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What Impact Does Developmental Coordination Disorder Have on Daily Routines?

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Title: What Impact Does Developmental Coordination Disorder Have on Daily Routines?
Language: English
Authors: Summers, Janet, Larkin, Dawne, Dewey, Deborah
Source: International Journal of Disability, Development and Education. Jun 2008 55(2):131-141.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals/default.html
Peer Reviewed: Y
Page Count: 11
Publication Date: 2008
Document Type: Journal Articles
Reports - Research
Descriptors: Focus Groups, Psychomotor Skills, Young Children, Preadolescents, Qualitative Research, Interviews, Foreign Countries, Motor Development, Daily Living Skills
Geographic Terms: Australia, Canada
DOI: 10.1080/10349120802033485
ISSN: 1034-912X
Abstract: In order to understand how age and motor difficulties impact on daily routines, this qualitative investigation used focus groups and in-depth interviews with Australian and Canadian parents to examine the daily routines of younger (5 to 7 years of age) and older children (8 to 9 years of age) with and without Developmental Coordination Disorder (DCD). Parents were asked to describe the typical school-day routine, one that was not typical and how weekend routines differed. Daily routines were consistent across families and cultures. Older children were expected to participate more independently in the daily routine. The level of structure and assistance provided to children with DCD was greater, and the parents' expectations of independent performance were lower. Children with DCD required consistent prompting and more structure to complete the morning tasks within the allotted time. Children with DCD were reported to be much happier on weekends and holidays, enjoying the relaxed atmosphere free of the time pressures and tasks of a school-day routine. The main factors that modified participation in daily routines were the child's age and their motor difficulties.
Abstractor: As Provided
Number of References: 32
Entry Date: 2008
Accession Number: EJ799416
Database: ERIC
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  Value: <anid>AN0031900038;54q01jun.08;2019Mar26.13:32;v2.2.500</anid> <title id="AN0031900038-1">What Impact does Developmental Coordination Disorder have on Daily Routines? </title> <p>In order to understand how age and motor difficulties impact on daily routines, this qualitative investigation used focus groups and in‐depth interviews with Australian and Canadian parents to examine the daily routines of younger (5 to 7 years of age) and older children (8 to 9 years of age) with and without Developmental Coordination Disorder (DCD). Parents were asked to describe the typical school‐day routine, one that was not typical and how weekend routines differed. Daily routines were consistent across families and cultures. Older children were expected to participate more independently in the daily routine. The level of structure and assistance provided to children with DCD was greater, and the parents' expectations of independent performance were lower. Children with DCD required consistent prompting and more structure to complete the morning tasks within the allotted time. Children with DCD were reported to be much happier on weekends and holidays, enjoying the relaxed atmosphere free of the time pressures and tasks of a school‐day routine. The main factors that modified participation in daily routines were the child's age and their motor difficulties.</p> <p>Keywords: Developmental Coordination Disorder; children; motor difficulties; daily routines</p> <hd id="AN0031900038-2">Introduction</hd> <p>Humans organise life around regularly occurring and predictable events, such as daily routines and a weekly work/rest cycle (Zerubavel, [<reflink idref="bib32" id="ref1">32</reflink>]). These daily routines, which consist of habituated activities and tasks (Chapparo & Ranka, [<reflink idref="bib3" id="ref2">3</reflink>]; Gallimore & Lopez, [<reflink idref="bib8" id="ref3">8</reflink>]), are so commonplace that individuals seldom consider the contribution of motor competence to their harmonious functioning. While it is well recognised that parents adapt the daily routine to accommodate the changing abilities of growing children, these abilities have rarely been explicitly linked to Developmental Coordination Disorder (DCD) (American Psychiatric Association [APA], [<reflink idref="bib2" id="ref4">2</reflink>]). Although parents of children with movement difficulties such as DCD, dyspraxia, and motor learning problems have identified that family life is constrained by the motor abilities of the child (Chesson, McKay, & Stephenson, [<reflink idref="bib4" id="ref5">4</reflink>]; Missiuna, Moll, King, & Law, [<reflink idref="bib19" id="ref6">19</reflink>]), limited research has focused on the daily routine.