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

Abstract

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.