T H E D Y S C O V E R Y C E N T R E

1 5 T H A N N I V E R S A R Y C E L E B R A T I O N

DCD: Where have we come from? Where

are we now?

David Sugden

University of Leeds

DCD: Where have we come from? Where are we now?

Different terminology and not totally sure individuals are studying same children but…

Certainly all note the presence of some form of motor impairment that is not a recognised condition such as CP.

Chronology taken from Sugden & Wade (In Press) Motor Development in Typical and atypical Development. MacKeith Press. Early work from Cratty 1994.

Early 20th Century

Before this period incoordination was noted and studied but with respect to specific neurological difficulties, Parkinson, Tourette.

1911 Dupre –Motor deficiency syndrome awkwardness of voluntary movement, excessive tendon reflexes, mild hypertonicity and neurological overflow.

Same time Collier identified some children as “congenitally maladroit”.

So by early 1900s scholars began to focus on coordination problems in children that were often hidden.

Early Development in 20th Century

Two strands in the 20s and 30s

Oseretsky assessment instrument for „motor idiocy‟ Cratty has a wonderful

clause “spawned numerous descendants”!

Orton co-occurrence, poor coordination among dyslexic children. Cratty quote “

Orton…viewed the problem through bifocal lenses”! But also noted social,

esteem, and emotional difficulties.

1940s to 1960s

During this period and particularly in the USA, motor incoordination was inextricably linked with other disorders in children such as general and specific learning difficulties.

Authors such as Delacato, “ontogeny recapitulates phylogeny”; Getman, visual processes, Kephart, “The Slow Learner in the Classroom”, and Barsch, “Movigenics” and “every infant is considered a terranaut”.

All exceptional clinicians and in some ways, remnants of these approaches are still around.

But also criticism with articles like “One jumped off the balance beam”. Kavale and Matson, meta analysis of effects.

The Sensory Emphasis

In the mid 1950s two influential persons emerged in Los Angeles and both established centre in that city. Again a broad range of children especially Frostig.

Jean Ayres, an occupational therapist termed the phrase “sensory integrative functions”. Cratty (1994) notes “tentative theoretical speculation” but “claims for effects of methods, exact and specific”. Debate still around.

Marianne Frostig, originally Austrian social worker and gym teacher, trained as educational psychologist in LA. Set up school and ran it for 25 years.

Both brilliant clinicians

The Empire Strikes Back

Over this side of the pond in 60s and 70s paediatricians and other medics becoming interested:

Dare and Gordon

Brenner et al

Walton et al

Illingworth

The „clumsy child‟ became the term and the centre of interest.

The Empire Strikes Back

Interesting that many of the medics shown in previous slides describe the children in behavioural terms first and then go to aetiology.

Prevalence figures make a start at this time but confusion because figures of learning problems were often taken as indicative of prevalence of motor problems.

E.g. Brenner‟s often quoted figure of 6.7% in 1966. But children only identified as clumsy after a visuomotorproblem had been identified.

Prevalence depends on criteria and cut off point; since that time ranges from 1.8% to over 15% with a personal favourite around 4%.

USA and Europe

As we hit the late 1960s and early 1970s a range of intervention programmes were being initiated.

Cratty at UCLA with his afternoon programmes using students to intervene with groups of children on individual programmes. Made claims only for improved motor proficiency but did use activities to „indirectly‟ improve academic skills. Thus “moving to learn” was coined.

Other programmes in the USA, Europe and Australia began some looking to improve coordination „learning to move‟ others to aid in general learning‟ moving to learn‟

This continues to day with either direct or indirect effects on learning claimed.

Terminology

clumsy

Dyspraxia

Developmental Coordination

Disorder

PerceptuomotorDysfunction

Movement Skills Difficulties

Current Scene

3 consensus statements95, 06, 10

Now some broad consensus facilitating cross continent comparisons

APA from

1987 use of

DCD

Evidence for

intervention in DCD

More evidence is now available but still not

enough

Accept heterogeneity, co-occurring

characteristics and subgroups

Work on early years and adullts

Work on causes involving biological

and cognitive/sensory

approaches

9 world conferences on DCD

Multiple modes of

assessment to address

criteria

The Future

Personal Preferences Accept current terminology and definitions Firm these up with characteristics such as used in ADHD & ASD for

example. In children where core characteristic is a motor difficulty more

concentration on how they coordinate movements. A link between co-occurring characteristics and how they affect

intervention. More work on levels of intervention as in „response to intervention

programmes‟ in reading. Levels of intervention involving different personnel performing different

roles. Participation becoming a focus-in our hands More work on early years and adults. A recognition that the problem does not reside solely in the

child.