Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
Self-Concept of Boys with Developmental
Coordination Disorder
Neralie Cocks, MAppSc (OT)
Belinda Barton, BA (Hons. Psych), PhD
Michelle Donelly, MA(Educ), PhD
ABSTRACT. Children with Developmental Coordination Disorder
(DCD) experience difficulties in motor coordination. During the last
decade there has been increasing interest in the psychosocial aspects of
children with motor coordination difficulties. To date, the majority of
studies have focused on the perceived competence and global self-worth
of children with DCD. This study examined the self-concept in academic and nonacademic domains of 30 boys (aged 7 to 12 years) with
DCD. Results indicated that boys with DCD had significantly poorer
self-concept for physical abilities and peer relations when compared to
normative mean values. Severity of motor difficulties was significantly
related to self-concept for physical abilities and reading. Self-concept
plays an integral role in the holistic management of children with DCD.
KEYWORDS. Developmental coordination disorder, self-concept, motor difficulties, children
Neralie Cocks, MAppSc (OT) is Senior Occupational Therapist, Child Development Unit, The Children’s Hospital at Westmead, Australia. Belinda Barton, BA (Hons.
Psych.), PhD, Head, Children’s Hospital Education Research Institute (CHERI),
The Children’s Hospital at Westmead, Australia. Michelle Donelly, BAppSC(OT),
MA(Educ), PhD is Lecturer, School of Occupation and Leisure Sciences, University
of Sydney, Lidcombe, Australia
Address correspondence to: Neralie Cocks, Child Development Unit, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia
(E-mail: [email protected]).
6
Physical & Occupational Therapy in Pediatrics, Vol. 29(1), 2009
Available online at http://potp.haworthpress.com
C 2009 by Informa Healthcare USA, Inc. All rights reserved.
doi: 10.1080/01942630802574932
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
Cocks et al.
7
Children with Developmental Coordination Disorder (DCD) experience
significant difficulties in motor coordination, which frequently interferes
with their academic achievement or the ability to successfully participate
in daily activities (Diagnostic and Statistical Manual of Mental Disorders
[DSM-IV]; American Psychiatric Association [APA], 1994). At home,
children with DCD may lack the ability to be independent in self-care
tasks such as dressing and managing cutlery (Dunford, Missiuna, Street,
& Sibert, 2005). In physical activities, children with DCD may look awkward when walking and running, and are less proficient than their peers
in ball skills, agility, and balance-based activities (Henderson & Sugden,
1992). In the classroom, children with DCD experience particular difficulties with pencil control, handwriting acquisition, organization, and legibility of written work (Dunford et al., 2005). This collection of difficulties
has raised concern among educators, psychologists, and therapists about
the secondary negative effects of DCD on the emotional and psychological well-being of children with the condition (Heath, Toste, & Missiuna,
2005).
During the last decade, there has been increasing interest in the psychosocial aspects of children with motor difficulties, which has included
investigations examining the “self.” Various terms such as self-esteem, selfworth, and self-concept have been used to describe the self and are often
used interchangeably and inconsistently (Butler & Gasson, 2005). Selfconcept refers to an individual’s perception of him- or herself (Shavelson,
Hubner, & Stanton, 1976). These perceptions are formed through one’s
experiences and interpretation of the environment, which is influenced by
reinforcements, the feedback of significant others, and one’s own attribution for behavior (Shavelson et al., 1976). Self-concept is defined as
including both evaluative and descriptive aspects of the self (Shavelson
et al., 1976). Self-concept plays a key role in the integration of personality, in motivating behavior and in achieving mental health (Burns, 1979;
Shavelson et al., 1976).
To date, no studies have investigated the self-concept of children with
motor difficulties. The majority of studies have examined the global selfworth and perceived competence of children with motor difficulties. Perceived competence is proposed to be predictive of global self-worth, the
overall evaluation of one’s worth or value as a person (Harter, 1985). Evidence to date indicates that children with motor coordination difficulties,
including those with DCD, perceive themselves to be less competent athletically and scholastically, and also have poorer perceptions about their
physical appearance when compared to children without motor coordination difficulties (Mæland, 1992; Piek, Dworcan, Barrett, & Coleman, 2000;
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
8
PHYSICAL & OCCUPATIONAL THERAPY IN PEDIATRICS
Rose, Larkin, & Berger, 1997; Schoemaker & Kalverboer, 1994; Skinner
& Piek, 2001; Watson & Knott, 2006).
Findings regarding the perceived social acceptance of children with
motor difficulties have been equivocal. Some studies indicate that children
with motor difficulties perceive themselves to be less socially accepted
when compared to children without motor difficulties (Rose et al., 1997;
Schoemaker & Kalverboer, 1994), whereas others have reported no significant differences (Mæland, 1992; Piek et al., 2000; Piek, Baynam, & Barrett,
2006; Skinner & Piek, 2001). Similarly, not all studies have found significantly lower self-worth in children with motor difficulties when compared
to children without motor difficulties (Mæland, 1992; Piek et al., 2000).
