A perceptual-motor intervention programme for grade 1-learners with developmental coordination disorder - De Milander, Monique (University of the Free State, 2015)
𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱 Developmental coordination disorder (DCD) is recognised as one of the most common developmental dysfunctions during childhood. Developmental coordination disorder is diagnosed in children who experience significant difficulties in motor learning and in the performance of functional motor tasks that are critical for success in their daily lives. However, one of the major concerns regarding children with DCD is that they are often not formally diagnosed, but rather described by their parents and teachers as lazy or awkward. In an attempt to identify children with DCD, several research tools, such as questionnaires for screening purposes and norm-referenced tests to measure the degree of movement difficulties, can be used. Even though children will not outgrow this disorder as previously believed, children can be helped by means of various interventions. 𝗔𝗶𝗺𝘀 The first aim of this study was to determine the prevalence of DCD among Grade 1 children in Bloemfontein. The second aim was to establish the ability of parents to identify Grade 1 children with DCD at home; in addition the third aim was to establish the ability of teachers in identifying Grade 1 children with DCD in the classroom. The fourth aim was to explore the influence of DCD on learning related skills. Aim five and six was to determine if the application of a perceptual-motor intervention as well as a sport stacking intervention will significantly improve the motor proficiency status of Grade 1 children identified with DCD independently. 𝗠𝗲𝘁𝗵𝗼𝗱 Participants For the purpose of aim 1, 559 participants’ between the ages of 5 and 8 years took part in this study. There were n=321 girls and n=238 boys. Aim 2 include 410 participants and consisted of n=226 girls and n=184 boys, whilst aim 3 had 506 participants and there were n=289 girls and n=217 boys. Furthermore, aim 4 had 347 participants including n=190 girls and n=157 boys. Aim 5 and 6, which relates to the two interventions used in this study was as follows. Seventy six (76) participants took part in the perceptual-motor intervention. The group consisted of girls (n=34) and boys (n=42) classified with DCD. The intervention had a pre-test/post-test experimental design (n=36) with a control group (n=40). With reference to the sport stacking intervention, 18 children between the ages of 6 and 7 years took part in this study. The group consisted of girls (n=6) and boys (n=12) classified with DCD. This intervention also had a pre-test/post-test experimental design (n=10) with a control group (n=8). 𝗠𝗲𝗮𝘀𝘂𝗿𝗶𝗻𝗴 𝗶𝗻𝘀𝘁𝗿𝘂𝗺𝗲𝗻𝘁𝘀 The instrument used to assess the participants motor proficiency levels and to identify symptoms of DCD was the Movement Assessment Battery for Children-2 (MABC-2 Test). This test includes manual dexterity, balance as well as aiming and catching, in addition the three sub-tests constitute a total test score. In order to determine if parents possess the ability to identify symptoms of DCD at home the Developmental Coordination Disorder Questionnaire ’07 (DCDQ’07) was used. With the purpose of determining if teachers possess the ability to identify DCD in the classroom the Movement Assessment Battery for Children-2 Checklist (MABC-C) was used. It is designed to identify primary school children likely to have movement difficulties. The Aptitude Test for School Beginners (ASB) was administered by qualified teachers to all participating children in the first two months of the school year. A requirement of the ASB is that it must be presented and completed in a child’s mother tongue. The ASB is a norm-based instrument and consists of eight sub-items, which include perception, spatial skills, reasoning, numerical skills, gestalt, coordination, memory and verbal comprehension. Each sub-item is evaluated by means of a standard score out of five. An evaluation score of 1 is regarded as below average and an evaluation score of 5 as above average. The aim of the ASB is to obtain a differentiated picture of certain aptitudes of grade 1 children. 