PLoS One. 2017 Oct 11;12(10):e0186126. doi: 10.1371/journal.pone.0186126. 

Catching-up: Children with developmental coordination disorder compared to healthy children before and after sensorimotor therapy.

Niklasson M1,2, Norlander T1,2,3, Niklasson I1,2, Rasmussen P2,4.

1Center for Research and Development, Evidens University College, Göteborg, Sweden.
2Center for Sensorimotor Research, Vestibularis Clinic, Kalmar, Sweden.
3Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
4Department of Neuroscience and Physiology, Insitute of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Göteborg, Sweden.

Abstract

The aims of the present study were to (a) compare healthy children in terms of sensorimotor maturity to untreated children diagnosed with developmental coordination disorder (DCD) and (b) compare healthy children to diagnosed children following completed treatment with sensorimotor therapy. Participants were 298 children, 196 boys and 102 girls, distributed into a Norm group of healthy children (n = 99) and a group of children diagnosed with DCD (n = 199) with a total mean age of 8.77 years (SD = 2.88). Participants in both groups were assessed on instruments aimed to detect sensorimotor deviations. The children in the DCD group completed, during on average 36 months, sensorimotor therapy which comprised stereotypical fetal- and infant movements, vestibular stimulation, tactile stimulation, auditory stimulation, complementary play exercises, gross motor milestones, and sports-related gross motor skills. At the final visit a full assessment was once more performed. Results showed that the Norm group performed better on all sensorimotor tests as compared to the untreated children from the DCD group, with the exception of an audiometric test where both groups performed at the same level. Girls performed better on tests assessing proprioceptive and balance abilities. Results also showed, after controls for natural maturing effects, that the children from the DCD group after sensorimotor therapy did catch up with the healthy children. The concept of “catching-up” is used within developmental medicine but has not earlier been documented with regard to children and youth in connection with DCD.

PMID: 29020061

 

Supplement

Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder with an estimated global prevalence of between 5% and 20%. Although its main feature is immature and delayed motor abilities affecting everyday activities the diagnosis does not include obvious medical or intellectual causes. Within child psychiatry and developmental medicine comorbidity is a rule rather than an exception i.e. the comorbidity between ADHD and DCD is estimated to 50%. Not the least therefore it is surprising that DCD is mentioned as the hidden disorder and treatment methods for motor problems despite its prevalence are being overlooked within psychiatric research. Motor skills problems are in fact serious threats to both psychological and physiological health.

In our studies we have focused on (congenital) primary reflexes, which the infant has to suppress or integrate in order to be able to develop well-functioning motor skills. This is done through various spontaneous exercises the infant performs e.g. grabbing, rolling around, tummy crawling and creeping on hands and knees. There are observations that indicate that children who skip a “training phase” such as tummy-crawl or creeping on hands and knees run a greater risk of having different motor problems later in life expressed as “clumsiness” and balance problems (now referred to as DCD, Development Coordination Disorder). These problems, in turn, may be a factor of importance in several neuropsychiatric disabilities. ADHD is now a clearly defined diagnosis, although with different variants (Hoogman et al., 2017). For a large group a significant feature of the disability are motor problems (DCD).

From our point of view this means that neither movement patterns nor the balance system are sufficiently automated. Therefore the brain has to intervene and more actively compensate for this immaturity and this process is very tiring for the individual. We all know that exhausted children may be more or less hyperactive. Children with ADHD do often have a more or less constant fatigue, which may be linked to DCD. When so the brain tries to compensate the fatigue through hyperactivity. That is why medicines containing central stimulant substances such as methylphenidate are helpful for many persons with ADHD.

Our present study indicated that sensorimotor problems could be treated through sensorimotor therapy (SMT), a rather novel therapy which uses the method Retraining for Balance i.e. combining an integration of aberrant primary reflexes with vestibular stimulation. SMT could be described in accordance with the Kinesthetic-Vestibular Development Model (Fig.1) where exercises (introductions) give rise to temporary physical and/or psychological regressions, which are followed by intervals of transformations (psychological and/or physical development). Our previous studies have shown that this recurring pattern is similar for both children and adults. It is interesting how closely intertwined the sensorimotor (physical) exercises are with the psychological part of the process. In this way SMT might be a promising therapy for psychological wellbeing as well as a method for physical development.

 

 

Hitherto the practicing of this kind of sensorimotor therapy has been limited to the Vestibularis Clinic in Sweden. A future challenge except from further studies would be to educate SMT-therapists. Hopefully, there will be an interest from different sources that will allow the method to continue to develop and spread.

 

References

Hoogman, M., Bralten, J., Hibar, D. P., Mennes, M., Zwiers, M. P., Schweren, L. S., … & de Zeeuw, P. (2017). Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. The Lancet Psychiatry, 4(4), 310-319.

Niklasson M., Niklasson I., & Norlander T. (2009). Sensorimotor therapy: using stereotypic movements and vestibular stimulation to increase sensorimotor proficiency of children with attentional and motor difficulties. Percept Mot Skills 108, 643-669. PMID: 19725302 doi:10.2466/PMS.108.3643-669

Niklasson M., Niklasson I., & Norlander T. (2010). Sensorimotor therapy: physical and psychological regressions contribute to an improved kinesthetic and vestibular capacity in children and adolescents with motor difficulties and concentration problems. Soc Behav Pers 38(3), 327-346. doi:10.1080/092434505000114173

Niklasson M., Rasmussen P., Niklasson I., & Norlander T. (2015). Adults with sensorimotor disorders: Enhanced physiological and psychological development following specific sensorimotor training. Front Psychol  6:480. PMID: 25954233 doi: 10.3389/fpsyg.2015.00480

Niklasson M., Norlander T., Niklasson I., & Rasmussen P, (2017). Catching-up: Children with developmental coordination disorder compared to healthy children before and after sensorimotor therapy. PLoS ONE 12(10):e0186126. https://doi.org/10.1371/journal.pone.0186126