It is plausible that the self-concept of children with motor difficulties,
particularly for physical domains, is related to the severity of motor difficulties. Of the few published studies that have reported on the relationship
between motor difficulties and self-perceptions, no significant association
was found between degree of difficulty, physical competence, social acceptance, or general self-worth (Mæland, 1992; Schoemaker & Kalverboer,
1994). However, the lack of significant association found in these studies
may be partly due to the small sample size and consequently poor statistical power to detect a relationship. Results from a recent study involving a
larger cohort of children with and without DCD indicated that age, gender,
and gross motor ability were significant predictors of perceived athletic
competence (Piek et al., 2006). For perceived scholastic ability, age, fine
motor ability, and a diagnosis of DCD were found to be significant predictors (Piek et al., 2006).
Other conditions that frequently occur in children with DCD may also
contribute to the development of a negative self-concept. Many children
with DCD have poor academic performance, learning problems, and Attention Deficit Hyperactivity Disorder ([ADHD]; APA, 1994), (Dewey,
Kaplan, Crawford, & Wilson, 2002; Rasmussen & Gillberg, 2000). Several studies have found that children with learning problems or ADHD have
significantly poorer self-concept in academic, social, and/or behavioral domains when compared to control groups (Bear, Minke, & Manning, 2002;
Dumas & Pelletier, 1999). It is possible that other conditions that occur
with DCD contribute to poorer self-concept in these children compared to
children with only DCD.
In summary, children with DCD perceive themselves to be less competent athletically and scholastically, and have poorer perceptions about
their physical appearance than children without motor difficulties. Findings
regarding other domains of self-perception such as social acceptance, as
well as the relationship between motor difficulties and self-perceptions are
Cocks et al.
9
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
less clear. To our knowledge, no studies have examined the self-concept
of children with DCD. Therefore, the aims of the present study were to
examine: (1) the self-concept of boys with DCD; (2) the relationship between motor difficulties and self-concept, and (3) the relationship between
self-concept domains. Boys were the focus of this study because of the
higher prevalence of DCD in boys than girls (Kadesjö & Gillberg, 1999).
METHODS
Participants
The study was approved by the following ethics committees: The Children’s Hospital at Westmead, The University of Sydney, The Department
of Training and Catholic Education. Parents and boys were provided with
an information sheet about the study and written informed consent was
obtained from both. Parental consent was obtained to contact the child’s
school.
Over an 18-month period, 41 boys aged between 7 and 12 years were
referred by their hospital pediatrician to the Occupational Therapy Department, The Children’s Hospital at Westmead, Sydney, Australia, for an
assessment of their motor coordination. The assessment was requested following parental concerns expressed to pediatricians of the boys’ motor coordination at home and/or at school. An occupational therapist (first author)
assessed all boys to determine whether they satisfied the DSM-IV criteria
(APA, 1994) for DCD. The DSM-IV criteria defines children with DCD
as having motor coordination substantially below that expected, given the
person’s age and intelligence, which affects their academic achievement
and/or activities of daily living.
Boys who scored below the 15th percentile on the Movement Assessment Battery for Children (M-ABC) (Henderson & Sugden, 1992) were
considered eligible to participate in the study. M-ABC scores between the
6th and 15th percentile suggests a degree of difficulty that is borderline,
while scores below the 5th percentile are indicative of a definite motor problem (Henderson & Sugden, 1992). Children with scores below the 15th
percentile were included, since those with borderline motor difficulties are
at risk of social and emotional difficulties especially when presenting with
a history of functional difficulties (Dewey et al., 2002; Dunford et al., 2005;
Piek et al., 2000). In addition, there has been some variation in the cut-off
point used to define motor coordination substantially below that expected,
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
10
PHYSICAL & OCCUPATIONAL THERAPY IN PEDIATRICS
which ranges from the 3rd to the 15th percentile on the M-ABC (Dunford,
Street, O’Connell, Kelly, & Sibert, 2004).
Parents and teachers completed questionnaires developed by the first
author to provide information about any motor difficulties children were
experiencing in the following domains: handwriting, fine motor skills,
gross motor skills, academic performance (teacher only), and self-care
(parent only). Items for each domain reflected commonly reported difficulties experienced by children with motor difficulties such as cutting
skills, speed of handwriting, letter formation, tying shoelaces, and managing cutlery. The Parent Questionnaire consisted of 29 items and required
parents to rate their satisfaction in their child’s performance for each domain using a five-point Likert scale (very dissatisfied to very satisfied).