</p> <p>Family routines evolve over time in response to the external demands of the environment and the internal dynamics of the family. The routine adapts to accommodate changes in children's performance as they get older and increases their ability to participate. Children's increased participation in daily routines evolves with biological, emotional, and cognitive development and is primed by social interaction. Adults set the standard for children's participation (Coster, [<reflink idref="bib6" id="ref7">6</reflink>]; Valsiner, [<reflink idref="bib28" id="ref8">28</reflink>]), and children generally learn these routines through a process of guided participation (Rogoff, [<reflink idref="bib22" id="ref9">22</reflink>]). Activities of daily living, which rely on motor skills, are an essential component of the daily routine, and research has reported that children with DCD have difficulties with activities of daily living such as dressing, personal hygiene, cutting, eating and playing (Mandich, Polatajko, & Rodger, [<reflink idref="bib16" id="ref10">16</reflink>]; May‐Benson, Ingolia, & Koomar, [<reflink idref="bib17" id="ref11">17</reflink>]; Missiuna et al., [<reflink idref="bib19" id="ref12">19</reflink>]; Rodger et al., [<reflink idref="bib21" id="ref13">21</reflink>]; Rosenblum, [<reflink idref="bib23" id="ref14">23</reflink>]; Summers, Larkin, & Dewey, [<reflink idref="bib26" id="ref15">26</reflink>]; Watkinson et al., [<reflink idref="bib29" id="ref16">29</reflink>]; Wright & Sugden, [<reflink idref="bib31" id="ref17">31</reflink>]). Efficient performance of daily activities requires competent motor functioning, yet children with DCD are known to have difficulties with the sequencing of motor tasks, the timing of tasks and the speed with which they perform motor tasks (Dewey & Tupper, [<reflink idref="bib7" id="ref18">7</reflink>]; Geuze, Jongmans, Schoemaker, & Smits‐Engelsman, [<reflink idref="bib10" id="ref19">10</reflink>]; Williams, [<reflink idref="bib30" id="ref20">30</reflink>]). These limitations may be reflected in their participation in the family routine. Further, the cultural expectations of adults regarding their children's motor behaviour (Cintas, [<reflink idref="bib5" id="ref21">5</reflink>]; Hopkins & Westra, [<reflink idref="bib12" id="ref22">12</reflink>]) may influence the approaches and strategies used to guide the daily routine. To the best of our knowledge, however, no studies have investigated cultural differences in the daily routines of children with DCD.</p> <p>The view that family routines are influenced by children's motor competence, biological development, and cultural expectations guided the present study. To obtain a comprehensive understanding of the impact of DCD on the family routine, it was essential to explore for typically developing children, parents' perceptions of family routines and their age‐appropriate expectations of performance (Harkness & Super, [<reflink idref="bib11" id="ref23">11</reflink>]; Rogoff, [<reflink idref="bib22" id="ref24">22</reflink>]; Tudge et al., [<reflink idref="bib27" id="ref25">27</reflink>]). Although a number of studies have investigated the construction of routines in families who have a child with a disability (Gallimore, Weisner, Kaufman, & Bernheimer, [<reflink idref="bib9" id="ref26">9</reflink>]; Kellegrew, [<reflink idref="bib13" id="ref27">13</reflink>]; Larson, [<reflink idref="bib15" id="ref28">15</reflink>]; Segal, [<reflink idref="bib24" id="ref29">24</reflink>], [<reflink idref="bib25" id="ref30">25</reflink>]), limited information is available on how the daily routine is constrained by the impairments in motor abilities associated with DCD. As biological development influences children's ability to participate in families' routines, we investigated how children's participation in family routines changed among younger (5 to 7 years of age) and older children (8 to 9 years of age). Further, we investigated whether cultural differences existed in the approaches and strategies used to guide the daily family routine in Australia and Canada.</p> <hd id="AN0031900038-3">Method</hd> <p></p> <hd id="AN0031900038-4">Design</hd> <p>A qualitative approach using focus groups (Krueger, [<reflink idref="bib14" id="ref31">14</reflink>]) and in‐depth interviews (McCracken, [<reflink idref="bib18" id="ref32">18</reflink>]) was chosen to examine parents' perspectives of the family routines of children with DCD and typical children. This approach provided a richer source of contextual information about family routines than was obtainable through questionnaires and quantitative research designs, and allowed us to explore the impact of children's motor problems, age and country of residence on family routines. The conceptual framework that guided the exploration of routines was based on an ecocultural model. Such a model assumes that human performance cannot be isolated from the social and cultural context in which it occurs (Valsiner, [<reflink idref="bib28" id="ref33">28</reflink>]) and that family routines are a means by which parents shape their children's activity and development to reflect cultural characteristics (Gallimore et al., [<reflink idref="bib9" id="ref34">9</reflink>]; Gallimore & Lopez, [<reflink idref="bib8" id="ref35">8</reflink>]).</p> <hd id="AN0031900038-5">Participants</hd> <p>Approval for the study was obtained from the university human ethics committees in Australia and Canada, and participants provided informed consent. Participants were Australian and Canadian parents of younger (5 to 7 years of age) and older (8 to 9 years of age) children. Purposive sampling was used to obtain participants. Parents of typically developing children came from school and community contacts. Parents of children with DCD were located through therapists, clinics and programs that specialised in children with motor difficulties. Each parent was familiar with the child's daily routines and at least one of the child's parents was a citizen of Australia or Canada.