Identifying Developmental Coordination Disorder in Children with Attention-Deficit/Hyperactivity Disorder: An Evidence-based Decision Tree Tool for Occupational Therapy Clinicians

ABSTRACT

Children with attention-deficit/hyperactivity disorder (ADHD) may also have undiagnosed developmental coordination disorder (DCD). Prevalence rates of the ADHD/DCD comorbidity are estimated between 30% and 50%. Given the significant impact these disorders have on a child’s occupational performance, lack of detection of DCD is of concern. Occupational therapists play a key role in screening children for the presence of DCD to provide timely and targeted intervention opportunities. However, despite synthesized research and clinical guidelines being available, inconsistency with identification of DCD continues to be reported. Currently, no clear decision-making support tool is available in Australia to aid DCD identification. We aimed to bridge this research-practice gap by developing an evidence-based decision tree tool (ADITA), to guide this identification process. Mapping of assessment and identification processes for DCD was undertaken, in accordance with DSM-5 diagnostic criteria and the European Academy for Childhood Disability (EACD) clinical practice recommendations. A pilot study was conducted to test agreement in identification of DCD between an occupational therapist and pediatrician when the decision tree tool was applied. The ADITA decision tree tool created was trialed with a sample of 19 children with ADHD, aged 8–12 years. Twenty-six percent of participants were assessed as having likely DCD by the occupational therapist, with 21% of ADHD participants subsequently confirmed with DCD by a pediatrician. An agreement rate of 94% was achieved. Preliminary support is provided for the use of ADITA, an evidence-based decision tree tool, to identify DCD in school-aged children with ADHD. The ADITA supports knowledge translation by facilitating implementation of research evidence for DCD, thereby assisting occupational therapists and health professionals to bridge the existing research-practice gap.

KEYWORDS:

• Attention deficit hyperactivity disorder (ADHD)
• developmental coordination disorder (DCD)
• knowledge translation
• implementation strategy
• decision tree
• school-aged children

Key Messages

• Occupational therapists play a pivotal role in identifying DCD for children with ADHD

• Implementation strategies are required to bridge the research-practice gap in DCD identification

• Using this decision tree tool for DCD identification will enable informed and consistent contribution by occupational therapists.

Authors’ Declaration Of Authorship Contribution

All authors declare that this is original work and that they meet the criteria for authorship. Leiemma A. Canty developed the concept, designed the study, extracted the data, conducted the analyses, and wrote the manuscript. Anoo Bhopti assisted with the concept, study design, data analyses and review, and editing of the manuscript. Leeanne M. Carey assisted with study design, data analyses and review, and editing of the manuscript.

Acknowledgments

The authors would like to thank all the families who participated in this study.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Ethics Approval

This study was approved by La Trobe University Human Ethics Committee (ethics no. HEC18239). Clinical Trial Registration Number: ACTRN12618001972213. Written, informed consent was obtained from all participants.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Research Reporting Guidelines

The STROBE Statement: guidelines for reporting observational studies (STROBE checklist: cohort studies) from the EQUATOR reporting guidelines was used for this study https://www.equator-network.org/reporting-guidelines/strobe/

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.