The Teacher Questionnaire consisted of 24 items, with teachers rating
the performance of the child in each domain compared to other children
in the same classroom using a five-point Likert scale (lowest 10%, next
lowest 20%, middle 40%, next highest 20%, highest 10%). If the teacher
rated the boy’s academic performance in the lowest 10% of the class in
two or more academic subjects (reading, spelling, written expression, and
mathematics), the boy was considered to have poor academic competence
when compared to his classroom peers. No formal standardized testing of
academic achievement or intelligence was administered; however, none of
the boys were in classes or special schools for students with an intellectual
disability. Prior to this study, the questionnaires were trialed with several
parents and teachers, and subsequently wording was refined. However, the
questionnaires were not validated. Ratings from these questionnaires, as
well as clinical information obtained from the parent at the time of the
assessment and performance on the M-ABC was used to diagnose DCD
(in collaboration with the boy’s pediatrician) and to describe the academic
competence of the boys.
Referral information from the boy’s pediatrician confirmed the absence
of neurological conditions. Boys with a language disorder, pervasive developmental disorder, or who had contact with occupational therapy services
in the last 12 months or attended a special school, were excluded. All boys
had English as their first language.
Of the 41 boys referred, 7 boys scored above the 15th percentile on
the M-ABC and were not eligible to participate. Therefore, 34 boys were
eligible to participate. However, two boys declined to participate although
parental consent had been given and two boys had inconsistent responses
to items on the self-concept questionnaire and were excluded from further
data analysis. Therefore, data was available for 30 boys, 14 (47%) of
whom had an existing diagnosis of ADHD as diagnosed by the referring
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
Cocks et al.
11
pediatrician, with 7 (23%) currently taking stimulant medication. The mean
age of boys’ was 9.5 years (SD = 1.4).
Assessment of SES was based on parental occupation (Daniel, 1983).
When both parents were working, the more prestigious occupation was
used. SES was classified as high, middle, or low (Daniel, 1983). Fiftythree percent (16/30) of boys were from low SES, 27% (8/30) boys were
from middle SES, and 20% (6/30) were from high SES families. Eight
(27%) boys were from families where the parent(s) was unemployed.
Responses from the parent questionnaire indicated that most parents
(86%) were dissatisfied with the handwriting performance of their child.
Also, almost half the parents were dissatisfied with the fine (47%) and
gross (40%) motor skills of their child. Information from the teacher questionnaire was available for 22 boys, 6 (27%) of whom were identified
as having poor academic competence. Approximately 60% of boys were
rated by teachers as being in the lowest 10% for fine motor skills and/or
handwriting. All boys had motor coordination difficulties that interfered
with their academic achievement and/or daily activities.
Measures
Movement Assessment Battery for Children (M-ABC; Henderson &
Sugden, 1992). The M-ABC was used to measure motor competence. The
child was required to perform eight tasks measuring manual dexterity, ball
skills, and balance. A Total Impairment Score is calculated by summing
the scores for all tasks; a higher impairment score indicates poorer motor
difficulties. The reliability and validity of the M-ABC are based on its
predecessor, the Test of Motor Impairment (TOMI) (Stott, Moyes & Henderson, 1984). The minimum value of the test-retest reliability at any age
for the TOMI is 0.75 and of the inter-rater reliability 0.70 (Henderson &
Sugden, 1992). For the M-ABC, test-retest reliability is high over a 1-week
period (0.92 to 0.98), with good concurrent validity with the BruininksOseretsky Test of Motor Proficiency (Bruininks, 1978) (moderate Pearson
correlation coefficients (r .60 to .90) (Croce, Horvat, & McCarthy, 2001)
and high inter-rater reliability (0.95 to 1.00) (Smits-Engelsman, Fiers,
Henderson, & Henderson, 2008). The M-ABC is an internationally recognized instrument for identifying children with motor difficulties (Barnett
& Henderson, 1998, Croce et al., 2001). The same senior occupational
therapist (first author) administered the M-ABC to all boys.
Self-Description Questionnaire I (SDQI; Marsh, 1992). The SDQI is a
76-item self-report inventory that is suitable for primary-aged children and
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
12
PHYSICAL & OCCUPATIONAL THERAPY IN PEDIATRICS
measures self-concept in the following areas: Nonacademic (physical ability, physical appearance, peer relations, and parent relations), academic
(reading, mathematics, general school), and general self that measures
overall self-satisfaction. Composite scores—total academic, total nonacademic, and total self (the average of total academic and total nonacademic)
are provided. Marsh (1992) recommends that scores for each domain of
self-concept be used instead of composite scores as evidence supports specific and multiple domains of self-concept. Responses were also checked
for consistency to correlated items and negativity bias as per the SDQI
manual to ensure responses were valid. The normative data are based on
responses by 3,562 Australian children.
The definition and model of self-concept proposed by Shavelson et al.
(1976) served as the basis for the SDQI. The SDQI is the most validated
self-concept instrument available (Byrne, 1996). Research has shown that
factor analyzes have consistently identified each a priori factor; the internal consistency reliability coefficients range from 0.81 to 0.94 and there is
strong support for the external and construct validity (Byrne, 1996; Hattie,
1992; Marsh, 1992; Marsh & MacDonald Holmes, 1990). The construct validity of the SDQI, based on the theoretical underpinning that self-concept
is multidimensional is well established (see Marsh & Gauvernet, 1989;
Marsh, Relich, & Smith, 1981). Scores on the SDQI have been found to correlate significantly with other measures of self-concept (Hymel, LeMare,
Ditner, & Woody, 1999; Marsh & MacDonald Holmes, 1990). The external validity of the SDQI for Australian students is well established with
similar response patterns being observed across public and private school
children (Marsh et al., 1981).
