White Matter Changes With Rehabilitation in Children With Developmental Coordination Disorder: A Randomized Controlled Trial

Abstract

Background and Objectives: Children with developmental coordination disorder (DCD) have difficulty learning motor skills, which can affect their participation in activities of daily living and psychosocial well-being. Over 50% of children with DCD also have attention deficit hyperactivity disorder (ADHD), which further exacerbates their motor problems and impact on quality of life. A rehabilitation approach known as Cognitive Orientation to Occupational Performance uses problem-solving strategies to help children learn motor skills they wish to achieve. While this cognitive approach has been effective for children with DCD, few studies have examined the effectiveness of this approach for children with co-occurring ADHD. Further, the underlying mechanism and neural basis of this intervention are largely unknown.Methods: In this randomized waitlist-controlled trial, we used MRI to examine white matter microstructure after intervention in 8–12-year-old children with DCD (n = 28) and with DCD and co-occurring ADHD (n = 25). Children in both groups were randomized to either a treatment group or waitlist group at their first MRI. The treatment group began the intervention after their MRI scan and returned for a post-treatment scan at 3 months, and follow-up scan at 6 months; the waitlist group waited 3 months before their second MRI, received the intervention, and then had a post-treatment scan. Each child received intervention once weekly for 10 weeks. Diffusion tensor imaging was used to acquire white matter diffusion parameters and was analyzed using tract-based spatial statistics (TBSS).Results and Conclusion: Children with DCD showed significant improvement in white matter microstructure in the bilateral anterior thalamic radiation, bilateral sensorimotor tract, bilateral cingulum, fornix, splenium and body of corpus callosum, right inferior fronto-occipital fasciculus, and white matter pathways to bilateral inferior gyri, right middle frontal gyrus, frontal medial cortex, and left cuneus. We suggest that these rehabilitation-induced neural changes in children with DCD occurred in regions associated with attention, self-regulation, motor planning, and inter-hemispheric communication, which positively affected brain connectivity and motor function. In contrast, children with DCD and co-occurring ADHD did not show any brain changes following the intervention. Modifications to the treatment protocol might help address the attentional and self-regulatory needs of children with a dual diagnosis.Clinical Trial Registration: ClinicalTrials.gov ID: NCT02597751.

Adolescents with ADHD and co‐occurring motor difficulties show a distinct pattern of maturation within the corticospinal tract from those without: A longitudinal fixel‐based study

“…The divergence in maturational pathways of the CST between those with ADHD + MI and ADHD supports recent arguments that motor difficulties observed in ADHD reflect a distinct symptom cluster rather than a core phenotypic characteristic of ADHD (Farran et al, 2020;Goulardins et al, 2015;Lee et al, 2021). This is inkeeping with a small existing body of literature that suggests distinct Zwicker, 2021). This study highlights that the CST may not be as susceptible to experientially driven plasticity in those with combined ADHD + MI relative to those with just one of the two disorders in isolation.…”

Behavioral and Neuroimaging Research on Developmental Coordination Disorder (DCD): A Combined Systematic Review and Meta-Analysis of Recent Findings

“…The attendant gains in skill, however small, have a reinforcing effect on the motivation of children and their willingness to persist in training. Interestingly, recent evidence shows that gains in motor performance following a Cognitive Orientation to Occupational Performance (CO-OP) intervention are accompanied by a sustained increase in white matter microstructure and functional connectivity between brain networks associated with emotion regulation, action inhibition, and attention for those with DCD (but not DCD+ADHD) (Izadi-Najafabadi and Zwicker, 2021 ; Izadi-Najafabadi et al, 2021 ). Together, the available evidence provides encouraging support for science-led intervention.…”

Association between screen time and suspected developmental coordination disorder in preschoolers: A national population-based study in China

“…Increased screen exposure time has previously been associated with lower microstructural integrity of brain white matter tracts in preschool-aged children ( 45 ). Children with DCD also showed significant brain differences in motor and sensorimotor white matter pathways when compared with controls ( 46 , 47 ). Furthermore, evidence suggested that higher screen exposure is independently associated with lower serum Brain-derived neurotrophic factor (BDNF) levels ( 48 ).…”