Tool use in children : neuropsychological approach of typical development and Developmental Coordination Disorder

Les perturbations des activités de vie quotidienne constituent l’un des critères diagnostiques du Trouble de l’Acquisition de la Coordination (TAC). Malgré leur impact sur l’autonomie de l’enfant, les troubles d’utilisation impliqués dans ces activités quotidiennes demeurent peu explorés (e.g., mécanismes sous jacents, profils inter-individuels, recul évolutif). A notre connaissance, la notion d’utilisation d’outil n’a pas fait l’objet d’une modélisation développementale spécifique.Elle se situe aujourd’hui au carrefour des modèles sur le développement perceptivo-moteur et des théories sur l’émergence des capacités cognitives de résolution de problème chez l’enfant. Des modèles récents développés chez l’adulte apraxique suggèrent que l’utilisation d’outil est le fruit d’un processus dialectique entre un raisonnement technique (i.e., analyse abstraite des moyens techniques pertinents pour un but donné) et des habiletés sensori-motrices (i.e., guidées par les représentations sur les transformations mécaniques à opérer). A l’appui de ces modèles, la présente thèse propose d’une part d’analyser le développement typique de l’utilisation d’outil et des processus sous-jacents.Nous explorons d’autre part l’hypothèse d’un développement atypique de l’utilisation d’outil chez des enfants diagnostiqués TAC. Nos résultats apportent des arguments en faveur de la contribution du raisonnement technique au développement typique de l’utilisation d’outil. Sur le plan clinique, l’analyse de l’étendue et des causes sous-jacentes des difficultés d’utilisation d’outil confirme l’importance d’un tel examen pour la validation des critères diagnostiques du TAC.Deficits in daily living activities are one of the diagnostic criteria of the Developmental Coordination Disorder(DCD). Despite their impact on child’s autonomy, tooluse disorders involved in these daily activities remainunder-assessed (e.g., underlying processes,interpersonal profiles, persistence disease). To ourknowledge, there is no theoretical framework of tool useformulated in a specifically developmental perspective.This concept actually remains at the crossroads between models of the perceptual-motor development and theories about cognitive processes of problem resolution in children. Recent models developed inadults with apraxia suggest that tool use is a dialectical process between a technical reasoning (i.e., abstractanalysis of technical means and ends) and sensory motorskills (i.e., managed by the representations on the mechanical transformations to be operated). According to these models, we first aim to analyze the typical development of tool use and the underlying processes.We then explore the assumption of an atypical development of tool use in children with DCD. Ourfindings provide evidence for the involvement of technical reasoning in typical development of tool use.From a clinical perspective, the analysis of tool use impairment and underlying deficits confirm the relevance of such an assessment for the validation of the diagnostic criteria of the DCD

L'utilisation d'outil chez l'enfant : approche neuropsychologique du développement normal et du Trouble de l'Acquisition de la Coordination

Deficits in daily living activities are one of the diagnostic criteria of the Developmental Coordination Disorder(DCD). Despite their impact on child’s autonomy, tooluse disorders involved in these daily activities remainunder-assessed (e.g., underlying processes,interpersonal profiles, persistence disease). To ourknowledge, there is no theoretical framework of tool useformulated in a specifically developmental perspective.This concept actually remains at the crossroads between models of the perceptual-motor development and theories about cognitive processes of problem resolution in children. Recent models developed inadults with apraxia suggest that tool use is a dialectical process between a technical reasoning (i.e., abstractanalysis of technical means and ends) and sensory motorskills (i.e., managed by the representations on the mechanical transformations to be operated). According to these models, we first aim to analyze the typical development of tool use and the underlying processes.We then explore the assumption of an atypical development of tool use in children with DCD. Ourfindings provide evidence for the involvement of technical reasoning in typical development of tool use.From a clinical perspective, the analysis of tool use impairment and underlying deficits confirm the relevance of such an assessment for the validation of the diagnostic criteria of the DCD.Les perturbations des activités de vie quotidienne constituent l’un des critères diagnostiques du Trouble de l’Acquisition de la Coordination (TAC). Malgré leur impact sur l’autonomie de l’enfant, les troubles d’utilisation impliqués dans ces activités quotidiennes demeurent peu explorés (e.g., mécanismes sous jacents, profils inter-individuels, recul évolutif). A notre connaissance, la notion d’utilisation d’outil n’a pas fait l’objet d’une modélisation développementale spécifique.Elle se situe aujourd’hui au carrefour des modèles sur le développement perceptivo-moteur et des théories sur l’émergence des capacités cognitives de résolution de problème chez l’enfant. Des modèles récents développés chez l’adulte apraxique suggèrent que l’utilisation d’outil est le fruit d’un processus dialectique entre un raisonnement technique (i.e., analyse abstraite des moyens techniques pertinents pour un but donné) et des habiletés sensori-motrices (i.e., guidées par les représentations sur les transformations mécaniques à opérer). A l’appui de ces modèles, la présente thèse propose d’une part d’analyser le développement typique de l’utilisation d’outil et des processus sous-jacents.Nous explorons d’autre part l’hypothèse d’un développement atypique de l’utilisation d’outil chez des enfants diagnostiqués TAC. Nos résultats apportent des arguments en faveur de la contribution du raisonnement technique au développement typique de l’utilisation d’outil. Sur le plan clinique, l’analyse de l’étendue et des causes sous-jacentes des difficultés d’utilisation d’outil confirme l’importance d’un tel examen pour la validation des critères diagnostiques du TAC