Higher scores on the SDQI reflect positive self-concept. While there are
no recommended cut-off scores that define low self-concept, scores below
the 25th percentile are considered low (Marsh, 1992). For the purpose of
this study, a relatively stringent cut-off mark was used and scores that were
less than the 15th percentile were defined as “low” self-concept, which
is consistent with previous research (Hay, Ashman, & van Kraayenoord,
1998).
Procedure
After the referral was received, the M-ABC was administered to the
child, in the presence of the parent, in a room located in the Occupational
Therapy Department. The first author, who administered the M-ABC to all
children, has extensive experience in the administration of this instrument
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
Cocks et al.
13
and has been a senior occupational therapist for over 15 years. Children
then completed the SDQI in the same room with parents not present. In
completing the SDQI, children were asked to respond to simple declarative sentences (e.g. “I’m good at mathematics”) by selecting one of five
responses (False, Mostly False, Sometimes False/Sometimes True, Mostly
True, True). All items of the SDQI were read out aloud by the first author to
each child. The assessment took approximately 90 min to complete. Children with ADHD and taking stimulant medication were assessed while
they were on medication.
Data Analysis
Data were analyzed using Statistical Package for Social Sciences for
Windows (SPSS; Version 11). Scores for all measures were examined
for univariate outliers, fit for normal distribution and test assumptions.
The SDQI provides normative data separately for boys in grades 2 to
4 and grades 5 to 6. Normative means for both groups were combined
to achieve a single mean value, as there were insufficient numbers to
conduct the analysis based on grade groupings. SDQI raw scores for boys
with DCD were compared to normative mean raw values using a onesample t-test or sign test for scores that were not normally distributed. For
scores with a non-normal distribution, the median and interquartile range
is reported. An independent t-test or the Mann–Whitney U test was used
to compare self-concept of children with DCD and ADHD to children with
DCD. The relationship between self-concept domains and also with motor
difficulties was examined using Pearson’s product moment, Spearman’s
rho, and Kendall’s tau correlations. All tests were two-tailed and level of
significance was set at 0.05. The Holm procedure was applied to control
the family-wise error rate (Aickin & Gensler, 1996).
RESULTS
Table 1 shows the median scores for subtests of the M-ABC and the classification of motor difficulties utilizing Total Impairment Scores. Almost
two-thirds (67%) of the boys had a definite motor impairment and a high
percentage of boys had manual dexterity skills below the 5th percentile.
14
PHYSICAL & OCCUPATIONAL THERAPY IN PEDIATRICS
TABLE 1. Median (IQ) Scores for the M-ABC and Classification of Motor
Impairment
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
M-ABC
Total impairment score
Manual dexterity
Ball skills
Static and dynamic balance
Median
(IQ)
Definite
MI n (%)
Borderline
MI n (%)
Normal
MI n (%)
19.00 (12.43)
9.00 (6.00)
2.75 (3.88)
7.50 (2.25)
20 (67)
22 (73)
8 (27)
15 (50)
10 (33)
4 (13)
10 (33)
9 (30)
—
4 (13)
12 (40)
6 (20)
M-ABC = Movement Assessment Battery for Children; MI = Motor Impairment
Definite MI = < 5th percentile; Borderline MI = 5–15th percentile; Normal MI = > 15th percentile.
Examination of Self-Concept of Boys with DCD
Boys with DCD had significantly lower mean scores for self-concept
in physical abilities and peer relations when compared to normative mean
values (Table 2). There were no other significant differences.
TABLE 2. Means (SD) Self-Concept Scores for Boys with DCD and
Comparisons to Normative Data (Males Grades 2 to 6)
SDQI Domain
Physical abilities
Physical appearance
Peer relations
Parent relations
Reading
Mathematics
General school
General self
Total nonacademic
Total academic
Total self
a Median
Boys with
DCD (n = 30)
SDQI Normative
Data (n = 1,971)
M (SD)
M (SD)
t (29)
p
30.07 (7.38)
27.07 (9.06)
25.70 (9.53)
31.97 (6.89)
30.57 (8.10)
35.50 (14.25)a
26.83 (8.69)
30.20 (7.73)
28.90 (6.70)
29.63 (7.38)
29.30 (5.87)
34.31 (5.51)
28.36 (8.14)
31.52 (6.30)
35.54 (5.01)
30.27 (7.88)
29.73 (8.84)
28.33 (7.25)
32.99 (5.60)c
32.54 (4.73)
29.43 (6.37)
31.22 (4.68)
−3.15
−0.78
−3.35
−2.84
0.20
−2.01b
−.1.00
−1.98
−2.98
0.15
−1.79
.004∗∗
.44
.002∗∗
.008
.84
.045
.35
.06
.006
.88
.08
(IQ) reported
value for sign test
c Total SDQI normative sample (n = 1,118), which includes girls as SDQI has no published data for
males in Grades 2–4.
