Intervention Protocol

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Task-oriented interventions for children with developmental co-ordination disorder

  1. Motohide Miyahara1,*,
  2. Susan L Hillier2,
  3. Liz Pridham2,
  4. Shinichi Nakagawa3

Editorial Group: Cochrane Developmental, Psychosocial and Learning Problems Group

Published Online: 9 JAN 2014

DOI: 10.1002/14651858.CD010914

How to Cite

Miyahara M, Hillier SL, Pridham L, Nakagawa S. Task-oriented interventions for children with developmental co-ordination disorder (Protocol). Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD010914. DOI: 10.1002/14651858.CD010914.

Author Information

  1. 1

    University of Otago, School of Physical Education, Dunedin, New Zealand

  2. 2

    University of South Australia (City East), International Centre for Allied Health Evidence, Sansom Institute for Health Research, Adelaide, SA, Australia

  3. 3

    University of Otago, Department of Zoology, Dunedin, New Zealand

*Motohide Miyahara, School of Physical Education, University of Otago, PO Box 56, Dunedin, New Zealand.

Publication History

  1. Publication Status: New
  2. Published Online: 9 JAN 2014




  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Acknowledgements
  6. Contributions of authors
  7. Declarations of interest
  8. Sources of support

Description of the condition

Children with developmental co-ordination disorder (DCD) (APA 2013) have significant difficulty in performing the essential motor tasks required for self care (for example, dressing), social and recreational activities (for example, riding a bicycle), and academic achievement (for example, handwriting) as compared with typically developing children of the same age. Additionally, the disturbance in movement skills is not explained by any known medical conditions (APA 2013).

A diagnosis of DCD is made if the child satisfies the diagnostic criteria from the Diagnostic and Statistical Manual for Psychiatric Disorders 5 (DSM-5) (APA 2013). The assessment involves taking a developmental history, performing a clinical examination to rule out possible medical conditions, assessing the child's functional motor skills (usually through parent or teacher report), and objectively assessing the child's motor competence using a performance-based motor assessment (Blank 2012). DCD is usually diagnosed between the ages of five and 16 years (Blank 2012). By definition, children with suspected DCD should be free from definite neurological conditions (Gibbs 2007); however, minor neurological dysfunctions are frequently reported in children with DCD, suggesting that early brain lesions might be causative (Hadders-Algra 2003). Moreover, studies on imaging report differences in neural networks and brain activation patterns between children with DCD and control children (Kashiwagi 2009; Zwicker 2010).

The prevalence of DCD has been cited as 6% of school-aged children (APA 2013) and the male to female ratio has been reported as 1.9 to 1 in a recent UK study of seven-year-olds (Lingam 2009). DCD may also be referred to as clumsy child syndrome, dyspraxia (Miyahara 2000), or specific developmental disorder of motor function (World Health Organization 2010). Currently, the DSM-5 criteria accept comorbidities of DCD with attention-deficit and/or hyperactivity disorder, communication disorders, intellectual disability, and specific learning disorders (APA 2013).

DCD is included in the manual of mental disorders because of its consequential avoidance behaviours and psychosocial impacts (Spitzer 1994). The self esteem of children with DCD, in terms of physical competence, is diminished to a greater extent than that of children with severe physical disabilities (Miyahara 2006). They are likely to be onlookers in playgrounds, isolated and solitary in the school yard (Smyth 2000). Rejection by their peers can lead to children with DCD missing out on important socialisation experiences, resulting in suboptimal social skills (Cummins 2005). They may be easy targets for bullies (Piek 2005). Their levels of depressive symptomatology and anxiety are higher than typically developing children (Schoemaker 1994) and adolescents (Cantell 1994). DCD influences children's physical functions and health status, as well as their emotional life and social participation, not only during childhood but also throughout adolescence (Losse 1991) and adulthood (Cousins 2003; Missiuna 2008). Their reduced levels of participation in physical activity (Cairney 2005) have secondary consequences, such as reduced cardio-respiratory fitness (Cairney 2006), and increased risk for obesity and coronary vascular disease (Cairney 2007). While the motor difficulties of children with DCD may appear to be less debilitating than those experienced by children with severe physical disabilities (for example, cerebral palsy), it is the high prevalence of DCD, and its impact on children's socio-emotional well-being and future health status, that makes DCD a significant condition in need of appropriate intervention.