</p> <p>Information on family routines was collected on 87 children born in Australia or Canada who were not more than two weeks premature. There were 34 Australian and 15 Canadian typical children, and 29 Australian and nine Canadian children with DCD (for more detail, see Summers et al., [<reflink idref="bib26" id="ref36">26</reflink>]). Parents reported that the typical children had no diagnosed neurological or behavioural disorder, were enrolled in regular classes at school, had not repeated a grade or received any educational intervention and had no known condition that would affect their performance of daily routines. Parents of children with DCD were located through therapists (e.g., occupational therapists, physiotherapists), clinics and intervention programmes that specialised in treating children with motor difficulties. Therapist, clinic, programme and parents' reports indicated that the children with DCD had no known neurological (e.g., cerebral palsy), neuromuscular (e.g., muscular dystrophy) or pervasive developmental disorders (e.g., autism or Asperger syndrome) and that none of the children had been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) or psychological disturbance. Some of the children, however, had repeated a grade or received intervention for language or specific learning difficulties. The children with DCD had been assessed by their various therapists or programs on standardised norm‐referenced measures of motor performance such as the McCarron Assessment of Neuromuscular Development, the Developmental Test of Visual–Motor Integration, the Bruininks–Oseretsky Test of Motor Proficiency, and the Movement Assessment Battery for Children, and been found to display performance below the average range (−1<emph>SD</emph>) on at least one of these measures. The practitioners' clinical observations of these children also noted problems in motor performance and motor performance levels below that of their peers.</p> <hd id="AN0031900038-6">Procedure</hd> <p>Parents of either typically developing children or children with DCD participated in either an individual interview or a focus group. Forty‐two parents participated in one of 12 focus groups, six for parents of typically developing children and six for parents of children with DCD. Individual interviews were conducted with parents who were unable to arrange their schedules to attend a focus group. To sensitise the parents to observe detailed aspects of the daily routine, they were given an outline of the main questions that would be asked and asked to monitor the daily routines of their children. The principal investigator initiated the focus groups and interviews, which ranged from 60–90 minutes and were audio‐taped and video‐taped, with the latter used in place of an assistant moderator (Kreuger, [<reflink idref="bib14" id="ref37">14</reflink>]). The focus groups and interviews took place in various locations (i.e., clinic offices, childcare centres, schools, family homes) based on the availability of space and parents' preferences. In all cases, parents were interviewed in the absence of their children.</p> <hd id="AN0031900038-7">Data Collection</hd> <p>For both the focus groups and the interviews, the principal investigator used semi‐structured and open‐ended questions—e.g., Please tell me about your family's typical school day routine. Does your typical family routine change on weekends?—in order to elicit broad contextual and unprompted information, followed by specific questions and probes about performance of family routines. The questions investigated daily routines in which the parents were asked to describe a "typical school day routine", one that was "not typical" for a school day and how weekend routines differed. Following each interview or focus group, detailed field notes were made by the principal investigator to record the experiences, feelings and thoughts that emerged (Patton,[<reflink idref="bib20" id="ref38">20</reflink>]). Analysis of group data from the focus groups and interviews was ongoing throughout the study, and the questions used in subsequent focus groups and interviews were modified in response to the emerging data. Interviews with Australian families of typically developing children and children with DCD were continued until saturation was reached and variation identified. Canadian families were interviewed at this point and cultural differences between Australian and Canadian families in terms of daily family routines were investigated.