Professor Anna Barnett

Purpose of review. Typing is an important skill for education and beyond and is often recommended for those with Developmental Coordination Disorder (DCD) and/or Specific Learning Disorder (SLD) when handwriting is a challenge. This review outlines a model of typing to demonstrate the language, perceptual, and motor components involved. It then summarises selected research on typing skill in DCD and SLD. The purpose of the review is to identify current knowledge of typing skill in these groups to enhance understanding and inform future work on assessment, accommodations, and intervention.

Recent findings. Thirteen relevant studies, published between 2008-2024, were identified. These vary widely in the types of disorder/difficulties studied, participant age, and language. They also include a range of tasks (alphabet writing, writing to dictation, copy writing, compositional writing) and employ different measures of typing. Taken together, they examine aspects of the typed ‘product’ (speed and accuracy), the ‘process’ of typing (efficiency, gaze and finger movements), and student ‘perceptions’ of typing. Despite the varied groups studied and methods employed, findings are consistent. Most studies report that in groups with developmental disorders, typing is poorer than handwriting, and typing is poorer compared to typically developing peers.

Summary. The findings have important implications for research and practice. They indicate the need for further research on typing in specific diagnostic groups. They also emphasise the need for practical tools to assess typing performance across a range of tasks. This will aid the identification of typing difficulties and help plan appropriate accommodations and/or intervention.

Students must be able to produce legible and fluent text when completing classwork and for exam purposes. Some students, however, present with handwriting difficulties in secondary school. When these are significant, intervention may be necessary or alternatives to handwriting may be offered (e.g. use of a word processor). Little is known about current practice of supporting secondary students with handwriting difficulties in England and how recommendations are made to transition to typing. Semi-structured interviews were conducted with 13 practitioners with a responsibility for supporting students with handwriting difficulties. Two themes were identified. The first theme, ‘doing the right thing’, illustrated the tension between practitioners' commitment to supporting students with handwriting difficulties and their uncertainty around what is the ‘right’ approach. The second theme, ‘influencing practice’, described the contextual factors (student and family, school environment and national context) that impact on practitioners' practice and their decision to transition from handwriting to typing. Findings highlight the complexities of supporting this group of students and an urgent need for guidance at a national level to assist best practice. Implications for practice are discussed. Further research examining the effectiveness of handwriting interventions with secondary students and the optimum time to start typing is warranted.

Background. 
Inhibition (Response Inhibition – RI and Interference Control – IC) have been inconsistently examined in Developmental Coordination Disorder (DCD) with response modalities often not considered.

Aims. 
To examine RI and IC in children with DCD.

Method. 
Twenty-five children 6-10 years with DCD, plus 25 matched typically developing peers completed motor and verbal RI and IC tasks.

Results. 
Children with DCD made significantly more errors in the motor and verbal RI tasks, had slower movement time and RT in the motor IC task, and longer completion time in the verbal IC task.

Conclusions.
Children with DCD have RI and IC difficulties in motor and verbal responses.

Students in higher education (HE) are required to complete a variety of writing tasks for coursework and examinations. However, for some students writing presents a major challenge.  In the UK, the availability of tools for specialist assessors to help identify difficulties with the quality of written composition is limited. The aim of this study was to develop a practical new tool, the Writing Quality Scale (WQS) for assessing writing quality in HE, that was both easy to use and did not require specialist or subject knowledge.  The reliability and validity of the tool and its ability to identify students in HE who may need support was evaluated by examining scripts from 120 students (60 male) aged 17-25 years. The WQS was found to have good inter-rater reliability and was sensitive enough to pick up age differences and differentiate between groups of students with and without dyslexia. The WQS will be a useful tool for specialist assessors in HE to help in the identification of those with poor writing quality and to understand more about the nature of their difficulties.

Background: In school, children are required to perform a range of handwriting tasks. The writing needs to be legible to the child and other readers. The aim of this study was to examine handwriting legibility across different writing tasks and to explore which components might predict overall handwriting legibility.
Methods: This was a secondary analysis of data from 148 school-aged children across writing scripts obtained from the Detailed Assessment of Speed of Handwriting: copying-best, copying-quickly and free-writing. 
Results: Results showed that letter formation was the major predictor of the total HLS score, and significant differences in handwriting legibility were found across the three tasks.
Conclusions: The HLS is a practical tool that can benefit occupational therapists who work in schools by assessing handwriting legibility across different handwriting tasks.

Writing and transcription skills (handwriting and typing) are critical throughout education and in employment. The use of robust assessment tools contributes to the identification of and support for individuals with writing and transcription difficulties. In this paper we outline practical ways to assess the speed and legibility of handwriting and to evaluate written composition skills. Application of the DASH17+, Handwriting Legibility Scale and Writing Quality Scale with scripts from 17-25 year olds are examined. The presentation of two case studies illustrates how this suite of tools provide a practical and holistic assessment of writing and transcription, useful for intervention planning. 

Although fine particulate matter (PM2.5) is a neurotoxicant, little is known about whether early-life PM2.5 exposure is associated with an increased risk of developmental coordination disorder (DCD). We  conducted a cohort study of 109 731 children aged 3–5 years from 551 county-level cities in
China between April 2018 and December 2019. Residential PM2.5 exposure was estimated using a hybrid satellite-based exposure model. Children’s motor performance was assessed using the Little DCD Questionnaire (LDCDQ). Linear mixed-effect models and generalized linear mixed models with a bino-
mial distribution were used to examine the associations of PM2.5 exposure with LDCDQ scores and risk of DCD, respectively. Both prenatal and postnatal exposure to a higher level of PM2.5 was significantly associated with reduced total LDCDQ score, and the impacts were evident on subscales of control dur-
ing movement and general coordination function but not fine motor function. For example, an interquartile range increase in PM2.5 exposure in ages 0–3 was associated with a 0.19 (95% confidence interval [CI]: 0.05, 0.33) decrement in the total score. Additionally, higher PM2.5 exposure was associated with increased risk of DCD, and the adjusted odds ratios were 1.06 (95% CI: 1.01, 1.10) and 1.06 (95% CI: 1.01, 1.13) for each interquartile range increase in PM2.5 exposure during the first trimester and the first 3 years, respectively. Children who were from rural areas, had neonatal intensive care unit admission, or were exclusively breastfed for less than 6 months appeared to be more susceptible to PM2.5 exposure than their counterparts. Our findings provide robust evidence that early-life PM2.5 exposure contributes to an elevated risk of DCD. 