DCD is often measured using performance-based and impairment-based motor outcomes. Performance-based outcomes assess general motor ability, which underpins activities of daily living and academic performance. These measures employ neutral tasks which vary slightly from real-life functional tasks to avoid item bias. They are also standardised, objective, and sensitive to change. Some measures of task performance, such as the Canadian Occupational Performance Measure (COPM) or the Goal Attainment Scale (GAS), offer a self report perspective of task-related outcomes and are used to complement objective measures of task performance. Impairment-based measures, an historic way of approaching intervention and assessment, cover the spectrum of WHO categories (Impairment, activity limitations, participation restrictions).


Description of the intervention

Existing interventions range from movement-based therapies and education (usually provided by physiotherapists, occupational therapists, and physical educators) to pharmacology, dietary supplements, and counselling. Traditionally, the movement-based approaches have been classified in accordance with the emphasis of the intervention; that is, task-oriented or process-oriented. Interventions that focus on the performance of specific movement tasks or 'occupations', such as tying shoelaces, ball catching, and handwriting, are collectively called task-oriented approaches. Within the task-oriented approach are task-specific training (Revie 1993), cognitive motor approach (Henderson 1992), cognitive orientation to daily occupational performance (CO-OP) (Missiuna 2001), neuromotor task training (NTT) (Schoemaker 2003), and ecological intervention (Sugden 2007). The common theme of the task-oriented approaches resides in the employment of specific tasks in an attempt to improve corresponding skills. The differences between the task-oriented approaches depend on where the relative emphasis is placed, such as task-specificity in motor skill learning (Revie 1993), the interaction between cognitive, affective, and motor competence (Henderson 2007), child-centred cognitive strategies (Missiuna 2001), analysis of neuromotor processes underlying motor control (Schoemaker 2003), and making the task relevant and ecologically valid (Sugden 2007). In contrast, process-oriented approaches work on the principle that there is an underlying deficit, which must be remediated before functional change can take place. One of the most popular approaches in this category is sensory integration therapy, first devised by Ayres in the 1960s, which aims to improve the effectiveness and efficiency of processing and coordinating sensory information input in order to improve motor performance (Ayres 1979). However, there is more evidence against the effectiveness of this approach than in favour of it (Zimmer 2012). In this review, we will evaluate existing research on the more recently proposed task-oriented approaches in comparison to these other process approaches so that consumers and professionals have the opportunity to make informed decisions.


How the intervention might work

Based on principles of motor control and learning, task-oriented approaches involve concentration on the tasks, or group of tasks, to be mastered. In essence, they capitalise on the assumption that learning and skill acquisition is strongest when the learner understands the meaning of the training, and finds the task to be useful or relevant to his or her life. Thus, aspects of motivation and engagement are catered for, as well as the current understanding around brain plasticity, which supports the idea that learning effectiveness is enhanced when the individual perceives the goal, or likely reward, as functional and beneficial (Hoerzer 2012). At the behavioural level, the intervention effects are explained in terms of the variables involved in motor learning, such as repetition, duration, intensity, frequency of practice, and the types of feedback given (Keogh 1985; Henderson 1992; Revie 1993; Schoemaker 2003). At the cognitive level, the improvement of motor skills is explained in terms of intellectual understanding of motor tasks and verbal mediation, or talking through movements in the process of perceiving stimuli, and preparing and executing movements (Cratty 1989; Henderson 1992; Missiuna 2001). The impact of incorporating ecological aspects involves adapting or manipulating the environment and context to reproduce, as closely as possible, the actual learning task environment. This ensures contextual relevance and meaning, and thus is ecologically valid to the child with the support of significant others such as parents and teachers (Sugden 2007).


Why it is important to do this review

Parents of children with DCD need a readily understandable review to help them make informed decisions about the best available interventions, as do service providers. Since the publication of the recent systematic (Hillier 2007) and meta-analytic reviews (Pless 2000) of the intervention effects for children with DCD, new evidence has accumulated. The latest systematic and meta-analytic reviews (Smits-Engelsman 2013; Wilson 2013) include the recent evidence only, and do not evaluate these data together with older evidence. The meta-analytic studies also considered the intervention effects of the foregoing studies altogether, rather than examining the differential intervention effects of the children's age, the environment of intervention, and interventionist (Hillier 2007). The identification of differential intervention effects would allow service providers and consumers to make more informed decisions. It is of clinical and theoretical interest whether the intervention effects are transferred from the specific intervened tasks to general motor ability.



