Developmental coordination disorder (DCD), sometimes called dyspraxia, is often identified when a child doesn’t reach the same milestones as other children, like being able to catch a ball or grip a pencil and draw inside the lines. Frequently associated with mood disorders such as anxiety and depression, DCD can persist into adulthood.
Now researchers at Goldsmiths, University of London working with Sussex Medical School, have found that encouraging these children to play with Wii Fit may lead to significant improvements in motor skills. Adam Smith spoke to Professor Elisabeth Hill of Goldsmiths to find out more.
Note: This research was not funded by Nintendo
Adam Smith: I’m in a rush. I need to catch the train, so I’m just dodging other pedestrians, and the newspaper giver-outers, ambulances, etc. And weaving in and out of the rose stall because it’s Valentines day. Platform… two, Crystal Palace… Now one of the things you probably don’t notice when you’re in a rush, is the way that, if you’re like me and able bodied, you can do quite amazing things, you can scooch between people, you can run upstairs really quickly without having to think too much about it… Now I’m going down to Goldsmiths University in Southeast London to meet with Elisabeth Hill who is a researcher in, among many other things, a condition known as developmental coordination disorder, DCD. It’s often discovered in children when they don’t reach the same milestones as other children like being able to catch a ball or being able to grip a pencil, that sort of thing. The reasons for DCD or dyspraxia are not really known by scientists, they’re still trying to work it all out. And yet it’s said to affect maybe up to one in 12 children, some people estimate it’s a bit lower at about one in 50… Here I am in the building now. Department of Psychology, says the sign. So it’ll be interesting to wonder whether this is a physiological problem or a psychological one. Maybe it’s a bit of both. I’m Adam Smith. Welcome to Pod Academy…So Elisabeth, thanks very much for agreeing to see me today in your very white, clean, pristine modern office her at Goldsmiths. First of all can you tell me a little bit about your research – all of the different things you look at here.
Professor Elisabeth Hill: My research is focused on what we call neurodevelopmental disorders. And that would include broadly, although not specifically, autism spectrum disorder, dyslexia, specific language impairment, ADHD (attention defecit hyperactivity disorder). And something that we focus on a lot, Developmental Coordination Disorder (DCD), which is a difficulty with movement and motor development and is often referred to as dyspraxia.
These are all examples of neurodevelopmental disorders. In my research group we focus on autism spectrum disorder and developmental cordination disorder, or DCD. There are historical reasons for that in terms of my background. I started looking at movement difficulties in children – we see movement difficulties in children diagnosed with DCD, that’s what that condition is about. These children have difficulties with motion control – controlling their bodies, their arms, their legs, moving objects, eating, drinking, and so on. It can be quite subtle. If you’re sitting at a table or walking down a street you wouldn’t know a child had DCD, but it has quite significant impacts on those children, on their academic development, their activities, dressing, playing and so on.
We also know that it has impacts in adulthood.
Movement difficulties are seen in these disorders, but aren’t part of their diagnosis. Not every child with dyslexia, language impairment, ADHD, autism, will have movement difficulties like those in DCD, but large numbers of those children do and so that’s how we’ve ended up researching some of these disorders, mostly from the point of view of motor difficulties. Also from the point of view of overlaps between motor difficulty and social development and between motor difficulty and what you might refer to as mood disorders or mental health ie high levels of anxiety, depression, poor quality of life satisfaction – there’s a kind of common thread around that. We are very interested in the adult presentation of this, which is something that nobody, or very few people, look at. But these children become adults, and that’s really important to understand.
AS: I couldn’t help but notice the big pink wall outside with the silver letters, Department of Psychology. Do all of these things fit within psychology?
EH: That’s a good question. Psychology’s very broad. In this department we have a lot of neuroscience – brain stimulation, brain measurements – which is a bit more physiological. In fact we have been running, and are developing, a new study with adults with DCD using electric stimulation, ECG, where you record the electrical activity on the surface of the brain whilst somebody’s doing a task. And we’ve been looking at adults with DCD, to see how their electrical activity varies from their non-DCD peers. We’ve been looking at adults who are the same age, the same gender, have the same education levels, but some have DCD versus those who don’t – to see how they respond when they have to do various tasks such as move a hand to a position either straight ahead or across the other side of the table space. We look to see what happens to their electrical activity. We know from studies of adults without any difficulties, that there are particular brain activity patterns, electrical activity patterns, in particular areas of the surface of the brain.
AS: And is it different in those with DCD?
EH: It’s a good question, it’s interesting , we’re looking at the data now. It looks like there’s a very specific difficulty.
When you’re sitting at the table with your two hands in front of you and you just move one hand straight ahead, it looks as if most of the electrical activity is very similar in most adults [those with DCD, and those without]. But as soon as you ask them to move their hands across the body mid-line – so if you divide your body in half down the trunk – you’re crossing your hand over into the other side of the space, we start to see some quite significant differences in the electrical activity.
Now, our study is the first time this has ever been investigated, so obviously we need to be really sure about our findings. And it needs to be replicated elsewhere. But it seems to be a really exciting finding because it suggests that we could start to pinpoint something very specific that might be in the brain leading to particular aspects of difficulty and we can link the brain activity to a behavioural response, actually making a movement. And that is not often something that’s done and it’s never been done with adults before.
