Karras, H. C., Morin, D. N., Gill, K., Izadi-Najafabadi, S., & Zwicker, J. G. (2019). Health-related quality of life of children with developmental coordination disorder. Research in developmental disabilities, 84, 85-95.
Introduction: Before presenting and criticizing our article, it is first necessary to define and contextualize the treated disorder, which is developmental coordination disorder (DCD). Still often called dyspraxia, the DCD is characterized by significant difficulties in planning, organizing and automating motor gestures to realize an action. These difficulties interfere with accomplishment of activities in daily living, academic achievement, leisure activities or work (Inserm, 2019). Today, “DCD” is the new terminology used by the DSM-V in 2015. Unfortunately, research has made little progress in this day with regard to intentional motor disturbances: causes of this disorder, identification and remediation are still being researched and being developed. The DCD may present alone or with comorbidities. In addition, manifestations can vary from person to person. Thus, the heterogeneity of the population appears at the motor as well as at the cognitive level, without forgetting the affective aspects and the consequences on the child’s well-being.
Problematic: The DCD is a disability that directly affects fine and/or gross motor skills. This is why “traditional” treatments mainly focus on improving specific motor results. However, motor difficulties have also a significant impact on psychosocial and emotional functioning. The psychological repercussions are often “forgotten” by teachers and health professionals in favor of motor rehabilitation…
Aims: To: 1) Describe the health-related quality of children’ life with DCD compared to typical development children; 2) compare the health-related quality of life from the perspectives of children with DCD and their parents; 3) explore predictors of health-related quality of life in children with DCD.
Methodology: To meet these objectives, the authors conducted a cross-sectional study from 2014 to 2016. Fifty children, including their parents, were recruited by the DCD Research Clinic (Sunny Hill Health Center in Vancouver, Canada). All participants were diagnosed with DCD according to DSM-V criteria (American Psychiatric Association, 2013). They were between the ages of 8 and 12 years and 84% were boys. It should be noted that 26% of the children had only one comorbidity, while 70% were suspected of having several comorbidities (ADHD, learning difficulties, etc.). The authors administered two questionnaires to the children and their parents. The first was the Strengths and Difficulties Questionnaire (Goodman, 1997), a screening tool that measures psychosocial strengths and weaknesses in children and youth aged from4 to 16 years. The second is the KidScreen-52 (KidScreen Group Europe, 2006), which measure children’s perceived quality of life and incorporates parents’ perspectives on their child’s quality of life (aged 8-18) (self-report and proxy questionnaire).
Results : 1) Children with DCD have significantly lower quality of life scores compared to typical developmentchildren in about half of the quality of life domains. 2) Compared to parents of typical developmentchildren, parents of children with DCD report significantly lower perceptions of their child’s quality of life in eight out of ten domains. 3) Parents of children with DCD report significantly lower scores than their child on about half of their child’s quality of life domains. 4) In all domains of child social-emotional functioning, parents with children’ DCD report significantly lower scores than others (which their child with DCD, parents of children typical development, and children with typical development).
Discussion : We chose to study this article for many reasons. On theone hand, DCD is a disorder that is still too little known. Yet there are as many children with DCD as there are children with dyslexia, which is a much more popular learning disability (Huron, 2012). On the other hand, we believe that this article contributes to the “de-stereotyping” of DCD in showing it from another angle which is very present. Indeed, it highlights the need for support that goes beyond motor skills and focuses on the importance of holistic care. Furthermore, this article provides a better understanding of which aspects of quality life are most affected in these children and thus offers us new avenues for psychological intervention. The results of this research also show that the disorder affect family dynamic. In fact, not only parents of children with DCD tend to report a poorer quality of life for their child than the child himself, but they also report a poorer personal quality of life than other parents. Thus, the presence of the disorder within family can negatively impact the support these children receive to manage their motor deficit and psychosocial experience, as well as their sense of parental well-being. It is for these reasons that we believe that implementing a family-centered approach is likely to promote better therapeutic outcomes for children with DCD. Moreover, the pharmacologic approach, also addressed in this research, seems to be insufficient: indeed, it only treats the physiological aspect without allowing the child to feel better and be happy in his life.
This article seemed to us to be accessible to reading although it seems to be intended for experts in the field since the DCD is not defined. This is why a first part centered on the description of this disorder would have seemed necessary in this article in order to allow as many people as possible to understand the complexity of this disorder in a first instance and the repercussions of this disorder on the quality of life of children and their parents in a second instance. Another limit of this study would be the great heterogeneity of the sample as well as the frequent association of this disability with other disorders. Indeed, the data are not very homogeneous due to the complex definition of the disorder itself. With regard to DCD, one can also speak of comorbidity caution, not always knowing which disorder is secondary to the other. Thus, although variability of manifestations is an integral part of the disorder, the fact that these children may present with other disorders leads, in a way, to “re interview” the results of this research. Finally, this article reminded us the work of some researchers from the faculty of Psychology at Nantes University. Indeed, Philippe Guimard, Agnès Florin, Fabien Bacro, Charlotte Coudronnière, Isabelle Nocus and others have realized studies on the well-being and quality of life of children in their daily life and in the school context. It is notably through the article on the well-being at school of children with intellectual disabilities written by Charlotte Coudronnière in 2016 that we made the link with this article. These two studies states that, compared to all children, children with intellectual disabilities or DCD report a lower quality of life. In our opinion, these two articles 1) contribute to the readers’ awareness of the psychological “suffering” of these children in their daily lives and 2) can serve as a basis for reflection and the design of new devices to be implemented in order to rebalance the level of quality of life perceived by these children.
To conclude, the article demonstrates there are real psychological repercussions in this population. This is why, through the redefinition of a new title for this article, we tried to interest our readers by revealing the “secrets” of the DCD, that is to say the invisible manifestations. Therefore, as future psychologists, we see ourselves becoming more involved in the care of children with DCD. As educational psychologists, we could play a role in prevention, identification of the disorder on the cognitive and social level, and particularly in orientation of the child with psychological distress. As a “clinical” psychologist, it could be relevant to accompany the child by working on self-esteem, self-confidence, social skills, problem-solving, positive coping strategies, etc. Psychological accompaniment with the family would also seem necessary through our skills in parental guidance, information/counselling in order to relieve possible anxiety or guilt feelings of parents and/or siblings.
Words we have learned: Trivialize – Thoroughly – Inquiry – Clumsiness
Bibliography:
American psychiatric association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA : American Psychiatric Association.
Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note.Journal of Child Psychology and Psychiatry, 38, 581–586.
Huron, C. (2012, juin). Dyspraxie: quand le cerveau s’emmêle. Conférence repérée sur https://www.youtube.com/watch?v=9kiiKTBzUwA
INSERM. (2019). Expertise collective : Trouble développemental de la coordination ou dyspraxie. Consultée sur https://www.inserm.fr/sites/default/files/2019-12/Inserm_EC_2019_Dyspraxie_Synthese_0.pdf
KidScreen Group Europe. (2006). The KidScreenQuestionnaires : Quality of life questionnaires for children and adolescents.Lengerich, Germany : Pabst Science Publishers.