𝗗𝗮𝘁𝗮 𝗮𝗻𝗮𝗹𝘆𝘀𝗶𝘀 Analysis of the data was done by a biostatistician using Statistical Analysis Software Version 9.1.3. Descriptive statistics, namely frequencies and percentages, were calculated for categorical data. Medians and percentiles were calculated for numerical data. Median differences were tested by calculating p-values using the signed-rank test. The Chi-square statistics were used to test for proportion differences. This was used to determine the prevalence of DCD (article 1), as well as for learning related skills and DCD (article 4) and for the sport stacking intervention (article 6). Furthermore, data analysis was performed using the Statistical Package for the Social Sciences (SPSS) for Windows (SPSS version 16.0), in order to determine if parents and teachers possess the ability to identify children with DCD. The convergent validity of the classification of motor problems (no motor difficulties or motor difficulties) using the MABC-2 Test and the classification of motor difficulties (no motor difficulties or motor difficulties) by the parents of the participants using the DCDQ’07 and the teachers using the MABC-C, the kappa (k-) coefficient was used. Finally, the Mann-Whitney-U test was used to compare differences between the experimental- and control group with reference to the perceptual-motor intervention for children with DCD (article 5). Probability level of 0.05 or less was taken to indicate statistical significance. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀 The results of aim 1 revealed the prevalence of DCD amongst Grade 1 learners in Bloemfontein is estimated to be 15%. The results also indicate that boys have a significantly higher (p=0.050) prevalence of DCD although marginally when compared to their female counterparts. Aim 2 indicated a 15% convergent validity between the MABC-2 Test and the DCDQ’07, similar results were obtained for aim 3, indicating a 11% convergent validity between the MABC-2 Test and the MABC-C. Therefore, it can be argued that parents using the DCDQ’07 and teachers using the MABC-2 could not identify children with DCD at home or in the classroom. The results in aim 4 indicated the prevalence of DCD to be 12%. Additionally, DCD had a significant effect (p=0.050) on five of the eight learning-related subtypes, namely reasoning, numerical skills, gestalt, coordination and memory. Furthermore, the results of aim 5 indicated that a perceptual-motor intervention only improved balance as a sub-test of the MABC-2 Test. Interesting to note is that children taking part in Physical Education classes presented by the teachers also prove to be beneficial. In contrast, aim 6 (sport stacking intervention for DCD) showed that the intervention had a significant effect (p=0.050) on two of the three sub-tests, namely manual dexterity, balance, as well as the total test score. This suggests that sport stacking can be used as an effective intervention programme for children with DCD. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻𝘀 The results revealed that the school age children in the current study had a higher incidence of DCD (15%) compared to the findings reported in the literature (5-6%). This information is important, and indicates that appropriate screening tools should be used to identify children earlier. Unfortunately the reliability of the MABC-C and the DCDQ’07 completed by parents and teachers to identify children with DCD was found to be low. Therefore it is recommended that specific norms should be developed for South African children. Furthermore, the results revealed that children with DCD do struggle with learning related skills. This knowledge enables teachers to address the specific needs of children with DCD. It can be concluded that perceptual-motor interventions have more often than not positive effects on children with DCD; however it is recommended that a combination of the bottom-up approach and top-down approach should be used for optimal results.