  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Acknowledgements
  6. Contributions of authors
  7. Declarations of interest
  8. Sources of support

To assess the effectiveness of task-oriented interventions on movement performance, psychosocial functions, activity, and participation for children with DCD. To examine differential intervention effects as a factor of age, sex, severity of DCD, intervention intensity, and type of intervention.



  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Acknowledgements
  6. Contributions of authors
  7. Declarations of interest
  8. Sources of support

Criteria for considering studies for this review


Types of studies

Randomised clinical trials and quasi-randomised trials.


Types of participants

Children aged four to 18 years, diagnosed with DCD as defined by the DSM-IV (APA 1994), DSM-5 (APA 2013), and/or children referred to as clumsy, physically awkward, or with dyspraxia who otherwise meet the criteria.


Types of interventions

We will include studies where the intervention is described as task-oriented and formally requires practice of a specific task or occupation as the principal form of intervention. This may include task-specific training, cognitive motor approach, ecological Intervention, neuromotor task training (NTT), and cognitive-orientation to occupational performance (CO-OP). If a trial intervention appears to be task-oriented but is not formally labelled as such, we will still include it if all authors agree.

We will include studies that compare the task-oriented intervention with either (1) an inactive control intervention, such as usual care or a waiting list control, or (2) an active control intervention, for example, a process-oriented approach such as sensory integration therapy (Ayres 1979), pharmacology, counselling, or dietary advice.


Types of outcome measures

We will use both movement performance- and impairment-based measures to examine changes in fine and gross motor function following intervention.


Primary outcomes

Changes in fine and gross motor function following intervention as measured by standardised performance outcome tests such as the following:


Secondary outcomes

Changes in fine and gross motor function following intervention as assessed by the following:

  • Changes in motor co-ordination, as measured by standardised rating scales based on parent and teacher report such as the Developmental Co-ordination Disorder Questionnaire (DCDQ), the Movement Assessment Battery for Children Checklist (MABC-C) (Henderson 1992; Henderson 2007)*.
  • Measures of impairment (for example, sensation as measured by tests such as stereognosis or pressure detection, muscle strength as measured by tests such as one repetition maximum, or co-ordination as measured by tests such as the Purdue pegboard).
  • Measures of psychosocial factors (self esteem, self concept) such as the Perceived Competence Scale for Children (PCSC) (Harter 1982), the Pictorial Scale for Perceived Competence and Social Acceptance for Young Children (PSPCSA) (Harter 1984)*.
  • Measures of occupational and task performance such as the Canadian Occupational Performance Measure (COPM) (Law 1998) and the Goal Attainment Scaling (McDougall 1999)*.
  • Adverse effects or events: no studies to date have identified adverse events resulting from task-oriented interventions. By its very nature, everyday tasks are performed under closer than usual scrutiny, supervision, or both, and therefore are assumed to be safer than those encountered in everyday life. However, we will record any reports of adverse events, which conceivably could include musculoskeletal injury, falls, or pain.
  • Measures of participation (academic level, sporting participation, recreation), such as LIFE-H (Fougeyrollas 1998), or teacher and family reports of level of participation.

*Outcomes to be included in a 'Summary of findings' table as recommended by the Cochrane Handbook for Systematic Reviews of Interventions (Schünemann 2008).


Search methods for identification of studies


Electronic searches

We will search the following electronic databases and trials registers.

  1. Cochrane Central Register of Controlled Trials (CENTRAL), part of T he Cochrane Library
  2. Ovid MEDLINE
  4. ERIC
  6. PsycINFO
  7. SPORTDiscus
  8. ProQuest Dissertations & Theses: A & I
  9. Science Citation Index - Expanded
  10. Social Sciences Citation Index
  11. Conference Proceedings Citation Index - Science
  12. Conference Proceedings Citation Index - Social Science and Humanities
  13. (
  14. Current Controlled Trials (
  15. WHO International Clinical Trials Registry Platform (
  16. Australian New Zealand Clinical Trials Registry (

We will use the following sensitive search strategy to search Ovid MEDLINE and adapt it for other databases. We will apply no language or date limits.

