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8/20/2019 Children With Dyspraxia - Percieved Interventions Study
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O R I G I N A L A R T I C L E
Children with “Dyspraxia”: A Survey of Diagnostic
Heterogeneity, Use and Perceived Effectivenessof Interventions
Motohide Miyahara & G. David Baxter
Published online: 19 April 2011# Springer Science+Business Media, LLC 2011
Abstract A survey was distributed to parents at a conference organized by a
dyspraxia support group, and mailed twice to the members with the support group’s
newsletters. Of 118 respondents, 84% reported that their children were diagnosed
with dyspraxia, whereas 25% stated that their children’s diagnosis was develop-
mental coordination disorder. All respondents were using food supplements.Moreover, 69% of respondents sent their children to unconventional education or
therapy, and 57% provided their children with some form of complementary and
alternative medicine (CAM). In terms of perceived effectiveness of interventions,
about half of the parents (53%) reported improvement of physical skills and
attributed such progress to standard intervention in the mainstream health care and
education systems in New Zealand. Despite popular use, effectiveness of
unconventional education, therapy, or CAM was rarely considered. These findings
have important implications for parents, health and educational service providers,
policy makers, and funding bodies.
Keywords Survey . Dyspraxia . Developmental coordination disorder . Motor
coordination . Complementary medicine
Parents have great influence on decision-making for their children’s health and
choice of educational products and services. One of the key factors in the
J Dev Phys Disabil (2011) 23:439–458
DOI 10.1007/s10882-011-9239-z
M. Miyahara (*)
School of Physical Education, University of Otago, PO Box 56, Dunedin 9054, New Zealand
e-mail: [email protected]
G. D. Baxter
School of Physiotherapy, University of Otago, PO Box 56, Dunedin 9054, New Zealand
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decision-making is their beliefs about service and product benefits, or perceived
effectiveness of interventions in case of children with developmental disabilities.
One of the less explored developmental disabilities, collectively named dyspraxia
by parental support groups in Australia, New Zealand, and the UK is the focus of
our interest. Their broad definition of dyspraxia refers to a core movement disorder, and encompasses other developmental disorders and comorbid con-
ditions which cover almost all childhood disorders in the formal classification
manuals (Peters et al. 2001). Below we will outline the context to the present
study, including the reasons why a broad definition of dyspraxia came to be used,
and why it is timely and important to investigate diagnostic heterogeneity,
interventions that these children receive, and how parents perceive the effective-
ness of such interventions.
The term, motor dyspraxia has been traditionally used to refer to the problems of
motor sequencing and selection exhibited by adult patients with acquired brainlesions, despite their intact motor systems (Miyahara and Möbs 1995). Neuro-
psychologists originally defined and assessed dyspraxia in terms of a disorder of
gestural performance on verbal and imitation command (Dewey 1995; Hill 1998;
Miyahara, Leeder, Francis, & Inghelbrecht, 2008 ). The term has since been assigned
at least two new and extended meanings. First, it was used for children with dyslexia
when they evidenced motor learning difficulties (Orton 1925). Based on its
etymology, the term was also applied to the inability to execute a variety of
functional activities, such as dressing, drawing figures, and gait (Miyahara and Möbs
1995). Some therapists use dyspraxia for a broad range of sensory and motor disorders rather arbitrarily (Cummins 1991). Parents’ support groups follow this
trend to extend the meaning of dyspraxia, and use the term for all sorts of
developmental disorders (Peters et al. 2001). As the meaning of dyspraxia expands,
no single assessment process is capable of diagnosing dyspraxia, and therefore,
holistic individual assessment is recommended (Sweeney 2007). In sum, a specific
neuropsychological definition of dyspraxia refers to a disorder of motor sequencing
and selection, whereas the lay use of dyspraxia extends to a wide variety of
childhood disabilities.
Dyspraxia is the term preferred by parents (Miyahara and Register 2000; Peters et al.