</p> <hd id="AN0031900038-8">Data Management and Data Analysis</hd> <p>Interviews were transcribed verbatim and NUD*IST software was used to assist with data management and data analysis. Each phrase was analysed separately by individual case (interview or focus group), and then cross‐case analysis was used to group responses to questions. The analysis was conducted in two stages. A content analysis was conducted first to identify, code, and categorise the primary patterns from the data into a manageable classification (Agar, [<reflink idref="bib1" id="ref39">1</reflink>]; Patton, [<reflink idref="bib20" id="ref40">20</reflink>]). To verify the classification, a second person coded the data separately. Initially the content was organised as descriptive data that addressed questions concerning routines. Interpretation sought to understand the daily routines of the children and the actions used to carry out those routines. This was followed by an inductive analysis that identified emerging categories, patterns, and themes (Agar, [<reflink idref="bib1" id="ref41">1</reflink>]; Patton, [<reflink idref="bib20" id="ref42">20</reflink>]). The categories were scrutinised to determine consistency and contradictions, to uncover the multiple perspectives of individuals and to develop an understanding of their experience and interactions. Trustworthiness of the study findings were augmented by collection of sufficient data for saturation to occur, an audit trail that documented the conceptual development of the research, verification of data by participant review, and an audit of transcripts by experienced researchers and clinicians.</p> <hd id="AN0031900038-9">Results</hd> <p>Differences between younger and older children with and without DCD in Australia and Canada were explored within the context of family routines. These are reported below within three separate categories: first, the <emph>typical school day</emph> routine; second, the <emph>non‐typical</emph> school day; and third, the <emph>weekend</emph> routine. Names used in quotes have been altered but do reflect the gender of the child.</p> <hd id="AN0031900038-10">Consistency of Family Routines</hd> <p>The study findings revealed that overall the activities and tasks that constituted the daily routines were consistent across families and countries. The structure of the family, daily rhythms, work patterns (especially those of the mother) and personal preferences, however, had an influence on the order in which family routines were performed and the expectations of the child's performance.</p> <hd id="AN0031900038-11">Typical School‐day Routine</hd> <p></p> <hd id="AN0031900038-12">Before School Routine</hd> <p>For all children the morning routine was characterised by being the most structured and regular in its requirements and sequence. Expectations for the morning routine on a typical school day focused on self‐maintenance, with productivity and leisure taking a lesser role. Time was an important factor in this routine and influenced what and how tasks were achieved. The time frame to complete the tasks involved in the morning routine varied among families, and the school‐day morning routines tended to follow a set pattern. The minimum expectation was that typical children would get themselves dressed, toileted, eat breakfast, clean their teeth and pack their school bag; a parent generally made lunch for school. A common expectation was that children first complete these essential tasks and then, if time permitted, engage in leisure activities such as watching television. Older children were expected to complete these independently without direction, whereas younger children received assistance with some of the tasks and required some direction and prompting to successfully complete the morning routine. Older children also had more responsibilities than younger children; they were expected to do small chores such as make their beds, pack their lunch into their school bags or assist with the care of younger siblings. "We have a wee 9 month old and she helps with her, she helps me get her dressed and holds her while I have a shower." Age differences were also noted in the time of waking. Younger children were more likely to sleep later and be woken by a parent, whereas older children more often woke spontaneously. The following quote sums up the morning routine of a younger child:</p> <p>Generally he's a little bit harder to wake up ... he comes down by himself ... we organise his breakfast ... then he does everything independently with some directions—"go brush your teeth." ... He gets himself dressed and he will want to go and turn the television on.</p> <p>In contrast, this quote is an example of the typical morning routine of an older child:</p> <p>I find now, that she is dressed and got her shoes on; she's had her breakfast, packed her bags. She doesn't make her lunch; I make it. She's tidied her room and then if she's done all those chores (I do have to help her with her hair because it does have to be put up and she can't do that) then she can watch TV.</p> <p>The before school routine for children with DCD, like typical children, was the most structured, and the tasks that constituted the morning routine were similar. For both younger and older children with DCD, however, a daily unchanging routine was seen as essential to accomplish the tasks required to get ready and out the door for school; "I have to have the routine and direction otherwise we just don't get out the door, with him just not organising himself to get ready for school, get dressed and have his breakfast". The level of structure and assistance provided to both younger and older children with DCD was greater than that provided to typical children and the parents' expectations of the level of independent performance less. Many younger and older children with DCD did not appear to be able to proceed independently without constant parental guidance and those with the most difficulty, particularly younger children, required actual assistance. Parents frequently reported that, without a consistent and high level of structure, their child would not complete the morning tasks within the allotted time frame. Implementing a high level of structure enabled the parents (usually the mother) to focus on the needs of the child with DCD and, if needed, attend to other children in the family.