Brain functional connectivity in children with developmental coordination disorder following rehabilitation intervention.

BACKGROUND Children with developmental coordination disorder (DCD) show improved motor function after Cognitive Orientation to Occupational Performance (CO-OP) intervention; however, the neural basis for these improvements is unknown. METHODS In this randomized waitlist-controlled trial, 78 children with DCD (with/without ADHD) were randomly assigned to either a treatment or waitlist group and underwent three resting-state MRI scans over six months. The treatment group received intervention between the first and second scan; the waitlist group received intervention between the second and third scan. RESULTS After CO-OP intervention, children with DCD [13 male, 8 female; mean (SD) age: 10.0 (1.7) years] showed increased functional connectivity between the default mode network and right anterior cingulate gyrus (p < 0.01). Additional gains were noted at follow-up three months after the intervention, with greater functional connectivity between the dorsal attention network and precentral gyrus (p < 0.02). However, children with DCD + ADHD [18 male, 1 female; mean (SD) age: 10.0 (1.14) years] did not show brain changes following CO-OP. CONCLUSION For children with DCD, increased functional connectivity in networks associated with self-, emotion-, and attention-regulation may underlie motor skill improvements observed after CO-OP intervention. Modifications to the CO-OP protocol may be required to induce similar brain changes in children with DCD + ADHD. IMPACT This study provides neuroscientific evidence for the Cognitive Orientation to Occupational Performance (CO-OP) approach as an effective rehabilitation intervention to induce brain and behavioral changes in children with DCD. While children with DCD ± ADHD showed improved motor function after CO-OP, only children with DCD showed brain changes after intervention. Children with DCD showed increased functional connectivity in networks associated with self-, emotion-, and attention-regulation after the intervention. Treatment modifications may be required to induce similar brain changes in children with DCD + ADHD. Pediatricians are encouraged to refer children with DCD  with and without ADHD for CO-OP intervention to improve their motor skills.