1 Motor Skills Disorders/
2 Psychomotor Disorders/
3 ((coordination or co-ordination) adj3 disorder$).tw.
4 (motor skill$ adj3 disorder$).tw.
5 (motor function$ adj3 disorder$).tw.
7 (clumsy or clumsiness).tw.
8 (physical$ adj1 awkward$).tw.
9 (incordination or in-cordination).tw.
10 (motor adj1 (competence or impair$ or difficulty or difficulties or proficiency)).tw.
11 (movement$ adj1 (difficulty or difficulties)).tw.
12 exp Apraxias/
13 dyspraxia$.tw.
14 or/1-13
15 Developmental Disabilities/ (14882)
16 (co-ordination or coordination or motor$).tw.
17 15 and 16
18 14 or 17
19 exp child/
20 Adolescent/
21 (child$ or preschool$ or pre-school$ or boy$ or Girl$ or teen$ or adolescen$ or young people$ or youth$).tw.
22 or/19-21
23 18 and 22
24 randomized controlled
25 controlled clinical
26 randomi#ed.ab.
27 placebo$.ab.
28 drug therapy.fs.
29 randomly.ab.
30 trial.ab.
31 groups.ab.
32 or/24-31
33 exp animals/ not
34 32 not 33
35 23 and 34


Searching other resources

We will distribute an email to members of the International Society for Research in DCD and ask them to provide any unpublished studies (including studies in languages other than English) that meet our inclusion criteria. We will also search the reference lists of relevant papers found by the literature search. We will also search relevant websites identified by international experts, such as advocacy groups or education resource listings, which may have identified unpublished trials.


Data collection and analysis


Selection of studies

Two authors (SH and MM) will independently assess all studies identified by the search strategy for inclusion. Disagreements will be resolved by discussion with the third and the fourth authors (LP, SN). We will perform a first screening by reading the titles and abstracts of the identified studies. We will determine final inclusion by reading the full paper. We will report reasons for exclusion for all studies considered to have closely missed inclusion during the selection process.


Data extraction and management

Two review authors (MM and SN) will independently extract data from the included trials using a standardised data extraction form specifically designed and piloted for this review. We will seek translations where necessary. Extracted data will include the following information from the included studies:

  1. methods - including aim, design, unit of allocation;
  2. participants - including inclusion and/or exclusion criteria, number randomised, withdrawals and exclusion, sample characteristics;
  3. intervention - type of intervention (for example, NTT or CO-OP), mode of delivery (individual or group), personnel (health, education, or non-trained staff), location (clinic, hospital, school, home), duration, frequency, and intensity;
  4. outcomes - including time points measured, unit of measurement, power;
  5. other - source of funding, possible conflicts of interest;
  6. 'Risk of bias' assessment - including details of sequence generation, allocation concealment, blinding, completeness of outcome data, selective outcome reporting;
  7. data and analysis - including length of follow-up, loss to follow-up, unit of analysis, statistical methods used.

In order to assess the effects of the intervention, we will extract data for outcomes of interest (means and standard deviations for continuous outcomes and number of events for dichotomous outcomes) where available in the published reports. Two review authors (MM and SN) will enter extracted data from each study into RevMan and verify this. Any inconsistencies will be resolved by discussion. A third author (SH) will assist in making a decision, if necessary.


Assessment of risk of bias in included studies

Two authors (MM and SH) will independently assess the risk of bias for each study and overall risk of bias, using The Cochrane Collaboration 'Risk of bias' tool (Higgins 2011a) for randomised controlled trials (RCTs). We will assess the risk of bias for each included study against key criteria: random sequence generation; allocation concealment; blinding of outcomes; incomplete data; and selective outcome reporting. Where possible, we will obtain trial protocols for comparison of planned outcome assessment to the outcome data available from each trial, to enable us to evaluate whether all outcomes assessed in a trial have been reported. We will also attempt to contact study authors if no outcome data relevant to the primary or secondary outcomes of the review have been published for a trial (Kirkham 2010). We will report the full 'Risk of bias' assessment and whether or not it reduces the confidence in the effects being analysed. If the risk of bias of the individual included studies is high, we will interpret the results of the studies with caution. We will explicitly judge each of the listed domains for risk of bias as: low risk of bias; high risk of bias; or unclear risk of bias (either lack of information or uncertainty over the potential for bias). Two independent assessors (LP and SN) will determine overall risk of bias and resolve disagreements by consensus using a third review author if necessary.