AS: Does every child who has DCD go on to become an adult with DCD?
EH: The longitudinal studies that exist where a group of children with diagnoses are followed through have essentially gone into adolescence and early 20s. Those studies are quite old now but they suggest that the majority of children with DCD are still adolescents and adults with DCD. There are small percentages of children who seem to grow out of the condition, maybe they just needed extra support, maybe they didn’t really have DCD in the first place, so we know that people from low socio-economic backgrounds who don’t always have the same physical input and physical environment, don’t always have the same opportunities to play in the park, kick a ball, do all these sorts of activities, often have poor motor skills compared to their higher socio-economic status peers. So, most children with DCD become adults with DCD.
There’s really very little work with adults, but the work that we started initially was talking to adults about what their difficulties were when they were children and what if anything their difficulties are now they are adults.
AS: Are they different?
EH: They do seem to be different. So when you ask adults to talk to you about it, they will typically say, “When I was a child my difficulties were with movement, with dressing, with PE. I was bullied in the playground because I didn’t kick the football as well as other children.” You can imagine the kinds of scenarios. As an adult those same people are tending to say, I do still have problems with my movement but I don’t wear lace-up shoes, I wear slip-ons, or I get velcro on my trainers. So Daniel Radcliffe, Harry Potter, is on the record, he has DCD, and he’s on the record as saying he’s sorry velcro didn’t take off more.
AS: I didn’t know Daniel Radcliffe had DCD.
EH: Yes, that’s quite widely reported on the web.
AS: I just don’t follow him around enough!
EH: I was at some point Googling celebrities with DCD and dyspraxia and he was the only one that came up! I’m sure there are plenty others.
AS: I’m sure he’s quite a good role model for children who do have it.
EH: It’d be great if more celebrities came out and said they had it because two to five per cent of the population would have a diagnosis. So to realise you can do all sorts of things and be successful and your peers can aspire to be like you, is not typical I think.
AS: Let’s go on to talk about one of your most recent studies then, involving Nintendo Wii.
EH: I had been musing on the benefits of the Wii, not being a particular technological user myself, for children with DCD, adults with DCD, and thinking about the fact you can do it in a social group. And these children are often excluded from social groups because of physical activity.
AS: What’s special about the Wii. How is it different from another computer console?
EH: The great thing about the Wii is the child or adult, the participant in the process, is very much physically engaged. So we’re not talking about using a joystick or button presses, we’re actually talking about holding onto something and playing tennis, moving your arms around, playing the drums – moving your arms and your body around as if you really were playing the drums.
AS: And the console tracks your movements and you appear on screen as a character in the computer game making those movements?
EH: Absolutely, so you can be Roger Federer at Wimbledon.
AS: Well, I don’t know whether I could be…
EH: Or Wayne Rooney or whoever you want to be. And your movements are tracked and you see those, and the crowd cheers and so on.
Also, the Wii Fit is very much about balance, so activities that involve balancing. Again, you’re seeing yourself on the screen, you can do this on your own, or you can do this as part of a group, maybe support each other, egg each other on, have a little competition and you’re actually seeing yourself on the screen, live.
AS: Is that the one where you have the board to stand on and it can, as you say, track your balance just how good you are standing on the board?
EH: Absolutely, that’s what it is, so it’s a wobble board, if you like, a balance board, and it tracks quite subtle wobbles or lack of balance, on the board. I think I had just heard about it and thought it sounded quite an interesting way of engaging children in a physical activity when children are, perhaps as a result of a few years or negative activity, not very keen to go out and do physical activity. And it’s a way of doing something quite cheap that people have in their homes anyway and children are quite motivated by. I was talking to Dido Green, who’s now at Oxford Brookes, she’s a very experienced occupational therapist, and I mentioned this to her and we sort of constructed a detailed study whilst we were at a conference in America.
AS: Over the back of an envelope or something?
EH: Basically yes, over a coffee break or something. And then I think quite serendipitously a pediatrician called Ian Male [in Sussex], who is interested in DCD, contacted me. My mother lives in Sussex, so I said, “I’ll come and talk to you, it’s an easy trip”. And somehow this project evolved. Ian has a link with a medical school, the medical students have to do a research project, and we had a couple of schools who were available for research to be undertaken. We then modified the proposal to collect some preliminary data to see if it worked. We had to figure out a way to tweak – well, not tweak, quite substantially change – the ideal protocol. The medical students then took that into the schools, collected the data and there we were.
AS: Why did you have to tweak the protocol then?
EH: So the protocol for evaluating interventions in a rigorous way is… controversial is a strong word but different research groups and people from different research traditions will have slightly different views about how you ought to control for things like, not doing anything, what the interventions are, what you’re comparing to what and so on.
AS: Right, because it would seem to me that if you’re testing the Wii for how good it is at helping children with DCD, that you would also test another group doing nothing, and another group of children doing the next best thing, something like that. That would seem the best way of doing it for me.
