| Objective:The purpose of this study is to establish the norm and criteria of the Movement Assessment Battery for Children Chinese edition (MABC-C) for preschool children through a large sample survey in Jiangsu Province; to investigate the epidemiological status of DCD in preschool children by the diagnostic criteria of Developmental Coordination Disorder (DCD) in the Diagnostic and Statistical Manual of Mental Disease,4tb edition,revised (DSM-IV-TR); to explore the relationship between DCD in preschool children and family motor environment by the Family Environment Scale on Motor Development for Pre-school Urban Children (FESMDPU); to develop the intervention programs for preschool children with DCD, and evaluate the effects.Methods:1. This study was approved by the ethics committee of Children's Hospital Affiliated to Soochow University. All the participants were voluntary to take part in the study and signed the informed consent. From January 2012,5 cities, Wujiang, Kunshan of southern Jiangsu, Yangzhou of middle Jiangsu, Huai'an, Yancheng of northern Jiangsu, were selected as the cooperation units. Children aged 3-6 were randomly selected by the cooperation units and the movement coordination was assessed by the MABC-C test. The norm and criteria of MABC-C were then established according to research principles in health statistics.2. Using a survey focusing on children's general conditions, MABC-C, Developmental Coordination Disorder Questionnaire (DCDQ), Wechsler Preschool and Primary Scale of Intelligence (WPPSI), all the preschool children were assessed according to DCD diagnostic criteria in DSM-IV-TR. The epidemiologic status of DCD in preschool children then was estimated according to the data. Logistic regression model was used to analyze the relevance between DCD and pregnancy outcomes and home environmental factors.3. The home motor environment in preschool children was investigated by the Family Environment Scale on Motor Development for Preschool Urban Children (FESMDP). Logistic regression model was used to analyze the relevance between DCD, manual dexterity, aiming & catching, balance and home motor environment.4. A nested case-control study was set up to find out whether there is a connection between DCD in preschool children and gross motor milestones development in early childhood, in order to recognize children with DCD tendency.5. Intervention programs for preschool children with DCD were developed, on the basis of features of DCD children as well as characteristics of DCD children's home motor environment. The effects on children's overall movement coordination, manual dexterity, aiming & catching, balance ability were assessed by linear regression based on Generalized Estimating Equation (GEE) 3 months later.Results:1. To establish the norm and criteria of MABC-C1.18137 children from 25 public kindergartens of the 5 cities were randomly selected, in which 2976 from southern Jiangsu,1521 from middle Jiangsu, and 3640 from northern Jiangsu. Six children quit because of health reasons, so a total of 8,131 children completed all the items of MABC-C test.1.2 In accordance with the characteristics of children's development, the sample was divided into six age groups:3-year-old group,3.5-year-old group,4-year-old group, 4.5-year-old group,5-year-old group,6-year-old group. According to the research principle of health statistics, the raw scores of the statistically percentile were calculated, and then were converted to a standard score of 1-19 points corresponding to 0.1-99.9 percentile, with an average score of 10 points and a standard deviation of 3 points. The raw scores of subscales, manual dexterity, aiming & catching, balance, as well as the total scores, were converted to the standard scores by the same way.1.3 The "traffic light" system was developed according to the MABC-C total scores and criteria. Scores at or below 63 points were labeled as abnormal movement coordination, and were marked in red; scores among 64-71 points, including 71 points were labeled as suspicious abnormal movement coordination, and were marked in yellow; scores up 71 points, were labeled as normal movement coordination, and were marked in green.2..Epidemiologic investigation in preschool children with DCD2.1356 out of totally 7894 children were diagnosed as DCD,249 boys and 107 girls, indicating a prevalence of 4.5%, and a gender ratio of 2.3:1. The younger group (3-year-group and 4-year-old group) had a higher DCD prevalence (5.4%) than the older group (5-year-old group and 6-year-old group (3.8%), the difference was statistically significant (X2=11.137, p<0.01). DCD prevalence in boys (5.7%) was significantly higher than girls (3.1%), with X2=30.179, p<0.001. No significant differences were found among the southern, middle and northern Jiangsu (X2=4.890, p>0.05). The results suggested that, DCD had a higher prevalence in younger children, as well as in boys, but had no regional differences.2.2 Analysis showed that DCD prevalence in preterm children (6.9%), and low-birth-weight children (8.0%) was significantly higher than that in full-term children (4.4%) and normal birth weight children (4.4%), X2=6.223,6.449, respectively, p both <0.05; No significant difference was found among different mother's and father's education level groups and different family structure groups, X2=7.192,1.521,3.898, respectively, p all>0.05). One-child families had a significantly higher DCD prevalence (4.8%), than the non one-child families (3.5%), with X2=4.668, p<0.05.2.3 Logistical regression analysis showed that, excluding the confounding factors, DCD was not significantly correlated to premature