Diagnosis Discussion- Developmental Coordination Disorder

 coordination

Of the older kiddos I see in the clinic (those over 3 years old), Developmental Coordination Disorder is one of the more common diagnoses that I see.

I think it’s important for parents to know about this disorder so they can help their children have more positive experiences in peer activities during their pre-school and school-age years.  I gathered this info from Medline PlusCanChild, and a research article from the Physical Therapy Journal of the APTA

What is Developmental Coordination Disorder (DCD)

From PTJ article [Barnhart RC, Davenport MJ, Epps SB, Nordquist VM. Developmental coordination disorder. Phys Ther. 2003;83:722–731.]

Developmental coordination disorder, a chronic and usually permanent condition found in children, is characterized by motor impairment that interferes with the child’s activities of daily living and academic achievement.3,5

In order for a child to be diagnosed with DCD, these motor impairments must negatively affect some other aspect of his or her life.6

From CanChild:

  • Developmental Coordination Disorder (DCD) is a motor skills disorder that affects five to six percent of all school-aged children. The ratio of boys to girls varies from 2:1 to 5:1, depending on the group studied.
  • DCD occurs when a delay in the development of motor skills, or difficulty coordinating movements, results in a child being unable to perform common, everyday tasks.
  • By definition, children with DCD do not have an identifiable medical or neurological condition that explains their coordination problems. For a list of the diagnostic criteria for DCD, click here.
  • Frequently described as “clumsy” or “awkward” by their parents and teachers, children with DCD have difficulty mastering simple motor activities, such as tying shoes or going down stairs, and are unable to perform age-appropriate academic and self-care tasks.
  • Children with DCD usually have normal or above average intellectual abilities. However, their motor coordination difficulties may impact their academic progress, social integration and emotional development.
  • DCD is commonly associated with other developmental conditions, including attention deficit/hyperactivity disorder(ADHD), learning disabilities (LD), speech-language delays and emotional and behavioural

The parents of the majority of the patients that I see with DCD, report the following concerns:

  • Their children are falling behind their peers in sports’ related activities and cannot keep up in PE classes.
  • Their child is wary to participate in new activities or sports and wary to join in with other children that are already participating in an activity.
  • Their child has decreased confidence with any sport related activity.  Their child falls/trips frequently and already has injured their legs or feet in some way from falling
  • Their child is not very good with catching/throwing/kicking balls
  • Their child has difficulty with activities that involve fine use with their hands: using scissors, pulling zippers, buttoning buttons, poor handwriting

How is DCD identified?     

  • Occupational therapists and physical therapists are skilled in the observation of fine and gross motor task performance and can assist in accurately identifying and assessing children with DCD.
  • Physical causes and other types of learning disabilities must be ruled out before the diagnosis can be confirmed.
  • Children with DCD are usually only mildly delayed with their initial gross motor milestones, so it cannot be identified based on that information.
  • There are 2 primary tests that are used to identify coordination problems in children: Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) and the Movement Assessment Battery for Children (M-ABC)
  • The degree of motor delays is greater than expected considering the child’s cognitive ability.  From PT Journal Article- Geuze et al recommended that a child scoring below the 15th percentile on standardized tests of motor skills and having an IQ score above 69 would qualify for a diagnosis of DCD.

Why is it important to identify DCD at a young age?  from CanChild

  • DCD can have a negative affect on many aspects of a child’s life.
  • Children with movement difficulties that are significant enough to impact upon their functional daily living skills often exhibit a number of related behavioural difficulties. They may demonstrate negative or destructive behaviour or be overly dependent and passive.
  • Research shows that children with DCD tend to withdraw from participation in physical and social activities, and this can be due to their poor motor performance or associated social and emotional difficulties.
  • Children with DCD have been noted to lose physical fitness over time, and appear to be at risk for many of the factors associated with a sedentary lifestyle, including cardiovascular disease and obesity.
  • Identifying DCD at an early age and developing appropriate management strategies can help to improve the physical, social, and emotional outcomes for children with DCD

Prognosis:

How well a child does depends on the severity of the disorder. The disorder does not get worse over time. It usually continues into adulthood.

Cause:

  • No clear cause of DCD is explicitly known.
  • Development of coordinated movements is a complicated process, but from research done (discussed in PT Journal linked above), it appears that children with DCD aren’t as efficient at performing a new activity and learning from it to help perform the activity better with multiple practice attempts.
  • Whenever we do a new task, our brain basically files away the basic requirements for doing that task, so that the next time we perform it, we can do it better since we already have on file how we did the task the first time.  For kids with DCD, it appears that they don’t make a file each time they do a new task, so that every time they perform more complex tasks, they have to relearn it and try to file away the requirements for performing that task, which is why they seem uncoordinated.
  • For example- When you practice catching a ball, your brain is filing the following info away: when the ball is coming towards you, you have to raise your arms and close your hands around the ball at the appropriate time to catch the ball.  Each time you practice this skill, your brain is making a more specific file on the proper hand placement and timing to catch a ball.

Just for fun, here’s a short video of kids learning to catch a ball:

Treatment:

Children with DCD usually receive Occupational Therapy and Physical Therapy to address their motor coordination.

From CanChild:

Coordination difficulties do not usually go away. But children can learn how to successfully execute many of the motor tasks that they need to perform everyday.

With practice and effort, gradual improvement will be seen in specific skills. A growing body of research demonstrates the value of an individualized, task-oriented approach which focuses on the direct teaching of functional skills that children need or want to perform in order to address activity and participation goals.

As the child attempts to solve a movement problem, they may discover several ways to complete a motor task and are encouraged to experience the resulting effects of using different aspects of their bodies or the environment.

While there is good evidence for children learning the tasks that are taught through this task-oriented approach, to date there has not been much evidence for transfer or generalization of skills, which are important for the child with DCD.

Like the task-oriented approach, cognitive approaches are intended to increase activity and participation in the child with DCD.

Cognitive approaches use direct skill teaching in their approach and combine this with a unique problem-solving framework which guide the child in discovering verbally based strategies to help them solve problems during the learning of motor activities. This approach is intended to help children generalize from the learning of one skill to the next and stresses the importance of children learning to monitor their performance and use self-evaluation.

 

 

From PT Journal Article:

There are usually 2 approaches to teaching motor skills:

Bottom up– Focus is on remediating underlying deficits- meaning focusing on the movement impairments that are leading to the coordination problems.  Some impairments include: balance, strength, proprioception.

Top down- Emphasis is on cognitive or problem-solving skills to select and implement the most appropriate strategies for successful task performance.

 

 

 

 

 



Categories: Diagnosis Discussion

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