Occupational therapy for children with developmental coordination disorder (dyspraxia) : outcomes and effectiveness

The overall aim of this thesis is to identify methods of improving the efficiency and effectiveness of occupational therapy services to children with developmental coordination disorder and their families. A method of applying the Diagnostic and Statistical Manual IV diagnostic criteria for developmental coordination disorder in a clinical setting is described. This process found that the majority (69%) of referrals were inappropriate. These included children whose difficulties could not be attributed to coordination as they scored above the fifteenth percentile on the Movement Assessment Battery for Children (28%), children with general learning difficulties (21%) and other medical conditions (10%). The similarities and differences between parent, teacher and child views of the impact of developmental coordination disorder on activities of daily living are assessed. Whilst parents, teachers and children all expressed concerns about schoolwork the children's concerns give us much more information about self-care, play and leisure tasks such as dressing, using cutlery, playing sports and riding a bike. A pilot trial is conducted which reflects child and parent/carer identified goals. It also explores how to measure the effectiveness of group occupational therapy intervention using a goal- orientated approach and the Canadian Occupational Performance Measure proved an effective tool when combined with other measures. The group was innovative as it was goal oriented and, rather than the usual once a week took place eight times in a two-week period. This new style group intervention appears to be successful in firstly achieving goals as 22/30 goals were met and secondly improving coordination as Movement Assessment Battery for Children scores improved significantly. These findings suggest that although this was an exploratory trial and there were therefore potential confounders such as non-blinded outcome assessment, there should be further evaluation of group occupational therapy intervention. The richness of information to show individual development and progressions is explored demonstrating that each child's and family's experience of intervention is unique. Finally combining the results of studies 1-3, current practice and the literature a model for service delivery is proposed.EThOS - Electronic Theses Online ServiceGBUnited Kingdo