2001). It is widely accepted that existing health care and educational systems do not
sufficiently recognize and manage such children’s difficulties, even in developed
countries, such as Australia (Hands and Larkin 2001), New Zealand (Miyahara 2001)
and the UK (Henderson et al. 1991). To address such limited services provision,
parents typically form groups to support each other by sharing information and
resources, promoting social awareness, and lobbying for better habilitation services.
In contrast, developmental coordination disorder (DCD) has been more
specifically and exclusively defined in the Diagnostic and Statistical Manual of
Mental Disorder (DSM-IV-TR)(American Psychiatric Association 2000). Diagnostic
criteria stipulate the severity of poor motor coordination: it must significantly
interfere with activities of daily living and academic achievement after chronological
age and measured intelligence are taken into consideration. Performance levels are
often assessed with standardized motor performance tests and questionnaires, such
as the ones included in the Movement Assessment Battery for Children-Second
Edition(Henderson et al. 2007). Differential diagnosis is also used to distinguish
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DCD from medical conditions that cause motor incoordination (e.g., cerebral palsy,
muscular dystrophy), pervasive developmental disorders (PDD), and mental
retardation (MR). Hence, the diagnosis of the comorbid condition of DCD with
PDD or MR has been avoided. However, the exclusive criteria of PDD and MR are
no longer listed in the proposed DSM-5 (American Psychiatric Association, 2010). If the currently proposed changes are made in DSM-5, the comorbid condition of DCD
with PDD or MR will become acceptable.
Diagnostic heterogeneity and comorbidity of developmental disabilities thus
depend on diagnostic criteria that can be artificial and unstable, as in the case
of DCD. Nonetheless, comorbidity may be useful for indicating a full range of
treatment options (First 2005) and strategies (Miyahara, Yamaguchi, and Green
2008). For treatment of movement problems in children with DCD, for example,
the functional skill approach is considered legitimate if the intervention is
conducted to remediate functional motor tasks (Sugden and Dunford 2007). The principle of direct skill training has been also applied to the remediation of
various functional skills in intellectual and developmental disabilities in
educational and rehabilitation settings (Davis and Rehfeldt 2007). If a child has
dual diagnoses of attention deficit hyperactivity disorder (ADHD) and DCD for a
handwriting problem, the standard treatment of behavioral modification and
stimulant medication may be prescribed for ADHD, and handwriting training
may be arranged with a remedial education teacher, occupational or physical
therapist.
In addition to the standard treatment, children with dyspraxia may also be givencomplementary and alternative medicine (CAM). This is controversial, based upon
the lack of a sound theoretical base, the absence of evidence of effectiveness, the
possible waste of time and money, and potential harm (Ernst 2003; Golden 1984).
While empathizing with parents’ disappointment in conventional treatments, parental
stress (Gottlieb 1989), and health consumers’ empowerment in contemporary
postmodern society (Chan and Chan 2000; Vos et al. 2002), medical specialists
have issued warnings against the use of controversial treatments for ADHD (Gottlieb
1989), specific learning disabilities (Golden 1984; Gottlieb 1989), and behavioral
problems (Wolraich 1997). Health consumers have also been advised to be wary of
treatments that make claim to a broad range of effects (Golden 1984); for this
particular reason, sensory integration therapy and perceptual motor training have
been considered controversial (Sugden and Dunford 2007) and ineffective (Kaplan et
al. 1993; Kavale and Mattson 1983; Polatajko et al. 1991; Smith et al. 2005) in
improving learning disorders (Golden 1984), and behavioral problems (Gottlieb
1989; Wolraich 1997).
