisal Limitations and gaps in research Model 2 Future research Take home points Discussion

Developmental Coordination Disorder Diagnostic Features Impairment in motor coordination. Interferes with academic achievement & ADLs. Prevalence Estimated to be as high as 6 % for children between the ages of 5-11 years. (American Psychiatric Association, 2000)

Developmental Coordination Disorder Manifestations of this disorder vary with age and development: younger children: clumsiness and delays in walking, crawling, sitting, tying shoelaces, buttoning shirts, zipping pants older children: difficulties with motor aspects of assembling puzzles, building models, playing ball, printing or writing (American Psychiatric Association, 2000)

Self-efficacy Belief in one’s ability to carry out specific actions that produce desired outcomes These beliefs determine how people feel, think, motivate themselves and behave (Bandura,1986; Bandura,1994)

Self-efficacy Self-efficacy beliefs are based on: Performance experiences Observational learning Verbal persuasion Emotional arousal (Bandura, 1997)

How did we come to frame our question? Interest in DCD from personal experience (had some background knowledge)  ↓ We each did an initial quick reference search, scratching the surface of the topic. ↓  After reading a few articles, we asked the broad question “Are there psychosocial factors involved which affect occupational performance in children with DCD? This question was then refined to ask more specifically “What is the relationship between self-efficacy and occupational performance in children with DCD?”

Model #1 DCD  Occupational Performance  Psychosocial  Self-efficacy Development  Self-efficacy

Outline for Finding Research Articles Keywords used: DCD, clumsy children, dyspraxia, motor difficulties, participation, performance, activities, physical activities, occupational performance self competence/esteem/efficacy, perceived competence

Outline for Finding Research Articles Databases: EMBASE, ERIC, CINAHL, Cochrane, PsychInfo, Proquest, PubMed, Taylor & Francis Additional Articles: References of journal articles, library for hard copy, contact Professors for additional articles

Methods Purpose Quantitative, Level II study Motor Proficiency in Children Reporting Low Levels of Participation in Physical Activity Hay & Missiuna, 1998 Purpose Assessed whether the Children’s Self-Perceptions of Adequacy in and Predilection for Physical Activity Scale (CSAPPA) could be used as a screening tool for DCD Methods Quantitative, Level II study 492 students from grade 4-8 with mean age 12.4 years

Hay & Missiuna, 1998 Results students with the lowest 5% CSAPPA scores had significantly lower Participant Questionnaire scores reported by teachers to be significantly less likely to perform physical activities well and to show less enjoyment of physical activities - had significantly lower scores in BOTOM (motor proficiency) than students with highest CSAPPA

Hay & Missiuna, 1998 How this relates to our research question? Poor self-efficacy in physical activities  less likely to be physically active and participate  occupational performance in physical activities is decreased

Hay & Missiuna, 1998 Limitations does not directly study DCD population, even though they want to use the CSAPPA as a screening tool for DCD only measures self-efficacy in terms of motor competence Concern for the validity and reliability of the instruments used

Rites of Passage: Understanding participation of children with DCD Mandich, Polatajko & Rodger, 2003 Purpose – explore the effect of DCD on children and the importance of participation in occupations Methods Qualitative, interviewed parents 10 children age 7-12 years, dx’d with DCD CO-OP intervention Results Poor occupational performance had negative effects on children With CO-OP, children able to participate in occupations   self-esteem and QOL

Mandich, Polatajko & Rodger, 2003 How this relates to our research question? Study does not look directly at self-efficacy and occupational performance difficulty mastering various occupations  sense of failure Bandura (1997) Past performance has strongest impact on self-efficacy Infer that poor occupational performance   self-efficacy

Mandich, Polatajko & Rodger, 2003 Positive Aspects (Trustworthiness ) Negative Aspects (Applicability) Credibility: semi-structured interview, member check, informal member check, triangulation, prolonged engagement The sample size (10 families) is too small Transferability: detailed participant records Most of the DCD children were boys Confirmability: extensive field notes, transcripts audited by 2 experienced researcher, informal member check (family) The children are receiving the COOP treatment Dependability: field notes, coding of 2 researchers Only have middle class families

Mandich, Polatajko & Rodger, 2003 Limitations The low variability in the sample decreases the applicability of findings to other individuals with DCD Since they did not directly interview the children with DCD, they may have lost some confirmability in their findings (i.e. parental bias)

– Examination of psychosocial variables on children Psychosocial implications of poor motor coordination in children and adolescents Skinner & Piek, 2001 Purpose – Examination of psychosocial variables on children and adolescents with and without DCD Methods Quantitative data & research design 8-10 year children & 12-14 adolescents with DCD Results DCD groups perceived themselves as less competent in several psychosocial domains & and had lower levels of self-worth

Skinner & Piek, 2001 How this relates to our research question? The study finds that poor motor skills may have adverse social and emotional implications Difficulties can affect how children/adolescents view themselves physically, socially and scholastically

Skinner & Piek, 2001 Limitations Validity: “Harter’s measures has not been adequately tested.” Reliability: Studies have mixed findings - “Most researchers have failed to find a significant difference in global self-worth between children with poor motor skills and those who are coordinated” Definitions: Self-worth, self-concept, self-efficacy, perceived competence, etc.

Model #2 ? DCD Anxiety Occupational Performance Perceived Social Support  Self-efficacy

Research Approaches for OS Further research be conducted on directly investigating the relationship between DCD, self-efficacy, and occupational performance Examine whether DCD children generalize their self-efficacy in one occupation to other occupations Further research on affective and cognitive components that affect self-efficacy and occupational performance

Research Approaches for OT Investigate effectiveness of increasing self-efficacy through enabling children with DCD to participate in meaningful occupations Evaluate effectiveness of family involvement in interventions of children with DCD Evaluate whether or not interventions are effective in natural environments of children with DCD To what extent do these interventions increase social participation

Take Home Points Self-efficacy is a significant factor in enabling occupation in children with DCD More research required to explore mechanism between self-efficacy and occupational performance DCD is relevant to occupational science and therapy

Discussion Case Study B (Losse, Henderson, Elliman, Hall, Knight, & Jongmans , 1991) “B.” was a bright child with severe motor problems. Both his parents and teachers were concerned about him in school due to the fact that although highly motivated to learn new motor skills, he found it difficult to do so. At school he had no social difficulties and had a verbal IQ of 129. When interviewed in adolescence he did not present himself as depressed by his difficulties. He had not done well academically and chose to leave school and was working as a postman, which he greatly enjoyed. He rated himself on the Harter scale as “sure of himself” and “happy the way he was”. He had many friends and seemed to be a “clumsy” but well-adjusted teenager. Question: This actual case study shows that not all children with DCD will experience decreased self- efficacy through the cycle described in our proposed model. Can anyone suggest any factors that may come into play in such cases?

Model #2 ? DCD Anxiety Occupational Performance Perceived Social Support  Self-efficacy

Discussion What can occupational therapists do to enhance occupational performance and self-efficacy in children with DCD?