</p> <p>A parent of a 7‐year‐old Australian boy with DCD said:</p> <p>I've got two older children but they just do their own thing, and I have to spend all my time on him, they get themselves up, dressed, ready and out the door, and I'll spend a whole hour on Nic. You have to do everything for him, make his breakfast, put his clothes out for him, you have to turn the shower on for him, you have to drag him to the shower, get him undressed, put him in the shower, get him out of the shower, dry him, make sure he's finished his breakfast, then put his socks, his jocks and everything on for him, because he just won't do it.</p> <p>The slow performance of the tasks involved in the morning routine by children with DCD contributed to the time pressures that exist for all families and imposed extra demands on the family: "You have to harass him to go and get dressed for school; I mean he's quite capable of dressing himself, he's just very very slow."</p> <p>Parents of younger and older children with DCD developed a number of different strategies to cope with the time pressures of the morning routine. Most parents laid out the clothes for their children even when they knew that it was something that they should "get away from":</p> <p>Some of the things that I have fallen into is selecting the clothes that he will wear, and giving them to him to put on, just to expedite the process, so I know that it is something I need to get away from ... right now it just er, the morning progress is quite tedious.</p> <p>The morning time frame did not leave time for play for both younger and older children with DCD. Only those few children who rose before the morning routine commenced were reported to have free time to choose to play or watch television. Play was a distraction that parents attempted to control because it interfered with the morning routine. A common strategy used with typical children was to reward them with time to play or watch television once they had independently completed all expected tasks associated with the morning routine. The use of such a strategy was not expressed by the parents of children with DCD.</p> <p>Overall, both older and younger children with DCD required significant structure and assistance to successfully complete the morning routine. Some age differences were noted. Older children with DCD were beginning to display more independence with some aspects of the morning routine such as personal hygiene and dressing; however, they continued to be very slow in carrying it out and continued to require parental prompting.</p> <hd id="AN0031900038-13">After School Routine</hd> <p>The after school routine was characterised by its regularity from week to week, and the expectation that the structure and specific content would change with the seasonal fluctuations in recreational activities. The order in which the activities and tasks were undertaken varied between families and from day to day, and depended on the working patterns of the mother and the children's activities. Most children had at least one evening when they attended an organised activity. Almost all children engaged in one after school activity, with older children engaging in more organised activities (sport and club) than younger children.</p> <p>After school it was expected that children needed time to wind down ("veg out" or "zone out"); however, this was forgone if a friend had been invited or there was an organised activity to attend. Homework and any chores were done either before or after the evening meal. Younger children's homework was mainly reading; older children generally had an additional 30 minutes of homework a week to be done over several nights. Regular chores included unpacking their school bag, setting the table and clearing the dishes. In Australia, bathing was frequently part of the daily evening routine. In Canada, however, many children did not bathe daily: "every second day I'll say why don't you go and have a bath and she'll go have a bath". A winding down time was part of the bedtime routine; there was an expectation that children would engage in quiet activities and once in bed this was followed by a period of reading or being read to. Bedtime was associated with the age of the child; in Australia it was between 7.30 and 8.30 p.m.; however, in Canada it was reported to be later, 8.00–9.00 p.m.</p> <p>The after school routine for children with DCD was more structured and there was less flexibility as the routine was determined by the programs they attended or the type of remedial practice they did. Some children with DCD were described as being very tired after their day at school; "He gets very tired so by the end of the day he will be more than happy to have some afternoon tea and lie on the couch until dinner time." While typical children were involved in seasonal recreation team sporting activities (e.g., soccer, football, T‐ball, hockey), children with DCD were more often involved in individual activities such as swimming or martial arts. Parents of children with DCD noted that such activities had the potential to develop coordination and also reduced the "comparison factor". Parents also reported using parks and encouraging outdoor and playground activities such as ball play, play on playground equipment and cycling to promote development of motor skills.