Measures of treatment effect


Continuous outcome data

We will obtain standardised mean differences (SMD), more precisely Hedges g (Borenstein 2009), from the primary trial data. SMD is dimensionless so we will be able to combine outcomes from studies which used different measurements. We will calculate SMDs (Hedges g) and associated sampling error variance from the available information in the included studies. Such information includes descriptive statistics (means, standard deviations (SDs), and sample sizes) and test statistics (t, F, P values etc.). In the case of no relevant information being available, we will request information from the authors.


Multiple outcome data

For studies with post-intervention data at multiple time points, we will extract the SMD from both post-intervention and follow-up phases, but we will analyse them separately in meta-analyses. The immediate post-intervention data will be considered primary.


Dichotomous data

We will calculate odds ratios and convert them to SMDs (Borenstein 2009) so we are able to combine and compare these outcomes with the aforementioned outcomes.

If results cannot be summarised as above, we will report them as 'other data' narratively and we will not include them in the meta-analysis. In all cases, we will perform primary statistical analysis with Review Manager 5.2 (Review Manager 2012).


Unit of analysis issues

For cross-over trials, we will calculate SMDs and associated variances by accounting for a carry-over effect (Higgins 2011b). This can be done by obtaining (inter-individual) correlation coefficients between pre- and post-intervention periods. If such information cannot be gathered from the publications, we will contact the authors.

For cluster-randomised trials, we will appropriately integrate the effect when calculating the SMDs and corresponding variances by obtaining intra-cluster correlation coefficients (from the authors of the studies as necessary).


Dealing with missing data

If we find any missing, inconsistent, or incomplete data (for example, missing outcomes, missing summary data, missing study characteristics), we will contact the correspondence author. We will record all relevant information on missing data and drop-outs for each study as part of our 'Risk of bias' assessment. We will also examine the reasons for missing data and drop-outs, and take those reasons into account when drawing conclusions.

Further, as part of a sensitivity analysis, we will use a multiple imputation technique for missing subgroup information, assuming the data are missing at random (Pigott 2012), although such missing data are not expected.


Assessment of heterogeneity

  1. MM, SH, and LP (each of whom possesses clinical experience) will assess clinical heterogeneity, evaluating the variability across participants (age, gender, severity of DCD, interventions (frequency, duration, types), and outcomes (types).
  2. We will assess methodological heterogeneity by evaluating variability in research designs and risk of bias (SN and SH). We will examine any difference in effect size between studies that use adequate randomisation, allocation concealment, and blinding, and the studies that do not perform them adequately. We will also group the reviewed studies into high and low risk of bias groups, and evaluate the difference in effect sizes.
  3. We will identify statistical heterogeneity by visual inspection of the forest plots, and by using the Chi2 test and I2 statistic. We will use a P value of 0.10 to determine the statistical significance of the Chi2 test for a small sample size (Deeks 2008). We will evaluate the importance of the I2 by an observed I2 value > 40%, the magnitude and direction of effects, and the evidence for heterogeneity from the Chi2 test. To address heterogeneity, we will conduct a random-effects meta-analysis and explore the causes of heterogeneity by conducting subgroup analyses and meta-regression.


Assessment of reporting biases

We will explore whether there are any small study effects and conduct visual assessment of funnel plot asymmetry to identify possible publication bias (Sterne 2008). If funnel asymmetry is due to a lack of data points in the non-statistically significant region of a funnel plot, we will interpret the funnel plot asymmetry as an indicator of possible publication bias; that is, multiple or singular publication of research findings, depending on the nature and direction of the results. We will only create a funnel plot for a meta-analysis that contains at least 10 studies (SMDs). To avoid reporting biases, we will search other sources as described above.


