1. College of Occupational Therapists Annual Conference Glasgow 2003

2. Children with developmental co- ordination disorder (DCD): Is screening assessment effective? Elizabeth Stephenson, Clinical Specialist Occupational Therapist, Royal Aberdeen Childrens Hospital Rosemary Chesson Professor of Health Services Research The Robert Gordon University

3. Structure of presentation DCD - Terminology Background Aims of project DCD clinic and assessment procedure Method Results Implications and issues

4. Terminology and definition More than 20 terms exist Definition is inconsistent Heterogeneity of DCD group Problems for research

5. Developmental co-ordination disorder (DCD) Performance in daily activities requiring motor co- ordination substantially below that expected for age and cognitive ability. Motor difficulty affects academic learning and activities of daily living. Not due to a medical condition such as CP, nor meeting the criteria for PDD Where cognitive delay exists, motor difficulty must be in excess of it

6. The study Investigation of assessment efficacy part of a wider study Study included survey of parent and referrer satisfaction Extension of study examines outcome for children with DCD

7. Collaborative working collaboration both between departments and staff in Royal Aberdeen Childrens Hospital & the Robert Gordon University (RGU) long term collaboration - grown over the years. joint working with OT department and Health Services Research Group, RGU.

8. Features of collaborative working Different perspectives - health services researcher (non clinician) and clinician - child specific focus vs broad age spectrum - different organisational contexts Common objectives - commitment to improve patient care - help establish evidence-based practice Outcomes - publications - future research

9. Aspects of research Research includes clinical and non-clinical elements: Clinical assessment screening One stop clinics Non-clinical parental views

10. Research to date regarding children with DCD High volumeLow volume - Assessment (incl tools)- Screening - Cause- One stop clinics - Treatment- Outcomes

11. Outcome Studies Few longitudional studies. Main emphasis on motor & academic outcome. Some work on associated emotional/behavioural problems. Effects on family neglected - none longitudinal - very few studies - earliest and largest (Chesson, McKay & Stephenson 1990) 31 children

12. Aims of the project Evaluation of the accuracy and efficacy of the occupational therapy screening within a one stop clinic procedure for children with DCD

13. Establishing the DCD clinic Increasing demand on occupational therapy service One stop clinic implemented trial Medical and occupational therapy screening on same day After 3 years (1995-1997) evaluation required

14. Basic screening procedure History Clinical observance Drawing and writing Posture imitation

15. Further assessment Additional screening tests: motor performance items; visual-motor skill and visual perception Fuller assessment: Movement ABC; VMI; MVPT/TVPS (sensory profile)

16. Method Two independent assessors recruited Records of 36 children scrutinised (15% of three year study group) Data entered into SPSS-PC Kappa values calculated to establish degrees of concordance in 5 areas.

17. Areas examined Accuracy of Clinical Observations Further tests following screening Diagnosis - sub-typing Intervention required Resource need: clinical/educational

18. Results Overall high levels of concordance between clinician screening & two external assessors Extent of concordance established using Kappa poor<or = 0.21 fair0.21 - 0.40 Moderate0.41 - 0.60 Sustantial0.61 - 0.80 Good>0.80

19. Concordance Highest levels: Clinical observations (at least 0.80) Lowest levels:Intervention required (0.08)

20. Concordance cont. Clinical observations Highest levels of concordance between: Clinician & Assessor 1 on neck reflexes Clinician & Assessor 2

21. Additional Tests Tests indicated to supplement basic screening (selection from list) None considered good & none poor Highest agreement between C & Assessor 1 regarding visual motor test

22. Types of dysfunction & diagnosis Types of dysfunction considerable range in degrees of concordance Primary diagnosis 20/36 cases of complete agreement on dx 11 cases of 2 way agreement 5 cases where there was no agreement

23. Intervention Intervention C/A1 C/A2 Therapy 0.11 0.49 Therapy ideas 0.08 0.45 Referral to an. agency 0.05 0.60 reflected also in resource needed (educational or clinical)

24. Implications For clinical practice For future research

25. Issue raising Clinical settings Resources