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Practice Guideline
. 2019 Mar;61(3):242-285.
doi: 10.1111/dmcn.14132. Epub 2019 Jan 22.

International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder

Rainer Blank  1   2 , Anna L Barnett  3 , John Cairney  4   5 , Dido Green  6 , Amanda Kirby  7 , Helene Polatajko  8 , Sara Rosenblum  9 , Bouwien Smits-Engelsman  10 , David Sugden  11 , Peter Wilson  12 , Sabine Vinçon  1
Affiliations
Practice Guideline

International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder

Rainer Blank et al. Dev Med Child Neurol. 2019 Mar.

Abstract
in English, Spanish, Portuguese

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.

What this paper adds: Updated international clinical practice guidelines on developmental coordination disorder (DCD). Refined and extended recommendations on clinical assessment and intervention for DCD. A critical synopsis of current research on mechanisms of DCD. A critical synopsis of psychosocial issues in DCD, with implications for clinical practice. The first international recommendations to consider adolescents and adults with DCD.

Objetivo: Estas recomendaciones internacionales para la práctica clínica (RPC) sobre el trastorno del desarrollo de la coordinación (TDC), iniciadas por la Academia Europea de Discapacidad Infantil (EACD), tienen como objetivo abordar preguntas clave sobre la definición, diagnóstico, evaluación, intervención y aspectos psicosociales de TDC relevantes para la práctica clínica.

Método: Las preguntas clave en cinco áreas fueron tratadas a través de revisiones bibliográficas y consenso formal de expertos. Para las recomendaciones basadas en la evidencia, las búsquedas en la literatura sobre “mecanismos”, “evaluación” e “intervención” se actualizaron desde las últimas recomendaciones en 2012. Se realizaron nuevas búsquedas para “problemas psicosociales” y “adolescentes / adultos”. La evidencia se calificó de acuerdo con la gradación del Centro de Oxford para Medicina Basada en la Evidencia (nivel de evidencia [LOE] 1–4) y en ello se basaron las recomendaciones. Para recomendaciones basadas en el consenso formal, se llevaron a cabo dos reuniones de un panel multidisciplinario internacional de expertos con cinco rondas Delphi adicionales para desarrollar recomendaciones de buena práctica clínica (BPC).

Resultados: Se realizaron 35 recomendaciones. Ocho de ellas se basaron en la evidencia de las revisiones de la literatura (tres en “evaluación”, cinco en “intervención”). Veintidós fueron actualizadas a partir de las recomendaciones de 2012. Las nuevas recomendaciones se relacionan con el diagnóstico y la evaluación (dos BPC) y las cuestiones psicosociales (tres BPC). Además, una nueva recomendación (LOE) trata acerca de los videojuegos activos como complemento de las intervenciones más tradicionales orientadas a la actividad y la participación, y se hicieron dos nuevas recomendaciones (una BCP, una LOE) para adolescentes y adultos con TDC.

Interpretación: Estas recomendaciones internacionales para la práctica clínica sobre TDC aportan una visión general completa sobre TDC y el conocimiento actual basado en evidencia de investigación y consenso de expertos. Brinda actualización para clínicos y científicos de diversas disciplinas. Las recomendaciones internacionales para la práctica clínica TDC pueden servir como base para recomendaciones nacionales.

Objetivo: Essas recomendações internacionais para a prática clínica (RPC) no transtorno do desenvolvimento da coordenação (TDC), iniciadas pela Academia Européia de Deficiência Infantil (EACD), objetiva direcionar questões chave na definição, diagnóstico, avaliação, intervenção e aspectos psicossociais do TDC relevantes para a prática clínica.

Métodos: Questões chave em cinco áreas foram consideradas através de revisões da literatura e consensos formais de especialistas. Para recomendações baseadas em evidências, buscas na literatura em “mecanismos”, “avaliação” e “intervenção” foram atualizadas desde as últimas recomendações de 2012. Novas buscas foram conduzidas para “problemas psicossociais” e “adolescentes/adultos”. Evidências foram classificadas de acordo com o Centro Oxford para Medicina Baseada em Evidência (nível de evidência [NE] 1‐4) e transferidas em recomendações. Para recomendações baseadas em consensos formais, dois encontros de um painel de especialistas internacional e multidisciplinar foram conduzidos com posteriormente cinco sessões Delphi para desenvolver recomendações de boa prática clínica (BPC).

Resultados: Trinta e cinco recomendações foram feitas. Oito foram baseadas em evidências de revisões da literatura (três em “avaliação”, cinco em “intervenção). Vinte e duas foram atualizadas das recomendações de 2012. Novas recomendações são relacionadas com diagnóstico e avaliação (duas BPC) e problemas psicossociais (três BPCs). Adicionalmente, uma nova recomendação (NE) se refere a jogos de videogame ativos como adjuntos à mais tradicional terapia orientada à tarefa e intervenção orientada à participação, e duas novas recomendações (uma BPC, um NE) foram feitas para adolescentes e adultos com TDC.

Interpretação: A RPC‐TDC apresenta uma visão geral do TDC e o conhecimento atual baseado em evidências de pesquisas e consenso de especialistas. Reflete o estado de arte dos clínicos e cientistas de disciplinas variadas. A RPC‐TDC internacional deverá servir como uma base para as diretrizes nacionais.

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Figures

Figure 1
Figure 1
From international recommendations to national guidelines. [Colour figure can be viewed at http://www.wileyonlinelibrary.com]
Figure 2
Figure 2
International expert panel. aServed in the intervention group until May 2016. [Colour figure can be viewed at http://www.wileyonlinelibrary.com]
Figure 3
Figure 3
Literature review. DCD, developmental coordination disorder; MABC, Movement Assessment Battery for Children; BOT, Bruininks‐Oseretsky Test of Motor Proficiency; DCDQ, Developmental Coordination Disorder Questionnaire; SD, standard deviation. [Colour figure can be viewed at http://www.wileyonlinelibrary.com]
Figure 4
Figure 4
Multi‐component account of motor skill development showing correlates of performance in developmental coordination disorder (DCD). IMD, internal modeling deficit; EF, executive function; WMN, white matter network; MNS, mirror neuron system. [Colour figure can be viewed at http://www.wileyonlinelibrary.com]
Figure 5
Figure 5
Prevalences in a population of 7‐year‐old children with attention‐deficit/hyperactivity disorder (ADHD) only, developmental coordination disorder (DCD) only, and ADHD/DCD combined.16
Figure 6
Figure 6
Overlap between emotional and behavioural disorders in children with developmental coordination disorder (DCD).185, 220
Figure 7
Figure 7
Flow chart assessment, treatment indication, and planning. DCD, developmental coordination disorder; ADL, activities of daily living; R, recommendation. [Colour figure can be viewed at http://www.wileyonlinelibrary.com]
Figure 8
Figure 8
Flow chart treatment planning, intervention, and evaluation. DCD, developmental coordination disorder; R, recommendation; S, statement.
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