∗
p < .05
∗∗
p < .01
bz
Cocks et al.
15
FIGURE 1. Percentage of the boys with DCD who have low self-concept
(< 15th percentile). Maths = Mathematics; G Sch = General School; G Self =
General Self; Phy Abil = Physical Abilities; Phy App = Physical Appearance;
Parent = Parent Relations; Peer = Peer Relations.
40
(%) Low self-concept
35
30
25
20
15
10
Pe
er
Pa
re
nt
Ap
p
Ab
il
Ph
y
f
h
Se
l
G
Sc
G
Ph
y
R
ea
di
ng
at
h
5
M
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
45
Forty percent (12/30) of boys had a low self-concept for physical abilities
and 43% (13/30) had a low self-concept for peer relations (Figure 1).
Eighty-three percent (10/12) of the boys who had low self-concept for
physical abilities and 76% (10/13) of the boys who had low self-concept
for peer relations had M-ABC scores below the 5th percentile. ADHD was
present in 43% (5/12) of the boys who had low self-concept in physical
abilities and in 69% (9/13) of the boys with low self-concept in peer
relations.
Mean self-concept scores for boys with DCD and boys with DCD and
ADHD are presented in Table 3. Boys with DCD and ADHD had significantly poorer self-concept for general school and total academic when
compared to boys with DCD.
Relationships Between Motor Difficulties and Self-Concept
Poor motor abilities were significantly associated with low self-concept
for physical abilities and reading (Table 4). Physical abilities self-concept
was significantly negatively correlated with ball skills and balance subtests
of the M-ABC (rs = −0.46, p = .001 and rs = −0.55, p = .002 respectively). There was no significant association between physical abilities
self-concept and manual dexterity scores (rs = 0.02, p = .90). Reading
16
PHYSICAL & OCCUPATIONAL THERAPY IN PEDIATRICS
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
TABLE 3. Means (SD) Self-Concept Scores for Boys with DCD and Boys
with DCD and ADHD
SDQI Domain
Physical abilities
Physical appearance
Peer relations
Parent relations
Reading
Mathematics
General school
General self
Total nonacademic
Total academic
Total self
Boys with
DCD (n = 16)
Boys with DCD
& ADHD (n = 14)
M (SD)
M (SD)
t (28)
p
27.88 (8.16)
28.00 (8.49)
29.00 (11.75)a
32.75 (6.45)
33.75 (6.35)
36.00 (7.75)a
31.50 (6.39)
32.06 (7.31)
31.00 (8.75)a
33.19 (5.72)
31.31 (5.55)
32.57 (5.65)
26.00 (9.89)
18.50 (23.00)a
31.07 (7.49)
26.92 (8.56)
32.50 (19.50)a
21.20 (7.99)
28.07 (7.89)
25.00 (13.50)a
25.57 (7.10)
27.00 (5.53)
1.81
−0.60
−1.29b
−0.66
−2.50
−1.83b
−3.81
−1.44
−0.23b
−3.25
−2.13
.08
.56
.21
.52
.02
.07
.001∗∗
.16
.82
.003∗∗
.04
a Median
(IQ) reported
value for sign test
∗
p < .05
∗∗
p < .01
bz
self-concept correlated with manual dexterity (rs = 0.39, p = .04) but not
ball skills (rs = 0.10, p = .61) or balance (rs = 0.19, p = .31). There was
no significant relationship between M-ABC scores and other self-concept
domains (Table 4).
Relationships Between Self-Concept Domains
Positive self-concept for Physical Abilities was significantly associated
with positive self-concept for physical appearance, peer relations, parent
relations and general self (Table 5). The magnitude of correlation coefficients was moderate. Age did not significantly correlate with physical
abilities self-concept (r = −0.15, p = .43).
DISCUSSION
The results indicate that boys with DCD have significantly lower selfconcept for physical abilities and peer relations when compared to a normative sample. These findings are relatively consistent with previous findings
of perceived competence for athletic and social domains in children with
Cocks et al.
17
TABLE 4. Correlations Between Movement ABC Total Motor
Impairment Scores and Self-Concept Scores for Boys with
DCD
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
Movement ABC Total Impairment (n = 30)
SDQI Domain
Physical abilities
Physical appearance
Peer relations
Parental relations
Reading
Mathematicsa
General school
General self
rs
p
−0.45
−0.02
−0.11
0.16
0.38
0.09
0.35
0.14
.01∗
.93
.57
.41
.04∗
.53
.06
.48
*p <.05
a Kendall’s tau.
DCD (Mæland, 1992; Rose et al., 1997; Schoemaker & Kalverboer, 1994).