Data synthesis

We will use both fixed-effect and random-effects meta-analyses to combine SMDs (Hedges g) and report results from both models using Review Manager 5.2 (Review Manager 2012). This will only be performed if studies are sufficiently similar with regard to clinical heterogeneity and if there are more than two studies available. A main meta-analysis will combine all data points (SMDs) except for data points from follow-up periods. We will conduct subsequent meta-analyses on subgroups according to the criteria described in the next section. Also, we will provide narrative descriptions of those studies that are unsuitable for meta-analysis.


Subgroup analysis and investigation of heterogeneity

If we find sufficient studies, we will perform the following subgroup analyses.

  1. Age (preschool versus junior; primary versus senior; primary versus secondary or high school).
  2. Sex (male versus female).
  3. Severity of DCD in terms of cutoffs used for standard performance outcome tests and questionnaires (for example, second percentile; fifth percentile; 15th percentile).
  4. Intervention intensity calculated as a combination of frequency and duration (for example, < 3 times a week versus ≧ 3 times a week; or < 6 weeks versus ≧ 6 weeks).
  5. Type of intervention (for example, NTT versus CO-OP).


Sensitivity analysis

We also plan sensitivity analyses to explore the impact of study quality (risk of bias), for example, for studies with a high risk of:

  • assessment bias (associated with issues of blinding);
  • attrition bias (associated with completeness of data);
  • selection bias (associated with sequence generation or allocation concealment).



  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Acknowledgements
  6. Contributions of authors
  7. Declarations of interest
  8. Sources of support

The University of Otago and the University of South Australia: the development and publication of this protocol and forthcoming review is made possible thanks to a salary from each author's university.

Cochrane Developmental, Psychosocial and Learning Problems Group: provided advice and assistance in producing this protocol.

Richard German (Reference Librarian), Health Sciences Library (Medical and Dental), University of Otago: assisted with searching the databases.


Contributions of authors

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Acknowledgements
  6. Contributions of authors
  7. Declarations of interest
  8. Sources of support

MM drafted the protocol and all authors contributed advice. MM will perform the initial search, and LP and SH will perform second review author roles with MM from inclusion through to risk of bias and data extraction stages. SN will provide statistical advice. MM, SH, and LP will write the final review text.


Declarations of interest

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Acknowledgements
  6. Contributions of authors
  7. Declarations of interest
  8. Sources of support

Motohide Miyahara - none known.
Susan L Hillier - none known.
Liz Pridham - none known.
Shinichi Nakagawa - none known.


Sources of support

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Acknowledgements
  6. Contributions of authors
  7. Declarations of interest
  8. Sources of support

Internal sources

  • University of Otago, New Zealand.
    In the form of a salary
  • University of South Australia, Australia.
    In the form of a salary


