404 Developmental Medicine & Child Neurology 2007, 49: 404–404 Acknowledgement that developmental coordination disorder (DCD) has short- and long-term impact for those experiencing the condition, their families, and communities underpins the quest to determine effective interventions. As Niemeijer and col- leagues have indicated in this issue, most promise, to date, has been found in performance-oriented approaches. 1 Neuromotor task training (NTT), along with other skill training 2 and cognitive- ly oriented approaches, 3 can be conceived as one of these interventions. The challenge is to develop the evidence base to justify the adoption of appropriate interventions. In this paper, Niemeijer and colleagues have attempted to take the first steps in this process with respect to NTT. Central to being able to research an intervention, however, is the careful detailing of the approach being investigated. Niemeijer et al. describe NTT as ‘a cognitive neuroscience approach to motor control’. The reader is referred to an earlier publication for details of the intervention. 4 The refer- ence provided outlines general principles of the intervention but does not enable easy replication by other researchers. More detailed procedural information about assessments employed and examples of how intervention is individually tailored would be valuable. Intervention with children with DCD is thought most appropri- ate if it targets the tasks which they are required to undertake to enable their participation in everyday activities. NTT, as described in this paper, is therapist-driven with children being taught the skills they need for daily activities. Given that the researchers talk about keeping treatment reports to enable them to determine the proximity between skill training employed in intervention and the tasks assessed in their outcome measures, this approach contrasts with others, such as Cognitive Orientation to daily Occupational Performance (CO-OP), 3 which captures the motivational aspect of learning by collaborative goal-setting with the child. A question which needs to be raised in the current study relates to the efficacy of employing the Movement Assessment of Battery for Children (MABC) and the Test of Gross Motor Development (TGMD-2) as both diagnostic and outcome measures, and also as pre- and post-measures of change following intervention. The Leeds Consensus Statement seminar series on movement inter- vention research discusses the problematic issue of pre-post mea- surements of change. The use of the MABC as a precise measure of change is not recommended because it ‘uses standardized impairment scores, which create a highly truncated measurement of performance’. 5 The use of the MABC and the TGMD-2 for pre- and post-test measures is also problematic when outcomes target improvements in skills, grounded in these measures. The claim that the ‘positive effects of NTT are not (only) due to attention or other Hawthorne effects’ is difficult to substantiate. Commentary Neuromotor task training for children with developmental coordination disorder Comparing a group of children who received intervention (of any kind) with a group of control children who receive nothing has inherent limitations. Furthermore, the limitations of the control group recruited for the current study must be discussed so that practitioners can evaluate the efficacy of a treatment and the scien- tific credibility of the results. For example, a significant limitation that introduces a bias into the study includes lack of randomization by using a no-treatment non-concurrent control group design. For children with DCD, poor performance of motor tasks can restrict participation opportunities. The focus on supporting the acquisition of important daily activities through adequate research interventions is, therefore, important for these children’s physical, social and emotional development. As children age, however, they, in collaboration with parents, are more able to control the demands placed upon them to enable optimal fit between their abilities and activity demands. It may be that interventions need to move from a focus on impairment and activity limitation to consid- er environmental factors alongside child-focused skill acquisition. 6 Irrespective of the intervention focus, research needs to be based on sound theory, and demonstrate empirical rigour in evaluation to provide public and scientific credibility. Jenny Ziviani Anne Poulsen University of Queensland References 1. Wilson PH. (2005) Practitioner review: approaches to assessment and treatment of children with DCD: an evaluative review. J Child Psychol Psychiatry 46: 806–823. 2. Larkin D, Parker HE. (2002) Task-specific intervention for children with DCD: a systems view. In: Cermak SA, Larkin D, editors. Developmental coordination disorder. Albany, NY: Delmar p 234–247. 3. Polatajko HJ, Mandich A. (2004) Enabling occupation in children: the Cognitive Orientation to daily Occupational Performance (CO-OP) approach. Ottawa, ON: CAOT Publications ACE. 4. Schoemaker MM, Smits-Engelsman BCM. (2005) Neuromotor Task Training: a new approach to treat children with DCD. In: Sugden DA, Chambers M, editors. Children with Developmental Coordination Disorder. London: Whurr. 5. Wilson P. (2006) Shaping movement intervention research: Seminar 4 – Intervention. In: Sugden D, editor. Leeds Consensus Statement: Developmental Coordination Disorder as a Specific Learning Difficulty. Economic&Social Research Council Seminar Series. http://www.dcd-uk.org/seminar4b.html. (accessed 20 March 2007) 6. Missiuna C. (2006). New models for changing the environment, not the child: Seminar 4 – Intervention. In: Sugden D, editor. Leeds Consensus Statement: Developmental Coordination Disorder as a Specific Learning Difficulty. Economic & Social Research Council Seminar Series. http://www.dcd-uk.org/seminar4b.html (accessed 20 March 2007) See related article on page 406