Université de Paris, Faculty of Health, Department of Medicine
Paris Descartes, IUF,
INSERM Unit 1018-CESP, Necker-Enfants Malades hospital, AP-HP. Centre, Paris, France.
Multidimensional contribution of assessment for the identification of neurodevelopmental markers : Developmental Coordination Disorder (DCD)
Developmental Coordination Disorder (DCD) defines a heterogeneous group of children exhibiting impairments in motor coordination that significantly interferes with an individual’s academic achievement and/or activities of daily living. There is no concensus in the literature about researches of DCD subtypes because the methodology of the studies are not homogeneous. Few studies have used cluster analysis to identify distinct subtypes.
Moreover, different cerebral functions have not be investigated, it is often used only a performance standardized measure of motor coordination, but few tools rely on a neurodevelopmental approach.
We will focus on our model studies using strict inclusion criteria of participants with a multidimentional investigations composed of standardized psychological, neuropsychological, neurovisual and MRI examination, and neuromotor and psychomotor assessments with the NP-MOT Battery (from 4 years old). These assessments (from NP-MOT) are neurodevelopmental with age-related normative data, and standardizedwith identical independent subtests across ages and qualitative and quantitative measures reflecting the development of neuro-physiological maturation.
Hierarchical Ward-based clustering and the k-means algorithms were used to identify three groups of subjects (Ideomotor, Visuo-Spatial/Constructional, and the Mixed DCD subtypes). Multivariate supervised statistical models were used to isolate specific markers for each of these three subtypes of DCD with high predictive discriminant power on an augmented database of DCD children.
The most discriminant diagnostic markers (significant, p< 0.05) to explain the specificity of the three subtypes evidenced are: digital praxis, imitation of gestures, digital perception, visuo-motor integration, manual dexterity, visual-spatial structuration, coordination between upper and lower limbs, and Lego blocks. This was confirmed by two multivariate statistical models (100% with Random Forest (RF) and 91,4 %, (0.713–0.999) with PLS discriminant analysis).
Neurodevelopmental assessments such as NP-MOT should be encouraged to be used to understand the nature of impairments and neurophysiological brain mechanisms involved in DCD. The choice of appropriate measures in methodology of the study and informations about characteristics of included participants have an impact on understanding of the nature and etiology of different subtypes of DCD. DCD should not be an umbrella diagnosis in the motor spectrum. The evidencing of comorbidity points to other cerebral mechanisms that could explain associated impairments in perception and visual perception, motor execution disorders (pyramidal pathway) or executive mental function disorders… etc
The NP-MOT battery thus contributes to providing important neuro-sensory motor semiological and diagnostic indications from a physiological and pathological viewpoint, and has been recommended in France by the French health authorities (Haute Autorité de la Santé – HAS) in the program dedicated to the Autism Spectrum Disorders and for the assessment of Neuro-Developmental Disorders. Transactional clinical assessments of phenotypage based on a fine semiology with developmental normative standardized tools in neuro-sensory-motor and cognitive functions appears relevant to better understand the underlying cerebral mechanism, the nature and the aetiology of a neurodevelomental disorder or genetic diseases. Moreover, the NP-MOT battery (now digitalized) can cover a whole field of clinical and transdisciplinary research and enables a clinical neurodevelopmental phenotyping, ranging from genetics to neuro-radiology, neuro-paediatrics, endocrinology, neurophysiology, ophthalmology and child psychiatry.
Professor Laurence Vaivre-Douret, PhD, Full Professor of Developmental Neuropsychology at the Université de Paris, Faculty of Health, Department of Medicine Paris Descartes, and Clinical Psychologist-Neuropsychologist, Physiotherapist, Psychotherapist in Children hospital AP-HP.Centre at Necker Enfants-Malades, in Paris, France. Senior Laureate at the Institut Universitaire de France (IUF), Paris. Head of a research team entitled “Neurodevelopment and learning disabilities” in 1018 Unit INSERM, PsyDev team, at Necker Hospital. And associated researcher to the team of Endocrinological Pediatric Department in the IMAGINE Institute of the genetic diseases. Area of expertises focus on the field of the neurodevelopmental knowledges on children, from neonate to adolescent, from a physiological and pathological viewpoint, with a multidimensional assessment for a clinical phenotyping (on neuro-sensorimotor, neuropsychological and psychopathological investigations), based on a fine semiology with the innovation of new standardized assessment tools on the neuromotor and psychomotor functions, tools recommended by the French Health Authority (HAS) in the 4th autism plan in France (2018-2022) and for neurodevelopmental disorders screening (Ministerial Order of Health, April 16th 2019). The aims being first to understand the underlying cerebral mechanism, the nature and the origin of a neurodevelopmental disorder with the identification of homogeneous profiles and trajectories in order to enhance the knowledges from a physiological or pathological/endophenotyping point of view, on nosography, aetiology, specific markers and involved factors, phenotyping characterization and genotyping/phenotyping correlations. Secondly, to contribute to the preventive intervention and remediation.