𝗔𝗴𝘁𝗲𝗿𝗴𝗿𝗼𝗻𝗱 Ontwikkelingskoördinasiesteurnis (developmental coordination disorder – DCD) word erken as een van die mees algemene ontwikkelingsdisfunksies tydens die kinderjare. Ontwikkelingskoördinasiesteurnis word gediagnoseer in kinders wat beduidende probleme ervaar met motoriese leer en in die uitvoering van funksionele motoriese take wat deurslaggewend vir sukses in hul daaglikse lewens is. Een van die vernaamste bekommernisse met betrekking tot kinders met DCD is egter dat hulle dikwels nie formeel gediagnoseer word nie, maar eerder deur hul ouers en onderwysers as lui of lomp beskryf word. Verskeie navorsingsinstrumente, soos vraelyste vir siftingsdoeleindes en normverwysde toetse om die mate van bewegingsprobleme te meet, kan gebruik word ten einde kinders met DCD te probeer identifiseer. Selfs al sal kinders nie die versteuring ontgroei, soos vantevore geglo is nie, kan hulle gehelp word deur middel van verskeie intervensies. 𝗗𝗼𝗲𝗹𝘀𝘁𝗲𝗹𝗹𝗶𝗻𝗴𝘀 Die eerste doelwit van hierdie studie was om die voorkoms van DCD onder graad 1-leerders in Bloemfontein te bepaal. Die tweede doelstelling was om die vermoë van ouers om graad 1-leerders met DCD tuis te identifiseer, te bepaal; daarbenewens was die derde doelstelling om die vermoë van onderwysers om graad 1-leerders met DCD in die klaskamer te identifiseer, te bepaal. Die vierde doelstelling was om die invloed van DCD op leerverwante vaardighede te ondersoek. Doelstellings vyf en ses was om te bepaal of die toepassing van ’n perseptueel-motoriese intervensie sowel as ’n sportstapelingsintervensie graad 1-leerders wat onafhanklik met DCD gediagnoseer is se status van motoriese vaardigheid beduidend sal verbeter. 𝗠𝗲𝘁𝗼𝗱𝗲 Deelnemers Vir doelstelling een het N=559 deelnemers tussen die ouderdomme van vyf en agt jaar aan hierdie studie deelgeneem. Daar was n = 321 meisies en n = 238 seuns. Doelstelling twee het 410 deelnemers gehad, saamgestel uit n = 226 meisies en n = 184 seuns, terwyl doelstelling drie 506 deelnemers gehad het, bestaande uit n = 289 meisies en n = 217 seuns. Voorts was daar 347 deelnemers vir doelstelling vier, saamgestel uit n = 190 meisies en n = 157 seuns. Vir doelstellings 5 en 6, wat verband hou met die twee intervensies wat in hierdie studie gebruik is, was die syfers soos volg. Sewe-en-sestig (76) deelnemers het aan die perseptueel-motoriese intervensie deelgeneem. Die groep het uit meisies (n = 34) en seuns (n = 42) wat met DCD geklassifiseer is, bestaan. Die studie het ’n voortoets-natoets- eksperimentele ontwerp gehad (n = 36) met ’n kontrolegroep (n = 40). Met betrekking tot die sportstapelingsintervensie het 18 kinders tussen die ouderdomme van ses en sewe jaar aan die studie deelgeneem. Die groep het uit meisies (n = 6) en seuns (n = 12) wat met DCD geklassifiseer is, bestaan. Hierdie studie het ook ’n voortoets-natoets- eksperimentele ontwerp (n = 10) met ’n kontrolegroep (n = 8) gehad. 𝗠𝗲𝗲𝘁𝗶𝗻𝘀𝘁𝗿𝘂𝗺𝗲𝗻𝘁𝗲 Die instrument wat gebruik is om die deelnemers se vlakke van motoriese vaardigheid te assesseer en om DCD te identifiseer was die Bewegingsassesseringsbattery vir Kinders-2 (“Movement Assessment Battery for Children-2” – MABC-2-toets). Hierdie toets sluit handvaardigheid, balans en mik-en-vang in, en daarbenewens vorm die drie subtoetse saam ’n totale toetstelling. Ten einde te bepaal of ouers oor die vermoë beskik om DCD tuis te identifiseer, is die Ontwikkelingskoördinasiesteurnissvraelys ’07 (“Developmental Coordination Disorder Questionnaire ’07” – DCDQ’07) gebruik. Ten einde vas te stel of onderwysers oor die vermoë beskik om DCD in die klaskamer te identifiseer, is die Bewegingsassesseringsbattery vir Kinders-2: Kontrolelys (“Movement Assessment Battery for Children-2 Checklist” – MABC-C) gebruik. Dit is ontwerp om laerskoolkinders wat waarskynlik bewegingsprobleme het, te identifiseer. Die Aanlegtoets vir Skoolbeginners (ASB) is in die eerste twee maande van die skooljaar vir al die deelnemende kinders deur gekwalifiseerde onderwysers afgeneem. ’n Vereiste van die ASB is dat dit in die kind se moedertaal aangebied en voltooi moet word. Die ASB is ’n normgebaseerde instrument en bestaan uit agt subitems, wat persepsie, ruimtelike vaardighede, redenering, numeriese vaardighede, gestalt, koördinasie, geheue en verbale begrip insluit. Elke subitem word deur middel van ’n standaardtelling uit vyf geëvalueer. ’n Evaluasietelling van een word as ondergemiddeld beskou en ’n evaluasietelling van vyf as bogemiddeld. Die doel van die ASB is om ’n gedifferensieerde beeld van sekere aanlegte van graad 1-leerders te verkry. 