Abstract

Background: Both sleep quality and quantity are essential for normal brain development throughout childhood, however, the association between preterm birth and sleep problems in preschoolers is not yet clear, and the effects of gestational age across the full range from preterm to post-term has not been examined. Our study investigated the sleep outcomes of children born at very-preterm (41 weeks).

Methods: A national retrospective cohort study was conducted with 114,311 children aged 3-5 years old in China. Children’s daily sleep hours and pediatric sleep disorders defined by the Children’s Sleep Habits Questionnaire (CSHQ) were reported by parents. Linear regressions and logistic regression models were applied to examine gestational age at birth with the sleep outcomes of children.

Results: Compared with full-term children, a significantly higher CSHQ score, and hence worse sleep, was observed in very-preterm (β=1·827), moderate-preterm (β=1·409), late-preterm (β=0·832), early-term (β=0·233) and post-term (β=0·831) children, all p41) was also seen in very-preterm (adjusted odds ratio [AOR]=1·287 95% confidence interval [CI] (1·157, 1·433)), moderate-preterm (AOR=1·249 95% CI (1·110, 1·405)), late-preterm (AOR=1·111 95% CI (1·052, 1·174)), and post-term (AOR=1·139 95% CI (1·061, 1·222)), all pp

Conclusions: Every degree of premature, early-term, and post-term birth, compared to full-term, have an association with sleep disorders and shortened daily sleep duration. Preterm, early-term, and post-term should therefore all be monitored with an increased threat of sleep disorder that requires long-term monitoring for adverse sleep outcomes in preschoolers.

Introduction: While most children have developed effective handwriting by secondary school age, some have handwriting difficulties that hamper academic progress. Occupational therapists play a role in assessment and planning support, which may include introducing typing as an alternative. However, there is limited understanding regarding how decisions are made about recommending typing. This study explored the support provided to adolescents with handwriting difficulties by occupational therapists, and the contextual factors that influence their decision-making.

Method: Semi-structured interviews were conducted with 13 occupational therapists and analysed using thematic analysis.

Findings: Although there was shared practice underpinned by occupational therapy philosophy, there was also divergent practice due to different approaches. Roles and responsibilities, resources, and evidence and experience influenced occupational therapists’ practice. Understanding the adolescent’s motivation, the effect of handwriting difficulties on well-being and the need for a functional method to record schoolwork, was central to occupational therapists’ decision-making to recommend typing.

Conclusion: Strategies are needed to address the knowledge-practice gap, including evidence-based guidelines. Closer collaboration between occupational therapists and school staff could increase understanding of roles and highlight the unique occupational therapy contribution. Further research examining whether, when and how to introduce typing as an alternative to handwriting would support best practice.

Background: The association between preterm birth and neurodevelopmental delays have been well examined, however, reliable estimates for the full range of gestational age (GA) are limited, and few studies explored the impact of post-term birth on child development.
Objective: This study aimed to examine the long-term neuropsychological outcomes of children born in a full range of GA with a national representative sample in China.
Methods: In this retrospective population-based cohort study, a total of 137,530 preschoolers aged 3-5 years old (65,295/47.5% females and 72,235/52.5% males) were included in the final analysis. The Ages and Stages Questionnaires-Third Edition (ASQ-3) was completed by parents to evaluate children’s neurodevelopment. The associations between GA and neurodevelopment were analyzed by a generalized additive mixed model with thin plate regression splines. Logistic regression was also conducted to examine the differences in children’s development with different GAs.
Results: There was a non-linear relationship between GA and children’s neurodevelopmental outcomes with the highest scores at 40 weeks gestational age. The adjusted risks of GAs (very and moderately preterm, late-preterm, early-term, and post-term groups) on suspected developmental delays were observed in communication (OR were 1.83, 1.28, 1.13, 1.21 respectively, each pConclusion: GAs is a risk factor for neurodevelopmental delays in preschoolers after controlling for a wide range of covariates, and 40–41 weeks may be the ideal delivery GA for optimal neurodevelopmental outcomes. Close observation and monitoring should be considered for early- and post-term born children as well as pre-term children.

Background: Successful self-feeding reflects the readiness of early motor development and environmental impacts, and the onset of self-feeding as a developmental milestone might be a predictor of subsequent motor development in children. In this study, we explored the association between the onset of self-feeding and childhood risk of Developmental Coordination Disorder in children from one-child and two-child families. Methods: We conducted a data-linkage prospective cohort study from 38 kindergartens in 6 cities in China. A total of 11,727 preschoolers were included in the final analysis and were assessed with the Movement Assessment Battery for Children-second edition (MABC-2) Test. The information on early self-feeding onset was obtained from parents. The mixed and multi-level logistic models utilizing a random intercept were used to investigate the associations between the onset time of self-feeding and subsequent motor performance. Results: The results showed that, compared with those beginning self-feeding at or younger than 12 months of age, children starting self-feeding at 13-24 months, 25-36 months, and later than 36 months, showed a decrease in their total MABC-2 scores of 2.181, 3.026 and 3.874, respectively; and had an increased risk of suspected DCD by 36.0%, 101.6%, 102.6% respectively; they also had 30.2%, 46.6%, 71.2% increased prevalence of at risk of suspected DCD, when adjusting for both child and family characteristics (each p

In school, children are required to perform a range of handwriting tasks. The writing needs to be legible to the child and other readers. The aim of this study was to examine handwriting legibility across different writing tasks and to explore which components might predict overall handwriting legibility. This was a secondary analysis of data from 148 school-aged children across writing scripts obtained from the Detailed Assessment of Speed of Handwriting: copying-best, copying-quickly and free-writing. The scripts were scored according to the Handwriting Legibility Scale (HLS), which assesses global legibility, overall effort to read the script, layout on the page, letter formation and alterations in the text. Results showed that letter formation was the major predictor of the total HLS score, and significant differences in handwriting legibility were found across the three tasks. The HLS is a practical tool that can benefit occupational therapists who work in schools by assessing handwriting legibility across different handwriting tasks.

