J Dev Phys Disabil (2011) 23:439–458

DOI 10.1007/s10882-011-9239-z
O R I G I N A L A RT I C L E

Children with “Dyspraxia”: A Survey of Diagnostic
Heterogeneity, Use and Perceived Effectiveness
of Interventions
Motohide Miyahara & G. David Baxter

Published online: 19 April 2011
# Springer Science+Business Media, LLC 2011

Abstract A survey was distributed to parents at a conference organized by a
dyspraxia support group, and mailed twice to the members with the support group’s
newsletters. Of 118 respondents, 84% reported that their children were diagnosed
with dyspraxia, whereas 25% stated that their children’s diagnosis was developmental coordination disorder. All respondents were using food supplements.
Moreover, 69% of respondents sent their children to unconventional education or
therapy, and 57% provided their children with some form of complementary and
alternative medicine (CAM). In terms of perceived effectiveness of interventions,
about half of the parents (53%) reported improvement of physical skills and
attributed such progress to standard intervention in the mainstream health care and
education systems in New Zealand. Despite popular use, effectiveness of
unconventional education, therapy, or CAM was rarely considered. These findings
have important implications for parents, health and educational service providers,
policy makers, and funding bodies.
Keywords Survey . Dyspraxia . Developmental coordination disorder . Motor
coordination . Complementary medicine

Parents have great influence on decision-making for their children’s health and
choice of educational products and services. One of the key factors in the

M. Miyahara (*)
School of Physical Education, University of Otago, PO Box 56, Dunedin 9054, New Zealand
e-mail: motohide.miyahara@otago.ac.nz
G. D. Baxter
School of Physiotherapy, University of Otago, PO Box 56, Dunedin 9054, New Zealand

440

J Dev Phys Disabil (2011) 23:439–458

decision-making is their beliefs about service and product benefits, or perceived
effectiveness of interventions in case of children with developmental disabilities.
One of the less explored developmental disabilities, collectively named dyspraxia
by parental support groups in Australia, New Zealand, and the UK is the focus of
our interest. Their broad definition of dyspraxia refers to a core movement
disorder, and encompasses other developmental disorders and comorbid conditions which cover almost all childhood disorders in the formal classification
manuals (Peters et al. 2001). Below we will outline the context to the present
study, including the reasons why a broad definition of dyspraxia came to be used,
and why it is timely and important to investigate diagnostic heterogeneity,
interventions that these children receive, and how parents perceive the effectiveness of such interventions.
The term, motor dyspraxia has been traditionally used to refer to the problems of
motor sequencing and selection exhibited by adult patients with acquired brain
lesions, despite their intact motor systems (Miyahara and Möbs 1995). Neuropsychologists originally defined and assessed dyspraxia in terms of a disorder of
gestural performance on verbal and imitation command (Dewey 1995; Hill 1998;
Miyahara, Leeder, Francis, & Inghelbrecht, 2008 ). The term has since been assigned
at least two new and extended meanings. First, it was used for children with dyslexia
when they evidenced motor learning difficulties (Orton 1925). Based on its
etymology, the term was also applied to the inability to execute a variety of
functional activities, such as dressing, drawing figures, and gait (Miyahara and Möbs
1995). Some therapists use dyspraxia for a broad range of sensory and motor
disorders rather arbitrarily (Cummins 1991). Parents’ support groups follow this
trend to extend the meaning of dyspraxia, and use the term for all sorts of
developmental disorders (Peters et al. 2001). As the meaning of dyspraxia expands,
no single assessment process is capable of diagnosing dyspraxia, and therefore,
holistic individual assessment is recommended (Sweeney 2007). In sum, a specific
neuropsychological definition of dyspraxia refers to a disorder of motor sequencing
and selection, whereas the lay use of dyspraxia extends to a wide variety of
childhood disabilities.
Dyspraxia is the term preferred by parents (Miyahara and Register 2000; Peters et al.
2001). It is widely accepted that existing health care and educational systems do not
sufficiently recognize and manage such children’s difficulties, even in developed
countries, such as Australia (Hands and Larkin 2001), New Zealand (Miyahara 2001)
and the UK (Henderson et al. 1991). To address such limited services provision,
parents typically form groups to support each other by sharing information and
resources, promoting social awareness, and lobbying for better habilitation services.
In contrast, developmental coordination disorder (DCD) has been more
specifically and exclusively defined in the Diagnostic and Statistical Manual of
Mental Disorder (DSM-IV-TR)(American Psychiatric Association 2000). Diagnostic
criteria stipulate the severity of poor motor coordination: it must significantly
interfere with activities of daily living and academic achievement after chronological
age and measured intelligence are taken into consideration. Performance levels are
often assessed with standardized motor performance tests and questionnaires, such
as the ones included in the Movement Assessment Battery for Children-Second
Edition(Henderson et al. 2007). Differential diagnosis is also used to distinguish