Nature and Specificity of Gestural Disorder in Children with Developmental Coordination Disorder: A Multiple Case Study

Aim: Praxis assessment in children with developmental coordination disorder (DCD) is usually based on tests of adult apraxia, by comparing across types of gestures and input modalities. However, the cognitive models of adult praxis processing are rarely used in a comprehensive and critical interpretation. These models generally involve two systems: a conceptual system and a production system. Heterogeneity of deficits is consistently reported in DCD, involving other cognitive skills such as executive or visual-perceptual and visuospatial functions. Surprisingly, few researches examined the impact of these functions in gestural production. Our study aimed at discussing the nature and specificity of the gestural deficit in DCD using a multiple case study approach.Method: Tasks were selected and adapted from protocols proposed in adult apraxia, in order to enable a comprehensive assessment of gestures. This included conceptual tasks (knowledge about tool functions and actions; recognition of gestures), representational (transitive, intransitive), and non-representational gestures (imitation of meaningless postures). We realized an additional assessment of constructional abilities and other cognitive domains (executive functions, visual-perceptual and visuospatial functions). Data from 27 patients diagnosed with DCD were collected. Neuropsychological profiles were classified using an inferential clinical analysis based on the modified t-test, by comparison with 100 typically developing children divided into five age groups (from 7 to 13 years old).Results: Among the 27 DCD patients, we first classified profiles that are characterized by impairment in tasks assessing perceptual visual or visuospatial skills (n = 8). Patients with a weakness in executive functions (n = 6) were then identified, followed by those with an impaired performance in conceptual knowledge tasks (n = 4). Among the nine remaining patients, six could be classified as having a visual spatial/visual constructional dyspraxia. Gestural production deficits were variable between and within profiles.Discussion: This study confirmed the heterogeneity of gestural production deficit among children with a diagnosis of DCD, at both intra- and inter-individual levels. The contribution of other cognitive deficits in most of the profiles allows discussing the specificity of gestural difficulties. This argues in favor of the necessity to distinguish gestural problems with other deficits made apparent through gesture

L’utilisation d’outils chez l’enfant : approche épistémologique et sémiologie clinique dans le trouble développemental de la coordination

International audienceTool use disorders are frequently reported in clinical pediatrics, specifically in the case of developmental coordination disorder (DCD). They can reduce children’s participation in day-to-day activities. However, operational strategies for assessment are unorganized and do not consistently consider the impact of impairments on daily life, due to the lack of a consensual explanatory theory in DCD. In this paper, we firstly examine the nature of gestural and motor coordination disorders in children with DCD, as well as their possible role in tool use. The relevance of theoretical concepts and clinical assessment used are also examined with regard to the analysis of tool use impairment. Second, we outline theoretical frameworks in typical development and in adult neuropsychology, which would shed light on the understanding of these symptoms in children with DCD. Finally, we discuss the clinical perspectives for a differential and theoretical assessment of tool use in children.Les troubles d’utilisation d’outils constituent une plainte fréquente en clinique pédiatrique, notamment en cas de trouble développemental de la coordination (TDC), et peuvent limiter la participation de l’enfant aux activités de vie quotidienne. Pourtant, l’absence de théorie explicative consensuelle dans le TDC induit des stratégies d’examen peu structurées, voire affranchies de cadrage théorique, qui n’intègrent pas automatiquement l’évaluation du retentissement des difficultés dans la vie quotidienne. Cet article propose d’interroger, dans une première partie, la nature des troubles gestuels et de coordination motrice chez l’enfant TDC ainsi que leur rôle éventuel dans l’utilisation d’outils. La pertinence des concepts théoriques et des évaluations cliniques mises en œuvre est également questionnée au regard de l’analyse des difficultés d’utilisation. La seconde partie expose les modélisations théoriques formulées dans le développement typique et en neuropsychologie adulte, susceptibles d’éclairer la compréhension de ces symptômes chez l’enfant TDC. Enfin, les perspectives d’un examen différentiel et théoriquement guidé de l’utilisation d’outils chez l’enfant sont abordées à l’issue de cette revue

