Odkrivanje in celostna specialno pedagoška diagnostična ocena petletnih otrok z razvojno motnjo koordinacije ; Screening and a comprehensive special educational diagnostic assessment of five-year-old children with developmental coordination disorder

Razvojna motnja koordinacije (v nadaljevanju RMK) je nevrorazvojna motnja, za katero so značilne težave pri učenju in izvajanju koordiniranih gibalnih spretnosti. Le-te se odražajo kot nerodnost, upočasnjenost in kot nenatančnost pri izvajanju gibalnih aktivnosti. Te težave tudi pomembno in vztrajno vplivajo na aktivnosti v vsakdanjem življenju, na učni uspeh, na predzaposlitvene in zaposlitvene aktivnosti, na prosti čas in igro. Tovrstne težave pri izvedbi določenih gibalnih spretnosti so vseživljenjske in niso progresivne. Simptomi RMK se pojavljajo že v zgodnjem razvojnem obdobju in niso odraz motnje v duševnem razvoju ali motnje vida oz. ne pripadajo nevrološkemu stanju, ki vpliva na gibanje. RMK se pojavlja pri približno 7 % otrok, pri čemer je pogostejša pri dečkih. Pogosteje se pojavlja pri otrocih z nizko porodno težo, pri prezgodaj rojenih otrocih, pri otrocih z motnjami pozornosti, z motnjami avtističnega spektra ali z govorno-jezikovnimi težavami. Otroci z RMK so prepogosto odkriti šele v šolskem obdobju. Glavni namen naše kvantitativno-kvalitativne raziskave je bil odkrivanje in oblikovanje celostne specialnopedagoške diagnostične ocene otrok z RMK pred vstopom v šolo. V prvem delu raziskave je bil izveden presejalni postopek z uporabo 3 preizkusov (ABC gibanja, Test vidno-motorične integracije in Vprašalnik razvojne motnje koordinacije), v katerega je bilo vključenih 196 petletnih otrok iz ljubljanskih javnih vrtcev. V našem vzorcu je bilo 6.6% otrok s kliničnimi znaki RMK, od tega 1.5% otrok s težjo obliko motoričnih težav v smeri RMK. Razmerje med spoloma je bilo 1.6:1 v prid dečkov, znotraj skupine otrok z mejno obliko RMK pa je bilo razmerje enakovredno med spoloma. Rezultati otrok z RMK so se statistično pomembno razlikovali od rezultatov otrok brez RMK pri vseh treh preizkusih in v okviru posameznih delov danih preizkusov. V drugem, kvalitativnem delu raziskave so bile opravljene študije 5 primerov dečkov s kliničnimi znaki RMK, ki so temeljile na celostnem diagnostičnem ocenjevanju s pomočjo uveljavljenih diagnostičnih preizkusov, na intervjujih s starši in s strokovnimi delavci vrtcev, na opazovanju in ocenjevanju otrokovih spretnosti pri vsakodnevnih aktivnostih in na ocenjevanju otrokovih dosežkov na posameznih razvojnih področjih. Rezultati so pokazali, da z vidika socialnih dejavnikov pri obravnavanih otrocih z RMK ni bilo posebnosti, razvojni dejavniki pa so pokazali različne rizične dejavnike v zgodnjem otroštvu. Obravnavani otroci so po pričakovanju imeli težave pri grobi motoriki, motoričnem planiranju, stranskosti, fini motoriki, zaznavanju in pri vsakodnevnih aktivnostih (počasnost, težave pri oblačenju in obuvanju, hranjenju, pri osebni negi in posebnosti pri igri). Posamezni otroci so imeli nekaj težav na področju komunikacije, govora in jezika ter na socialno-čustvenem področju. Nekateri so imeli tudi težave z motivacijo ter z odkrenljivo pozornostjo. Njihova močna področja so bila na govorno-jezikovnem področju ter z vidika spoznavnih sposobnosti. Na podlagi naših ugotovitev smo oblikovali dvostopenjski model odkrivanja in celostne specialnopedagoške diagnostične ocene petletnih otrok z RMK. V končnem modelu sta v presejalni postopek vključena le ABC gibanja in Vprašalnika razvojne motnje koordinacije, širok nabor drugih diagnostičnih preizkusov, opazovanje in pridobivanje informacij s strani staršev in strokovnih delavcev vrtca pa zajemajo celostno diagnostično oceno. Pri celostni diagnostični oceni predlagamo razširitev tima, torej bolj interdisciplinarni pristop. V raziskavi smo na koncu izpostavili raznolikost pojava RMK, pomen ocenjevanja tako močnih kot šibkih področij, slabši uvid otrokovega okolja v njegove razvojne zmožnosti ter tudi nekatere druge pomembne in še ne raziskane vidike RMK, kot so večja pojavnost deklic od pričakovanega v skupini otrok z mejno obliko RMK, izjemne psihometrične lastnosti Vprašalnika razvojne motnje koordinacije, ki je izpolnjen s strani vzgojiteljev, in pomembno vlogo ocenjevanja močnih področij pri otrocih z RMK. ; Developmental coordination disorder (DCD) is a