J Dev Phys Disabil (2011) 23:439–458 441 DCD from medical conditions that cause motor incoordination (e. 2002). and behavioral problems (Wolraich 1997). Health consumers have also been advised to be wary of treatments that make claim to a broad range of effects (Golden 1984). Gottlieb 1989). Rosenbaum 2003). The principle of direct skill training has been also applied to the remediation of various functional skills in intellectual and developmental disabilities in educational and rehabilitation settings (Davis and Rehfeldt 2007). Nonetheless. If a child has dual diagnoses of attention deficit hyperactivity disorder (ADHD) and DCD for a handwriting problem. sensory integration therapy and perceptual motor training have been considered controversial (Sugden and Dunford 2007) and ineffective (Kaplan et al. for this particular reason. and severe physical disabilities (Liptak et al. In addition to the standard treatment. Hanson et al. 2010). occupational or physical therapist. the standard treatment of behavioral modification and stimulant medication may be prescribed for ADHD. cerebral palsy. 2005. the absence of evidence of effectiveness. Vos et al. for example. and potential harm (Ernst 2003. and health consumers’ empowerment in contemporary postmodern society (Chan and Chan 2000. Bridging the gap in the knowledge base is important because such information will useful for stakeholders to understand the diagnoses that the concerned children receive and the parents’ consumer behavior. medical specialists have issued warnings against the use of controversial treatments for ADHD (Gottlieb 1989). Wolraich 1997). 2003). 2006). Liptak et al. specific learning disabilities (Golden 1984. based upon the lack of a sound theoretical base. This is controversial. and mental retardation (MR).. the diagnosis of the comorbid condition of DCD with PDD or MR has been avoided. 1991. Diagnostic heterogeneity and comorbidity of developmental disabilities thus depend on diagnostic criteria that can be artificial and unstable. Investigation of the use of CAM for developmental disabilities has been limited to autism spectrum disorder (75%) (Green et al. and Green 2008). the functional skill approach is considered legitimate if the intervention is conducted to remediate functional motor tasks (Sugden and Dunford 2007). 2006. and handwriting training may be arranged with a remedial education teacher. pervasive developmental disorders (PDD). the exclusive criteria of PDD and MR are no longer listed in the proposed DSM-5 (American Psychiatric Association. 1993. Smith et al. the possible waste of time and money.g. the comorbid condition of DCD with PDD or MR will become acceptable. specific learning disabilities (55%) (Bull 2009). Yamaguchi. and behavioral problems (Gottlieb 1989. Golden 1984). ADHD (54%) (Chan et al. While empathizing with parents’ disappointment in conventional treatments. The data on the parents’ perceived efficacy for . Hence. For treatment of movement problems in children with DCD. comorbidity may be useful for indicating a full range of treatment options (First 2005) and strategies (Miyahara. However. If the currently proposed changes are made in DSM-5. as in the case of DCD. Polatajko et al. muscular dystrophy). Kavale and Mattson 1983. children with dyspraxia may also be given complementary and alternative medicine (CAM). 2007. No research has been conducted to survey the use and the perceived effect of CAM interventions for children labeled as having dyspraxia. parental stress (Gottlieb 1989). 2005) in improving learning disorders (Golden 1984).