</p> <hd id="AN0031900038-14">Adapting to a Non‐typical Day</hd> <p>A non‐typical day occurred when a child had to get up early or leave home early because of an appointment, because the parent had to leave for work early or because of a sports carnival or a dress‐up day at school. Typical children were more accepting of alterations to the daily routine, although a few 6‐year‐old children were reported to be "out of sorts" and complain about such changes. In contrast, parents of children with DCD reported that their children had difficulty adjusting to changes in routines:</p> <p>We try to keep it [the routine] the same everyday because he doesn't cope well with change, he falls apart, he just doesn't seem to know what to do. So there will be lots of tears and confusion and it just doesn't go well. (Parent of 6‐year‐old boy with DCD)</p> <p>Even older children with DCD had difficulty coping with change in the routine: "any change [in the routine] she will react negatively to, even at 9 she will have a full blown tantrum" (parent of 9‐year‐old girl with DCD). To reduce the stress associated with changes in routine and to help the child cope, parents worked hard at informing and preparing the child for the change:</p> <p>One parent of an eight‐year‐old boy with DCD said:</p> <p>On those days [when the typical routine is not followed] we have to talk about what the plan is and we have to go into great detail step by step and talk it through, and then review that several times throughout the day about OK we've done this and this is coming up next and so he's ready for it. And even then it's a lot of coaxing him through what it is actually, to do what it is that's different, you know its a lot of coaxing step by step.</p> <p>Some parents of children with DCD did report that their children coped with changes to their routine, describing them as adaptable, flexible and "going with the flow". However, probing revealed that it was not always the child who was adaptable but that the child's apparent coping was a result of the parent's responsiveness to the changed situation. "I think that he is adaptable but we tend to change things to take into account that he can't do things."</p> <hd id="AN0031900038-15">Weekend Routine</hd> <p>The weekend routine was characterised by its variability. Unless there was a sporting or other commitment, the pressure of getting ready on time was reduced. The children were often allowed to stay up later and sleep in; however, they were often out of bed before their parents. Daily routine tasks often stayed the same but the timing and order was different and the atmosphere more relaxed. Children were involved in family domestic activities such as shopping, and some older children had extra domestic jobs. Families usually did some leisure activity together. Many typical older children were involved in sporting activities on a Saturday or Sunday. They were motivated and there were no reported difficulties in getting ready for and participating in these events.</p> <p>Children with DCD were reported to be much happier at weekends and holidays. These children and their parents reported that they enjoyed a relaxed atmosphere free of the time pressures and set tasks of a school‐day routine: [weekends are] "easier really, John just loves not having the routine of having to head off somewhere in the morning". When the pressures of time were removed and these children could wake and get up in their own time, most could dress without assistance. The children had few commitments; sporting events were not a feature for these children. For those children with DCD who were involved in organised weekend sporting activities, participation was somewhat stressful:</p> <p>His dad and he and his brother all do karate on Saturday mornings and he finds it hard ... he whines before he goes to it. Then he'll say to me afterwards when I ask how it was, he says "Kind of good." "So you enjoyed it?" "No not really good, just kind of good.</p> <p>Although typical children liked to laze around in their pyjamas, this behaviour was more commonly reported for children with DCD. "Saturday is probably his favourite day because that's his day he stays in pyjamas all day and probably doesn't get dressed 'til 2 or 3 in the afternoon and I'm quite happy with that." Children with DCD enjoyed the lack of routine at the weekend and this was in contrast to their need for routine during the school week. The change in atmosphere was reflected in the description of these children's responses to weekdays versus weekends. Terms used to describe weekday mornings such as "stressful" and "drama" were replaced by "loves" and "relaxed" for weekend mornings. When the pressure of time was removed, such as on the weekend, many children with DCD could demonstrate a higher level of independence than during the week. For example, some children would get their own breakfast, choose their own clothing and dress themselves. This increased independence at the weekend was clearly demonstrated by the two children who required the most assistance during the week. The parent of the 6‐year‐old said, "He's started sometimes to dress himself, it's quite surprising really". A dependent 8‐year‐old boy was independent at the weekend: "He gets up, gets himself dressed, [and] does his own hair. He gets up when he's ready, sleeps in until 9.30 ... He can go to the cupboard and get cereal and milk and stuff."