neurodevelopmental disorder that manifests itself as difficulties in acquisition and execution of coordinated motor skills, and difficulties that are manifested as clumsiness as well as slowness and inaccuracy of performance of motor skills. This motor skills deficit significantly and persistently interferes with activities of daily living, and impacts academic/school productivity, prevocational and vocational activities, leisure, and play. Difficulties in specific motor skills performance are long-standing and non-progressive. Onset of symptoms is in the early developmental period, and motor skills deficits are not better explained by intellectual disability or visual impairment and are not attributable to a neurological condition affecting movement. It occurs in approximately 7% of children, and is more common in boys. It is more common in children with low birth weight, in prematurely born children, and in children with attention disorders, autistic spectrum disorders, or with speech and language disorders. Children with DCD are too often identified in school, and not sooner. The main purpose of our quantitative and qualitative research was to identify children with DCD, and apply our comprehensive special educational diagnostic assessment of children with DCD before entering school. In the first part of the study, a screening procedure was carried out using 3 tests (the Movement ABC, the Developmental Test of Visual-Motor Integration and the Developmental Coordination Disorder Questionnaire), which included 196 five-year-olds from Ljubljana public kindergartens. In our given sample there were 6.6% of children with clinical signs of DCD, 1.5% of them with severe motor problems in terms of DCD. Male to female ratio was 1.6:1. In the borderline DCD group ratio was equal between genders. Results of children with DCD were statistically different from the results of children without DCD in all three tests and in all parts of the tests. In the second, qualitative part of the study, 5 case studies involving boys with presumable DCD were analised, based on comprehensive diagnostic assessment using established diagnostic assessment tools, on interviews with parents and professional staff in kindergartens, on the observation and assessment of children's competences in activities of daily living, and on the assessment of children’s individual developmental achievements. Results showed no specific deviations in term of social factors for the assessed children with DCD. Analysis of the developmental factors, on the other hand, showed different risk factors in early childhood. As expected, the assessed children had problems in gross motor skills, motor planning, lateral dominance, fine motor skills, perception, and in activities of daily living (slowness, difficulties in dressing themselves, in feeding, personal care, and a specific play). Some difficulties were also encountered in individual’s communication, speech and language, some had difficulties in the socio-emotional domain, some with motivation, and some had attention difficulties. Their strengths were in the verbal domain and in cognitive abilities. Based on our findings, we developed a two-stage model of identification and a comprehensive special educational diagnostic assessment of five-year-old children with DCD. In our final model, the screening process included only the Movement ABC and the Developmental Coordination Disorder Questionnaire. A wide range of other diagnostic assessment tools, observation and information received from significant others was included in the later comprehensive diagnostic assessment, for which we proposed a wider range of the team of professionals, that is to take a more interdisciplinary approach. In the end, our research showed a diversity of the DCD phenomenon, an importance of assessing both strengths and difficulties in a child, and a poor insight of child's significant others into his developmental achievements. Furthermore, some other important and currently not yet researched DCD aspects were found, such as a higher prevalence of girls than expected in a group of children with a borderline DCD, the exceptional psychometric properties of Developmental Coordination Disorder Questionnaire, which was applied to preschool teachers, and finally, the important role of assessing strengths in children with DCD.