We adapted the questions about demographic information on the basis of New Zealand Census (Table 2). 2005. we decided to use a questionnaire previously used by Quinn et al. Green et al. psychologists. Hanson et al. Liptak et al. named Connection. 2003. 2006. and for the nature of our sample. 2006. Weber et al. 2008). and professionals in New Zealand. physiotherapists. The US brand names for prescription medications were converted to New Zealand trade names by an experienced child psychiatrist who had worked in both USA and New Zealand. 2007. developmental disabilities (Table 3). and resource teachers are an integral part of the mainstream educational system in New Zealand. of which 260 members subscribed to the group’s newsletter. Materials Survey Questionnaire Development After reviewing all available CAM survey studies on developmental disabilities (Chan et al. Liptak et al. including parents. and specific learning disorder lessons/remedial training conducted by occupational therapists. Australia. 2008) in our prototype questionnaire. and other countries. and increasing awareness and understanding of dyspraxia. sensory integration. 2005. and therefore. (2008) as a template for our study because we found the format of the questionnaire (Table 1) most suitable for the purposes of our study. and included all interventions appeared in the existing CAM survey studies on developmental disabilities (Chan et al. 2007. This was formed in 1992 to help parents support each other by sharing information and resources. . included in the section of therapy and education instead of the CAM section.442 J Dev Phys Disabil (2011) 23:439–458 individual treatment would also help other parents to make informed decisions. A list of prescribed medication (Table 5) was based on the list in the survey conducted by Hanson et al. Although perceptual motor program (PMP) and sensory integration are controversial (Sugden and Dunford 2007). 2003. Membership was over 800. To produce such knowledge. this survey study aimed to answer the following research questions: & & & What kinds of diagnoses do such children receive? What kinds of interventions do the children receive? What are parents’ perceptions of intervention effects with regard to academic performance and problem domains? Methods Participants Respondents (N=118) for this survey were a purposive cluster sample of parents and care givers who were affiliated with the Dyspraxia Support Group of New Zealand. Weber et al. he also suggested additions and deletions of medications possibly used by children with dyspraxia. PMP. Hanson et al. care givers. Green et al. (2007).

J Dev Phys Disabil (2011) 23:439–458 443 Table 1 Questionnaire outline and exemplary questions. and the president of the Dyspraxia Support Group of New Zealand who had over a decade of experience in consulting the group members. The latter person had . the prototype questionnaire was reviewed by the International Scientific Committee members of the Developmental Coordination Disorder Research Group. Excerpts from the instruction: You are invited to complete all of the following questions about yourself and your child’s intervention…This survey is entirely voluntary…There are no right or wrong answers…Your response will only be used for the purposes of this research and will be treated in the strictest confidence l l l l l l l l l l l l ll l l l l l l l l l l l l l l l l l l l l l l l ll l l l I I l l l l Pilot Prior to the main survey.

000 35 34 38 $20. 5. (2007). 10. following the CAM survey conducted by Hanson et al. Time reference was not asked for . and they suggested that a yes/no question would be easiest for a majority of parents in New Zealand to respond. the pilot respondents found this format difficult to answer. Perceived effectiveness was originally asked on a five point Likert scale. 6).001 . In the past. handwriting) was followed by a question to elicit the name of specific intervention used (Tables 7. The prototype questionnaire was also piloted by five parents whose children attended the Movement Development Clinic at the University of Otago. 11. parents from the same support group had also experienced difficulties in responding to the semantic differential scale used by Miyahara and Register (2000). Each question asking perceived improvement in specific area (e. the questionnaire was subsequently revised by deleting unknown intervention items and adding available but missing intervention items (Tables 4.g.. 9..444 J Dev Phys Disabil (2011) 23:439–458 Table 2 Sample(N=118) characteristics in comparison with the percentage of 2006 New Zealand census data Female (n=117) Sample (n) % Population % 109 93 53 0 0 36 Age in year (n=116) < 25 25 . 8.000 18 17 27 >$40. 12).44 47 40 15 >45 63 54 36 Ethnic group (n=116) European 106 91 65 Maori 4 3 14 Pacific people 4 3 7 Asian 2 2 9 Highest Education (n=69) Doctorate degree 0 0 1 14 12 2 2 2 2 Bachelor degree and level 7 qualification 37 53 37 Level 5–6 diploma Masters degree Post-graduate and honors degrees 11 10 8 Level 1–4 certificate 1 8 39 No qualification 4 3 22 < $20.$40.g.001 50 49 24 Income (n=103) n is the number of participants who responded to the item assisted a former survey study involving the group members (Miyahara and Register 2000). Therefore. motor coordination) or skill (e. and understood the challenges of eliciting responses from the group members.34 6 5 13 35 . we decided to use a yes/no question format. Based on their feedback. However.