Children with Developmental Coordination Disorder (DCD) have been shown to have different coordination patterns on some tasks compared to their typically developing peers. However, it is unclear whether these differences are driven by the fact that typically developing children tend to be more practiced at the task on which coordination is being measured. The current study used a novel pedalo task to measure coordination in order to eliminate any practice differences. Thirty children (8 years -16 years), 15 with DCD and 15 without were recruited for this study. Children pedalled along an 8m line 20 times. Movement of the 7th Cervical Vertebra, shoulders, elbows, wrists, hips, knees, ankles and toes was recorded. In terms of outcome measures, pedalling speed was not different between the groups but the coefficient of variation of speed was higher in the children with DCD indicating a less smooth movement. Coordination was measured by calculating angles at the shoulder, elbow, hip, knee and ankle. A higher correlation coefficient (more tightly coupled movement) and a greater variation in joint angle was seen in the typically developing children for specific joint segments. The relationship between group and movement outcome (smoothness of movement) was mediated by inter-limb coordination variability. Therefore, the poor coordination and slower learning generally reported in children with DCD could be due to a slower or less optimal exploration of motor solutions.

The United Kingdom and Ireland have a well-established research base in motor competence (MC) research, ranging from reporting and monitoring levels of MC, developing assessment tools for MC, providing innovative curriculum and intervention design to support learning and development, as well as providing advocacy for particular groups, such as those with motor impairments. This expert statement, on behalf of the International Motor Development Research Consortium, draws together what is currently known about levels of MC in the United Kingdom and Ireland as well as current approaches to intervention in both countries. Subsequently presented are recommendations for researchers and practitioners to advance the field of MC for the benefit of children and youth in the United Kingdom, Ireland, and worldwide.

Background: Individuals with developmental coordination disorder (DCD) experience motor skill and executive function (EF) difficulties that challenge their daily activities. Aim/Objective: This systematic review aims to provide an in-depth analysis of the relationships between motor skills and EFs in studies among individuals with DCD. Material and Methods: We conducted a systematic search of eight electronic databases for articles (published 1994–2021) reporting on quantitative studies that estimated relationships between motor skills and EFs when assessing children, adolescents and adults with DCD. Motor skills and EFs were assessed via reliable and validated assessment tools. Two reviewers independently screened the articles. We evaluated the quality of the selected articles according to EPHPP guidelines and the methodological quality of the assessments from these studies using the COSMIN checklist and reported
results following the PRISMA-P checklist. This systematic review was registered in PROSPERO (CRD42019124578). Results: A total of 30,808 articles were screened. Eleven articles met the inclusion
criteria and were reviewed. Findings from nine studies demonstrated weak to strong correlations between aspects of motor skills and EFs. Conclusions and significance: Limited evidence supports the relationships between motor skills and EFs among individuals with DCD. Occupational therapists should
consider the possibility of this relationship and give more consideration to these components when planning intervention for individuals with DCD. 

Importance. 

It remains unknown whether children born at different degrees of prematurity, early-term and post-term might have a higher risk of developing Developmental Coordination Disorder (DCD) compared to completely full-term children (39-40 gestational weeks). 

Objective.

To differentiate between suspected DCD in children with different gestational ages based on a national representative sample in China.
DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective cohort study in China from 2018 to 2019. A total of 152,433 children from 2,403 public kindergartens in 551 cities of China aged 3-5 years old were included in the final analysis. The association between gestational age and motor performance was investigated. A multi-level regression model was developed to determine the strength of association for different gestational ages associated with suspected DCD when considering kindergartens as clusters.

Main outcomes and measures. 
Children’s motor performance was assessed using the Little Developmental Coordination Disorder Questionnaire (LDCDQ), completed by parents. Gestational age was determined according to the mother’s medical records.

Results.

Of the 152,433 children aged 3-5 years old, 80,370 (52.7%) were male, and 72,063 (47.3%) were female. There were 45,052 children aged 3 years old (29.6%), 59,796 aged 4 years old(39.2%), and 47,585 children aged 5 years old (31.2%). The LDCDQ total scores for very-preterm (β=-1.74, 95%CI: -1.98, 1.50; p

Conclusions and relevance. 

We found significant associations between every degree of prematurity at birth, early-term and post-term birth with suspected DCD when compared with full-term birth. Our findings have important implications for understanding motor development in children born at different gestational ages. Long-term follow-up and rehabilitation interventions should be considered for early- and post-term born children.

Parents and teachers have knowledge of children’s daily motor performance yet may make different judgments about the levels of competence observed at home and school. The current study aimed to examine the discrepancies between parent and teacher reports using the Movement ABC-2 Checklist and the Developmental Coordination Disorder Questionnaire (DCDQ) on children with and without suspected Developmental Coordination Disorder (DCD). The Movement ABC-2 Test was administered to 1276 children aged 5–10 years in China. The Movement ABC-2 Checklist and DCDQ were completed by both parents and teachers of all children. A total of 172 children achieving a score below the 15th percentile on the Movement ABC-2 Test were identified as children with suspected DCD. Both parents and teachers showed suitable agreement in judging children’s motor competence but low sensitivity in identifying children with DCD. Parent scores of children’s motor competence were more closely associated with test performance scores compared to teacher scores. Teachers tended to over-rate children’s motor competence. The motor difficulties identified by parents were associated with low Movement ABC-2 Test scores on Manual Dexterity and Balance components, while motor difficulties identified by teachers were associated with the Balance component only. The results demonstrated discrepancies between parent and teacher reports, suggesting the importance of using a range of measures to identify and describe motor difficulties in children

The ability to finely control our movement is key to the achieving many of the educational milestones and life-skills we develop throughout our lives. Despite the centrality of coordination to our early development, there is a vast gap in our understanding of the underlying biology. Like most complex traits, both genetics and environment influence motor coordination, however, the specific genes, early environmental risk factors and molecular pathways are unknown.