Greater severity of motor difficulties was significantly associated with
poorer self-concept for physical abilities. Children’s perceptions appear to
be accurate when it comes to describing their motor performance, since
TABLE 5. Correlation Between Self-Concept for Physical
Abilities and Other Domains of Self-Concept for Boys with
DCD
Physical Abilities Self-Concept n = 30
Self-concept domain
r
p
Physical appearance
Peer relations
Parent relations
General school
General self
Total nonacademic
Total academic
Total self
0.64
0.46
0.38
0.18
0.58
0.75
0.10
0.58
<.0001∗∗
.01∗
.04∗
.33
.001∗∗
<.0001∗∗
.30
.0001∗∗
∗∗
∗
p < .01
p < .05
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
18
PHYSICAL & OCCUPATIONAL THERAPY IN PEDIATRICS
motor skills are measurable and can be observed by both the participant
and others (Dunford et al., 2005).
The significant relationship between severity of motor difficulties and
self-concept for physical abilities was of a slightly higher magnitude than
previously reported (Mæland, 1992; Schoemaker & Kalverboer, 1994).
While previous studies have not reported a significant relationship, this
is partly attributable to different measures used, smaller sample size, or
both. Our results indicated that boys who were more competent in ball
and balance skills had higher self-concept for physical abilities. Manual
dexterity was not associated with self-concept for physical abilities. This
result may be related to the fact that the SDQI items for physical abilities
assess self-concept for gross motor activities and not fine motor abilities
such as manual dexterity. Poor manual dexterity was associated with positive self-concept for reading. It is not clear as to why there was a significant
relationship between Reading self-concept and manual dexterity. It is possible that this is a spurious result and a confounding variable could account
for this relationship.
On average, boys with DCD had poor self-concept for peer relations,
indicating that they perceived themselves to have few friends, to be unpopular, and that they do not make friends easily. Previous studies report
poor social acceptance of children with motor difficulties (Rose et al.,
1997; Schoemaker & Kalverboer, 1994; Skinner & Piek, 2001). Collectively, these findings suggest that children with motor difficulties are at
increased risk of peer rejection and social isolation. Support from peers
is a strong predictor of self-worth, particularly during adolescence and
adulthood (Harter, 1999). As motor coordination difficulties continue into
adulthood (Rasmussen & Gillberg, 2000), this suggests that the impact of
these problems on self-concept and psychosocial functioning may potentially be long-lasting.
Boys with DCD did not have significantly lower self-concept for physical appearance when compared to the normative mean value. Other studies
have also found that children with DCD did not experience low self-concept
for physical appearance despite the possibility of their physical appearance
being “different” because of uncoordinated and awkward movements (Rose
et al., 1997; Skinner & Piek, 2001). However, it should be noted that SDQI
items for this domain focus on looks and facial appearance.
Boys with DCD and ADHD had significantly poorer self-concept for
general school and total academic than boys with DCD. Previous studies have found that the self-concept of children with ADHD for academic domains is significantly poorer when compared to boys without
ADHD (Dumas & Pelletier, 1999; Eisenberg & Schneider, 2007; Kaneko
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
Cocks et al.
19
& Okamura, 2005). ADHD is associated with poorer school performance—
children with ADHD have significantly poorer academic achievement, as
well as significantly higher rates of school absenteeism, grade retention,
and school dropouts compared to children without ADHD (Barkley, 1998;
Barbaresi, Katusic, Colligan, Weaver, & Jacobsen, 2007). In addition,
children with ADHD demonstrate poor executive functioning and have
difficulty learning, due to deficits in the acquisition of information and a
disorganized approach to encoding (Denckla, 1996; Mahone et al., 2002).
Poor school performance, as well as these cognitive impairments may contribute to the negative self-perceptions of children with ADHD and may
account for the poorer self-concept of boys with DCD and ADHD.
A limitation of our study is that responses were compared to normative
mean values rather than an age-matched control group of boys without
motor difficulties. In addition, almost half of the cohort had ADHD, which
is consistent with previous studies (Gillberg, 2003) and a few boys had
poor academic competence as measured by the teacher questionnaire. It
is possible that comorbid conditions may have confounded the results.
Studies that have examined the self-worth of children with DCD have not
reported on the frequency of ADHD or academic competence, and have not
specified whether children with comorbid conditions were excluded. Other
limitations of our study are that no formal IQ testing was conducted, which
would have provided a profile of the boys’ intellectual functioning, and
that the psychometric properties of the parent and teacher questionnaires
had not been established. Future studies could compare the self-concept of
boys with DCD, boys with DCD and ADHD, and normal-achieving male
peers. A stricter cut-off point, that is, boys with definite motor impairment
(M-ABC total impairment score < 5th percentile) could also be employed.
Self-concept of girls with DCD is also worthy of investigation as gender
differences have been found in specific domains of self-concept, especially
that of physical appearance (Marsh, Smith, & Barnes, 1985). The impact
DCD has on the self-concept of adolescents also requires further research
as during adolescence there can be a period of changing self-awareness
and self-criticism (Thompson, 1999).