J Dev Phys Disabil (2011) 23:439–458 445 Table 3 Percentage of respondents whose children received single or dual diagnoses Diagnosis n % Dyspraxia (incl. autism. time durations after interventions. The survey of group members was completed in two phases: the first phase . we aimed to assess the parents’ subjective impression of improvement from each intervention. apraxia) 99 84 Developmental coordination disorder (DCD) 29 25 Specific learning disabilities/disorders 26 22 Attention deficit hyperactivity disorder 22 19 Pervasive developmental disorders (incl. Procedures Questionnaires were distributed through the Dyspraxia Support Group of New Zealand. Instead. Asperger) 20 17 Dyslexia 13 11 Dysgraphia 6 5 Mental retardation/intellectual disabilities 7 6 Oppositional defiant disorder 6 5 Dyscalculia 5 4 Epilepsy 3 3 Cerebral palsies 2 2 Conduct disorder 1 1 Dyspraxia and DCD 23 19 Dyspraxia and specific learning disabilities/disorders 23 19 Dyspraxia and pervasive developmental disorders 16 14 Dyspraxia and dyslexia 11 9 Dyspraxia and mental retardation/intellectual disabilities 5 4 Dyspraxia and oppositional defiant disorder 5 4 Dyspraxia and dyscalculia 5 4 Dyspraxia and attention deficit hyperactivity disorder 3 3 Comorbid condition with dyspraxia Dyspraxia and dysgraphia 3 3 Dyspraxia and cerebral palsies 2 2 Comorbid condition with DCD DCD and specific learning disabilities/disorders 8 7 DCD and attention deficit hyperactivity disorder 7 6 DCD and dyslexia 4 3 DCD and dysgraphia 4 3 DCD and dyscalculia 2 2 DCD and oppositional defiant disorder 1 1 improvement because of multiple factors involved in the timing. and the accuracy of memory. such as the ages of children.

and herbal remedies Used intervention n % Food supplements Fish oil 44 37 Omega 3 fatty acids 42 36 Evening primrose oil 9 8 Pycnogenol 1 1 Blue green algae 1 1 Other food supplements 6 5 Modifieddiet Removal of foodadditives 15 13 Wheat free 12 10 Megavitamins 8 7 Sugar free 3 3 Feingold 2 2 Mineral therapy 2 2 Vegan 0 0 17 14 Otherdiet Herbal remedies St. A total of 54 parents (22% of attendees) either returned the forms via the dropbox. The instruction for the questionnaire asked the subscribers to respond to the questionnaire only if they have not responded before. and a drop box was placed at the registration desk. or mailed the forms to the researchers using the attached self-addressed envelopes by the end of October 2007. During the conference. 2007 and April. John’sWort 3 3 Valerian 1 1 Kava 1 1 Ginseng 1 1 Gingkobiloba 1 1 Chamomile 1 1 Wild OatSeed 0 0 Skullcap 0 0 Other Herbal Remedies 8 7 during the New Zealand Dyspraxia conference. By the end of January. New Zealand from 5th-7th October. In December. As part of the first phase. questionnaires along with self-addressed stamped envelopes were included in conference bags and distributed to all participants (n=250) at the registration desk of the Fourth National Dyspraxia Conference held in Christchurch. modified diet. 24 forms (9%) were . questionnaires were mailed with the group’s newsletter Connection to all subscribers (n = 260). participants were encouraged to respond to the survey by announcements and posters.446 J Dev Phys Disabil (2011) 23:439–458 Table 4 Use of food supplement. 2008. 2007. 2008. and the second phase through the group’s newsletter distribution.

Melatonin. Weber et al. Loxamine) 7 Clonidine (Dixarit. and a further 40 forms (15%) were returned by the end of April. 2006. Statistical Analysis In keeping with previous CAM surveys on developmental disabilities (Chan et al. we were unable to determine the overall response rate. Catapres) 5 4 Dexamphetamine 5 4 Fluoxetine (Fluox. Lactose. . the multivariate frequency distributions of different interventions are not analyzed. Liptak et al. 2008. Because of a large number of intervention items in the survey questionnaire and the focus of the present study. Hanson et al. Percentage data were not included for the questions as to perceived effectiveness because low and variable response rates in this section could create confusions between percentages of the total respondents (N=118). Green et al.J Dev Phys Disabil (2011) 23:439–458 447 Table 5 Use of prescribed medication Medication (Brand name) n % Paroxetine (Aropax. Inferential statistics were not performed due to the descriptive nature of this study. Prozac) 4 3 Sodium Valproate (Epilim) 4 3 Carbamazepine (Tegretol) 3 3 Risperidone (Risperdal) 2 2 Methylphenidate (Concerta. 2008). Rubifen) 1 1 11 9 Othera 6 a Other medication consisted ofcitalopram (Celapram). Because of two different sources of samples. 2003. 2007. and Lithium returned. Ritalin. but noteworthy observations are described in the Results section. The final sample consisted of 118 respondents. All respondent parents were 25 years of age or older. and varying numbers of respondents to different questions. Results Sample Characteristics Characteristics of the sample are presented in Table 2 in comparison with data from the census of New Zealand population in 2006. microlax. member attrition and initiating new members. Flixotide. 2005. A relatively large proportion consisted of European descendants educated at university levels and earning upper middle to high personal income compared to the general New Zealand population. and mothers constituted 93% of the sample. ibuprophen (Rubiprofen). only descriptive statistics were performed using frequencies and percentages.

