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Attention Deficit Disorder with Developmental Coordination Disorders

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Attention Deficit Disorder with Developmental Coordination Disorders Arch Dis Child 1998;79:207–212 207 Arch Dis Child: first published as 10.1136/adc.79.3.207 on 1 September 1998. Downloaded from ORIGINAL ARTICLES Attention deficit disorder with developmental coordination disorders Magnus Landgren, Bengt Kjellman, Christopher Gillberg Abstract 6 years.1–4 The term DAMP is used in Nordic Aims—To analyse the contribution of cer- countries as an operational diagnosis for this tain social, familial, prenatal, perinatal, combination of deficits in children who do not and developmental background factors in have mental retardation or cerebral palsy.5 the pathogenesis of deficits in attention, DAMP and ADHD overlap to a considerable motor control, and perception (DAMP). degree.4 All children with DAMP have the Methods—A population based case- combination of attention deficits—amounting control study was carried out with 113 to full ADHD in about half of all cases—and children aged 6 years, 62 diagnosed with motor perceptual deficits (MPD). Some chil- DAMP and 51 controls without DAMP. dren with ADHD do not have MPD.4 The The children’s health and medical records diagnosis of MPD corresponds closely with were studied and their history with regard that of developmental coordination disorder to background factors was taken at an (Kadesjö, Gillberg, unpublished data).2 DAMP interview with the mother using a stand- is conceptualised as a neurodevelopmental ardised schedule. Familial factors, possi- dysfunction syndrome with a high degree of ble non-optimal factors during pregnancy psychiatric comorbidity.67 (including smoking), developmental fac- Several reports have shown an association of tors (including early language develop- specific risk factors and neurodevelopmental– ment), and medical and psychosocial data neuropsychiatric disorders.8–10 In a Swedish were scored in accordance with the re- population study in Gothenburg 20 years ago, duced optimality method. urban children diagnosed as having DAMP were Results—Low socioeconomic class was found to have a variety of socially non-optimal common in the group with DAMP.Famil- familial, prenatal, and perinatal potentially http://adc.bmj.com/ ial language disorder and familial motor brain damaging factors in their histories.11 clumsiness were found at higher rates in We have now carried out an epidemiological the DAMP group. Neuropathogenic risk study of 6 year old children living in a small factors in utero were also more common town with rural surroundings (the municipal- in the children with DAMP. Maternal ity of Mariestad).4 We report here the testing smoking during pregnancy appeared to be of three hypotheses generated in previous an important risk factor. Language prob- studies: (a) hereditary factors play an impor- lems were present in two thirds of the tant part in the pathogenetic chain of events in on September 27, 2021 by guest. Protected copyright. children with DAMP. Sleep problems and DAMP; (b) potentially brain damaging risk gastrointestinal disorders, but not atopy factors, including smoking in pregnancy and or otitis media, were significantly more Table 1 Criteria for deficits in attention, motor control, common in the DAMP group. and perception Conclusions—Prenatal familial and neu- ropathogenic risk factors contribute to the A. Attention deficit disorder as manifested by: (a) Severe problems in at least one, or moderate problems Department of Child development of DAMP. Primary preven- in at least two, of the following areas: attention span, activity and Adolescent tion, such as improved maternal health level, vigilance, and ability to sit still; and Psychiatry, Göteborg care and early detection or treatment, or (b) Cross situational problems in the areas mentioned University, Annedals under (a) documented at two or more of the following: both, of associated language problems psychiatric, neurological, psychological evaluation, and Clinics, S-413 45 appear to be essential. Gothenburg, Sweden maternal report ( 1998; :207–212) B. Developmental coordination disorder or motor perception C Gillberg Arch Dis Child 79 dysfunction as manifested by severe: Keywords: developmental coordination disorder; atten- (a) gross motor dysfunction according to neurological Department of examination,12 or tion deficit hyperactivity disorder; motor control and Pediatrics, Skövde (b) fine motor dysfunction according to neurological Central Hospital, perception; language; prenatal factors; perinatal factors examination,12 or Skövde, Sweden (c) visuomotor/perceptual dysfunction according to M Landgren testing with the block design and object assembly subtests of the WISC-III13 (a discrepancy of > 15 IQ points on any of B Kjellman Attention deficit hyperactivity disorder these relative to overall IQ) or visuomotor dyscoordination (ADHD) and deficits in attention, motor con- test outlined in Rasmussen et al14 Correspondence to: trol, and perception (DAMP) are common C. Problems not accounted for or associated with mental retardation Professor Gillberg. childhood symptom combinations, each occur- or cerebral palsy Accepted 9 March 1998 ring in about one in 20 Swedish children aged AllofA,B,andChavetobemet. 