Investigation of the use of CAM for developmental disabilities has been
limited to autism spectrum disorder (75%) (Green et al. 2005; Hanson et al. 2007;
Liptak et al. 2006), ADHD (54%) (Chan et al. 2003), specific learning disabilities
(55%) (Bull 2009), and severe physical disabilities (Liptak et al. 2006; Rosenbaum
2003). No research has been conducted to survey the use and the perceived effect
of CAM interventions for children labeled as having dyspraxia. Bridging the gap in
the knowledge base is important because such information will useful for
stakeholders to understand the diagnoses that the concerned children receive and
the parents’ consumer behavior. The data on the parents’ perceived efficacy for
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individual treatment would also help other parents to make informed decisions. To
produce such knowledge, this survey study aimed to answer the following research
questions:
& What kinds of diagnoses do such children receive?& What kinds of interventions do the children receive?
& What are parents’ perceptions of intervention effects with regard to academic
performance and problem domains?
Methods
Participants
Respondents ( N =118) for this survey were a purposive cluster sample of parents and
care givers who were affiliated with the Dyspraxia Support Group of New Zealand.
This was formed in 1992 to help parents support each other by sharing information
and resources, and increasing awareness and understanding of dyspraxia. Member-
ship was over 800, including parents, care givers, and professionals in New Zealand,
Australia, and other countries, of which 260 members subscribed to the group’s
newsletter, named Connection.
Materials
Survey Questionnaire Development After reviewing all available CAM survey
studies on developmental disabilities (Chan et al. 2003; Green et al. 2005; Hanson
et al. 2007; Liptak et al. 2006; Weber et al. 2008), we decided to use a
questionnaire previously used by Quinn et al. (2008) as a template for our study
because we found the format of the questionnaire (Table 1) most suitable for the
purposes of our study, and for the nature of our sample. We adapted the questions
about demographic information on the basis of New Zealand Census (Table 2),
developmental disabilities (Table 3), and included all interventions appeared in the
existing CAM survey studies on developmental disabilities (Chan et al. 2003;
Green et al. 2005; Hanson et al. 2007; Liptak et al. 2006; Weber et al. 2008) in our
prototype questionnaire. Although perceptual motor program (PMP) and sensory
integration are controversial (Sugden and Dunford 2007), PMP, sensory integra-
tion, and specific learning disorder lessons/remedial training conducted by
occupational therapists, physiotherapists, psychologists, and resource teachers are
an integral part of the mainstream educational system in New Zealand, and
therefore, included in the section of therapy and education instead of the CAM
section.
A list of prescribed medication (Table 5) was based on the list in the survey
conducted by Hanson et al. (2007). The US brand names for prescription
medications were converted to New Zealand trade names by an experienced child
psychiatrist who had worked in both USA and New Zealand; he also suggested
additions and deletions of medications possibly used by children with dyspraxia.
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Pilot Prior to the main survey, the prototype questionnaire was reviewed by the
International Scientific Committee members of the Developmental Coordination Disorder
Research Group, and the president of the Dyspraxia Support Group of New Zealand who
had over a decade of experience in consulting the group members. The latter person had
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Table 1 Questionnaire outline and exemplary questions. Excerpts from the instruction: You are invited to
complete all of the following questions about yourself and your child’s intervention…This survey is
entirely voluntary…There are no right or wrong answers…Your response will only be used for the
purposes of this research and will be treated in the strictest confidence
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improvement because of multiple factors involved in the timing, such as the ages of
children, time durations after interventions, and the accuracy of memory. Instead, we
aimed to assess the parents’ subjective impression of improvement from each
intervention.