and dyslexia (10%). followed by DCD (25%). Diagnoses of both dyspraxia and DCD have been given to 23 children. children . specific learning disabilities/disorder (22%). 19% of the sample. ADHD (19%). Consistent with the exclusion criteria of the current DSM. pervasive developmental disorder (PDD) (17%). Of the children represented by parents in the sample. dyspraxia is the most common diagnosis (84%).448 J Dev Phys Disabil (2011) 23:439–458 Table 6 Use of therapy and education Used intervention n % Occupational therapy Sensory integration 62 53 I don’t know the detail 39 33 Cognitive orientation too ccupational performance (COOP) 10 8 2 2 19 16 I don’t know the detail 23 19 Sensory integration 23 19 Bobath Other occupational therapy Physiotherapy Bobath 4 3 Doman-Delacato patterning 1 1 Kabat 0 0 Other physiotherapy 8 7 Specific learning disorder lessons/remedial training 27 23 Behavior therapy (Applied behavior analysis) 11 9 Clinical psychology 11 9 Cognitive behavior therapy 8 7 I don’t know the detail 7 6 Psychotherapy 2 2 Behavior therapy (TEACCH) 1 1 Other psychology 8 7 Brain gym (applied kinesiology) 42 36 Optometric training 23 19 Musictherapy 12 10 Chiropractic 9 8 Dance/movement therapy 9 8 Art therapy 7 6 Dore 7 6 Conductiveeducation 4 3 Mindfulness training 0 0 Psychology Alternativetherapy and education Diagnosis Characteristics of the sample by diagnosis are summarized in Table 3.

J Dev Phys Disabil (2011) 23:439–458 449 Table 7 Use of complementary and alternative medicine (CAM) Intervention used n % Osteopathy 23 19 Homeopathy 20 17 Massage/bodywork 12 10 Craniosacraltherapy 8 7 Meditation/Relaxation response 6 5 Hypnotherapy (guidedimagery) 6 5 Faith/Spiritual Health 5 4 Aromatherapy 5 4 Reflexology 3 3 Healer/healingtouch 3 3 Biofeedback 3 3 Yoga 2 2 Alexander Technique 2 2 Shiatsu/Acupressure 1 1 Prayer/shaman 1 1 Acupuncture 1 1 Tai Chi/Qui Gongs 0 0 Rolfing 0 0 Table 8 The breakdowns of frequency (n=69) for responses to the question: Did your child’s physical coordination improve? and the descriptions to the question: Which intervention do you think helped the improvement? Response Frequency Yes 62 Intervention used Occupational therapy Physiotherapy Frequency No 7 Intervention used 15 5 Sensory integration 4 PMP 3 Brain gym 2 School education 1 Optometric training 1 Brain gym 1 Cranial osteopathy 1 Movement clinic Response 1 No description 28 No description 7 Subtotal 62 Subtotal 7 PMP Perceptual motor programme .