208 Landgren, Kjellman, Gillberg Arch Dis Child: first published as 10.1136/adc.79.3.207 on 1 September 1998. Downloaded from Table 2 Background factors studied; criteria for reduced previously.4 The screening procedure com- optimality prised: the Conners’ parent questionnaire; a parent psychomotor questionnaire; a preschool Factor Optimal teacher questionnaire; and a standardised Family factors (first degree relatives only) motor examination at the child health Speech/language retardation Absent 15 16 Learning disorder Absent centre. The clinical assessment comprised a Motor clumsiness Absent detailed history, psychiatric and neurodevelop- Left handedness Absent mental examination, neuropsychological test- Mental retardation Absent Epilepsy Absent ing, and speech/language evaluation performed Tics Absent by a multidisciplinary team. The examining Attention deficit Absent doctor was unaware of the results of the assess- Prenatal factors ment performed by his team members. The Smoking No Gestational age (weeks) 37–41 routine paediatric physical examination and Small for gestational age No the neurodevelopmental examination were Large for gestational age No performed by the first author in all instances. Eclampsia/pre-eclampsia Absent Antiepileptic drugs No The methods used have good to excellent Severe infections in pregnancy Absent interrater and test-retest reliability.12 16–18 Alcohol exposure No Intrapartal factors BACKGROUND FACTORS Apgar score 9–10 Vacuum extraction No The obstetric, child health centre, and medical Twins or multiple birth No records of the children were collected and Breech or foot presentation No Cord prolapse, around neck/knot No scrutinised according to preset standards. Child severely traumatised (fractures, No Table 2 shows the criteria of optimality lots of petechiae) modified from Gillberg and Rasmusen.11 For Neonatal factors each factor with optimal conditions a score of 0 Hypoglycaemia No Septicaemia/meningitis Absent was given and for each factor with non- Respiratory distress Absent optimum conditions a score of 1 was given. Hyperbilirubinaemia not treated Absent Smoking in pregnancy was recorded as present Hyperbilirubinaemia treated Absent DiYculties regulating temperature No in mothers who reported smoking more than Irritable/floppy infant No the occasional cigarette during pregnancy. Postnatal factors Smallness for gestational age and largeness for Encephalitis Absent gestational age were defined as birth weights Meningitis Absent Concussion Absent less than two standard deviations (SDs) and Convulsions Absent greater than two SDs respectively according to 19 Social factors norms of Swedish growth charts. Hyper- Social class I, II, or III20 bilirubinaemia (untreated) was defined as Ethnicity Parent: Swedish/immigrant > 150 mmol/l at birth weights less than 2500 g Family structure Parent: or > 200 mmol/l at birth weights of 2500 g or married/divorced/ more. Hypoglycaemia was defined as blood single http://adc.bmj.com/ Child living with half sugar < 1.5 mmol/l. Pre-eclampsia was defined siblings as comprising at least two of the following: albuminuria, high blood pressure (> 140/90 low birth weight, contribute to the develop- mm Hg), and generalised oedema. Social class ment of DAMP; and (c) early language prob- was rated on the basis of the father’s lems in preschool children predict a diagnosis occupation.20 In single parent families, the rat- of DAMP at the age of 6 years. ing was based on the parent having the main rearing responsibility for the child. Immigrant on September 27, 2021 by guest. Protected copyright. Subjects status was defined as having at least one parent The DAMP group, 52 boys and 10 girls, com- being born as a non-Swedish citizen. prised all 28 children (25 boys) diagnosed with A language problem was defined as one or DAMP (table 1) in the total population of 589 more of: (a) speech delay according to parents children aged 6 years screened for DAMP in or to child health centre records, or both—that the municipality of Mariestad, and the first 34 is, 8–10 simple words only after the age of 18 children (27 boys) with DAMP recruited after months and intelligible sentences only after the screening covering the surrounding district of age of 3 years; (b) receptive language dysfunc- Skaraborg.4 The children from Mariestad and tion at the age of 6 years according to the those from the rest of the district were similar child’s
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