Relationship between motor skills, participation in leisure activities and quality of life of children with Developmental Coordination Disorder: Temporal aspects

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Highlights

  • The study focuses on the relationship between motor skills, leisure participation and quality of life of children with DCD.

  • The relationship between these factors is examined within a temporal context: school days vs. summer vacation.

  • Children's quality of life appears to be related to the leisure-activity level.

  • This relationship seems to differ within the school days and summer vacation.

Abstract

The study examined the relationship between motor skills, participation in leisure activities and quality of life (QOL), within a temporal context (school year vs. summer vacation and school days vs. weekends). Parents of 22 children with Developmental Coordination Disorder (DCD) and of 55 typically developing children, aged 6–11, filled out two questionnaires relating to their children's participation in leisure activities (vigorous, moderate and sedentary) and QOL. The Movement Assessment Battery for Children-2 (MABC-2) was administered to their children. Results showed that among the children with DCD, balance scores positively correlated with participation in sedentary activities, and in both groups both balance and aiming and catching were related to the physical and school aspects of QOL. Furthermore, participation in vigorous activities in the summer was positively correlated with social and school QOL. In contrast, among typically developing children, participation in vigorous activities during the school year was negatively correlated with school QOL. Finally, in both groups, participation in sedentary activities during school days was negatively correlated with school QOL. These results suggest that the parents’ perceptions of their children's QOL may be related to the level of activeness of the leisure activities but also to temporal aspects. Therefore, it is important that therapists and educators consider the temporal aspects, when consulting with parents and their children regarding participation in leisure activities.

Introduction

Children participate in various occupational areas such as self-care, play, education and leisure, within different contexts (e.g. physical, social, and temporal; American Occupational Therapy Association [AOTA], 2008). Participation has been found to be vital for children's social and academic development as well as for their sense of competence and self-identity (Cairney, Hay, Veldhuizen, Missiuna, & Faught, 2010). Therefore, it is considered one of the most important outcome measures of health intervention (Weintraub, Rot, Shoshani, Pe’er, & Weintraub, 2011). Children's participation is most successful and meaningful when there is a balance between the ‘just right challenge’, the required skills and body functions to perform the activities, a supportive environment and a sense of satisfaction (Law, Baum, & Dunn, 2005). Participation in activities is commonly evaluated using various measures such as duration, diversity, independence level, enjoyment and satisfaction (Bart, Rosenberg, Erez, & Jarus, 2009).

Leisure is one of the important occupational areas in which children participate. Studies have shown that children spend 30% of their day in leisure activities (Jarus, Anaby, Bart, Engel-Yeger, & Law, 2010). These activities are defined as non-obligatory, intrinsically motivating and performed during discretionary time (AOTA, 2008). Participation in leisure activities may vary according to the type of activities and the level of physical activeness the activity requires, i.e. vigorous, moderate or sedentary (Lifshitz et al., 2011, Ziviani et al., 2004). Vigorous-level activities (that entail high levels of activeness) may include ball games or swimming, which require gross motor skills such as balance and coordination (Kioumourtzoglou, Derri, Tzetzis, & Theodorakis, 1998). Moderate-level activities, such as art work or playing musical instruments, require mostly fine motor skills. Sedentary activities, such as playing on the computer or watching television, require little physical exercise and are normally performed while sitting. These activities may vary with respect to the type of motor skills they entail, mostly fine-motor skills (Biddle, Marshall, Gorely, & Cameron, 2009).

Children's participation in everyday activities is thought to be related to their motor competence (Polatajko and Mandich, 2004, Summers et al., 2008). Yet, studies examining the relationship between motor abilities and participation in leisure activities are limited (Engel-Yeger & Kasis, 2010). These studies focused mostly on children with Developmental Coordination Disorder (DCD), a developmental deficit in motor coordination. Individuals with DCD may be impaired predominantly in gross motor skills, in fine motor skills, or in both. DCD affects 5–6% of school aged children (American Psychiatric Association [APA], 2013).