birth, nor to the low birth weight (p=0.057,0.107, respectively), while one-child families were significantly associated with DCD (OR=1.359,95%CI=1.021-1.810).3. Relationship between DCD in preschool children and home motor environment3.1 In the DCD group, the scores of outdoor movement affordances, gross motor toys, and fine motor toys were all significantly lower than that of normal group, U=125380.500, 131806.500,123529.500, respectively, p all<0.01. While scores of the indoor movement affordances had no significant difference between the two groups (U=149310.000, p=0.230). Children from families with poor parenting skills had a significantly higher DCD prevalence (5.6%) than those from good parenting skills (3.5%), with X2=6.324, p=0.012.3.2 Logistic regression analysis showed that, excluding the confounding factors, outdoor movement affordances were significantly associated with DCD (OR=0.787, 95%CI=0.699-0.887); Gross motor toys were significantly associated with DCD (OR =0.833,95%CI=0.738-0.940); but indoor movement affordances, fine motor toys and parenting skills were not significantly associated with DCD (p=0.080,0.608,0.249, respectively).3.3 Logistic regression analysis showed that, excluding the confounding factors, fine motor toys were significantly correlated with manual dexterity (OR=0.892,95%CI=0.810-0.983); aiming & catching ability was significantly correlated with outdoor movement affordances (OR=0.852,95%CI=0.759-0.955), and indoor movement affordances (OR=1.269,95%CI=1.070-1.504); outdoor movement affordances were also significantly correlated with balance (OR=0.864,95%CI=0.767-0.974).4. Relationship between DCD in preschool children and early gross motor development4.1 No significant differences were found among the abnormal, suspicious, normal groups of independently sitting development, as well as the abnormal, suspicious, normal groups of independently crawling development (X2=3.566,3.356, respectively, p>0.05); but DCD prevalence in the abnormal group (9.8%) was significantly higher than the suspicious group (4.9%) and the control group (3.2%), with X2=25.422, p<0.001.4.2 Logistic regression analysis showed that, excluding the confounding factors, independently sitting and crawling development were not significantly associated with DCD (p=0.700,0.708, respectively). Independently walking retardation significantly associated with DCD (OR=2.911,95%CI=1.733-4.889).4.3 Logistic regression analysis showed that, excluding the confounding factors, children with independently walking retardation were significantly associated with manual dexterity (OR=2.264,95%CI=1.426-3.595), aiming & catching (OR=1.786,95%CI= 1.084-2.943), and balance (OR=1.716,95% CI=1.024-2.875).5. Evaluation of intervention effects on DCD in preschool children5.1 After 3-months-interverntion, compared to the scores before intervention, no significant difference was found on manual dexterity scores (t=0.287, p=0.774). But MABC-C total scores after intervention (58.17±6.13) were significantly higher than that before intervention (55.06±7.24), the aiming & catching scores after intervention (12.93±3.40) were significantly higher than that before intervention (11.83±3.27), the balance scores after intervention (28.21±5.51) were significantly higher than that before intervention (26.41±6.60), t=2.967,2.106,2.256, respectively, p all<0.05. The results suggested that, after the intervention, the scores of MABC-C, aiming & catching and balance were significantly improved.5.2 Linear regression analysis showed that, excluding intervention effects and other confounding factors, three months later, the scores of MABC-C significantly increased 1.308 units (p<0.001). Excluding basis points, time effects and other confounding factors, after intervention, the MABC-C scores of intervention group were 1.680 times higher than the scores of the control group(p<0.001), and were 1.802 times higher than the scores before intervention(p<0.001).5.3 Linear regression analysis showed that, excluding interventions and other confounding factors, three months later, the scores of manual dexterity and balance did not significantly increased (p=0.859,0.053), but the aiming & catching scores significantly increased 0.731 units (p=0.004). Excluding basis points, time effects and other confounding factors, after intervention, scores of manual dexterity and aiming & catching in the intervention group, were neither significantly higher than the scores of control group (p=0.491,0.160), nor significantly higher than the scores before intervention (p=0.348,0.269). But the balance scores of intervention group were 1.212 times higher than the scores of the control group (p=0.008), and were 1.451 times higher than the scores before intervention (p=0.004).Conclusions:1. This study has established the norm and criteria of MABC-C for the first age band. A "traffic light" system has been developed, to assess DCD in preschool children.2. The results showed a DCD prevalence of 4.5% in preschool children according to DSM-IV-TR diagnostic criteria. DCD prevalence in preschool children is related to children's age and gender, but there are no differences among the three districts. The study finds out that one-child family is the one of most important risk factors of DCD.3. Outdoor movement affordances and toys for gross motor are significantly associated with DCD, when home motor environment is concerned.4. Walking independently later than 15 months, is closely related to DCD.5.3-month intensive training can improve the balance and overall motor coordination ability in preschool children with DCD. |
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