Previous studies have shown that about 5% of school-age children experience unexplained difficulties with motor coordination. These children are said to have Developmental Coordination Disorder (DCD). For children with DCD, these motor coordination difficulties significantly impact their everyday life and learning. DCD is associated with poorer academic achievement, reduced quality of life, it can constrain career opportunities and increase the risk of mental health issues in adulthood. Despite the high prevalence of coordination difficulties, many children remain undiagnosed by healthcare professionals. Compounding under-diagnosis in the clinic, research into the etiology of DCD is severely underrepresented in the literature.

Here we present the first genome-wide association study (GWAS) to examine the genetic basis of early motor coordination in the context of motor difficulties. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) we generate a derived measure of motor coordination from four components of the Movement Assessment Battery for Children (MABC), providing an overall measure of coordination across the full range of ability. We perform the first genome-wide association analysis focused on motor coordination (N=4542). No single nucleotide polymorphisms (SNPs) met the threshold for genome-wide significance however 59 SNPs showed suggestive associations. Three regions contained multiple suggestively associated SNP, within five preliminary candidate genes: IQSEC1, LRCC1, SYNJ2B2, ADAM20 and ADAM21.

Association to the gene IQSEC1 suggests a potential link to axon guidance and dendritic projection processes as a potential underlying mechanism of motor coordination difficulties. This represents an interesting potential mechanism, and whilst further validation is essential, it generates a direct window into the biology of motor coordination difficulties. This research has identified potential biological drivers of DCD, a first step towards understanding this common, yet neglected neurodevelopmental disorder.

Lifecourse epidemiology suggests that preconception is a valuable opportunity for health promotion with young women.  Yet young women are less likely than older women to be research participants, limiting evidence about their needs and risks.  Marketing data indicate that young adults are not engaged with one advertising strategy because they transition through three life stages: (1) limited independence and focus on own interests, (2) increased independence and time with peers, (3) establishing a home and family.  The aim of this study was to explore whether these marketing lifestage categories could inform the tailoring of strategies to recruit young women.Three focus groups per lifestage category were conducted (49 women aged 16 to 34 years).  Lifestage category (1) was represented by further education students, category (2) by women in workplaces, and (3) by mothers.  Questions explored participants’ lifestyles, identity, reasons for  participation in the current study and beliefs about researchers.   Three major themes were identified through framework analysis: Profiling how young women spend their time; Facilitators of participating in research; and Barriers to participating.  Students and women in work valued monetary remuneration whereas mothers preferred social opportunities.  Participants’ perceived identity influenced whether they felt useful to research.   All groups expressed anxiety about participation.  Altruism was limited to helping people known to participants.  Therefore, the marketing categories did not map exactly to differences in young women’s motivations to participate but have highlighted how one recruitment strategy may not engage all.   Mass media communication could, instead, increase familiarity and reduce anxiety about participation.

Purpose of review. Handwriting is a particular difficulty in DCD. Children who struggle to produce legible and sufficiently fast handwriting may under-achieve at school. Using van Galen’s model, this review examines recent research to describe the nature of handwriting difficulties in DCD. The range of assessment tools is highlighted and recommendations for intervention provided. 
Recent findings. Embedded in the broader skill of writing, handwriting involves more than motor skill.  Children with DCD tend to produce less writing than their peers. Their slow rate of production is characterised by frequent pauses. Errors in letter formation negatively impact on legibility and the quality of written composition is also poor. Different types of assessment help to capture the range of difficulties. 
Summary. Comprehensive assessment helps gain a full understanding of the nature of handwriting difficulties in DCD. International recommendations and guidelines provide a valuable framework for assessment and principles for intervention. 

The Test component of the Movement Assessment Battery for Children 2nd Edition (Movement ABC-2) is used worldwide to identify children with Developmental Coordination Disorder (DCD). In China, practitioners have been using this test with the assumption that the published UK norms are valid for Chinese children. However no systematic investigation has previously been undertaken to check this assumption. 2185 children aged 3–10 years old from a national representative sample in China were therefore recruited to the current study. Performance on the Movement ABC-2 was assessed and compared with the UK standardization norms. Gender differences were also examined. The comparisons revealed that Chinese children were generally better in Manual Dexterity and Balance tasks compared to their UK peers; while UK children were better in Aiming & Catching tasks. Further analysis showed an interaction of country and age with mixed results. For both countries, girls were generally better in Manual Dexterity and Balance tasks, and boys were generally better in Aiming & Catching. Possible explanations for the country differences are discussed. The results suggest that local norms for the Movement ABC-2 Test are needed in China.

Knowledge of obstetric and environmental influences on Developmental Coordination Disorder (DCD) helps provide increased understanding of the mechanisms underlying the disorder. However, the literature to date has not adequately examined the obstetric and environmental risk factors for DCD in a population-based sample. The current study was therefore conducted to explore the prenatal, perinatal, neonatal, and family environmental risk factors for DCD. A total of 2185 children aged 3-10 years from a national representative sample in China were included; the Movement Assessment Battery for Children-2 was used to assess motor
function, and a questionnaire was completed by parents. DCD was identified in 156 children according to the DSM-5 criteria. Multilevel logistic regression was used, and comparisons were made between the DCD and non-DCD group. The results confirmed that male sex, BMI score, preterm birth, and some prenatal conditions are significant risk factors for DCD. Parents’ education level and one-child status as two significant environmental risk factors for DCD appear largely independent of other risk factors in the Chinese population. This study provides an opportunity to explore the etiology of DCD and suggest potential assessment, monitoring and intervention programs for DCD that could be examined in the future. 

It is widely assumed that by identifying spelling errors and suggesting replacement words, spellcheck allows writers to revise spelling errors even if they do not have the necessary spelling knowledge. However, there have been no studies evaluating the efficacy of modern spellcheck tools for students with spelling difficulties, such as dyslexia. In fact, the very limited and dated research into use of spellcheck by writers with dyslexia indicated that, even when using spellcheck to revise spelling errors, this group left many misspellings in their texts. The current study is the first to investigate whether a modern spellcheck program allows college students with dyslexia to produce texts that are as free from misspellings as texts by their peers, and whether this affects the quality of the text in other ways.

