The Predictors of Emotional and Behavioral Problems in Preschool Children with Developmental Coordination Disorder
Date Issued
2012
Date
2012
Author(s)
Chen, Yu-Lan
Abstract
Objectives: Developmental Coordination Disorder (DCD) is a marked impairment in the development of motor coordination in children that cannot be attributed to a general medical condition or mental retardation. The prevalence of DCD has been estimated to be as high as 6% for children aged from 5 to 11 years in America. In addition to motor coordination problems, studies have demonstrated that children with DCD often have an increased risk of emotional and behavioral problems, such as depression, anxiety and attention deficit. In contrast to the rate of emotional and behavioral problems in typically developing children (5% to 12%), that in children with DCD was much higher (43.2 % to 62 %). There have been some studies investigating emotional and behavioral problems in children with DCD. Despite that, some limitations were noted as follows: 1) participants were from a wide range of age (from preschoolers to adolescents) ; 2) only one or two facets of the emotional and behavioral problems in DCD were examined, for example anxiety and depression. Furthermore, no study considered both emotional and behavioral problems simultaneously; 3) no study took into account both personal factors and environmental factors when examining the predictors of emotional and behavioral problems in preschoolers with DCD. In view of the vital importance of early intervention, this study employed the preschoolers with DCD. The aim of this study was threefold, 1) to examine group differences in both emotional and behavioral problems between preschoolers with DCD and typically developing preschoolers (TD), considering both internalizing and externalizing problems simultaneously, 2) to investigate the rate of the emotional and behavioral problems occurred in preschoolers with DCD, 3) to identify the predictors of the behavioral and emotional problems in preschoolers with DCD taking into account both the personal factors (e.g., gender, age) and environmental factors (e.g., birth order, parenting stress ).
Methods: Participants aged between 3 and 5.9 years were recruited from 22 kindergartens in Taiwan and two rehabilitation clinics of two medical centers in Taipei area. Letters describing the purpose and procedure of the study were distributed to 1680 parents of children; 1367 families agreed to participate and completed the Chinese version of the Little Developmental Coordination Disorder Questionnaire Chinese version (LDCDQ-C) to screen motor coordination problems. One hundred and seventy children who scored below the 15th percentile on the LDCDQ-C were further tested with Movement Assessment Battery for Children-2 (MABC-2) to confirm their motor problems. Among them, 86 scored below the 15th percentile on both the LDCDQ-C and MABC-2 were classified as DCD. Fifty six typically developing children (TD) from community samples who scored above the 15th percentile on both the LDCDQ-C and MABC-2 served as controls. Parents of both groups were asked to fill out the Child Behavioral Checklist Chinese version 1.5-5 (CBCL-C/1.5-5), Daily living skills subscale of the Vineland Adaptive Behavior Scale Chinese version (VABS-C) and the Parenting Stress Index Short Form (PSI-SF). Group differences in the CBCL-C/1.5-5 were examined using independent two-sample t test. Furthermore, the percentage of DCD and TD who scored in the clinically significant range on the emotional and behavioral problems was investigated. Multiple linear regression models were fitted to identify the predictors of behavioral and emotional problems as measured by the CBCL-C/1.5-5 in preschooler with DCD. The dependent variables were the CBCL-C/1.5-5 T scores (including internalizing and externalizing scores), the independent variables including personal factors: gender, age, perinatal risk (e.g., anoxia, prolonged or difficult labor, mechanical injuries, and intracranial hemorrhage), level of motor impairment, daily living skills and extrinsic factors: birth order, family socio-economic status, mothers’ age at the birth of the child and parenting stress.
Results: Results showed that preschoolers with DCD had more severe internalizing (t=4.76, p<0.001) and externalizing (t=5.96, p<0.001) problems as measured by the CBCL-C/1.5-5 than TD. Further, in seven narrow-band syndrome scales of the CBCL-C/1.5-5, preschoolers with DCD showed more severe emotional and behavioral problems than TD excepting the Somatic Complaints (t=1.22, p=0.22). As regards the rate of emotional and behavioral problems, more preschoolers with DCD scored in the clinically significant range i.e., 32.6% (DCD) vs. 3.5% (TD) for the total score of CBCL-C/1.5~5; 34.9% (DCD) vs. 10.7% (TD) for the internalizing problems ; 26.7% (DCD) vs. 1.7% (TD) for the externalizing problems. About one half (57 %) of children with DCD had at least one CBCL-C narrow-band syndrome scale scores falling in the clinically significant range, which was much higher than that of typically developing children (12.5%). The highest percentage of clinically significant scores in children with DCD was Withdrawn behavior (38.4%), followed by Attention problems (24.4%) and Emotionally reactive (23.3%). The predictors of the emotional problems in preschooler with DCD were parenting stress and severity of fine motor impairment whereas those of behavioral problems were parenting stress, family SES and gender. The higher parenting stress and severer fine motor impairment, the more emotional problems occurred in children with DCD. The higher parenting stress, the lower family SES, and male gender, the more behavioral problems occurred in children with DCD. The Results of the study indicated that both environmental and personal characteristics factors have impacts on the emotional and behavioral problems of preschooler with DCD.
Conclusions: Results of the study indicated that in addition to motor clumsiness, clinicians have to recognize the need for assessing the emotional and behavioral problems in preschoolers with DCD, especially in withdrawn, attention and emotionally reactive problems. Knowledge of predictors of emotional and behavioral problems helps clinicians and educators to plan intervention and educational programs targeted at these predictors, for examples providing coping strategies or parent support groups to help relieve parents’ stress, providing fine motor skill training for children with DCD. Moreover, in addition to assessment of motor function, it is essential to recognize the need for assessment of emotional and behavioral problems in boys with DCD or in children from families with low SES. By identifying such problems at preschool stage, and proactively helping these children and their parents, they will be able to more actively participate in society and live more productive lives.
Subjects
Developmental Coordination Disorder (DCD)
emotional and behavioral problems
parenting stress
Type
thesis
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