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Community child health, public health and epidemiology: C Gillberg Deficits in attention, motor control, and perception: a brief review Arch Dis Child 2003; 88: 904-910 [Abstract] [Full text] [PDF]

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Deficits in attention, motor control, and perception: a brief review.

Niels Henrik Rasmussen   (17 November 2003)

Deficits in attention, motor control, and perception: a brief review. 17 November 2003
Niels Henrik Rasmussen, Neuropediatric Consultant Pediatric Department, University Hospital, KAS Gentofte, DK 2900 Hellerup Send letter to journal: Re: Deficits in attention, motor control, and perception: a brief review. niras{at}gentoftehosp.kbhamt.dk Niels Henrik Rasmussen	Dear Editor I have read C. Gilberg’s paper[1] with interest but also with concern because there to my knowledge is no scientific valid paper about children with DAMP (deficits in attention, motor control, and perception). The term DAMP was first introduced by C. Gilberg in 1986 [2] and based on a study of 6 years old children in Gothenburg, Sweden.[3] The main aim of this study was to construct a screening instrument in order to detect MBD (minimal brain dysfunction) in Swedish public preschool children and analyse different aspects of the concept of MBD from a psychiatric point of view. Unfortunately the Swedish studies by G. Gilberg have great methodological problems. In the study a non-validated questionnaire for preschool teachers was used from which the children were classified in a high load or low load index group. In the groups an unpublished number of children were included which did not have ”attention deficit” but ”conduct problems” (involving conduct problems in the definition of MBD and later DAMP the boarderline between DAMP and conduct disorder became unclear). In the final investigation, partly by selfmade non-validated tests, the 22 children from the ”high-load” group and 60 children from the low-index group (66 boys and 16 girls) were compared with a random control group, which finally consisted of 59 children (29 boys and 30 girls). Of these 141 children 42 were diagnosed as having MBD, 40 were found in the index groups, 2 in the control group, of whom one had no preschool qustionnaire ”symptoms” at all. Futhermore 3 children in the index group were diagnosed as having mental retardation, 8 of the children had psychotic behaviour to a marked degree (one of the boys was already diagnosed as having infantile autism) and two children were considered to suffer from marked depressive syndrome.[4] So 10 of 14 children diagnosed as suffering from severe MBD, had severe psychiatric disorders which one could consider the primary diagnosis and MBD a secondary diagnosis. It could also explain the reason why children with socalled severe MBD/DAMP, autistic features were extremely common. It was the above mentioned group of 42 children who in 1986 swiched name to children with DAMP and followed till they were 22 years old. The above mentioned methodological problems also lead to a very high prevalence of DAMP, estimated to 18%,[1] page 112 , and in one of the later studies from 2000 where C. Gilberg et co-workers suggest a new school screening examination 5 based on the earlier studies the result of the 11 factors of WISC-III the curve for control children and children with socalled DAMP is completely parallel which means that it is children with generalized developmental problems and not specific problems that is found by the new screening test. So the term DAMP is based on studies with very great methodological problems and thereby not a valid diagnosis. In spite of this C. Gilberg now suggests a revival of the DAMP term and shifts to a new definition by combining ADHD and DCD. I would suggest that instead of confusing futher investigation one should concentrate on the ADHD diagnosis and perhaps examine if there are important subgroups e.g. children with ADHD who also have problems with motor control, of which there already are several studies.[6,7]. References (1) Gillberg C. Deficits in attention, motor control, and perception: a brief review. Arch Dis Child 2003;88:904-10. (2) Gillberg C. Attention deficit disorder: Diagnosis, prevalence, management and outcome. Pediatrician 1986;13:108-18. (3) Gillberg C, Rasmussen P, Carlstrøm G et al. Perceptual, motor and attentional deficits in six-year-old children. Epidemiological aspects. J Child Psychol Psychiatry 1982;23:131-44. (4) Gilberg, C. Perceptual, motor- and attentional deficit in Swedish primary schoolchildren. Some psychiatric aspects. J Child Psychol Psyciat 1983;24;377-403. (5) Landgren M, Kjellman B, Gillberg C. Deficits in attention, motor control and perception (DAMP): A simplified school entry examination. Acta Pediatr Scand 2000;89:302-9. (6) Pitcher TM, Piek JP, Hay DA. Fine and gross motor ability in males with ADHD. Dev Med Child Neurol 2003;45:525-535. (7) Kalff AC, de Sonneville LM, Hurks PP et al. Low- and high-level controlled processing in executive motor control tasks in 5-6 year-old children at risk of ADHD. J Child Psychol Psychiatry. 2003;44:1049-57.