</p> <hd id="AN0031900038-16">Discussion</hd> <p>There were many similarities across cultures, age groups and levels of motor competence in the daily routines of families; however, these three factors modulated the structure and rhythm of the daily routine. Parents used many different strategies to guide the family routine. Age‐related expectations influenced the child's participation in daily family routines. Typical younger children were learning the social requirements that supported participation to a level described by parents as basic independence. Basic independence was supported by parental actions that consisted of minimal physical assistance such as tying shoelaces, direct supervision related to quality of performance and task completion, and direction and prompting particularly related to the temporal aspects of the routine. Typical older children had an established routine, increased performance expectation and decreased tangible support from parents that reflected their greater capacity. Children with motor difficulties generally needed much more structural support and temporal prompting than their same‐aged peers in order to engage in the family routine.</p> <p>Cultural differences in the approaches and strategies used by Australian and Canadian parents to guide children's participation in daily routines were few. Further, only negligible differences were noted in routine expectations. The need to adjust routines to suit seasonal changes in organised activities especially sport occurred in both cultures. The colder Canadian winter had an influence on self‐maintenance activities of Canadian children relative to Australian children as they were required to manage hats, gloves and more complex and bulky clothing than was needed in Australia.</p> <p>The morning routine was the least flexible in all families because it was constrained by time. Segal ([<reflink idref="bib24" id="ref43">24</reflink>]) also observed this phenomenon in families of children with Attention Deficit Disorder who identified that time for getting to school or work required enabling strategies and routine adaptations. Children with DCD needed more time prompts, partly because they were slower to perform the essentials tasks. Pressure of time was greater for working mothers, and to sustain the routine two opposing strategies were reported: either expecting a high level of independence that would free them to do another task or providing more assistance to the child. This latter strategy was most often used with children with DCD.</p> <p>Strategies for coping with changes to routine were common across all families and differed only slightly with age. If the regular flow of the routine was to be disrupted parents typically gave their child plenty of warning and explained the reasons for change; reminded them at regular intervals prior to the disruption; and took responsibility for reorganising tasks and the temporal rhythm so that the routine was completed successfully. These adaptations could require parents taking on some of the child's tasks, giving more direction, time prompts and assistance. Typical children generally could adapt to changes in daily routines. However, children with DCD were much less amenable to change and needed more reminders and assistance to accomplish daily tasks when the daily routine was altered.</p> <p>The conclusions drawn from this study are limited by purposive sampling and the socio‐economic status of the parents who were predominantly well educated, middle class and married or living with a partner. The perspective of parents from more diverse cultures than Australia and Canada could contribute to a broader view of cultural variation in daily routines. Although the study suggests that DCD has a significant impact on daily family routines, we cannot definitively conclude this based on the findings reported here. Longitudinal prospective studies are needed to strengthen the credibility of these findings. Future studies could examine in greater detail the increased participation of children with DCD in family routines as they develop, and examine whether interventions designed to improve functional skills have an impact on children's participation in family routines.</p> <p>Most studies that have examined children with DCD have focused on these children's impairments in coordination, and few have specifically investigated in a detailed manner how the impairment in motor coordination impacts the daily routines of the family (Missiuna et al., [<reflink idref="bib19" id="ref44">19</reflink>]). This qualitative investigation suggests that the motor impairments of children with DCD significantly interfere with these children's participation in the daily family routine. This contention is supported by statements of parents that siblings that were younger than the child with DCD, as well as older siblings, were much more independent in terms of their participation in the family routine. Postural control and motor coordination were identified by parents of children with DCD as two significant factors that impacted the participation of these children (Summers et al., [<reflink idref="bib26" id="ref45">26</reflink>]). Additional constraints noted by these parents