The difficulties of children with DCD often evoke a negative cycle. The motor impairments may affect their physical health, and cause secondary emotional and psycho-social problems (Engel-Yeger and Kasis, 2010, Mandich et al., 2003). These impairments may also limit their performance in different occupational areas such as activities of daily living (ADL), play, leisure and academic skills (Cermak and Larkin, 2002, Dunford et al., 2005). This, in turn, may result in further delay in acquisition of new skills. Engel-Yeger and Kasis (2010) found that 5–9-year-old children with DCD showed less preference to participate in leisure activities (requiring various levels of activeness) compared to typical children. The authors also reported a moderately significant correlation between the children's motor skills and their preference to participate in leisure activities. Yet, they did not examine this relationship in children without DCD. Similarly, Cairney et al. (2005) showed that children in Grades 4–8, with probable DCD (pDCD) participated less frequently in sports and in other physical play activities. In a later 3-year longitudinal study, Cairney et al. (2010) followed 2083 children (ages 9.11–11.11 years), of which 111 were with pDCD. The children with pDCD reported participating less in organized and free-play activities compared to their typically developing peers. These differences persisted over time.

The limited performance and participation in daily activities may affect the quality of life (QOL) of children with DCD. Individuals’ participation in activities is believed to influence their QOL. Quality of life relates to individuals’ dynamic appraisal of their life satisfaction, hope, self-concept and well-being, in relation to their goals, expectations, culture, values and beliefs (Skevington et al., 2004, WHOQOL, 1995). It reflects their functional and health status, independence level and ability to participate in meaningful, motivating and empowering occupations (Christiansen et al., 2005, Eiser and Morse, 2001). QOL may be measured by objective factors or subjective perspectives (Cummins, 2005). Subjective QOL may be obtained from the individuals themselves or from proxies. Often parents serve as the proxies (Connoly and Johnson, 1999, Weintraub et al., 2011), since they have been found to be sensitive to their children's perception of their well-being and provide reliable data (Morrow, Quine, Heaton, & Craig, 2010).

Only a few studies examined the QOL of children with DCD (Zwicker, Harris, & Klassen, 2012). A review of the literature indicated that even fewer studies have explored the relationship between their QOL and participation in leisure activities, in general, and specifically within a temporal context. As early as preschool years, children with DCD have been found to experience less pleasure and satisfaction from daily functions (Bart et al., 2009). As they grow older, Flapper and Schoemaker, 2008, Flapper and Schoemaker, 2013 found that school-aged children with co-occurrence of attention deficits, DCD and with specific language impairment-DCD as well as their parents, perceived the motor, autonomic, cognitive, psychosocial and overall QOL of the children to be significantly lower than perceived by their typical peers and their parents. Similar results were noted by Wuang, Wang, & Mao-Hsiung (2012), who studied the perceptions of parents of children with DCD and of typically developing children, regarding their children's and their own QOL. They found that the children with DCD and their parents had significantly lower psychosocial QOL, compared to typically developing children and their parents.

From the review above it is clear that the studies examining the underlying assumption of the bio-psychosocial model with respect to children with DCD are limited. The few studies that did examine this issue (e.g. Cairney et al., 2010) did not differentiate between the children's motor deficits (i.e. fine or gross motor), nor did they examine the relationship between the child's specific motor skills and participation in leisure activities, requiring varying levels of activeness (i.e. sedentary, moderate or vigorous). Finally, they did not relate to the temporal aspect of participation (i.e. during the school year or school days versus the summer or weekends). Tucker and Gilliland (2007), based on an extensive review, noted that the season of year may have significant effects on the type and duration of children's participation in physical activities. Therefore, in studying children's participation behaviors, such temporal aspects need to be considered. Similarly, the research on the QOL of children with DCD is scarce, and the studies that do exist did not examine the relationship between specific motor skills and children's QOL, nor did they examine the participation in leisure activities requiring varying levels of activeness, and QOL.

The purpose of this study was to examine the relationship between motor skills, participation in leisure activities and QOL among children with and without DCD. These relationships were examined within a temporal context (school year vs. summer vacation and school days vs. weekends). However, in order to determine whether the relationships among these factors are unique to children with DCD, the relationships among these factors were also examined within a group of typically developing children. We expected to find a relationship between the children's motor skills and the duration and type of leisure activities in which children participated (i.e. children with better motor skills will participate more in vigorous activities and children with poorer motor skills will participate more in sedentary activities). We also expected that the children's motor skills and participation in the various activities would be related to their QOL. Finally, we hypothesized that these correlation patterns among three factors will differ during the school days versus weekends or during the school year versus the summer vacation. For example, we expected to find a correlation between motor skills and participation in vigorous activities during the week, but not during the weekends, because during the weekends, all children spend more time engaging in sedentary activities. The results of this study may expand the understanding of the impact of DCD on children's participation in leisure activities and their QOL, and shed light on the importance of addressing the temporal context, while working with these children.