College students with dyslexia (n=18) and a control group of peers (n=18) wrote two short essays using Microsoft Word, one with spellcheck active and one without spellcheck active. Spelling accuracy and overall quality of the texts were measured. Without spellcheck, students with dyslexia made more misspellings than the control group, however, with spellcheck active students from both groups left almost zero misspelled words in their texts. Text quality was not affected. Results demonstrate that spellcheck helps college students with dyslexia to overcome the limitations that poor spelling knowledge imposes. Importantly, results indicate that spellcheck does not lead to improvements in text beyond spelling accuracy, or lead to poorer quality texts, indicating that it is suitable for use in exam conditions.

Aim. These international clinical practice recommendations (CPR) for developmental coordination disorder (DCD), initiated by the European Academy of Childhood Disability (EACD), aim to address key questions on the definition, diagnosis, assessment, intervention, and psychosocial aspects of DCD relevant for clinical practice. Method. Key questions in five areas were considered through literature reviews and formal expert consensus. For recommendations based on evidence, literature searches on ‘mechanisms’, ‘assessment’, and ‘intervention’ were updated since the last recommendations in 2012. New searches were conducted for ‘psychosocial issues’ and ‘adolescents/adults’. Evidence was rated according to the Oxford Centre for Evidence-Based Medicine (level of evidence [LOE] 1–4) and transferred into recommendations. For recommendations based on formal consensus, two meetings of an international, multidisciplinary expert panel were conducted with a further five Delphi rounds to develop good clinical practice (GCP) recommendations. Results. Thirty-five recommendations were made. Eight were based on the evidence from literature reviews (three on ‘assessment’, five on ‘intervention’). Twenty-two were updated from the 2012 recommendations. New recommendations relate to diagnosis and assessment (two GCPs) and psychosocial issues (three GCPs). Additionally, one new recommendation (LOE) reflects active video games as adjuncts to more traditional activity-oriented and participation-oriented interventions, and two new recommendations (one GCP, one LOE) were made for adolescents and adults with DCD. Interpretation. The CPR–DCD is a comprehensive overview of DCD and current understanding based on research evidence and expert consensus. It reflects the state of the art for clinicians and scientists of varied disciplines. The international CPR–DCD may serve as a basis for national guidelines.

Background. The standardized test within the Movement Assessment Battery for Children-2nd edition (MABC-2) is used worldwide to assess motor problems in children. Ideally, any country using a test developed in another country should produce national norms to ensure that it functions effectively in the new context. Aim. The first objective of this study was to explore the differences in motor performance between Italian and British children. The second was to examine the structural validity of the test for the Italian sample. Method. A total of 718 Italian (IT) and 765 British (UK) children, aged 3–10 years, were individually tested on the age-appropriate items of the MABC-2 Test. Results. Developmental trends emerged on every task and differences between IT and UK children were obtained on 11 of 27 task comparisons. Interactions between age and country indicated that differences were not consistently in favor of one culture. Confirmatory factor analysis generally supported the proposed structure of the MABC-2 Test. Conclusion. Although the differences between the IT and the UK children were relatively few, those that did emerge emphasize the need for population specific norms and suggest that cultural diversity in motor experiences should be considered when evaluating motor abilities in children.

Adjustments to locomotion to avoid an obstacle require a change to the usual pattern of foot

placement, i.e. changes to step length and/or step width. Previous studies have demonstrated a

difficulty in individuals with Developmental Coordination Disorder (DCD) in controlling stability

while both stepping over and while circumventing an obstacle. In a previous study we have

considered the way in which individuals with DCD prepare for the possibility of an obstacle

appearing (Wilmut and Barnett, 2017). Using a parallel data set from this same task on the same

individuals the aim of the current study was to investigate the exact nature of changes in foot

placement during obstacle avoidance, as this was not clear from previous work. Children and adults aged from 7 to 34 years of age took part in the study. Forty-four met the criteria for a diagnosis of DCD and there were 44 typically developing (TD) age and gender matched controls. Participants walked at a comfortable pace down an 11m walkway; on 6 out of 36 trials a ‘gate’ closed across their pathway which required circumvention. These 6 ‘gate close’ trials were analysed for this study. The number and magnitude of step length and step width adjustments were similar across the DCD and TD groups, however, the younger children (7-11yrs) made a greater number of early adjustments compared to the older children and adults (12-34 years of age). In contrast the adults made a greater number of adjustments later in the movement compared to the children. In terms of foot placement adjustments a clear preference was seen across all participants to use adjustments which resulted in reducing step length, stepping away from the obstacle and a combination of these. Apart from subtle differences, the individuals with DCD make step placements to circumvent an obstacle in line with their peers. It is suggested that the choice of foot placement strategy in individuals with DCD, although in line with their peers, may not be optimal for their level of motor ability. 

Method and procedure: The current study included 62 participants with and 62 without DCD (aged 7-34 years). Participants were asked to walk continuously for 1 minute up and down a walkway while movement was captured using an optical tracking system. Measures of step length and step time were taken for both the right and the left leg and symmetry ratios were calculated.

Results: The DCD group showed significantly higher symmetry ratios for both measures compared to the typically developing (TD) group, with approximately a third of DCD participants falling outside the normative range for symmetry. Furthermore, a relationship was found between movement variability and degree of asymmetry.

Conclusions: These findings demonstrate an asymmetry in the gait of individuals with DCD which, despite improving with age, does not reach the same level as that shown by TD individuals. 

coordination disorder (DCD), a condition characterized by everyday movement difficulties. Previously, in a preliminary study, we found higher rates of parent-reported sleep disturbance in children with DCD compared to controls.

Aims: To examine sleep in DCD using objective measures and to examine links with daytime fatigue and sleepiness.

Methods: Two groups (primary and secondary school-aged) of 15 children with DCD, plus matched controls, participated. Parent-reported child sleep was assessed using the Children’s Sleep Habits Questionnaire and actigraphy provided an objective measure of sleep–wake patterns over 1 week (including weekdays and weekend). Pediatric restless legs syndrome (RLS) semi-structured diagnostic interview was conducted with each child and parent to capture symptoms of RLS. Aspects of self-rated child functioning were assessed with questionnaires (Pre-sleep Arousal Scale, Pediatric Daytime Sleepiness Scale, PedsQL Multidimensional Fatigue Scale) and mothers’ reported thoughts about child sleep with the Maternal Cognitions about Infant Sleep Questionnaire. 
 