Procedures
Questionnaires were distributed through the Dyspraxia Support Group of New
Zealand. The survey of group members was completed in two phases: the first phase
Table 3 Percentage of respondents whose children received single or dual diagnoses
Diagnosis n %
Dyspraxia (incl. apraxia) 99 84
Developmental coordination disorder (DCD) 29 25
Specific learning disabilities/disorders 26 22
Attention deficit hyperactivity disorder 22 19
Pervasive developmental disorders (incl. autism, Asperger) 20 17
Dyslexia 13 11
Dysgraphia 6 5
Mental retardation/intellectual disabilities 7 6
Oppositional defiant disorder 6 5
Dyscalculia 5 4
Epilepsy 3 3
Cerebral palsies 2 2
Conduct disorder 1 1
Comorbid condition with dyspraxia
Dyspraxia and DCD 23 19
Dyspraxia and specific learning disabilities/disorders 23 19
Dyspraxia and pervasive developmental disorders 16 14
Dyspraxia and dyslexia 11 9
Dyspraxia and mental retardation/intellectual disabilities 5 4Dyspraxia and oppositional defiant disorder 5 4
Dyspraxia and dyscalculia 5 4
Dyspraxia and attention deficit hyperactivity disorder 3 3
Dyspraxia and dysgraphia 3 3
Dyspraxia and cerebral palsies 2 2
Comorbid condition with DCD
DCD and specific learning disabilities/disorders 8 7
DCD and attention deficit hyperactivity disorder 7 6
DCD and dyslexia 4 3DCD and dysgraphia 4 3
DCD and dyscalculia 2 2
DCD and oppositional defiant disorder 1 1
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during the New Zealand Dyspraxia conference, and the second phase through the
group’s newsletter distribution.
As part of the first phase, questionnaires along with self-addressed stamped
envelopes were included in conference bags and distributed to all participants
(n=250) at the registration desk of the Fourth National Dyspraxia Conference held
in Christchurch, New Zealand from 5th-7th October, 2007. During the conference,
participants were encouraged to respond to the survey by announcements and posters,
and a drop box was placed at the registration desk. A total of 54 parents (22% of
attendees) either returned the forms via the dropbox, or mailed the forms to theresearchers using the attached self-addressed envelopes by the end of October 2007.
In December, 2007 and April, 2008, questionnaires were mailed with the group’s
newsletter Connection to all subscribers (n =260). The instruction for the
questionnaire asked the subscribers to respond to the questionnaire only if they
have not responded before. By the end of January, 2008, 24 forms (9%) were
Table 4 Use of food supplement, modified diet, and herbal remedies
Used intervention n %
Food supplements
Fish oil 44 37
Omega 3 fatty acids 42 36
Evening primrose oil 9 8
Pycnogenol 1 1
Blue green algae 1 1
Other food supplements 6 5
Modifieddiet
Removal of foodadditives 15 13
Wheat free 12 10
Megavitamins 8 7
Sugar free 3 3
Feingold 2 2
Mineral therapy 2 2
Vegan 0 0
Otherdiet 17 14
Herbal remedies
St. John’sWort 3 3
Valerian 1 1Kava 1 1
Ginseng 1 1
Gingkobiloba 1 1
Chamomile 1 1
Wild OatSeed 0 0
Skullcap 0 0
Other Herbal Remedies 8 7
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returned, and a further 40 forms (15%) were returned by the end of April, 2008. The
final sample consisted of 118 respondents. Because of two different sources of
samples, member attrition and initiating new members, we were unable to determine
the overall response rate.
Statistical Analysis
In keeping with previous CAM surveys on developmental disabilities (Chan et al.
2003; Green et al. 2005; Hanson et al. 2007; Liptak et al. 2006; Weber et al. 2008),
only descriptive statistics were performed using frequencies and percentages.
Percentage data were not included for the questions as to perceived effectiveness
because low and variable response rates in this section could create confusions
between percentages of the total respondents ( N =118), and varying numbers of
respondents to different questions. Inferential statistics were not performed due to
the descriptive nature of this study. Because of a large number of intervention items
in the survey questionnaire and the focus of the present study, the multivariate
frequency distributions of different interventions are not analyzed, but noteworthy
observations are described in the Results section.
Results
Sample Characteristics
Characteristics of the sample are presented in Table 2 in comparison with data from
the census of New Zealand population in 2006. All respondent parents were 25 years
of age or older, and mothers constituted 93% of the sample. A relatively large
proportion consisted of European descendants educated at university levels and
earning upper middle to high personal income compared to the general New Zealand
population.
