The Study Of The Influencing Factors In Dynamical System On The Children’s Developmental Coordination Disorder

The study of the influencing factors in dynamical system on the children’s developmental coordination disorder[Objectives]Based on the "Dynamic System" Theory of Developmental Coordination Disorder, we aimed to assess the reliability and validity of the Movement Assessment Battery for Children (MABC) and construct the Family Environment Scale on Motor Development for Pre-school Urban Children(FESMDPU). Applying these quantitative tools, we would explore the influences of the factors during pregnancy and infancy and the environmental factors in family and kindergarten (class). We would study further the validity of these factors so as to provide the clues for constructing the DCD "Dynamic System" ecological intervention.[Methods]1. Through the pretest data, the items of MABC and FESMDPU were analyzed preliminarily using Critical Ratio and Exploratory Factor Analysis (EFA). Through the survey for the validity and reliability study, the test-retest reliability was analyzed using Intraclass Correlation Coefficient(ICC); the internal consistent reliability using Cronbach a coefficient. The content and construct validity were analyzed using Item-level content validity index (I-CVI) and Confirmatory Factor Analysis (CFA). When the developmental Coordination Disorder Questionnaire (DCDQ) was considered as the criteria, the criteria-related validity of MABC was assessed using the area under the ROC curve. When the Home Observation for Measurement of the Environment Revisited was considered as the criteria, the criteria-related validity of FESMDPU was estimated using the Spearman correlation coefficient.2. The above quantitative tools, the Early Childhood Environment Rating Scale-Revised (ECERS-R) and investigation table of the influencing factors during pregnancy and infancy were used in the cross-sectional study. The clustering of the data was analyzed using ICC usning the null model. The multilevel Logistic regression model was utilized to analyze the data according to the ICC. Respectively, the influencing factors on DCD during pregnancy and infancy and the environmental factors of DCD were analyzed using multilevel Logistic regression model. Moreover, the Structural Equation Model was used to assess the "structural" relationship between these influencing factors and children’s motor coordination.3. The area under the ROC curve and OR were used to analyze the validity of the above results. And the importance of the intervention was identified according to the value of the effect (OR, Structural Coefficient; Factor Loading) of each item.[Results]1. The study on the quantization tools of the dynamic system1.1 The reliability and validity of MABC1.1.1 The results of the pretest showed that the Critical Ratio of eight items were significant statistically. Three factors were acquired through EFA which were defined as manual dexterity, aiming/catching and balance. Only the factor loading of the Drawing and Walking Heels Raised were less than 0.3. However, all items reserved temporarily. Moreover, the study showed that the ICC of the other items was more than 0.9 in addition to the Drawing and Walking Heels Raised. It indicated the test-retest reliability of MABC was high. The total Cronbachαcoefficient were 0.502. And the total Cronbach a coefficient were 0.549 when the Drawing and Walking Heels were deleted. It indicated the internal consistent reliability of MABC was low.1.1.2 The formal validity and reliability study showed that the I-CVI of the eight items w ere 1.0、1.0、0.96、1.0、1.0、1.0、0.96、0.96. The average I-CVI was 0.985. This result indicated that the content validity of MABC was good. The results of the final CFA model showed that the x2=65.306, df=11,x2/df=5.937. Other index of the model’s Fit of Goodness were GFI(0.994), AGF(0.980), NFI(0.954), CFI(0.967). Each of them was above 0.9. The RMSEA were 0.036 which showed that the the model’s Fit of Goodness were good. However, according to this model, the relationship between these factors was high. So the high-step CFA of MABC was analyzed. The result of the high-step model showed that the x2=20.4, df=6, x2/df=3.406. Other index of the model’s Fit of Goodness were GFI(0.994), AGF(0.980), NFI(0.954), CFI(0.967). Each of them was above 0.9. The RMSEA were 0.036 which showed that the the model’s Fit of Goodness were good. The high-step factor could be defined as "Coordination Structure".The above results showed that the construct validity of MABC were good.1.1.3 The validity and reliability study showed that, when the age, gender and different Kaup were controlled, the areas under ROC curve of the MABC-revised total score (the items of Drawing and Walking Heels Raised were deleted) and DCDQ were different significantly (x2=110.145, P<0.001) which indicated that the value of diagnosing DCD were different between them. The MABC was better than DCDQ.1.2 The compilation and the validity and reliability study of FESMDPU1.2.1 The results of the pretest showed that the Critical Ratio of 30 items were significant statistically. However, the spearman coefficient of T17、T25～T29 was less than 0.3, and which were deleted. In addition, four factors were extracted which were defined as Outside Space, Inside Space, Toy, Parental Rearing Patterns respectively according to the results of the first EFA. The factor loadings of each items were