Involvement of Technical Reasoning more than Functional Knowledge in development of tool use in childhood

It is well-known that even toddlers are able to manipulate tools in an appropriate manner according to their physical properties. The ability of children to make novel tools in order to solve problems is, however, surprisingly limited. In adults, mechanical problem solving has been proposed to be supported by technical reasoning skills, which are thought to be involved in every situation requiring the use of a tool (whether conventional or unusual). The aim of this study was to investigate the typical development of real tool use skills and its link with technical reasoning abilities in healthy children. Three experimental tasks were adapted from those used with adults: mechanical problem solving (three different apparatus), real tool use (10 familiar tool-object pairs), and functional knowledge (10 functional picture matching with familiar tools previously used). The tasks were administered to 85 healthy children divided into six age groups (from 6 to 14 years of age). The results revealed that real tool use (p = .01) and mechanical problem solving skills improve with age, even if this improvement differs according to the apparatus for the latter (p < .01 for the Hook task and p < .05 for the Sloping task). Results also showed that mechanical problem solving is a better predictor of real tool use than functional knowledge, with a significant and greater weight (importance weight: 0.65; Estimate±Standard Error: 0.27±0.08). Ours findings suggest that real tool use and technical reasoning develop jointly in children, independently from development of functional knowledge. In addition, technical reasoning appears partially operative from the age of 6 onwards, even though the outcome of these skills depends of the context in which they are applied (i.e., the type of apparatus)

Praxis skills and executive function in children with neurofibromatosis type 1

International audienceThis study aimed at examining motor and ideomotor praxis skills in children with neurofibromatosis type 1 (NF1). The impact of executive dysfunction, frequently described in children with NF1, on the expression of praxis impairments was also studied. Eighteen children with NF1 were included and matched with 20 control children for age (7–14 years), sex, laterality, and parental education level. Both groups of children underwent an assessment based on cognitive models of apraxia including visuomotor tasks, executive tests, and everyday life questionnaires. The group of children with NF1 showed a trend to weaker performances on motor and ideomotor praxis than the control group, only on the finger use condition (ps  .08). Moreover, these praxis difficulties disappeared when executive dysfunctions (planning and inhibition) were controlled. These findings support the negative impact of executive dysfunctions on praxis skills in children with NF1. The identification of praxis and executive function disorders as well as their interaction is important for differentiating primary praxic disorder from a cognitive deficit that may be expressed in gesture. Clinically, this distinction is essential to optimize targeted and effective rehabilitative interventions

Nature and Specificity of Gestural Disorder in Children with Developmental Coordination Disorder: A Multiple Case Study

International audiencePraxis assessment in children with developmental coordination disorder (DCD) is usually based on tests of adult apraxia, by comparing across types of gestures and input modalities. However, the cognitive models of adult praxis processing are rarely used in a comprehensive and critical interpretation. These models generally involve two systems: a conceptual system and a production system. Heterogeneity of deficits is consistently reported in DCD, involving other cognitive skills such as executive or visual-perceptual and visuospatial functions. Surprisingly, few researches examined the impact of these functions in gestural production. Our study aimed at discussing the nature and specificity of the gestural deficit in DCD using a multiple case study approach. Method: Tasks were selected and adapted from protocols proposed in adult apraxia, in order to enable a comprehensive assessment of gestures. This included conceptual tasks (knowledge about tool functions and actions; recognition of gestures), representational (transitive, intransitive), and non-representational gestures (imitation of meaningless postures). We realised an additional assessment of constructional abilities and other cognitive domains (executive functions, visual-perceptual and visuospatial functions). Data from 27 patients diagnosed with DCD were collected. Neuropsychological profiles were classified using an inferential clinical analysis based on the modified t-test, by comparison with 100 typically developing children divided into five age groups (from 7 to 13 years old). Results: Among the 27 DCD patients, we first classified profiles that are characterised by impairment in tasks assessing perceptual visual or visuospatial skills (n = 8). Patients with a weakness in executive functions (n = 6) were then identified, followed by those with an impaired performance in conceptual knowledge tasks (n = 4). Among the 9 remaining patients, 6 could be classified as having a visual spatial/visual constructional dyspraxia. Gestural production deficits were variable between and within profiles. Discussion: This study confirmed the heterogeneity of gestural production deficit among children with a diagnosis of DCD, at both intra- and inter-individual levels. The contribution of other cognitive deficits in most of the profiles allows discussing the specificity of gestural difficulties. This argues in favour of the necessity to distinguish gestural problems with other deficits made apparent through gesture

