This blog post was written by Sinead Rhodes, Claire Tai, Peter Wu and Penny Shutt
We have been busy working on a pilot study to see if EPIC activities would be suitable for children with Dyspraxia/Developmental Co-ordination Disorder (DCD). A pilot study is a small-scale study with a small number of children taking part – in this case – to see if a programme would be suitable for children with DCD. DCD is a common condition that affects movement and coordination.
Why would activities focused on thinking difficulties be relevant for children with DCD when the condition is characterised by fine and or gross motor skill difficulties, such as tying shoelaces and cycling a bicycle?
Research with children with DCD is not as extensive as for other neurodevelopmental conditions such as ADHD and autism, but the evidence available suggests that these children also have difficulties in what is known as ‘executive functions.’ These are processes such as using thinking skills to remember information, how you plan and organise tasks in your mind, being able to control responses, and using your attention flexibly.
A growing number of studies suggest that these thinking processes are an area of difficulty for children with DCD. Children with the same condition can differ in the set of executive function difficulties they present, and the EPIC approach focuses on helping a child to understand the specific aspects they need support with. For one child it may be memory and planning, and for another it could be being able to think flexibly and control their responses. What is important is that the child and their support network (especially their parents and teachers) understand the child’s particular set of difficulties. This is known as ‘Psychoeducation’ (i.e. the ‘P’ in EPIC!)
Once everyone understands the child’s particular thinking difficulties, we can then look at appropriate strategies to support them. Sometimes what we call ‘internal’ strategies can be useful. Examples of internal strategies include rehearsal, mental imagery, and chunking (also known as grouping) information to help remember information.
‘External’ strategies can also be useful — such as making a mind map to plan out writing a story or using a mini-whiteboard or planner to identify steps in a task and their best order. Another strategy is to simply practice these strategies through playing games like ‘Simon Says’ as a way to practice holding back responses.
In this pilot study, we carried out an 8-week 16-session EPIC programme with primary school aged children with DCD, a parent and a teacher. Children completed thinking and educational tasks before and after participating in the intervention, and parents and teachers completed questionnaires about their child’s symptoms and behaviour. The study identified that the EPIC programme was feasible and acceptable for these children, parents and teachers. While the small numbers preclude statistical analysis, we can see that children made gains in the thinking skills that were the focus of the intervention delivery such as planning and memory.
Most importantly, the children and teachers were interviewed before and after they took part in the EPIC programme. Children showed improved understanding of DCD following intervention involvement. Prior to taking part, they referred to the movement aspects of DCD but in the interview afterwards they showed awareness of DCD being associated with thinking skill differences. They also showed an awareness of a greater range of strategies that could be used to support their thinking skills.
Teachers similarly showed a broader understanding of DCD in the range of thinking skills they associated with the condition after participation in the programme. They also showed an awareness that these thinking differences may not just impact learning, but also, for example, social relationships. They, similarly to the children, showed an awareness of a greater range of strategies that could be used to support their thinking skills. Teachers expressed that participation helped not only the child taking part in the research study but also other pupils benefitted because they were able to use some of the strategies they learned with other pupils. They witnessed the pupils putting these into practise as a result of the ongoing dialogue with the teacher around when a strategy might come in useful and which one.
This study shows that EPIC activities can potentially be useful for children with DCD. This condition has been considerably overlooked in relation to other conditions like ADHD and Autism, despite being more common.
It is critical that every child is understood and supported in relation to all the difficulties they have that influence their learning, social relationships and wellbeing. The learning we have from this pilot study is that the support and understanding from the resources and use of EPIC activities has been a step towards identifying this. Use of the EPIC programme has helped to address unmet needs that have wide-reaching implications for an under-recognised population. That is epic!
Our free downloadable booklets can be found here: https://www.ed.ac.uk/clinical-brain-sciences/research/epic-edinburgh-psychoeducation-intervention/epic-resources
This study was funded by the RS MacDonald Seedcorn fund.
Visual production credit: photographer sturti via Getty Images