𝗗𝗮𝘁𝗮-𝗮𝗻𝗮𝗹𝗶𝘀𝗲 Data-analise is deur ’n biostatistikus gedoen met die gebruik van Statistical Analysis Software, weergawe 9.1.3. Beskrywende statistieke, naamlik frekwensies en persentasies, is vir kategoriese data bereken. Mediane en persentiele is vir numeriese data bereken. Mediaanverskille is getoets deur p-waardes te bereken met gebruik van die betekenderang-toets. Die chi-kwadraatstatistieke is gebruik om vir proporsieverskille te toets. Dit is gebruik om die voorkoms van DCD te bepaal (artikel 1), sowel as vir leerverwante vaardighede en DCD (artikel 4), en vir die sportstapelingsintervensie (artikel 6). Voorts is data-analise gedoen deur middel van die Statistical Package for the Social Sciences for Windows (SPSS weergawe 16.0). Ten einde te bepaal of ouers en onderwysers oor die vermoë beskik om kinders met DCD te identifiseer. Die konvergerende geldigheid van die klassifikasie van motoriese probleme (geen motoriese probleme of motoriese probleme) deur middel van die MABC-2-toets en die klassifikasie van motoriese probleme (geen motoriese probleme of motoriese probleme) deur die ouers van die deelnemers deur middel van die DCDQ’07 en die onderwysers deur middel van die MABC-C, is die kappa- (k-) koëffisiënt gebruik. Laastens is die Mann-Whitney U-toets gebruik om verskille tussen die eksperimentele en die kontrolegroep met betrekking tot die perseptueel-motoriese intervensie vir kinders met DCD te vergelyk (artikel 5). ’n Waarskynlikheidsvlak van 0.05 of minder is gebruik om statistiese beduidendheid aan te dui. 𝗥𝗲𝘀𝘂𝗹𝘁𝗮𝘁𝗲 Die resultate van doelstelling een het getoon dat die voorkoms van DCD onder graad 1-leerders in Bloemfontein op 15% bepaal is. Die resultate dui ook daarop dat seuns ’n beduidend hoër (p=0.050) voorkoms van DCD het as meisies, hoewel margimaal. Doelstelling twee het ’n konvergerende geldigheid van 15% tussen die MABC-2-toets en die DCDQ’07 aangedui; soortgelyke resultate is vir doelstelling 3 verkry, waar ’n konvergerende geldigheid van 11% tussen die MABC-2-toets en die MABC-C aangedui is. Dit kan dus aangevoer word dat ouers wat die DCDQ’07 gebruik het en onderwysers wat die MABC-C gebruik het, nie kinders met DCD tuis of in die klaskamer kon identifiseer nie. Die resultate van doelstelling 4 het getoon dat die voorkoms van DCD 12% is. Daarbenewens het DCD ’n beduidende effek (p = 0.050) gehad op vyf van die agt leerverwante subtipes, naamlik redenering, numeriese vaardighede, gestalt, koördinasie en geheue. Verder het die resultate van doelstelling 5 getoon dat ’n perseptueel-motoriese intervensie slegs balans as ’n subtoets van die MABC-2-toets verbeter het. Dit is interessant om daarop te let dat kinders se deelname aan Liggaamlike Opvoeding-klasse wat deur onderwysers aangebied is, ook voordelig bewys is. In teenstelling hiermee het doelstelling ses (sportstapelingsintervensie vir DCD) getoon dat die intervensie ’n beduidende effek (p = 0.050) op twee van die drie subtoetse, naamlik handvaardigheid en balans, sowel as op die totale toetstelling gehad het. Dit dui daarop dat sportstapeling as ’n effektiewe intervensieprogram vir kinders met DCD gebruik kan word. 𝗚𝗲𝘃𝗼𝗹𝗴𝘁𝗿𝗲𝗸𝗸𝗶𝗻𝗴𝘀 Die resultate het getoon dat die kinders van skoolgaande ouderdom in die huidige studie ’n hoër voorkoms van DCD (15%) gehad het as die bevindings wat in die literatuur gerapporteer word (5%-6%). Hierdie inligting is belangrik, en dui daarop dat geskikte siftingsinstrumente gebruik moet word om kinders vroeër te identifiseer. Ongelukkig is daar gevind dat die betroubaarheid van die MABC-C en die DCDQ’07 wat deur ouers en onderwysers voltooi is om kinders met DCD te kan identifiseer, laag is. Dit word daarom aanbeveel dat spesifieke norme vir Suid-Afrikaanse kinders ontwikkel moet word. Voorts het die resultate getoon dat kinders met DCD wel problem ervaar met leerverwante vaardighede. Hierdie kennis stel onderwysers in staat om aan die spesifieke behoeftes van kinders met DCD aandag te gee. Daar kan tot die gevolgtrekking gekom word dat perseptueel-motoriese intervensies gewoonlik ’n positiewe uitwerking op kinders met DCD het; daar word egter aanbeveel dat ’n kombinasie van die onder-na-bo- en bo-na-onder-benaderings gebruik moet word vir optimale resultate.
Thesis (Ph.D. (Human Movement Science (Kinderkinetics)))--University of the Free State, 2015
Keywords: Movement Assessment Battery for Children - 2; Movement Assessment Battery for Children - 2 Checklist; Developmental Coordination Disorder Questionnaire ‘07; Aptitude Test for School Beginners; Children