External sources

  • No sources of support supplied


Additional references

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Acknowledgements
  7. Contributions of authors
  8. Declarations of interest
  9. Sources of support
  10. Additional references
APA 1994
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Edition. Washington, DC: American Psychiatric Association, 1994.
APA 2013
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Edition. Washington, DC: American Psychiatric Association, 2013.
Ayres 1979
  • Ayres J. Sensory Integration and the Child. Los Angeles: Western Psychological Services, 1979.
Blank 2012
  • Blank R. European Academy of Childhood Disability (EACD): recommendations on the definition, diagnosis and intervention of developmental coordination disorder (pocket version). German-Swiss interdisciplinary clinical practice guideline S3-standard according to the Association of the Scientific Medical Societies in Germany. Pocket version. Definition, diagnosis, assessment, and intervention of developmental coordination disorder (DCD). Developmental Medicine and Child Neurology 2012;54(11):e1-7.
Borenstein 2009
  • Borenstein M, Hedges LV, Higgins JPI, Rothstein HR. Introduction to Meta-Analysis. Chichester: John Wiley & Sons, 2009.
Bruininks 1978
  • Bruininks RH. The Bruininks-Oseretsky Test of Motor Proficiency. Circle Pines, MN: American Guidance Service, 1978.
Bruininks 2005
  • Bruininks RH, Bruininks BD. The Bruininks-Oseretsky Test of Motor Proficiency. 2nd Edition. Circle Pines, MN: American Guidance Service, 2005.
Cairney 2005
  • Cairney J, Hay JA, Faught BE, Wade TJ, Corna L, Flouris A. Developmental coordination disorder, generalized self-efficacy toward physical activity, and participation in organized and free play activities. Journal of Pediatrics 2005;147(4):515-20.
Cairney 2006
  • Cairney J, Hay JA, Wade TJ, Faught BE, Flouris A. Developmental coordination disorder and aerobic fitness: is it all in their heads or is measurement still the problem?. American Journal of Human Biology 2006;18(1):66-70.
Cairney 2007
  • Cairney J, Hay JA, Faught BE, Flouris A, Klentrou P. Developmental coordination disorder and cardiorespiratory fitness in children. Pediatric Exercise Science 2007;19(1):20-8.
Cantell 1994
  • Cantell MH, Smyth MM, Ahonen TP. Clumsiness in adolescence: educational, motor, and social outcomes of motor delay detected at 5 years. Adapted Physical Activity Quarterly 1994;11(2):115-29.
Cousins 2003
Cratty 1989
  • Cratty BJ. Adapted Physical Education in the Mainstream. Denver, CO: Love Publishing Company, 1989.
Cummins 2005
Deeks 2008
  • Deeks JJ, Higgins JPT, Altman DG. Chapter 9: Analysing data and undertaking meta-analysis. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Chichester: John Wiley & Sons, 2008.
Fougeyrollas 1998
  • Fougeyrollas P, Noreau L, Bergeron H, Cloutier R, Dion SA, St-Michel G. Social consequences of long term impairments and disabilities: conceptual approach and assessment of handicap. International Journal of Rehabilitation Research 1998;21(2):127-42.
Gibbs 2007
Hadders-Algra 2003
  • Hadders-Algra M. Developmental coordination disorder: is clumsy motor behaviour caused by a lesion of the brain at early age?. Neural Plasticity 2003;10(1-2):39-50.
Harter 1982
  • Harter S. The Perceived Competence Scale for Children. Child Development 1982;53(1):87-97.
Harter 1984
  • Harter S, Pike R. The pictorial scale of perceived competence and social acceptance for young children. Child Development 1984;55(6):1969-82.
Henderson 1992
  • Henderson SE, Sugden DA. Movement Assessment Battery for Children. London: Psychological Corporation, 1992.
Henderson 2007
  • Henderson SE, Sugden DA, Barnett A. Movement Assessment Battery for Children. 2nd Edition. London: Pearson, 2007.
Higgins 2011a
  • Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
Higgins 2011b
  • Higgins JPT, Deeks JJ, Altman DG. Chapter 16: Special topics in statistics. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Chichester: John Wiley & Sons, 2011.
Hillier 2007
  • Hillier SL. Intervention for children with developmental coordination disorder: a systematic review. The Internet Journal of Allied Health Science and Practice 2007;5(3):1-11.
Hoerzer 2012
  • Hoerzer GM, Legenstein R, Maass W. Emergence of complex computational structures from chaotic neural networks through reward-modulated Hebbian learning. Cerebral Cortex 2012 Nov 11 [Epub ahead of print]. [DOI: 10.1093/cercor/bhs348]
Kashiwagi 2009
  • Kashiwagi M, Iwaki S, Narumi Y, Tamai H, Suzuki S. Parietal dysfunction in developmental coordination disorder: a functional MRI study. NeuroReport 2009;20(15):1319-24.
