Is EPIC suitable for children with DCD/Dyspraxia?

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

Co-production of the EPIC programme with children, parents, education and clinical professionals

The EPIC programme aims to improve thinking, learning and behaviour in neurodivergent children. EPIC focuses on understanding and supporting thinking difficulties, through psychoeducation and use of strategies. This understanding and support can help improve everyday life for neurodivergent children at home and school. The principles of EPIC such as a transdiagnostic individualised approach were developed from a considerable body of research evidence. Alongside that research evidence though, the voices of young people, their parents/carers and the health and education professionals who support them, have been critical to EPIC. Their voices have played a central role in how these principles work in practice and in designing and shaping the resources used in EPIC. This infographic summarises the process by which the EPIC programme was shaped and refined.

Children and young people are at the centre of EPIC. If we want to truly understand a condition it is vital to include the perspectives of these young people themselves. Members of our team were involved in a research priority exercise a few years back (a very systematic exercise called the James Lind Alliance priority setting partnership). The outcome of this exercise which was produced by young people with learning difficulties, their parent(s), and professionals who support them was a list of the Top Ten questions they wanted answered by research. The number 1 prioritised question was ‘what knowledge, skills and training do educational professionals need to identify the early signs of learning difficulties and provide optimal support for children and young people affected to help them achieve the best possible outcomes?’ This highlights the need for research to support teachers in understanding how best these young people can be supported at school. We followed this up with interviews with neurodivergent children to find out what children themselves understood about being neurodivergent and the strategies they found useful at school. At every stage we have involved children and young people informally and formally to identify the kinds of supports they would find useful. One of the key findings that came out of this was that neurodivergent young people feel they can engage best when tasks and activities are personalised to their interests. Some of the examples included using lego to do number work or using crafts to learn about thinking skills such as planning and breaking tasks down into steps. Children have also given us huge insights into strategies they find helpful. Many of these are quite practical – such as being able to use fidget toys, and taking movement or sensory breaks.

Teachers and other education professionals have also influenced the shaping of the EPIC programme across interviews and workshops. In a formalised set of interviews, teachers gave us their insights into strategies they find useful in the classroom. Very importantly, they identified that using a child’s strengths to overcome their difficulties can be a particularly good approach such as using a child’s creativity to complete a language task. In a series of workshops, teachers worked with us to design booklets that would focus on understanding and supporting children with ADHD and DCD. More recently, we have had teacher involvement in designing our new booklet focused more generically on neurodivergent children (so it will be suitable for children on waiting lists and those who don’t end up getting a diagnosis). This involvement has been essential to make sure that resources we develop are useful and appropriate to the context the child is in. Teachers have consistently commented on how neruodivergent children with the same diagnosis can differ greatly from one another in their individual strengths and difficulties. They have also emphasised that a strategy that is successful with a child one day may not work the next with the same child and similarly may not work for all children even if they have the same diagnosis. As a result we have developed the booklets in the style of ‘pick and choose’ the areas of strengths and difficulties a teacher or parent/carer wants to focus. The booklets also have a range of strategies to draw on and there is an emphasis on being flexible – from using a ‘chunking’ technique to support memory with one child to using an external item like a mini whiteboard to achieve the same goal with another child.

Parents and carers have also been critical to the development of the EPIC programme and the resources we use. Across 3 research studies we have conducted interviews with parents to identify the issues they need support with and the strategies that best work. At the moment we are developing a ‘self-delivery with support’ version of the EPIC programme that parents and teachers can do with their child / the child in their class with support from the team. Ultimately the idea is that this will be an empowering approach with parents leading the way on identifying their child’s strengths and difficulties and ways to use EPIC activities and resources to support the needs of their individual child.

Clinicians have also play a key role in the development of the EPIC programme. Many of our researcher led sessions in our studies were run by CAMHS psychiatrists with involvement of other health professionals. They also provided regular feedback on the development of resources and for example providing feedback on the need to design booklets that are generic so they can be given to children on waiting lists and be useful for those who end up not getting a diagnosis. Ultimately, if we want to truly understand neurodivergent children and effect change for them then all of those who support and care for them need to be involved in translating research evidence into effective practices.

Welcome to the EPIC blog!

We are really pleased to launch our blog ‘Edinburgh Psychoeducation Intervention for Children and Young People’ (EPIC) today!  Our website can be found here with downloadable resources to facilitate thinking, learning and wellbeing in children.

EPIC takes an individualised approach to child development with the aim of facilitating optimal learning, behaviour, well-being and mental health in children and young people. At the heart of the EPIC approach is understanding the individual child’s strengths and difficulties regardless of age, sex, or clinical diagnosis. There is a common saying ‘if you meet one autistic person you have met one autistic person’ – the same applies to other diagnoses such as ADHD and DCD.   We have developed resources for parents and teachers that are available on our website. These resources are suitable for all children and young people, but may be particularly helpful for children with neurodevelopmental difficulties (e.g. ADHD, ASD, DCD/Dyspraxia) and children born prematurely.

During the last few years we have been developing an intervention with children, their parents and teachers. We are currently working with children undergoing ADHD assessment and autistic children. The intervention we have been developing is an 8 week 16 session school and home based intervention. EPIC is focused on psychoeducation involving the child, parent and teacher developing an understanding of the individual child’s strengths and difficulties. We then pair strategies with these difficulties and practice thinking skills using a range of games and activities. In early 2022, we will be extending this work out to children with DCD. In the meantime our resources highlight a lot of our activities with children and young people and can be used by parents and teachers outwith being involved in an intervention.

The booklets contain ideas for how to identify what the individual child’s strengths and difficulties are.  Is there an attention difficulty? Or is the difficulty actually a memory or sensory processing problem that looks like a loss of concentration? Once this understanding is built up, the parent or teacher can use it to inform two key practices – psychoeducation and pairing of strategies to target areas. 

The EPIC blog will include regular posts about child development particularly focusing on thinking and learning skills and wellbeing. Our work is evidence based but importantly posts will be written in a non-academic style to be useful to everyone. Please follow our blog http://www.epic-information.com and us on twitter @InformEpic to keep an eye out for our posts.

Visual production credits: SDI Productions via Getty Images