Results: The DCD groups had greater parent-reported sleep disturbance. Actigraphy results suggested that for secondary aged children with DCD their sleep quality was impaired and there were differences in the timing of sleep compared to controls (including some differences in the variation between weekday and weekend sleep times). The actigraphy of the primary age group with DCD was unremarkable compared to controls. No child in the study met the criteria for RLS. Exploratory analyses suggested that daytime fatigue, aspects of pre-sleep arousal, and daytime sleepiness were reported as greater in the DCD groups and were particularly related to objective sleep parameters in the DCD groups. Maternal thoughts about sleep did not differ between the DCD and control groups.

Conclusion: The nature and underlying cause of sleep disturbance and how it might be linked with aspects of daytime functioning in adolescents with DCD requires further research. Meanwhile, clinical awareness of the risk of atypical sleep patterns/sleep problems in DCD is important to ensure early identification and implementation of appropriate support.

Children with Developmental Coordination Disorder demonstrate a lack of automaticity in handwriting as measured by pauses during writing. Deficits in visual perception have been proposed in the literature as underlying mechanisms of handwriting difficulties in children with DCD. The aim of this study was to examine whether correlations exist between measures of visual perception and visual motor integration with measures of the handwriting product and process in children with DCD.

Method

The performance of twenty-eight 8–14 year-old children who met the DSM-5 criteria for DCD was compared with 28 typically developing (TD) age and gender-matched controls. The children completed the Developmental Test of Visual Motor Integration (VMI) and the Test of Visual Perceptual Skills (TVPS). Group comparisons were made, correlations were conducted between the visual perceptual measures and handwriting measures and the sensitivity and specificity examined.

Results

The DCD group performed below the TD group on the VMI and TVPS. There were no significant correlations between the VMI or TVPS and any of the handwriting measures in the DCD group. In addition, both tests demonstrated low sensitivity.

Conclusion

Clinicians should execute caution in using visual perceptual measures to inform them about handwriting skill in children with DCD.

Method: Twenty eight children with DCD participated in the study, with 28 typically developing (TD) age and gender matched controls. The children completed the ‘free writing’ task from the Detailed Assessment of Speed of Handwriting (DASH), which was evaluated for compositional quality using the Wechsler Objective Language Dimensions (WOLD). 
 

Results: The children with DCD performed significantly below their TD peers on 5 of the 6 WOLD items. They also had a higher percentage of misspelled words. Regression analyses indicated that the number of words produced per minute and the percentage of misspelled words explained 55% of the variance for compositional quality. 
 

Conclusion: The handwriting difficulties so commonly reported in children with DCD have wider repercussions for the quality of written composition.

Previous research has shown that adults with Developmental Coordination Disorder (DCD) show increased variability of foot placement measures and movement of the centre of mass (CoM) while walking. The current study considered the gait patterns of young and older children with DCD. Fourteen young children with DCD (7-12 years), 15 older children with DCD (12-17 years) and 29 age and gender matched typically developing children took part. Children were asked to walk up and down a flat 10m long pathway for one minute while the movement of their feet and trunk was recorded using motion analysis. The gait pattern of children with DCD was characterised by wider steps, elevated variability in the time spent in double support and stride time and greater medio-lateral velocity and acceleration compared to their peers. An elevated variability in medio-lateral acceleration was also seen in the young but not the older children with DCD. In addition, the young children showed a greater variability in velocity and acceleration in all three directions compared to the older children. The data suggest that the high incidence of trips and falls seen in children with DCD may be due to differences in the control of the centre of mass.

Background. Developmental Coordination Disorder (DCD) affects the learning and performance of everyday motor skills. It commonly co-occurs with other developmental disorders and a range of associated psycho-social impairments. Recent evidence-based guidelines on diagnosis, assessment and intervention provide valuable information for practitioners. However these are directed primarily at German-speaking countries and focus on work with children.

Aim. The aim of this project was to consider the application of these guidelines in the UK and to extend them for use with adults with DCD.

Methods. Individuals with DCD, parents and professionals from a wide range of disciplines were invited to two workshops to discuss and debate the guidelines, to adapt them for the UK and produce dissemination materials.

Results. A working definition of DCD was agreed, minor revisions were made to the guidelines to reflect the UK context, an extension for adults was compiled and a series of leaflets was produced to disseminate this information to health and education professionals, parents and employers.

Conclusions. This work will raise awareness of the condition across different professional groups. It provides information to help those working with children and adults with DCD in the UK to assist in the process of diagnosis, assessment and intervention.

Several studies have shown that Developmental Coordination Disorder (DCD) is a condition that continues beyond childhood. Although adults with DCD report difficulties with dynamic balance, as well as frequent tripping and bumping into objects, there have been no specific studies on walking in this population. Some previous work has focused on walking in children with DCD but variation in the tasks and measures used has led to inconsistent findings. The aim of the current study therefore was to examine the characteristics of level walking in adults with and without DCD. Fifteen adults with DCD and 15 typically developing (TD) controls walked barefoot at a natural pace up and down an 11 m walkway for one minute. Foot placement measures and velocity and acceleration of the body were recorded, as well as measures of movement variability. The adults with DCD showed similar gait patterns to the TD group in terms of step length, step width, double support time and stride time. The DCD group also showed similar velocity and acceleration to the TD group in the medio-lateral, anterior-posterior and vertical direction. However, the DCD group exhibited greater variability in all foot placement and some body movement measures. The finding that adults with DCD have a reduced ability to produce consistent movement patterns is discussed in relation to postural control limitations and compared to variability of walking measures found in elderly populations.

During everyday life we move around busy environments and encounter a range of obstacles,

such as a narrow aperture forcing us to rotate our shoulders in order to pass through.

In typically developing individuals the decision to rotate the shoulders is body scaled and

this movement adaptation is temporally and spatially tailored to the size of the aperture.

This is done effortlessly although it actually involves many complex skills. For individuals

with Developmental Coordination Disorder (DCD) moving in a busy environment and negotiating

obstacles presents a real challenge which can negatively impact on safety and participation

in motor activities in everyday life. However, we have a limited understanding of the

nature of the difficulties encountered. Therefore, this current study considered how adults

with DCD make action judgements and movement adaptations while navigating apertures.