Keogh 1985
  • Keogh J, Sugden D. Movement Skill Development. New York: Macmillan, 1985.
Kirkham 2010
  • Kirkham JJ, Dwan KM, Altman DG, Gamble C, Dodd S, Smyth R, et al. The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews. BMJ 2010;340:c365.
Law 1998
  • Law M, Baptiste S, Carswell A, McColl MA, Polatajko H, Pollock N. Canadian Occupational Performance Measure. 2nd Edition. Toronto, ON: CAOT Publications ACE, 1998.
Lingam 2009
  • Lingam R, Hunt L, Golding J, Jongmans M, Emond A. Prevalence of developmental coordination disorder using the DSM-IV at 7 years of age: a UK population-based study. Pediatrics 2009;123(4):e693-700.
Losse 1991
  • Losse A, Henderson SE, Elliman D, Hall D, Knight E, Jongmans M. Clumsiness in children - do they grow out of it? A 10-year follow-up study. Developmental Medicine and Child Neurology 1991;33(1):55-68.
McCarron 1997
  • McCarron LT. McCarron Assessment of Neuromuscular Development. Dallas, TX: Common Market Press, 1997.
McDougall 1999
  • McDougall J, King GA. Goal Attainment Scaling: Description, Utility, and Applications in Pediatric Therapy Services. London, Ontario: Thames Valley Children’s Centre, 1999.
Missiuna 2001
  • Missiuna C, Mandich AD, Polatajko HJ, Malloy-Miller T. Cognitive orientation to daily occupational performance (CO-OP). Physical & Occupational Therapy in Pediatrics 2001;20(2-3):69-81.
Missiuna 2008
  • Missiuna C, Moll S, King G, Stewart D, Macdonald K. Life experiences of young adults who have coordination difficulties. Canadian Journal of Occupational Therapy 2008;75(3):157-66.
Miyahara 2000
Miyahara 2006
  • Miyahara M, Piek J. Self-esteem of children and adolescents with physical disabilities: quantitative evidence from meta-analysis. Journal of Developmental and Physical Disabilities 2006;18(3):219-34.
Piek 2005
Pigott 2012
  • Pigott TD. Advances in Meta-Analysis. New York: Springer, 2012.
Pless 2000
  • Pless M, Carlsson M. Effects of motor skill intervention on developmental coordination disorder: a meta-analysis. Adapted Physical Activity Quarterly 2000;17(4):381-401.
Revie 1993
  • Revie G, Larkin D. Task-specific intervention with children reduces movement problems. Adapted Physical Activity Quarterly 1993;10(1):29-41.
Review Manager 2012
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Schoemaker 1994
  • Schoemaker MM, Kalverboer AF. Social and affective problems of children who are clumsy: how early do they begin?. Adapted Physical Activity Quarterly 1994;11(2):130-40.
Schoemaker 2003
  • Schoemaker MM, Niemeijer AS, Reynders K, Smits-Engelsman BC. Effectiveness of neuromotor task training for children with developmental coordination disorder: a pilot study. Neural Plasticity 2003;10(1-2):155-63.
Schünemann 2008
  • Schünemann HJ, Oxman AD, Higgins JPT, Vist GE, Glasziou P, Guyatt GH. Chapter 11: Presenting results and 'summary of findings' tables. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Chichester: John Wiley & Sons, 2008.
Smits-Engelsman 2013
  • Smits-Engelsman BCM, Blank R, Van Der Kaay A, Mosterd-Van Der Meijs R, Vlugt-Van Den Brand E, Polatajko HJ, et al. Efficacy of interventions to improve motor performance in children with developmental coordination disorder: a combined systematic review and meta-analysis. Developmental Medicine and Child Neurology 2013;55(3):229-37.
Smyth 2000
  • Smyth MM, Anderson HI. Coping with clumsiness in the school playground: social and physical play in children with coordination impairments. British Journal of Developmental Psychology 2000;18(3):389-413.
Spitzer 1994
  • Spitzer RL, Gibbon M, Skodol AE, Williams JBW, First MB. DSM-IV Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Press, Inc, 1994.
Sterne 2008
  • Sterne JAC, Egger M, Moher D. Chapter 10: Addressing reporting biases. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Chichester: John Wiley & Sons, 2008.
Sugden 2007
  • Sugden D, Henderson SE. Ecological Intervention for Children with Movement Difficulties. London: Harcourt Assessment, 2007.
Ulrich 1985
  • Ulrich D. Test of Gross Motor Development. Austin, TX: Pro-Ed, 1985.
Ulrich 2000
  • Ulrich D. Test of Gross Motor Development. 2nd Edition. Austin, TX: Pro-Ed, 2000.
Wilson 2013
World Health Organization 2010
  • World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th Revision. Geneva: Churchill Livingstone, 2010.
Zimmer 2012
  • Zimmer M, Desch L. Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics 2012;129(6):1186-9.
Zwicker 2010
  • Zwicker J, Missiuna C, Harris S, Boyd L. Brain activation of children with developmental coordination disorder is different than peers. Pediatrics 2010;126(3):e678-86.