Involvement of Technical Reasoning More Than Functional Knowledge in Development of Tool Use in Childhood

International audienceIt is well-known that even toddlers are able to manipulate tools in an appropriate manner according to their physical properties. The ability of children to make novel tools in order to solve problems is, however, surprisingly limited. In adults, mechanical problem solving (MPS) has been proposed to be supported by "technical reasoning skills," which are thought to be involved in every situation requiring the use of a tool (whether conventional or unusual). The aim of this study was to investigate the typical development of real tool use (RTU) skills and its link with technical reasoning abilities in healthy children. Three experimental tasks were adapted from those used with adults: MPS (three different apparatus), RTU (10 familiar tool-object pairs), and functional knowledge (FK; 10 functional picture matching with familiar tools previously used). The tasks were administered to 85 healthy children divided into six age groups (from 6 to 14 years of age). The results revealed that RTU ( = 0.01) and MPS skills improve with age, even if this improvement differs according to the apparatus for the latter ( &lt; 0.01 for the Hook task and &lt; 0.05 for the Sloping task). Results also showed that MPS is a better predictor of RTU than FK, with a significant and greater weight (importance weight: 0.65; Estimate ± Standard Error: 0.27 ± 0.08). Ours findings suggest that RTU and technical reasoning develop jointly in children, independently from development of FK. In addition, technical reasoning appears partially operative from the age of six onward, even though the outcome of these skills depends of the context in which they are applied (i.e., the type of apparatus)

Un demi-siècle d’apraxie: histoire récente et perspectives futures

International audienceLes 40 ans de la Société de neuropsychologie de langue française sont l'occasion de retracer l'histoire récente du concept d'apraxie. Depuis les travaux de Geschwind dans les années 1970 qui ont largement inspiré les modélisations cognitives encore utilisées aujourd'hui, ces dernières décennies ont vu un nombre important de notions émergées. Cet article a pour objectif de retracer, en sui-vant une logique chronologique, l'émergence et l'évolution des concepts qui se sont donné pour but d'expliquer les troubles praxiques. Parmi ces concepts théoriques, trois ont été particulièrement étudiés : la mémoire sémantique, les engrammes gestuels et les approches basées sur le raisonnement. Si ces courants permettent de fournir un cadre d'analyse inté-ressant aux troubles observés dans la clinique, ils comportent également des limites et ne cessent d'alimenter les débats actuels. Dans une dernière partie, nous proposerons des pistes de réflexion sur les questions qui animent et animeront l'étude de l'apraxie dans les années à venir. Nous aborderons notamment le lien entre apraxie et schéma corporel et le rôle de l'expérience. La nécessité de proposer un cadre théorique cohérent aux difficultés praxiques observées chez l'enfant sera également discutée. Mots clés : apraxie · mémoire sémantique · engrammes gestuels · approche basée sur le raisonnemen

Imitation of meaningless gestures in normal aging

International audienceWhile imitation of meaningless gestures is a gold standard in the assessment of apraxia in patients with either stroke or neurodegenerative diseases, little is known about potential age-related effects on this measure. A significant body of literature has indicated that different mechanisms (i.e., executive functioning, visuospatial skills, sensory integration, body knowledge, categorical apprehension) may underlie the performance depending on imitation conditions (i.e., finger/hand, uni-/bimanual, symmetric/asymmetric, crossed/uncrossed configurations). However, neither the effects of these conditions on performance, nor the contribution of the abovementioned mechanisms to imitation have been explored in normal aging. The aim of the present study was to fill this gap. To do so, healthy adults (n = 103) aged 50 to 89 were asked to imitate 45 meaningless gestures. The authors controlled for general cognitive function, motor function, visual-spatial skills, executive function, sensory integration, body knowledge, and mechanical problem-solving skills. The results showed that asymmetry, body-midline crossing and, to a lesser extent, bimanual activity added an additional layer of difficulty to imitation tasks. After controlling for motor speed and cognitive function, age had an effect on imitation skills after 70 years old. This may reflect a decline in body knowledge, sensory integration, and executive functions. In contrast, the visuospatial and mechanical problem-solving hypotheses were ruled out. An additional motor simulation hypothesis is proposed. These findings may prove useful for clinicians working in memory clinics by providing insights on how to interpret imitation deficits. Lower performance after 70 years old should not be considered abnormal in a systematic manner