Fifteen adults with DCD and 15 typically developing (TD) controls passed through a series

of aperture sizes which were scaled to body size (0.9-2.1 times shoulder width). Spatial and

temporal characteristics of movement were collected over the approach phase and while

crossing the aperture. The decision to rotate the shoulders was not scaled in the same way

for the two groups, with the adults with DCD showing a greater propensity to turn for larger

apertures compared to the TD adults when body size alone was accounted for. However,

when accounting for degree of lateral trunk movement and variability on the approach, we

no longer saw differences between the two groups. In terms of the movement adaptations,

the adults with DCD approached an aperture differently when a shoulder rotation was required

and then adapted their movement sooner compared to their typical peers. These results

point towards an adaptive strategy in adults with DCD which allows them to account

for their movement difficulties and avoid collision.

Although handwriting is typically taught during early childhood and keyboarding may not be taught explicitly, both may be relevant to writing development in the later grades. Thus, Study 1 investigated automatic production of the ordered alphabet from memory for manuscript (unjoined), cursive (joined), and keyboard letter modes (alphabet 15 sec) and their relationships with each other and spelling and composing in typically developing writers in grades 4 to 7 (N = 113). Study 2 compared students with dysgraphia (impaired handwriting, n=27), dyslexia (impaired word spelling, n=40), or oral and written language learning disability (OWL LD) (impaired syntax composing, n=11) or controls without specific writing disabilities (n=10) in grades 4 to 9 (N=88) on the same alphabet 15 modes, manner of copying (best or fast), spelling, and sentence composing. In Study 1, sequential multilevel model regressions of predictor alphabet 15 letter production/selection modes on spelling and composition outcomes, measured annually from grade 4 to grade 7 (ages 9 to 13 years), showed that only the cursive mode uniquely, positively, and consistently predicted both spelling and composing in each grade. For composing, in grade 4 manuscript mode was positively predictive and in grades 5-7 keyboard selection was. In Study 2 all letter production modes correlated with each other and one’s best and fast sentence copying, spelling, and timed sentence composing. The groups with specific writing disabilities differed from control group on alphabet 15 manuscript mode, copy fast, and timed sentence composing. The dysgraphia and dyslexia groups differed on copying sentences in one’s best handwriting, with the dysgraphia group scoring lower. The educational and theoretical significance of the findings are discussed for multiple modes and manners of letter production/selection of the alphabet that support spelling and composing beyond the early grades in students with and without specific writing disabilities.   

Spelling is a prerequisite to expressing vocabulary in writing. Research has shown that children with dyslexia are hesitant spellers when composing. This study aimed to determine whether the hesitant spelling of children with dyslexia, evidenced by frequent pausing, affects vocabulary choices when writing. A total of 31 children with dyslexia, mean age 9 years, were compared to typically developing groups of children: the first matched by age, the second by spelling ability. Oral vocabulary was measured and children completed a written and verbal compositional task. Lexical diversity comparisons were made across written and verbal compositions to highlight the constraint of having to select and spell words. A digital writing tablet recorded the writing. Children with dyslexia and the spelling-ability group made a high proportion of spelling errors and within-word pauses, and had a lower lexical diversity within their written compositions compared to their verbal compositions. The age-matched peers demonstrated the opposite pattern. Spelling ability and pausing predicted 53% of the variance in written lexical diversity of children with dyslexia, demonstrating the link between spelling and vocabulary when writing. Oral language skills had no effect. Lexical diversity correlated with written and verbal text quality for all groups. Practical implications are discussed and related to writing models.

Difficulties with handwriting are reported as one of the main reasons for the referral of children with Developmental Coordination Disorder (DCD) to healthcare professionals. In a recent study we found that children with DCD produced less text than their typically developing (TD) peers and paused for 60% of a free-writing task. However, little is known about the nature of the pausing; whether they are long pauses possibly due to higher level processes of text generation or fatigue, or shorter pauses related to the movements between letters. This gap in the knowledge-base creates barriers to understanding the handwriting difficulties in children with DCD. The aim of this study was to characterise the pauses observed in the handwriting of English children with and without DCD. Twenty-eight 8–14 year-old children with a diagnosis of DCD participated in the study, with 28 TD age and gender matched controls. Participants completed the 10 min free-writing task from the Detailed Assessment of Speed of Handwriting (DASH) on a digitising writing tablet. The total overall percentage of pausing during the task was categorised into four pause time-frames, each derived from the literature on writing (250 ms to 2 s; 2–4 s; 4–10 s and >10 s). In addition, the location of the pauses was coded (within word/between word) to examine where the breakdown in the writing process occurred. The results indicated that the main group difference was driven by more pauses above 10 s in the DCD group. In addition, the DCD group paused more within words compared to TD peers, indicating a lack of automaticity in their handwriting. These findings may support the provision of additional time for children with DCD in written examinations. More importantly, they emphasise the need for intervention in children with DCD to promote the acquisition of efficient handwriting skill.

The defining feature of Developmental Coordination Disorder (DCD) is a significant motor difficulty

that has an impact on everyday life movement tasks. The notion of a ‘movement thermometer’ suggests that not only

can the extent and severity of the motor impairment be accurately measured but also that its impact on daily activities can

be gauged. Recent European guidelines on the assessment of children with DCD recommend several well-established motor

tests and questionnaires for application in research and clinical practice. The formal assessment of adults, however, has been

largely neglected, even though the persistence of the condition

has been well documented. This article considers the assessment of motor behaviour and activities of daily living in

children and adults with DCD, as well as the impact of associated features and environmental factors on the performance

of everyday activities. It is argued that there is a need to go beyond the formal testing of motor skills in order to adequately

assess the true ‘temperature’ or impact of the condition.

The defining feature of Developmental Coordination Disorder (DCD) is a significant motor difficulty that has an impact on everyday life movement tasks. The notion of a ‘movement thermometer’ suggests that not only can the extent and severity of the motor impairment be accurately measured but also that its impact on daily activities can be gauged. Recent European guidelines on the assessment of children with DCD recommend several well-established motor tests and questionnaires for application in research and clinical practice. The formal assessment of adults, however, has been largely neglected, even though the persistence of the condition

has been well documented. This article considers the assessment of motor behaviour and activities of daily living in children and adults with DCD, as well as the impact of associated features and environmental factors on the performance

of everyday activities. It is argued that there is a need to go beyond the formal testing of motor skills in order to adequately assess the true ‘temperature’ or impact of the condition.