In summary, the results of this study suggest that boys with DCD are
at an increased risk for developing negative self-concept about their physical abilities and peer relationships. Boys with DCD and ADHD appear
to be more likely to report poorer self-concept for academic domains.
The findings highlight the importance of examining specific domains of
self-concept. From a clinical perspective, domain-specific self-evaluations
could be incorporated into therapy sessions. Tools such as the Perceived Efficiency and Goal Setting System (PEGS; Missiuna, Pollock, & Law, 2004)
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
20
PHYSICAL & OCCUPATIONAL THERAPY IN PEDIATRICS
can assist in identifying young children’s perceptions of their abilities required for completing daily living tasks, and priority areas for intervention.
This enables the therapist to gain insight into how the child views his or
her own performance within the context of actual task performance. For
example, a child rates his or her own performance in scissor use before and
at the conclusion of a therapy session using such techniques as a 10-point
“response wheel” (Hymel et al., 1999). The 10-point rating scale is sensitive to change and allows greater response variability. An understanding of
how children with DCD perceive their abilities and performance is an essential component of goal setting for therapy intervention and monitoring
of intervention efficacy.
REFERENCES
Aickin, M., & Gensler, H. (1996). Adjusting for multiple testing when reporting
research results: The Bonferroni vs Holm methods. American Journal of Public
Health, 86, 726–728.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental
disorders: DSM-1V (4th ed.). Washington, DC: American Psychiatric Association.
Barbaresi, W. J., Katusic, S. K., Colligan, R. C., Weaver, A. L., & Jacobsen, S. J.
(2007). Long-term school outcomes for children with Attention Deficit Hyperactivity Disorder: A population-based perspective. Journal of Developmental and
Behavioral Pediatrics, 28, 265–273.
Barkley, R. A. (1998). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (2nd ed.). New York: Guilford Press.
Barnett, A. L., & Henderson, S. E. (1998). An annotated bibliography of studies using
the TOMI/Movement ABC. London: Psychological Corporation.
Bear, G. G., Minke, K. M., & Manning, M. A. (2002). Self-concept of students with
learning disabilities: A meta-analysis. School Psychology Review, 31(3), 405–427.
Bruininks, R. H. (1978). The Bruininks-Oseretsky Test of motor proficiency: Examiners
manual. Circle Pines, MN: American Guidance Service.
Burns, R. B. (1979). The self-concept. London: Longman.
Butler, R. J., & Gasson, S. L. (2005). Self esteem/self-concept scales for children and
adolescents: A review. Child and Adolescent Mental Health, 10(4), 190–201.
Byrne, B. A. (1996). Measuring self-concept across the life span: Issues and instrumentation. Washington, DC: American Psychological Association.
Croce, R. V., Horvat, M., & McCarthy, E. (2001). Reliability and concurrent validity
of the movement battery for children. Perceptual and Motor Skills, 93, 275–280.
Daniel, A. (1983). Power, privilege and prestige: Occupations in Australia. Melbourne:
Longman Cheshire.
Denckla, M. B. (1996). Biological correlates of learning and attention: What is relevant to learning disability and attention-deficit hyperactivity disorder? Journal of
Developmental & Behavioral Pediatrics, 17, 114–119.
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
Cocks et al.
21
Dewey, D., Kaplan, B. J., Crawford, S. G., & Wilson, N. (2002). Developmental
coordination disorder: Associated problems in attention, learning and psychosocial
adjustment. Human Movement Science, 21, 905–918.
Dumas, D., & Pelletier, L. (1999). Self-perception in hyperactive children. Maternal
Child Nursing, 24, 12–19.
Dunford, C., Missiuna, C., Street, E., & Sibert, J. (2005). Children’s perceptions of the
impact of developmental coordination disorder on activities of daily living. British
Journal of Occupational Therapy, 68, 207–214.
Dunford, C., Street, E., O’Connell, H., Kelly, J., & Sibert. J. R. (2004). Are referrals
to the occupational therapy for developmental coordination disorder appropriate?
Archives of Disease in Childhood, 89, 143–147.
Eisenberg, D., & Schneider, H. (2007). Perceptions of academic skills of children
diagnosed with ADHD. Journal of Attention Disorders, 10, 390–397.
Gillberg, C. (2003). Deficits in attention, motor control, and perception: a brief review.
Archives of Disease in Childhood, 88, 904–910.
Harter, S. (1985). Manual for the self-perception profile for children. Denver, CO:
University of Denver.
Harter, S. (1999). The construction of the self: A developmental perspective. New
York: Guilford Press.
Hattie, J. (1992). Self-Concept. Hillsdale, NJ: Lawrence Erlbaum.
Hay, I., Ashman, A. F., & van Kraayenoord, C. E. (1998). Educational characteristics of
students with high or low self-concept. Psychology in the Schools, 35(4), 391–400.
