Transtorno do desenvolvimento da coordenação e estado nutricional: estudo em escolares de 7 a 10 anos de idade

Abstract

Developmental Coordination Disorder (DCD) is characterized not only by a deficit in motor skills, but also by its impact on daily activities. There are specific criteria for the diagnosis of DCD, which are not always applied consistently in research, generating variable prevalence rates. Although what characterizes DCD is the deficit in motor performance, children have variable characteristics, and there is no consensus on all aspects. Difficulties in motor learning suggest cognitive impairment; however, evidence on the relationship between motor performance and cognitive level is still inconclusive. Children with DCD seem to feel less competent than peers with typical development and are more prone to physical inactivity, which may lead to weight gain, on the other hand, weight gain has an impact on motor performance, further investigation of the relationship between DCD and obesity. In this complex scenario of factors to be considered when investigating DCD, with variability in prevalence rates, criteria and cut-off points of the motor tests used, and considering the specificities of each culture, further studies on the characteristics these children to support public health strategies related to the management of DCD. Objective: To investigate the motor performance of 7-10 year-old students with DCD and its relationship with health history, cognitive level, nutritional status and self-perception of competence. Method: The final sample consisted of 402 children, with a mean age of 110.75 (± 13.22) months, of which 227 (56.5%) girls were recruited from the full-time public school system of Belo Horizonte. Horizonte - Minas Gerais and enrolled in the Segundo Tempo Program. Children were assessed with the Movement Assessment Battery for Children 2nd ed. (MABC-2); with the Developmental Coordination Disorder Questionnaire (DCDQ-Brazil) to analyze performance in daily living activities (ADL), the Raven Progressive Matrices (Raven) cognitive test, the Self-Perception Profile for Children (SPPC) competency perception questionnaire, a questionnaire with child health history and physical measurements of Body Mass Index. The economic level was estimated using the Brazil Economic Classification Criterion. Data were analyzed using descriptive statistics and comparison tests. Results: Differences were found in the prevalence of DCD depending on the criterion used. Following the criteria of the Diagnostic and Statistical Manual of Mental Disorders 5th ed. (DSM-5), a prevalence of 8.7% of children with DCD (15% percentile) was found, of which 6.2% was DCD-Severe (5% percentile). No difference was found in cognitive percentiles among children with and without DCD (p = 0.223), but there was a significant association between motor performance and cognitive level in the DCD group (p = 0.023), with a trend towards higher cognitive percentiles in the Non-DCD group. Regarding the neonatal characteristics, no differences were found in birth weight and preterm condition among the DCD, DCD-Severe and Non-DCD groups. There were 13 eutrophic children (3.2%) and 23 children with obesity (5.7%) with DCD (15% percentile), while in the DCD-Severe group (5% percentile) 9 children were eutrophic (2.2%) and 17 obese (4.2%), with no statistical differences between the nutritional groups. The eutrophic and obese subjects with DCD had similar results in the motor test, only differences in the ability to balance in the DCD group were found (p = 0.04). Obese children with severe motor disorder perceive themselves less able to motor than eutrophic children. Conclusion: The prevalence rate of DCD found in this study is very close to those described in the literature. The results reinforce the heterogeneous profile of children with DCD in motor, cognitive and nutritional status, demonstrating the importance of adopting complete criteria for the accurate identification of the disorder, so that effective interventions can be made, preventing future complications.