Academic journal article New Zealand Journal of Occupational Therapy

Developmental Coordination Disorder: The Domain of Child and Adolescent Mental Health Occupational Therapists?

Academic journal article New Zealand Journal of Occupational Therapy

Developmental Coordination Disorder: The Domain of Child and Adolescent Mental Health Occupational Therapists?

Article excerpt

Abstract

The purpose of this case study is to explore the question of whether interventions for Developmental Coordination Disorder are within the domain of child and adolescent mental health (CAMH) occupational therapists. The Model of Professional Thinking was used to guide this practice review and the development of clinical guidelines. Findings identified significant inconsistencies in clinical experience and published literature that supported a limited contribution from occupational therapists in a CAMH context. This paper will argue that child and adolescent mental health occupational therapists have a key role to play in screening for Developmental Coordination Disorder as well as addressing accompanying occupational performance issues related to emotional and mental wellbeing.

Key words

Model of professional thinking, Developmental Coordination Disorder Questionnaire 2007, clinical reasoning.

Reference

Tokolahi, E. (2014). Developmental Coordination Disorder: The domain of child and adolescent mental health occupational therapists? New Zealand Journal of Occupational Therapy, 67(1), 21 - 25.

Developmental Coordination Disorder (DCD) is a neuro-developmental condition that affects up to 10% of children (Jackson, 1999) and interferes with the complex interface between sensory, cognitive and motor processes (Tempest & Roden, 2008). Children with DCD present with impaired development of motor coordination that significantly disrupts performance of activities of daily living and academic achievement (Ayyash & Preece, 2003). While paediatric occupational therapists may be familiar with such a presentation, in my experience clinicians working in Child and Adolescent Mental Health Services (CAMHS) are less so, unless they have previously worked in a paediatric setting. This understanding was reinforced through discussion in an online forum which will be discussed later. Children presenting with DCD tend to be more susceptible to psychological distress, they may be more likely to engage in severely problematic behaviours or have delayed development of play impacting on social relationships; all of which will increase the likelihood of them presenting to mental health services at some stage (Prior, 2001; Verkerk, 1999). This raises the question of whether CAMHS occupational therapists need to be equally familiar with assessment and treatment interventions for this population.

When reflecting on such a challenging practice issue it is useful to be guided by a model of clinical reasoning. The Model of Professional Thinking (MPT) was developed by Bannigan and Moores (2009) to guide clinical reasoning by 'integrating evidence-based practice with reflective practice in making decisions' (p. 344).

This model can be used in the clinical context to develop guidelines for practice and review challenging practice issues (Pearson & Bannigan, 2012). Once the clinical context is defined the clinician addresses three stages: What? So what? What now? In the first stage, 'What?' identifies the event or clinical question instigating the overall process. In the second stage, 'So what?' embeds evidence-based practice into the process utilising different levels of evidence including clinical experience, published research and peer review. In the final stage, 'What now?' the clinician reflects on evidence obtained from experience as well as published literature, considers the implications for their own practice and makes a decision on how to proceed. MPT was deemed an appropriate model for reviewing the role of occupational therapists who practice in CAMHS and provide interventions for children presenting with DCD.

Clinical context

At the CAMHS where I work, occupational therapists are often asked to assess motor function for DCD. There are currently no national or local practice guidelines for this and the clinical responses vary according to the confidence and prior experience of the therapist involved. …

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