from 0.463 to 0.803. Therefore,23 items were retained according to the EFA analysis.1.2.2 The study showed that the ICC of all items was above or close to 0.9 which indicated the test-retest reliability of MABC was high. The total Cronbachαcoefficient were 0.875. And the Cronbach a coefficient were 0.868-0.873 when each items were deleted, and the change was minimal. The results indicated the internal consistent reliability of MABC was fair.1.2.3 The formal validity and reliability study showed that I-CVI of the 23 items were 0.79～1.00. The average I-CVI was 0.92. This result indicated that the content validity of MABC was good. The results of the CFA model showed that the X2=1077.5,, df=224,x2/df=4.810. Other index of the model’s Fit of Goodness were GFI(0.949), AGF(0.937), NFI(0.889), CFI(0.896). Each of them was above or close to 0.9. The RMSEA were 0.046 which showed that the model’s Fit of Goodness could be accepted. The factor loadings were all above 0.3 with statistical significance. However, according to this model, the strength of relationship between Outside Space, Inside Space and Toy were high. So the high-step CFA of FESMDPU was analyzed. The result of the high-step model showed that the x2=1099.4, df=226,x2/df=4.864. Other index of the model’s Fit of Goodness were GFI(0.948), AGFI(0.936), NFI(0.887), CFI(0.898). Each of them was above 0.9. The RMSEA were 0.046 which showed that the the model’s Fit of Goodness were good. The high-step factor could be defined as "Family Material Environment" and "Family Rearing Environment". The above results showed that the construct validity of MABC were good.1.2.4 The results showed that the Spearman Coefficient of the total score of FESMDPU and HOME scales were 0.476 (each P<0.001). Among them only learning staff and movement variety were correlated comparatively highly with Toy, Parental Rearing Patterns. Spearman coefficient were all above 0.3 (each P<0.001)。However the Spearman coefficients of others were all less than 0.3 which could be regarded as no relationship between them.2. The analysis on the influencing factors of dynamical system in children with DCD2.1 The suspicious children were screened according to the criteria of the revised MABC when the age, gender and different Kaup were controlled. And the suspicious children were identified as DCD according to the DSM-IV. The prevalence rate of DCD were 8.3%,95%CI were 7.4%-9.0%。2.2 The multivariable analysis on the influencing factors of dynamical system2.2.1 The results of multivariable Logistic model of the pregnant factors showed that when children’s gender, age, different Kaup were included in the model as the control variables, acute fetal distress, premature and newborn pathological jaundice were included in the model (OR were 6.951,3.543,1.876, eachP<0.001).The ICC were 0.150 (95%CI为0.091-0.210) according to the null model when the ’Class’level identified as the high level. This result indicate that there was clustering at the’Class’level. Therefore, the multilevel Logistic model was used to analysis. The multilevel Logistic model result showed that when children’s gender, age, different Kaup and other variables were included in the model as the control variables, acute fetal distress, premature and newborn pathological jaundice were included in the model (OR were 7.030,3.374,1.993, each P<0.001)2.2.2 The results of multivariable Logistic model of the environmental factors showed that when children’s gender, age, different Kaup were included in the model as the control variables, Class Space and Faculty, Class Movement, Class Interaction, Family Material Environment and Family Rearing Environment were included in the model (OR were 2.612,1.483,1.581,1.519,1.337,1.876, each P<0.05). The multilevel Logistic model result showed that when children’s gender, age, different Kaup were included in the model as the control variables, Class Space and Faculty, Class Movement, Class Interaction, Family Material Environment and Family Rearing Environment were included in the model (OR were 3.486,1.840, 1.623,1.531,1.379, each P<0.05)2.2.3 The results of multivariable Logistic model of influencing factors in dynamic systems showed that when children’s gender, age, different Kaup were included in the model as the control variables, Class Space and Faculty, Class Movement, Class Interaction, Acute Fetal Distress, Premature, Newborn Pathological Jaundice, Family Material Environment, Family Rearing Environment and the interaction between Premature and Newborn Pathological Jaundice were included in the model (OR were 2.564,1.513,1.586,8.023,2.253,1.652,1.552,1.370,2.675, each P<0.05). The multilevel Logistic model result showed that when children’s gender, age, different Kaup were included in the model as the control variables, Class Space and Faculty, Class Movement, Class Interaction, Acute Fetal Distress, Premature, Newborn Pathological Jaundice, Family Material Environment, Family Rearing Environment were included in the model (OR were 3.160,1.768,1.635, 7.058,3.424,2.028,1.551,1.408, each P<0.05)2.3 The analysis on the structural relationship of the influencing factors in dynamic system2.3.1 The final SEM model reflecting the relationship between the factors during pregnancy and children’s motor ability showed that x2=44.83, df=23,x2/ df=1.949. Other index of fitting of goodness such as GFI (0.995), AGFI (0.990) were above 0.9, and NFI (0.960), CFI (0.980) were close to 