Heath, N. L., Toste, J. R., & Missiuna, C. (2005). An exploration of the relationship
between motor impairment and emotional/behavioral difficulties amongst children
suspected of having DCD. The Israel Journal of Occupational Therapy, 14(4),
153–171.
Henderson, S. E., & Sugden, D. A. (1992). Movement assessment battery for children.
London: Psychological Corporation.
Hymel, S., LeMare, L., Ditner, E., & Woody, E. (1999). Assessing self-concept in
children: Variations across self-concept domains. Merrill-Palmer Quarterly, 45,
602–623.
Kadesjö, B., & Gillberg, C. (1999). Developmental coordination disorder in Swedish
7-year-old children. Journal of American Academy of Child and Adolescent Psychiatry, 38, 820–828.
Kaneko, F., & Okamura, H. (2005). Study on the social maturity, self-perception,
and associated factors, including motor coordination, of children with attention
deficit hyperactivity disorder. Physical and Occupational Therapy in Paediatrics,
25, 45–58.
Mæland, A. F. (1992). Self-esteem in children with and without motor co-ordination
problems. Scandinavian Journal of Educational Research, 36, 313–321.
Mahone, E. M., Hagelthorn, K. M., Cutting, L. E., Schuerholz, L. J., Pelletier, S. F.,
Rawlins, C., et al. (2002). Effects of IQ on executive function measures in children
with ADHD. Child Neuropsychology, 8, 52–65.
Marsh, H. W. (1992). Self description questionnaire I (SDQI): Manual. Sydney, NSW:
Marsh, H.W.
Phys Occup Ther Pediatr Downloaded from informahealthcare.com by University of Montreal on 12/02/14
For personal use only.
22
PHYSICAL & OCCUPATIONAL THERAPY IN PEDIATRICS
Marsh, H. W., & Gauvernet, P. J. (1989). Multidimensional self-concepts and perceptions of control: Construct validation of response by children. Journal of Educational Psychology, 81, 57–69.
Marsh, H. W., & MacDonald Holmes, I. W. (1990). Multidimensional self-concepts:
Construct validation of responses by children. American Educational Research
Journal, 27(1), 89–117.
Marsh, H. W., Relich, J., & Smith, I. D. (1981). Self concept: The construct validity
of the self description questionnaire. Sydney: The University of Sydney. (ERIC
Document Reproduction Service No. ED210306)
Marsh, H. W., Smith, I., & Barnes, J. (1985). Multidimensional self-concepts: Relationship with sex and academic ability. Journal of Educational Psychology, 77,
581–596.
Missiuna, C., Pollock, N., & Law, M. (2004). Perceived efficacy and goal setting
system (PEGS). San Antonio, TX: Harcourt Assessment.
Piek, J. P., Baynam, G. B., & Barrett, N. C. (2006). The relationship between fine and
gross motor ability, self-perceptions and self-worth in children and adolescents.
Human Movement Science, 25, 65–67.
Piek, J. P., Dworcan, M., Barrett, N. C., & Coleman, R. (2000). Determinants of
self-worth in children with and without developmental coordination disorder. International Journal of Disability Development and Education, 47, 259–272.
Rasmussen, P., & Gillberg, C. (2000). Natural outcome of ADHD with developmental
coordination disorder at age 22 years: A controlled, longitudinal, community-based
study. Journal of American Academy of Child and Adolescent Psychiatry, 39, 1424.
Rose, B., Larkin, D., & Berger, B. (1997). Coordination and gender influences on
the perceived competence of children. Adapted Physical Activity Quarterly, 14,
210–221.
Schoemaker, M. M., & Kalverboer, A. F. (1994). Social and affective problems of
children who are clumsy: How early do they begin? Adapted Physical Activity
Quarterly, 11, 130–140.
Shavelson, R. J., Hubner, J. J., & Stanton, G. S. (1976). Self-concept: Validation of
construct interpretations. Review of Educational Research, 46, 407–441.
Skinner, R. A., & Piek, J. P. (2001). Psychosocial implications of poor motor coordination in children and adolescents. Human Movement Science, 20, 73–94.
Smits-Engelsman, B. C. M., Fiers, M. J., Henderson, S. E., & Henderson, L. (2008).
Interrater reliability of the movement assessment battery for children. Physical
Therapy, 88(2), 286–294.
Stott, D. H., Moyes, F. A., & Henderson, S. E. (1984). The test of motor impairment.
San Antonio, TX: The Psychological Corporation.
Thompson, R. A. (1999). The individual child: Temperament, emotions, self, and
personality. In M. H. Bornstein & M. E. Lamb (Eds.), Developmental psychology:
An advanced textbook (4th ed., 394–409pp). Mahwah, NJ: Lawrence Erlbaum.
Watson, L., & Knott, F. (2006). Self-esteem and coping in children with developmental
coordination disorder. British Journal of Occupational Therapy, 69(10), 450–456.