included the difficulties that the children with DCD had with the organisation and timing of the activities that made up the routine. This study also revealed that older typical children were more independent than younger children in their participation in daily routines and that this reduced demands and stresses on parents. Although older children with DCD were growing in independence, like the younger cohort with DCD, they generally needed much more parental support and assistance than their same‐aged peers in order to successfully complete daily family routines, particularly on school days. This parental support and assistance reduced the burden of the daily before and after school routines for both children with DCD and their parents. When the temporal pressures of the daily routine were reduced on weekends and children with DCD were able to set their own time frame and structure, they were more successful in participating in the family routine, which in turn contributed to a more relaxed and harmonious household.</p> <p>The next step in this research is to examine how children with DCD view their participation in family routines, what parts of the routines they find enjoyable and what parts are viewed as challenging. Such research could assist us in developing a better understanding of these children's perceptions of the impact of their motor difficulties on the performance of daily routines and could assist us in developing family‐based interventions that could create environments in the home that would promote learning and active participation in family routines. A second direction for research is in the area of longitudinal prospective studies that examine how participation in daily routines by children with DCD change for early school age to adolescence and what factors promote increased participation.</p> <hd id="AN0031900038-17">Acknowledgement</hd> <p>This paper was based on data collected by Janet Summers for her Ph.D. but regrettably she died before she was able to publish the results of her research. There was no research funding for this study, and no restrictions have been imposed on free access to, or publication of, the research data.</p> <ref id="AN0031900038-18"> <title> References </title> <blist> <bibl id="bib1" idref="ref39" type="bt">1</bibl> <bibtext> Agar, M. H.1996. The professional stranger , (2nd ed.), San Diego: Academic Press.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref4" type="bt">2</bibl> <bibtext> American Psychiatric Association. 1994. 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The seven day circle, New York: Free Press.</bibtext> </blist> </ref> <aug> <p>By Janet Summers; Dawne Larkin and Deborah Dewey</p> <p>Reported by Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib32" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib19" firstref="ref6"></nolink> <nolink nlid="nl3" bibid="bib28" firstref="ref8"></nolink> <nolink nlid="nl4" bibid="bib22" firstref="ref9"></nolink> <nolink nlid="nl5" bibid="bib16" firstref="ref10"></nolink> <nolink nlid="nl6" bibid="bib17" firstref="ref11"></nolink> <nolink nlid="nl7" bibid="bib21" firstref="ref13"></nolink> <nolink nlid="nl8" bibid="bib23" firstref="ref14"></nolink> <nolink nlid="nl9" bibid="bib26" firstref="ref15"></nolink> <nolink nlid="nl10" bibid="bib29" firstref="ref16"></nolink> <nolink nlid="nl11" bibid="bib31" firstref="ref17"></nolink> <nolink nlid="nl12" bibid="bib10" firstref="ref19"></nolink> <nolink nlid="nl13" bibid="bib30" firstref="ref20"></nolink> <nolink nlid="nl14" bibid="bib12" firstref="ref22"></nolink> <nolink nlid="nl15" bibid="bib11" firstref="ref23"></nolink> <nolink nlid="nl16" bibid="bib27" firstref="ref25"></nolink> <nolink nlid="nl17" bibid="bib13" firstref="ref27"></nolink> <nolink nlid="nl18" bibid="bib15" firstref="ref28"></nolink> <nolink nlid="nl19" bibid="bib24" firstref="ref29"></nolink> <nolink nlid="nl20" bibid="bib25" firstref="ref30"></nolink> <nolink nlid="nl21" bibid="bib14" firstref="ref31"></nolink> <nolink nlid="nl22" bibid="bib18" firstref="ref32"></nolink> <nolink nlid="nl23" bibid="bib20" firstref="ref38"></nolink>
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  Data: In order to understand how age and motor difficulties impact on daily routines, this qualitative investigation used focus groups and in-depth interviews with Australian and Canadian parents to examine the daily routines of younger (5 to 7 years of age) and older children (8 to 9 years of age) with and without Developmental Coordination Disorder (DCD). Parents were asked to describe the typical school-day routine, one that was not typical and how weekend routines differed. Daily routines were consistent across families and cultures. Older children were expected to participate more independently in the daily routine. The level of structure and assistance provided to children with DCD was greater, and the parents' expectations of independent performance were lower. Children with DCD required consistent prompting and more structure to complete the morning tasks within the allotted time. Children with DCD were reported to be much happier on weekends and holidays, enjoying the relaxed atmosphere free of the time pressures and tasks of a school-day routine. The main factors that modified participation in daily routines were the child's age and their motor difficulties.
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