0.9, RMSEA were 0.049<0.05. The result showed that the model could be accepted. And the standardized structural coefficient of the remained path of the final model (Minimal Brain Dysfunction�'Coordination Structure) were -0.18 with statistical significance.2.3.2 The final SEM model reflecting the relationship between the Class Environment and children’s motor ability showed that x2=1714.6, df=370,x2/df=4.63. Other index of fitting of goodness such as GFI (0.909), AGFI (0.903) were above 0.9, and NFI (0.885), CFI (0.898) were close to 0.9, RMSEA were 0.047<0.05. The result showed that the model could be accepted. And the standardized structural coefficient of the remained path of the final model (Class Movement�'Coordination Structure) (Class Interaction�'Coordination Structure) were 0.310, 0.114 with statistical significance. 2.3.3 The final SEM model reflecting the relationship between the family environment and children’s motor ability showed that x2=2435.394, df=369,x2/df=6.600. Other index of fitting of goodness such as GFI (0.958), AGFI (0.951) were above 0.9, and NFI (0.883), CFI (0.896) were close to 0.9, RMSEA were 0.037<0.05. The result showed that the model could be accepted. And the standardized structural coefficient of the remained path of the final model (Family Material Environment�'Coordination Structure) (Family Rearing Environment�'Coordination Structure) were 0.108,0.059 with statistical significance.2.3.4 The final SEM model reflecting the relationship between the influencing factor of dynamic system and children’s motor ability showed that x2=2435.394, df=369, x2/df=6.600. Other index of fitting of goodness such as GFI (0.958), AGFI (0.951) were above 0.9, and NFI (0.883), CFI (0.896) were close to 0.9, RMSEA were 0.037<0.05. The result showed that the model could be accepted. And the standardized structural coefficient of the remained path of the final model((Minimal Brain Dysfunction�'Coordination Structure)(Class Movement�'Coordination Structure) (Class interaction�'Coordination Structure) (Family Material Environment�'Coordination Structure) were 0.270,0.188,0.110,-0.125 with statistical significance.3. Assessing the validity of the influencing factors in "dynamical system" and constructing the ecological intervention model.3.1 According to the multivariate Logistic regression model in the previous part, the validity influencing factor model during pregnancy based on the traditional theory, the environment factor model, and the influencing factor model of dynamic system were assessed using the area under ROC curve. The result showed that the area under ROC curve of the models were different from 0.5 with statistical significance with, and they were when compared with the area under ROC curve 0.5 (P<0.001). When the three models were compared with each other, there was no difference between the pregnancy model and the environment model. But the influencing factor model of dynamic system was better than other two models with statistical significance.3.2 According to the multilevel Logistic regression model in the previous part, the validity influencing factor model during pregnancy based on the traditional theory, the environment factor model, and the influencing factor model of dynamic system were assessed using the area under ROC curve. The result showed that the area under ROC curve of the models were different from 0.5 with statistical significance with and they were when compared with the area under ROC curve 0.5 (P<0.001). When the three models were compared with each other, there was no difference between the pregnancy model and the environment model. But the influencing factor model of dynamic system was better than other two models with statistical significance.3.3 In order to establish effective and simple intervention model, each item when its attached factor’s OR was above 1.5 and were significant in the SEM and its factor loading was above 0.71 were selected as the importance of the intervention model.3.4 According to the above results, Based the influencing factor model of dynamic system whose validity was best, the DCD "dynamical system" ecological intervention model were constructed including the environment intervention, sensory integrative training and daily life motor skills training. Moreover, we would apply the "dynamical system" ecological intervention model in the three-grade prevention of DCD. Additionally, Cute Fetal Distress, Premature and Newborn Pathological Jaundice were selected in the first grade prevention. The MABC were also identified as the tools for early diagnosis of DCD[Conclusions]1. The reliability and validity of MABC were engaged in this study. The result showed that MABC could apply well in China.2. The compilation and the validity and reliability study of FESMDPU were engaged in this study. The result showed this localized scale could apply well in China.3. Trough the cross-sectional study, the prevalence rate of DCD and its distribution were acquired in this study. And the influencing factors of dynamic system were correlated with DCD. Additionally, there were structural relationship between these factors and children’s motor ability.4. The validity of the influencing factors in "dynamical system" was assessed in this study. The intervention items and the key items were identified so as to constructing the "dynamical system" ecological intervention model which would be applied in the three-grade prevention of DCD.