EH: Absolutely, so what you want to do is, you need to be able to say, if there was a change in these children after they spent a few weeks doing Wii Fit in school, that change isn’t just to do with those children or it’s not to do with the fact that they would have changed anyway, or that they had more PE lessons or more football lessons or whatever it was. So you’re comparing to ideally another intervention and probably to something we would describe as a waitlist. But on top of that you need to be able to say, if you have three different groups of children, one does a Wii Fit over that month, one group has the standard intervention over the same month, and one group does nothing over that same month. Any differences, any change, still might be just to do with that group of children. So ideally what you want to do is have all the children in all the versions at different times and that makes for a long study because you will probably want to have a significant number of children for, say, a three-month period on the Wii Fit, then a break, then the same children for that same period of time on the existing intervention, then a break, then on no intervention.
AS: And how many children do you think you would need ideally, you said a significant number?
EH: Probably you’d be thinking 40, 50, 60 children. Now we recruited 20 in this project, that was we were able to recruit in the time available for the medical students and the school. So that’s something you have to think about when you’re looking at your results, but also if you get a particular result and it’s rigorous then it lends quite a lot of positivity to the thought that you would get a stronger result or that you’ve got a viable result that would be seen in a larger group.
AS: So what did you end up with? 20 kids doing what?
EH: We had 20 kids, split into two groups. One was 10 and one actually ended up being nine because one child dropped out, wasn’t in school enough. One of the groups spent 10 minutes three times a week for a month during a lunch break playing on the Wii Fit, they did that in small groups so they’d each individually spend time on the Wii Fit but they’d have someone with them. The other group was doing an intervention programme developed and used in this particular area of Sussex which is called Jump Ahead, which runs for 45 minutes per week. The activities in that involve mostly sitting at a table and doing things like threading beads onto a string ie practising fine motor skills. Things you do with your finger and thumb, mostly at the table, cutting things with scissors, drawing round things and so on.
AS: So that’s a lot more specific than, as you said, practising tennis using the Wii and waving your arms about, and trying to balance on a board.
EH: Absolutely, it’s quite a different type of intervention and again that’s something that you need to consider. We were expecting that we might show that the Wii intervention might be more fun, more motivating for groups of children, particularly considering that most of these children are boys who are probably not that interested in sitting at the table threading beads, as they might be if they were girls, and would motivate them to get more involved and try things at home.
AS: So what did you find?
EH: We found that when we tested children’s motor skill on a whole range of what we call gross motor tasks, so balance, hopping, skipping, jumping, standing on one leg without falling over, running and fine motor tasks eg threading beads, cutting with scissors, drawing round a trail, those children who were involved in the Wii Fit intervention, or the children before and after the Wii FIt intervention, showed a significant change in their motor skill. So their motor skill improved to an extent that we would say was statistically significant. It made an impact in the month that they were on the Wii Fit intervention.
AS: Can you just explain on an individual child basis what that would mean? I appreciate that you would want the statistical significant across the group, but for one child what would that mean?
EH: So for one child that would mean that perhaps they went from being very very slow at being able to put pegs into a board, maybe knocking pegs onto the floor in the process, which wouldn’t be something you’d see in a [non DCD] peer. Drawing round a trail where they couldn’t stay between the lines, and were always zigzagging out, not having good pencil control, standing on one leg and falling over quite a lot, not being able to hop in a hopscotch type set up, as good as you’d expect for their age, to shifting after that one-month Wii intervention to be able to do those tasks not perfectly, not as you’d expect them to be able to do those tasks for their age, but much, much better. Maybe the pegs aren’t falling on the floor, they might be going into the board quicker, balancing on one leg, maybe you’re quite wobbly but you’re not falling over now, being able to run a bit faster, being able to throw a ball into a box. So subtle differences, differences that were also measurable or identifiable to the child, so the children also reported that they felt their motor skills had improved from before to after. So their self esteem in relation to that got better and I think that would have an impact on other things.
AS: So this is still just a small study, a small number of children, but it does show a statistically significant improvement.
AS: Did Nintendo fund the study?
EH: No, Nintendo did not fund the study. The medical school funded the study in as much as they pay up to a certain amount for costs related to their students going to do work. So to some extent it was funded through goodwill, everybody thinking it was important, wanting to get the information and doing it for that reason.
AS: Have you got a time frame in mind for the next stage of this research?
EH: It would be great to get something going over the next year or so. I suspect that might be optimistic but the results look striking, the study’s had a lot of interest. It was really popular with the children, lots of children in the school were pleading to take part, so there’s motivation, we can use this kind of work to really help support parents who don’t get much support – the NHS doesn’t do much for them. The teachers don’t know much about it, so it can be a really supportive experience for those families. It could also build into something which could be quite significant for adults, which is one of my really key targets over the next, well probably the rest, of my working life.
AS: You can read a transcript of this podcast and follow links to further information at podacademy.org or you can tweet us @podacademy.
Note: This research was not funded by Nintendo and corporate funding of research raises ethical questions. In a related blog post on Pod Academy, Adam Smith and Professor Hill discuss these tricky issues.
Notes and links