Table 5 Use of prescribed medication
Medication (Brand name) n %
Paroxetine (Aropax, Loxamine) 7 6
Clonidine (Dixarit, Catapres) 5 4
Dexamphetamine 5 4
Fluoxetine (Fluox, Prozac) 4 3
Sodium Valproate (Epilim) 4 3
Carbamazepine (Tegretol) 3 3
Risperidone (Risperdal) 2 2
Methylphenidate (Concerta, Ritalin, Rubifen) 1 1
Other a 11 9
a Other medication consisted ofcitalopram (Celapram), Melatonin, Lactose, Flixotide, microlax,
ibuprophen (Rubiprofen), and Lithium
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Diagnosis
Characteristics of the sample by diagnosis are summarized in Table 3. Of the
children represented by parents in the sample, dyspraxia is the most common
diagnosis (84%), followed by DCD (25%), specific learning disabilities/disorder
(22%), ADHD (19%), pervasive developmental disorder (PDD) (17%), and dyslexia
(10%). Diagnoses of both dyspraxia and DCD have been given to 23 children, 19%
of the sample. Consistent with the exclusion criteria of the current DSM, children
Table 6 Use of therapy and education
Used intervention n %
Occupational therapy
Sensory integration 62 53
I don’t know the detail 39 33
Cognitive orientation too ccupational performance (COOP) 10 8
Bobath 2 2
Other occupational therapy 19 16
Physiotherapy
I don’t know the detail 23 19
Sensory integration 23 19
Bobath 4 3
Doman-Delacato patterning 1 1
Kabat 0 0
Other physiotherapy 8 7
Psychology
Specific learning disorder lessons/remedial training 27 23
Behavior therapy (Applied behavior analysis) 11 9
Clinical psychology 11 9
Cognitive behavior therapy 8 7
I don’t know the detail 7 6
Psychotherapy 2 2
Behavior therapy (TEACCH) 1 1
Other psychology 8 7
Alternativetherapy and education
Brain gym (applied kinesiology) 42 36
Optometric training 23 19
Musictherapy 12 10
Chiropractic 9 8
Dance/movement therapy 9 8Art therapy 7 6
Dore 7 6
Conductiveeducation 4 3
Mindfulness training 0 0
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Table 8 The breakdowns of frequency (n=69) for responses to the question: Did your child’s physical
coordination improve? and the descriptions to the question: Which intervention do you think helped the
improvement?
Response Frequency Response Frequency
Yes 62 No 7
Intervention used Intervention used
Occupational therapy 15
Physiotherapy 5
Sensory integration 4
PMP 3
Brain gym 2
School education 1
Optometric training 1
Brain gym 1
Cranial osteopathy 1
Movement clinic 1
No description 28 No description 7
Subtotal 62 Subtotal 7
PMP Perceptual motor programme
Table 7 Use of complementary and alternative medicine (CAM)
Intervention used n %
Osteopathy 23 19
Homeopathy 20 17
Massage/bodywork 12 10
Craniosacraltherapy 8 7
Meditation/Relaxation response 6 5
Hypnotherapy (guidedimagery) 6 5
Faith/Spiritual Health 5 4
Aromatherapy 5 4
Reflexology 3 3
Healer/healingtouch 3 3
Biofeedback 3 3
Yoga 2 2
Alexander Technique 2 2
Shiatsu/Acupressure 1 1
Prayer/shaman 1 1
Acupuncture 1 1
Tai Chi/Qui Gongs 0 0
Rolfing 0 0
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with DCD have not been diagnosed with PDD or MR. In contrast, 16 children withdyspraxia received the dual diagnoses of PDD, and 5 children with dyspraxia also
had MR.
Table 10 The breakdowns of frequency (n=61) for responses to the question: Did your child’s
achievement in physical education improve? and the descriptions to the question: Which intervention do
you think helped the improvement?