and 5 children with dyspraxia also had MR. In contrast.450 J Dev Phys Disabil (2011) 23:439–458 Table 9 The breakdowns of frequency (n=68) for responses to the question: Did your child’s hand writing improve? and the descriptions to the question: Which intervention do you think helped the improvement? Response Frequency Response Frequency Yes 58 No 10 Intervention used Occupational therapy School education Intervention used 16 5 Typing 3 Physiotherapy 2 Optometric training 2 Brain gym 2 Cranial osteopathy 1 PMP 1 Sensory integration 1 Educational psychology 1 No description 24 No description 10 Subtotal 58 Subtotal 10 PMP Perceptual motor program with DCD have not been diagnosed with PDD or MR. 16 children with dyspraxia received the dual diagnoses of PDD. Table 10 The breakdowns of frequency (n=61) for responses to the question: Did your child’s achievement in physical education improve? and the descriptions to the question: Which intervention do you think helped the improvement? Response Frequency Yes 52 Intervention used Occupational therapy Frequency No 9 Intervention used 14 Physiotherapy 8 Sensory integration 3 No specific intervention 2 PMP 2 School education 2 Brain gym 1 Cranial osteopathy 1 Movement clinic Response 1 No description 18 No description 9 Subtotal 52 Subtotal 9 PMP Perceptual motor program .

and vitamin C. Under ‘other diet’. homeopathy. Few used herbal remedies. unknown Oriental Table 12 The breakdowns of frequency (n=34) for responses to the question: Did your child’s achievement in math improve? and the descriptions to the question: Which intervention do you think helped the improvement? Response Frequency Response Frequency Yes 22 No 12 Intervention used Intervention used School education 5 No specific internvention 3 Occupational therapy 3 Number works 2 Kumon 2 Physiotherapy 1 Speech therapy 1 No description 5 Subtotal 22 Cranial osteopathy 1 No description 11 Subtotal 12 . dairy free. More than one third of the sample used fish oil and Omega 3 fatty acids. horseradish. food supplements were more popular than modified diet and herbal remedies. Effalex. several listed Bryophyllum Argento Cult. garlic. Supplements reported in the ‘other food supplements’ category included calcium. organic.J Dev Phys Disabil (2011) 23:439–458 451 Table 11 The breakdowns of frequency (n=45) for responses to the question: Did your child’s achievement in music improve? and the descriptions to the question: Which intervention do you think helped the improvement? Response Frequency Yes 31 Intervention used Response Frequency No 14 Intervention used Music lesson/therapy 4 Occupational therapy 3 No specific internvention 2 School education 2 Physiotherapy 1 Cranial osteopathy 1 Optometric training 1 No description 17 No description 14 Subtotal 31 Subtotal 14 Interventions As shown in Table 4. multivitamin. flax seed oil. Failfree diet and gluten free diet were reported. cod liver oil. Approximately 10% of the sample removed food additives and wheat from children’s diet. dietician monitoring fat content.

Some form of CAM was provided by 57% of the respondents to their children. Among the conventional therapies. Carbamazepine). and massage/body work (10%). and sleep remedy under ‘other herbal remedies’. Methylphenidate). and the other 49 (42%) made no response or chose the “not applicable” response (Table 8). and cognitive behavior therapy (7%) were the most commonly used interventions. 7 (6%) in the negative. A combined total of 9% used medication for ADHD (i. meditation and relaxation response (5%). sensory integration was jointly ranked first (19%) with “I don’t know the detail” response. Approximately 9% of the sample reported that their children used serotonin reuptake inhibitors (SSRI) for anxiety and depression (i. Perceived Efficacy In response to the question as to whether or not any intervention improved physical coordination. and aggression (e. Among those 62 parents who answered in the affirmative.452 J Dev Phys Disabil (2011) 23:439–458 herbs. Use of prescribed medication is summarized in Table 5. clinical psychology (9%). such as music therapy (10%). these were therefore used by minorities in the sample. Among the alternative therapy and education interventions in Table 6. lactose and microlax to ease constipation. a mood stabilizer. Medication for the management of psychosis and aggression (i.g. 5 parents . dance/movement therapy (8%) and art therapy (6%) are an integral part of standard medical care in the USA. those that are considered controversial. With regard to physiotherapy. mood changes.. A combined total of 6% of the sample reported use of medication commonly prescribed to control epilepsy. 15 parents thought occupational therapy helped their children’s physical coordination. specific learning disorder lessons/remedial training (23%). Overall.e. The popularly used forms of CAM were osteopathy (19%). Dexamphetamine. Paroxetine. Among the orthodox psychological interventions.e. followed by craniosacral therapy (7%). Flixotide to control asthma. when we browsed the raw data. melatonin (commonly used for insomnia).. Rocket tablets. Expressive art therapies. ibuprofen for pain control.e. Though not possible to deduce from Table 4. Fluoxetine). and hypnotherapy and guided imagery (5%). it caught our attention. Sodium Valproate. 69% of respondentssent their children to at least one of the unconventional education or therapy. but are not yet part of standard health care in New Zealand. A wide variety of other CAM was also used by a small number of the sample as detailed in Table 7. 62 parents (53%) answered in the affirmative. occupational therapy was most popular. Table 6 shows therapies and educational interventions ranging from conventional to non-conventional with the numbers of respondents who used these. One third of the sample was uncertain about the specific approach of occupational therapy. and more than half of the sample reported that the therapists had used sensory integration. namely Brain Gym (Educational Kinesiology) (36%) and optometric training (19%) were most widely used. and lithium.. behavior therapy (applied behavior analysis) (9%).. Clonidine. homeopathy (17%). that all 118 respondents had reported their use of at least one food supplement. rescue remedy. Risperidone) was used by 2% of the sample. Under the heading of “Other medication” a subtotal of 9% of the sample listed the following medications: another SSRI called Celapram.

