Identification of developmental coordination disorder in primary school aged Kuwaiti children

Abstract

Developmental Coordination Disorder (DCD) is a heterogeneous disorder and each child may exhibit different features. Children with DCD have motor coordination impairments and their motor abilities, which are substantially below their age and intelligence levels, impact on their activities at home and/or at school. The motor impairments are not due to any medical or neurological disorder.Many studies have been conducted to investigate the prevalence of DCD in many countries but not all of them comply with the DSM-IV criteria, resulting in different prevalence estimates. Researchers that have stringently applied the four criteria of the DSM-IV when making a diagnosis have found the prevalence to be 1.8% of seven year old children (N = 6990). A further factor that appears to influence prevalence is culture, and no studies to date have investigated DCD in Kuwait.DCD is not well identified in Kuwait and children with DCD may be underdiagnosed and/or misdiagnosed with other developmental disorders such as Attention Deficit/Hyperactivity Disorder, and Learning Disorder. Another reason may be the different labelling that has been given to DCD. In Kuwait, the term “sensory integration disorder” is more common than DCD. The overlapping and interchangeable use of terms causes disagreement in research and clinical practice in assessing and treating children with motor coordination difficulties. This thesis investigates the prevalence of DCD in a representative sample of Kuwaiti children. A secondary aim was to ascertain the knowledge of health and educational professionals.Study one investigated the prevalence of DCD in primary school-aged children (5-9 year old) in the State of Kuwait based on the DSM-IV criteria. The Movement Assessment Battery for Children – 2nd Edition (MABC-2) was administered to 297 Kuwaiti 5-9 year old children (147 boys and 150 girls) who were recruited from public and private primary mainstream schools in urban and rural areas. This was used to assess DCD Criterion A. Criterion B was assessed using the DCD Questionnaire – New Edition (DCDQ’07) which was completed by the children’s parents. In order to achieve this aim, the validity of the MABC-2 and DCDQ’07 were also examined. In addition to prevalence, the motor performance of Kuwaiti children was compared with the performance of the UK children used for the MABC-2 norms. Gender, age, and school type (private or public) were investigated. The results of study one showed that the prevalence of DCD was 5.7% which is considered high when the DSM-IV criteria are stringently applied. The construct validity of the MABC-2 revealed that the drawing item was problematic. However, after re-standardization of the drawing item the construct validity of the MABC-2 was confirmed. There were significant differences between Kuwaiti boys and girls in aiming and catching skills. Also, Kuwaiti children were significantly behind the UK children in the total score of the MABC-2, manual dexterity, and balance. The reliability of the DCDQ’07 was confirmed, however, its validity was poor.The second study used interviews to explore the DCD knowledge of educational and health professionals, and to explore the facilities available in both health and educational sectors for children with DCD. Twenty-two professionals from educational and health sectors were interviewed. The results of study two revealed that professionals from both sectors were unaware of the definition of DCD. Although professionals from the health sector were more able than the educational professionals to describe children with DCD, they were unaware of the consequences and prognosis. Facilities were not provided for children with DCD in either health or education sectors.In conclusion, our findings have emphasised the importance of complying with the DSM-IV criteria in the identification of children with DCD, and the necessity of using reliable and valid assessment tools that are suitable for different cultures.The differences in children’s motor abilities between genders and between children from different countries were task-specific that may be influenced by biological, cultural, and environmental factors. Hence, consideration should be given for these differences in assessing children’s motor ability. Individual intervention plans are required for children with DCD that should cover each child’s needs. Researchers and clinician should consider the factors that cause such differences while identifying DCD.