Response Frequency Response Frequency
Yes 52 No 9
Intervention used Intervention used
Occupational therapy 14
Physiotherapy 8
Sensory integration 3
No specific intervention 2
PMP 2
School education 2
Brain gym 1
Cranial osteopathy 1
Movement clinic 1
No description 18 No description 9
Subtotal 52 Subtotal 9
PMP Perceptual motor program
Table 9 The breakdowns of frequency (n=68) for responses to the question: Did your child’s hand
writing improve? and the descriptions to the question: Which intervention do you think helped the
improvement?
Response Frequency Response Frequency
Yes 58 No 10
Intervention used Intervention used
Occupational therapy 16
School education 5
Typing 3
Physiotherapy 2
Optometric training 2
Brain gym 2
Cranial osteopathy 1
PMP 1
Sensory integration 1
Educational psychology 1
No description 24 No description 10
Subtotal 58 Subtotal 10
PMP Perceptual motor program
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Interventions
As shown in Table 4, food supplements were more popular than modified diet and
herbal remedies. More than one third of the sample used fish oil and Omega 3 fatty
acids. Supplements reported in the ‘other food supplements’
category includedcalcium, cod liver oil, flax seed oil, garlic, horseradish, multivitamin, and vitamin C.
Approximately 10% of the sample removed food additives and wheat from
children’s diet. Under ‘other diet ’, organic, dairy free, dietician monitoring fat
content, Effalex, Failfree diet and gluten free diet were reported. Few used herbal
remedies; several listed Bryophyllum Argento Cult, homeopathy, unknown Oriental
Table 12 The breakdowns of frequency (n=34) for responses to the question: Did your child’s
achievement in math improve? and the descriptions to the question: Which intervention do you think
helped the improvement?
Response Frequency Response Frequency
Yes 22 No 12
Intervention used Intervention used
School education 5 Cranial osteopathy 1
No specific internvention 3
Occupational therapy 3
Number works 2
Kumon 2
Physiotherapy 1
Speech therapy 1
No description 5 No description 11
Subtotal 22 Subtotal 12
Table 11 The breakdowns of frequency (n=45) for responses to the question: Did your child’s
achievement in music improve? and the descriptions to the question: Which intervention do you think
helped the improvement?
Response Frequency Response Frequency
Yes 31 No 14
Intervention used Intervention used
Music lesson/therapy 4
Occupational therapy 3
No specific internvention 2
School education 2
Physiotherapy 1
Cranial osteopathy 1
Optometric training 1
No description 17 No description 14
Subtotal 31 Subtotal 14
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herbs, rescue remedy, Rocket tablets, and sleep remedy under ‘other herbal
remedies’. Though not possible to deduce from Table 4, it caught our attention,
when we browsed the raw data, that all 118 respondents had reported their use of at
least one food supplement.
Use of prescribed medication is summarized in Table 5. Approximately 9% of thesample reported that their children used serotonin reuptake inhibitors (SSRI) for
anxiety and depression (i.e., Paroxetine, Fluoxetine). A combined total of 9% used
medication for ADHD (i.e., Clonidine, Dexamphetamine, Methylphenidate). A
combined total of 6% of the sample reported use of medication commonly
prescribed to control epilepsy, mood changes, and aggression (e.g., Sodium
Valproate, Carbamazepine). Medication for the management of psychosis and
aggression (i.e., Risperidone) was used by 2% of the sample. Under the heading of
“Other medication” a subtotal of 9% of the sample listed the following medications:
another SSRI called Celapram, melatonin (commonly used for insomnia), lactoseand microlax to ease constipation, Flixotide to control asthma, ibuprofen for pain
control, and lithium, a mood stabilizer.
Table 6 shows therapies and educational interventions ranging from conventional
to non-conventional with the numbers of respondents who used these. Among the
conventional therapies, occupational therapy was most popular, and more than half
of the sample reported that the therapists had used sensory integration. One third of
the sample was uncertain about the specific approach of occupational therapy. With
regard to physiotherapy, sensory integration was jointly ranked first (19%) with “I
don’t know the detail
” response. Among the orthodox psychological interventions,specific learning disorder lessons/remedial training (23%), behavior therapy (applied
behavior analysis) (9%), clinical psychology (9%), and cognitive behavior therapy
(7%) were the most commonly used interventions.