This response pattern indicates that those interventions that are perceived as most effective are conducted by therapists working in the mainstream health care system in New Zealand. To be more specific. most commonly due to school education (9 respondents). enhanced achievement in physical education was reported by 52 parents (44%) who most commonly attributed the improvement to occupational therapy (14 respondents). By contrast. Improved music achievement was reported by 52 parents (44%). most frequently from school education (5 respondents) (Table 12) and reading improved in 55 respondents (47%). about half of the parents (53%) reported improvement of physical skills and attributed such progress to occupational therapy. such as math. Progress in physical and non-physical domains indicated Table 13 The breakdowns of frequency (n=63) for responses to the question: Did your child’s reading improve? and the descriptions to the question: Which intervention do you think helped the improvement? Response Frequency Yes 55 Intervention used Response Frequency No 8 Intervention used School education 9 Occupational therapy 5 Optometric training 5 No specific intervention 3 Brain gym 1 Davis method 1 Kyp McGrath lessons 1 Cranial osteopathy 1 No description 30 No description 8 Subtotal 55 Subtotal 8 . improved handwriting was reported by 58 parents (49%) and ascribed most frequently to occupational therapy (16 respondents) and school education (5 respondents) (Table 9). The seven parents who answered in the negative did not specify which intervention failed to improve their children’s physical coordination. Music is another subject that demands physical coordination. and school education which are all part of the mainstream health care and education systems in New Zealand. improved in 22respondents (19%). occupational therapy (5 respondents). physiotherapy (8 respondents). school subjects with little physical component. and sensory integration (3 respondents) that was presumably conducted as part of occupational therapy and physiotherapy (Table 10). In summary.J Dev Phys Disabil (2011) 23:439–458 453 mentioned physiotherapy. physiotherapy. especially when children play musical instruments. With regard to the school subjects with strong physical components. most commonly as a result of music lesson/therapy (14 respondents) and physiotherapy (8 respondents) (Table 11). and optometric training (5 respondents) (Table 13). Some of the parents who made no response or chose the “not applicable” response reported in Section D that their combined use of different intervention methods made it impossible for them to determine which one was working. and 4 parents listed sensory integration (which is administered by occupational therapists or physiotherapists).