Section snippets

Study design and participants

The design of this study is correlative. Using a convenience sampling method, the children with DCD were recruited from an out-patient clinic for children with mild motor and sensory disabilities and from a workout facility for children with special needs. The typically developing children were recruited using a convenient and snowball sampling method. The study sample included 77 children and their parents; 22 with DCD or probable DCD (72.7% boys; Mage = 8.6 years, SD = 1.4) and 55 typically

Results

The two groups’ motor skills and functional difficulties are described in Table 1. As can be seen, compared to the typical group, the motor skills (MABC-2) of the children with DCD were significantly lower and children with DCD had more functional difficulties.

Both groups’ participation patterns during school year/summer as well as during school days/weekends, are described in Table 2a, Table 2b. As can be seen in Table 2a, children in both groups had participated for a longer duration in

Discussion

Based on the bio-psychosocial model (WHO, 2001), it is presumed that motor skills are necessary for children's participation in daily activities (Mandich et al., 2003). It is further suggested that children with DCD participate less in activities, thus affecting their QOL (Heah, Case, McGuire, & Law, 2007). The goal of this study was to examine the relationship between motor skills, participation in leisure activities and QOL among children with and without DCD. These relationships were studied

Conclusions

Overall, motor skills were not found do not appear to be related to children's participation in leisure activities, with the exception of poor balance skills among children with DCD, which were found to be related to participation in sedentary activities. In contrast, gross motor skills of children with DCD do appear to be somewhat related to the physical and school dimensions of their QOL. The association between participation in both sedentary and vigorous activities and QOL seems to be

Acknowledgement

We thank all the children and parents who participated in the study; the Alyn hospital for their financial support.

References (56)

  • J.W. Varni et al.

    The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity

    Ambulatory Pediatrics

    (2003)
  • American Occupational Therapy Association [AOTA]

    Occupational therapy practice framework: Domain and process (2nd ed.)

    The American Journal of Occupational Therapy

    (2008)
  • American Psychiatric Association [APA]

    Developmental Coordination Disorder. Diagnostic and statistical manual (5th ed., DSM-5)

    (2013)
  • O. Bart et al.

    Early data on how do children with DCD participate and enjoy daily activities?

    (2009 June)
  • S.J.H. Biddle et al.

    Temporal and environmental patterns of sedentary and active behaviors during adolescents’ leisure time

    International Journal of Behavioral Medicine

    (2009)
  • J. Cairney et al.

    Developmental coordination disorder, sex, and activity deficit over time: a longitudinal analysis of participation trajectories in children with and without coordination difficulties

    Developmental Medicine & Child Neurology

    (2010)
  • S.A. Cermak

    Demographic, Medical and Motor Questionnaire

    (2007)
  • S.A. Cermak

    Physical Activity and Sedentary Behavior-Questionnaire

    (2007)
  • H.F. Chen et al.

    Social participation for children with Developmental Coordination Disorder: Conceptual, evaluation and intervention considerations

    Physical & Occupational Therapy in Pediatrics

    (2003)
  • M.A. Connoly et al.

    Measuring quality of life in pediatric patients

    Pharmaco Economics

    (1999)
  • R.A. Cummins

    Moving from the quality of life concept to a theory

    Journal of Intellectual Disability Research

    (2005)
  • C. Dunford et al.

    Children's perceptions of the impact of Developmental Coordination Disorder on activities of daily living

    British Journal of Occupational Therapy

    (2005)
  • C. Eiser et al.

    Can parents rate their child's health-related quality of life? Results of a systematic review

    Quality of Life Research

    (2001)
  • B. Engel-Yeger et al.

    The relationship between Developmental Coordination Disorder, child's perceived self-efficacy and preference to participate in daily activities

    Child: Care, Health and Development

    (2010)
  • A. Fisher et al.

    Fundamental movement skills and habitual physical activity in young children

    Medicine and Science in Sports and Exercise

    (2005)
  • B.C. Flapper et al.

    Effects of methylphenidate on quality of life in children with both Developmental Coordination Disorder and ADHD

    Developmental Medicine and Child Neurology

    (2008)
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