Among the alternative therapy and education interventions in Table 6, those that
are considered controversial, namely Brain Gym (Educational Kinesiology) (36%)
and optometric training (19%) were most widely used. Expressive art therapies, such
as music therapy (10%), dance/movement therapy (8%) and art therapy (6%) are an
integral part of standard medical care in the USA, but are not yet part of standard
health care in New Zealand; these were therefore used by minorities in the sample.
Overall, 69% of respondentssent their children to at least one of the unconventional
education or therapy.
The popularly used forms of CAM were osteopathy (19%), homeopathy (17%), and
massage/body work (10%), followed by craniosacral therapy (7%), meditation and
relaxation response (5%), and hypnotherapy and guided imagery (5%). A wide variety
of other CAM was also used by a small number of the sample as detailed in Table 7.
Some form of CAM was provided by 57% of the respondents to their children.
Perceived Efficacy
In response to the question as to whether or not any intervention improved physical
coordination, 62 parents (53%) answered in the affirmative, 7 (6%) in the negative,
and the other 49 (42%) made no response or chose the “not applicable” response
(Table 8). Among those 62 parents who answered in the affirmative, 15 parents
thought occupational therapy helped their children’s physical coordination, 5 parents
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mentioned physiotherapy, and 4 parents listed sensory integration (which is
administered by occupational therapists or physiotherapists). This response pattern
indicates that those interventions that are perceived as most effective are conducted
by therapists working in the mainstream health care system in New Zealand. The
seven parents who answered in the negative did not specify which intervention failedto improve their children’s physical coordination. Some of the parents who made no
response or chose the “not applicable” response reported in Section D that their
combined use of different intervention methods made it impossible for them to
determine which one was working.
To be more specific, improved handwriting was reported by 58 parents (49%) and
ascribed most frequently to occupational therapy (16 respondents) and school
education (5 respondents) (Table 9). With regard to the school subjects with strong
physical components, enhanced achievement in physical education was reported by
52 parents (44%) who most commonly attributed the improvement to occupationaltherapy (14 respondents), physiotherapy (8 respondents), and sensory integration
(3 respondents) that was presumably conducted as part of occupational therapy and
physiotherapy (Table 10). Music is another subject that demands physical
coordination, especially when children play musical instruments. Improved music
achievement was reported by 52 parents (44%), most commonly as a result of music
lesson/therapy (14 respondents) and physiotherapy (8 respondents) (Table 11). By
contrast, school subjects with little physical component, such as math, improved in
22respondents (19%), most frequently from school education (5 respondents)
(Table 12) and reading improved in 55 respondents (47%), most commonly due toschool education (9 respondents), occupational therapy (5 respondents), and
optometric training (5 respondents) (Table 13).
In summary, about half of the parents (53%) reported improvement of physical
skills and attributed such progress to occupational therapy, physiotherapy, and
school education which are all part of the mainstream health care and education
systems in New Zealand. Progress in physical and non-physical domains indicated
Table 13 The breakdowns of frequency (n=63) for responses to the question: Did your child’s reading
improve? and the descriptions to the question: Which intervention do you think helped the improvement?
Response Frequency Response Frequency
Yes 55 No 8
Intervention used Intervention used
School education 9 Cranial osteopathy 1
Occupational therapy 5
Optometric training 5
No specific intervention 3
Brain gym 1
Davis method 1
Kyp McGrath lessons 1
No description 30 No description 8
Subtotal 55 Subtotal 8
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the domain-specific nature of perceived intervention effects. The effect of alternative
education, therapy, or medicine was rarely reported.