and reported ineffectiveness. adolescence. the limitations of the study and future research directions follows. depression. A discussion of the possible relation between the comorbid conditions and the parental definition of dyspraxia. 2003. Except for the accepted comorbidity of DCD with ADHD for example. and mood disorders. but also with other comorbid developmental disorders. movement problems may not be specifically acknowledged and attended in children with MR or PDD. ranging from ADHD. Frequency of the diagnosis of dyspraxia was three times more than the frequency of the diagnosis of developmental coordination disorder (DCD). This finding echoes and substantiates the statement by Peters et al. severe physical disabilities (Liptak et al. 2007) that reported a high prevalence of CAM use (70%) among the child patients of general practice surgeries and a paediatric diabetes clinic. and cerebral palsies.454 J Dev Phys Disabil (2011) 23:439–458 the domain-specific nature of perceived intervention effects. and stronger beliefs about the general harm of conventional medicines. oppositional defiant disorder. for instance. The effect of alternative education. Liptak et al. aggression. (2001) that the parental definition of dyspraxia seems to cover a wide variety of childhood disorders. Rosenbaum 2003). New Zealand (Wilson et al. Discussion This study surveyed parents who were affiliated with a dyspraxia support group. This may be due to the stringent criteria of DCD (American Psychiatric Association 2000) which excludes mental retardation (MR). or adulthood. It is noteworthy that some of the children with dyspraxia or DCD seem to have neuropsychiatric disorders. 2007. Because the present survey did not ask when medications were first prescribed. parental use of CAM. 2006. Weber et al. 2006). over half of the sample used alternative interventions. These seemingly unrelated disorders may share common underlying processes. Hanson et al. pervasive developmental disorders (PDD). Despite their controversial nature. About a half of the parents perceived conventional therapies and school education as effective. 2008). thus drawing attention to the motor domain of the children with MR and PDD. Diagnostic heterogeneity among children with dyspraxia is present in the lists of diagnoses and prescription medications given. High prevalence of CAM use revealed in our study is consistent with other disability groups. The study also found that female parents accompanying the children. early identification. it is difficult to determine whether these disorders started during childhood. or medicine was rarely reported. It turned out that many of their children were not only diagnosed with dyspraxia or DCD. ADHD (Chan et al. and a recent study in Christchurch. and psychology. and management of the other. increased household income. were . higher parental education. It would be an interest of future research to investigate the onsets of neuropsychiatric disorders in relation to the timing of movement disorder. such as autism spectrum disorder (Green et al. This may be why the term dyspraxia is used to allow comorbidity of movement difficulties with MR and PDD. and the identification of one disorder may help the prediction. 2005. epilepsy. and some parents were unaware of the specific intervention methods used in occupational therapy. therapy. physiotherapy.

Throughout the descriptive studies runs a common thread that CAM users are often highly educated. the reader needs to be mindful of this sample bias. the prevalence and varieties of intervention we found may be overestimated compared to the population average in terms of frequencies. For example. and personal income. At best. and that the group promoted sensory integration therapy over other interventions. they probably would not have been involved in the parental support group. most research has not been driven theoretically. The first author’s interview with the president of the support group revealed that the group preferred the label of dyspraxia to DCD. To relate our findings to different societies in the world. Therefore. In line with this study. This bias will inform us the world views from the parents’ perspectives. This survey successfully uncovered such parents’ views.J Dev Phys Disabil (2011) 23:439–458 455 significantly associated with CAM use. and Barrett 2008). attitudes. if they were fully satisfied with existing health care and educational support. such as impulsivity and poor handwriting (Miyahara. the notion of cooccurring disorders within a child can be confusing for the parents who see their child as a whole person. and behaviors. The majority of our sample is also female. not as a collection of different disabilities. well off. Given perceived effectiveness of conventional intervention. These seemingly contradictory behaviors need to be explained by theoretical models that could predict and possibly control the phenomenon. our sample could be skewed towards those parents who are actively seeking diagnosis and treatment for their children. of high income. First of all. Piek. our results are based on parent reports and perceptions. Even if a child has multiple problems over different domains. our sample perceived conventional health care and educational support as being effective: CAM was rarely identified as associated with their children’s improvement. we sampled our respondents through the Dyspraxia Support Group of New Zealand. There are several limitations in our study. our sample may well be disillusioned with conventional medicines. associations between CAM use and the characteristics of the users have been investigated. Arguably. the theories of reasoned action and planned behavior were tested for their predictive utility for the intention to use CAM (Furnham and Lovett 2001). we need to consider the influence of the support group on the diagnosis and treatment. Paradoxically. age. and report relative ineffectiveness of CAM. the behavioral and motor difficulties may seem to be interrelated in the child rather than co-occurring separate . and highly educated. future theory-driven studies should investigate the entire process involved in the intervention users’ beliefs. nor the rest of the world. they are probably not representative of all parents whose children have dyspraxia in New Zealand. albeit possibly different from the views of clinicians and researchers. It is possible that those parents who are not affiliated with the support group may leave their children’s condition undiagnosed and untreated. Being involved with the support of their children. are descriptive in nature. However. Secondly. including this study. ethnicity. While comorbidity of developmental disorders is the rule rather than the exception. why do parents still resort to spending extra money on CAM? Most CAM studies. Although parental use of CAM has not been asked in our study. Although our sample covers a wide variety of people in terms of gender. education. which may be subject to bias and are of unknown accuracy and validity for the diagnosis and treatment efficacy. Thirdly. or simply rely on mainstream services.

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