Current models of writing do not sufficiently address the complex relationship between the 2 transcription skills: spelling and handwriting. For children with dyslexia and beginning writers, it is conceivable that spelling ability will influence rate of handwriting production. Our aim in this study was to examine execution speed and temporal characteristics of handwriting when completing sentence-copying tasks that are free from composing demands and to determine the predictive value of spelling, pausing, and motor skill on handwriting production. Thirty-one children with dyslexia (Mage = 9 years 4 months) were compared with age-matched and spelling-ability matched children (Mage = 6 years 6 months). A digital writing tablet and Eye and Pen software were used to analyze handwriting. Children with dyslexia were able to execute handwriting at the same speed as the age-matched peers. However, they wrote less overall and paused more frequently while writing, especially within words. Combined spelling ability and within-word pausing accounted for over 76% of the variance in handwriting production of children with dyslexia, demonstrating that productivity relies on spelling capabilities. Motor skill did not significantly predict any additional variance in handwriting production. Reading ability predicted performance of the age-matched group, and pausing predicted performance for the spelling-ability group. The findings from the digital writing tablet highlight the interactive relationship between the transcription skills and how, if spelling is not fully automatized, it can constrain the rate of handwriting production. Practical implications are also addressed, emphasizing the need for more consideration to be given to what common handwriting tasks are assessing as a whole. 

When picking up an object, adults show a longer deceleration phase when the onward action has a greater precision requirement. Tailoring action in this way is thought to need forward modelling in order to predict the consequences of movement. Some evidence suggests that young children also tailor reaching in this way; however, how this skill develops in children with Developmental Coordination Disorder (DCD) is unknown. The current study compared the kinematics of reaching to an object when the onward intention was: to place the object on a target (either with high or low precision requirements), to throw the object or to lift the object vertically. Movements of both adults (N=18) and children (N=24) with DCD and their age-matched controls were recorded. The typically developing adults discriminated across all action types, the adults with DCD and the typically developing children only across the actions to place and throw and the children with DCD only between the actions to lift and throw. The results demonstrate developmental progression towards fine tuning the planning of reaching in relation to onward intentions. Both adults and children with DCD are able to plan movement using inverse models but this skill is not yet fully developed in early adulthood.

The aims of this study were to investigate whether individuals with AS have impaired motor abilities and sensorimotor processing and whether these impairments were age-related. Sensorimotor abilities were examined using the Movement Assessment Battery for Children-2, and the Sensory Integration Praxis Test. Fifty boys with AS aged 7-14 years old were compared with typically developing boys. Overall, children with AS showed significant impairment of movement performance as well as proprioceptive and vestibular processing. There were no interaction effects of age and clinical group on level of performance deficit in any of the modalities tested. Increasing our understanding of motor and sensory impairment in AS could have treatment implications for those supporting individuals with AS.

During everyday locomotion, we encounter a range of obstacles requiring specific motor responses; a narrow aperture which forces us to rotate our shoulders in order to pass through is one example. In adults, the decision to rotate their shoulders is body scaled (Warren and Whang in J Exp Psychol Hum Percept Perform 13:371-383, 1987), and the movement through is temporally and spatially tailored to the aperture size (Higuchi et al. in Exp Brain Res 175:50-59, 2006; Wilmut and Barnett in Hum Mov Sci 29:289-298, 2010). The aim of the current study was to determine how 8-to 10-year-old children make action judgements and movement adaptations while passing through a series of five aperture sizes which were scaled to body size (0.9, 1.1, 1.3, 1.5 and 1.7 times shoulder width). Spatial and temporal characteristics of movement speed and shoulder rotation were collected over the initial approach phase and while crossing the doorway threshold. In terms of making action judgements, results suggest that the decision to rotate the shoulders is not scaled in the same way as adults, with children showing a critical ratio of 1.61. Shoulder angle at the door could be predicted, for larger aperture ratios, by both shoulder angle variability and lateral trunk variability. This finding supports the dynamical scaling model (Snapp-Childs and Bingham in Exp Brain Res 198:527-533, 2009). In terms of movement adaptations, we have shown that children, like adults, spatially and temporally tailor their movements to aperture size.

Background The Movement ABC test is one of the most widely used assessments in the field of Developmental Coordination Disorder (DCD). Improvements to the 2nd edition of the test (M-ABC-2) include an extension of the age range and reduction in the number of age bands as well as revision of tasks. The total test score provides a measure of motor performance, which can be used to help make a diagnosis of DCD. M-ABC-2 also provides 3 sub-scales for Manual Dexterity, Aiming and Catching and Balance but the validity of these conceptually derived sub-scales has not previously been reported. Aim To examine the factor structure of the M-ABC-2 test across the three age bands (AB): AB1 (3-6-year olds), AB2 (7-10-year olds) and AB3 (11-16-year olds). Method Data from the 2007 standardisation sample (N = 1172) were used in this study. Confirmatory factor analyses (CFA) and structural equation modelling (LISREL 8.8) were employed to explore the relationship between the tasks within each of the 3 age bands. A model trimming approach was used to arrive at a well fitting model. Results In AB1 a complex factor structure emerged providing evidence for an independent general factor, as well as specific factors representing the 3 test components. In AB2 a final model emerged with four correlated factors, an additional distinction being drawn between static and dynamic balance. In addition, a 2nd order general factor explained a considerable amount of variance in each primary factor. In AB3 CFA supported the 3-factor structure of the M-ABC-2, with only modest correlations between each factor. Conclusions The confirmatory factor analyses undertaken in this study further validate the structural validity of the M-ABC-2 as it has developed over time. Although its tasks are largely associated with the three sub-components within each age band, there was also clear evidence for a change in the factor structure towards differentiation in motor abilities with age. Research highlights The factor analyses undertaken support the structure of the Movement ABC 2 Test. Results suggest a developmental process towards specialization in movement abilities.The results have clinical as well as theoretical significance.