Discussion
This study surveyed parents who were affiliated with a dyspraxia support group. It
turned out that many of their children were not only diagnosed with dyspraxia or
DCD, but also with other comorbid developmental disorders. About a half of the
parents perceived conventional therapies and school education as effective, and
some parents were unaware of the specific intervention methods used in
occupational therapy, physiotherapy, and psychology. Despite their controversial
nature, and reported ineffectiveness, over half of the sample used alternative
interventions. A discussion of the possible relation between the comorbid conditionsand the parental definition of dyspraxia, the limitations of the study and future
research directions follows.
Diagnostic heterogeneity among children with dyspraxia is present in the lists of
diagnoses and prescription medications given. This finding echoes and substantiates
the statement by Peters et al. (2001) that the parental definition of dyspraxia seems to
cover a wide variety of childhood disorders. Frequency of the diagnosis of dyspraxia
was three times more than the frequency of the diagnosis of developmental
coordination disorder (DCD). This may be due to the stringent criteria of DCD
(American Psychiatric Association 2000) which excludes mental retardation (MR), pervasive developmental disorders (PDD), and cerebral palsies. Except for the
accepted comorbidity of DCD with ADHD for example, movement problems may
not be specifically acknowledged and attended in children with MR or PDD, for
instance. This may be why the term dyspraxia is used to allow comorbidity of
movement difficulties with MR and PDD, thus drawing attention to the motor
domain of the children with MR and PDD.
It is noteworthy that some of the children with dyspraxia or DCD seem to have
neuropsychiatric disorders, ranging from ADHD, oppositional defiant disorder,
epilepsy, depression, aggression, and mood disorders. Because the present survey
did not ask when medications were first prescribed, it is difficult to determine
whether these disorders started during childhood, adolescence, or adulthood. It
would be an interest of future research to investigate the onsets of neuropsychiatric
disorders in relation to the timing of movement disorder. These seemingly unrelated
disorders may share common underlying processes, and the identification of one
disorder may help the prediction, early identification, and management of the other.
High prevalence of CAM use revealed in our study is consistent with other
disability groups, such as autism spectrum disorder (Green et al. 2005; Hanson et al.
2007; Liptak et al. 2006), ADHD (Chan et al. 2003; Weber et al. 2008), severe
physical disabilities (Liptak et al. 2006; Rosenbaum 2003), and a recent study in
Christchurch, New Zealand (Wilson et al. 2007) that reported a high prevalence of
CAM use (70%) among the child patients of general practice surgeries and a
paediatric diabetes clinic. The study also found that female parents accompanying
the children, increased household income, higher parental education, parental use of
CAM, and stronger beliefs about the general harm of conventional medicines, were
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conditions. Indeed, comorbidity may reflect the current limitation in understand-
ing the underlying processes linked to multiple disorders (First 2005). Frequent
use of sensory integration and the perceived effect of the sensory integration
therapy and occupational therapy, where sensory integration therapy often takes
place, may be affected by such an orientation of the support group. For instance,the group members may be encouraged to visit health care professionals who tend
to diagnose children with dyspraxia and to treat dyspraxia with sensory integration
therapy.
Conclusion
The present study provided the first data on diagnostic heterogeneity and the
interventions for children whose parents are affiliated with a dyspraxia support
group. Parents tend to perceive conventional and free-of-charge interventions asmore effective than alternative interventions. This finding would be useful for the
parents, health and educational service providers, policy makers, and funding bodies
to make informed decisions. Future theory-driven research needs to explore the
mechanisms involved in decision-making.
Acknowledgements We thank the Dyspraxia Support group of New Zealand for contributing to this
study, and gratefully acknowledge the support of Ms. Brigid Ryan through the Centre for Physiotherapy
Research, School of Physiotherapy, Ms. Kate Heveldt through Movement Development Clinic, School of
Physical Education in assisting with the survey and in proofing the paper, and Dr. Juan García at the Child,
Adolescence, and Family Service for pharmacological information.
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