For the parents of the “clumsy kids” and the “awkward movers”, Developmental Coordination Disorder (DCD) can be a confusing diagnosis and difficult to understand how it affects your child as well as what can be done to help eliminate negative effects of having it. In this blog, Dr. McIntyre goes over DCD. Hopefully this blog improves your insight on the condition: what it is, how its treated, and how your child can overcome it.
What is Developmental Coordination Disorder?
Developmental Coordination Disorder (DCD) is a condition where children experience delays in motor skills, specifically with coordinated movements, that result in a the child have difficulty with or being unable to perform common every day tasks. It affects 5-6% of school aged children and the effects can persist into adolescents and adulthood. These are typically the children labeled as clumsy or awkward by teachers, parents and peers.
The following listed are the medical criteria for diagnosis with DCD by a medical professional:
A) Learning and execution of coordinated motor skills is below expected level for age, given opportunity for skill learning.
B) Motor skill difficulties significantly interfere with activities of daily living and impact academic/school productivity, prevocational and vocational activities, leisure and play.
C) Onset is in the early developmental period.
D) Motor skill difficulties are not better explained by intellectual delay, visual impairment or other neurological conditions that affect movement.
The delays are typically first noticed when the child is attempting to learn motor patterns that require precision or skill (roughly preschool to early elementary age). Typical early milestones such as sitting unsupported or rolling over are not effected. Skills that are typically affected or delayed:
Kids with DCD will be challenged by games that involve ball skills.
Self care skills:
feeding: using utensils
getting dressed: managing a button or zipper
Whole Body Coordination
Where arms and legs are doing different things
i.e. Jumping Jacks, skips, galloping
Hand-eye coordination
i.e. catching, throwing, kicking
Grading the movement (how far to throw or kick)
Timing of the movement (when to catch or kick)
Here are some other signs that indicate an assessment for DCD:
A child with DCD may struggle with writing and school work.
moves awkwardly
seems clumsy or poorly coordinated
frequently trips, or drops things
prints or writes poorly, and with much effort
has trouble with daily activities such as handling utensils, catching a ball, cutting with scissors, tying shoelaces
avoids participation in physical or motor-based activities
has difficulty learning and transferring new motor skills
While DCD is a condition all in and of itself, it can be associated with other conditions diagnosed in early childhood. Some of these conditions include: ADHD, speech delays, learning delays, and behavioral conditions.
What causes DCD?
There is no known cause of DCD but doctors have some speculations on what is occurring in the brain to cause the symptoms of the condition. Likely it has something to do with the cerebellum which is the brain’s coordination control center. Here are a couple of leading theories:
Children with DCD may have difficulty with processing their environment. The nerves of the body receive “input” from the environment which is then sent to the brain. Potentially as the information reaches the brain, the child is having issues with processing this information into a motor output. If the brain processes the information poorly or incorrectly the motor output in response is poorly coordinated, graded, or timed when compared to the original input.
Children with DCD have also been shown to have difficulty with postural control and body awareness. These children rely heavily on visual input to known where they are in their environment. This may indicate they struggle with relying on other sources of information to adjust their body position and posture in space.
What makes DCD so Different?
Other motor delays are typically caused by a known underlying pathology - i.e. neurological or genetic condition. In these conditions obtaining new skills can be hard. The child may have strength issues, low tone or high tone etc. However, there is no barrier to the coordination of these skills in terms of processing environment when looked at in a text book manner. Obviously children with other conditions can have some of the same processing issues as children with DCD.
However, in children who have only DCD, there is no clinical loss of strength, typically no tone issues, no visual impairments etc that can be described as a “cause” of their lack of coordination development. DCD can be more of a silent condition unless parents or teachers become concerned about a child’s ability to perform play and self care tasks.
While DCD does seem like a struggle for the child that has it and maybe frustrating for the parent who has to help them with tying their shoes every morning… the negative effects of DCD can run far greater. DCD is imperative to treat early if diagnosed. The following are some of the negative implications of DCD on other realms of development:
Behavioral difficulties: If you treat early you can avoid behavioral issues with your child as they become more frustrated with their difficulty with simple every day tasks
Decreased physical activity: Children with DCD tend to have decreased physical activity levels as they avoid the movements they struggle to perform. In the long run this leads to potential obesity and cardiovascular concerns.
Poor social engagement: Children with DCD may also withdraw from social activities as they feel awkward with attempting to interact with their peers on the playground playing ball or other game. This can lead to decreased social performance and social anxiety over time.
So how do I know if my child has DCD?
After a conversation with your child’s doctor about your concerns you will likely be referred to either physical therapy or occupational therapy. There are several tools used by your physical therapist (or occupational therapist) to determine if your child has DCD or is at risk for a coordination delay.
-Movement Assessment Battery for Children (M-ABC2), Second Edition: A tool used to evaluate your child’s coordination development and look for motor function impairment. It looks at three different categories - manual dexterity, ball skills, and static and dynamic balance. It will categorize your child as typical, at risk, or delayed. It can be used on children 3 to nearly 17 years of age.
-Test of Gross Motor Development (TGMD-2): A tool used to evaluation your child’s gross motor development and coordination. It looks at 2 different categories of movement: Locomotor skills (like running or galloping) and Object Control (like dribbling and catching). It ranks children on a percentile based on normative values. It can be used on children 3-11 years of age.
-Peabody Developmental Motor Scales (PDMS-2): A tool used to evaluation your child’s gross motor and fine motor skills compared to norm referenced values. It looks at 6 different subcategories: Reflexes (for infants), Stationary skills, locomotor skills, object manipulation skills, visual-motor integration skills, and grasping skills. These subcategories can be lumped into two larger categories of gross motor skills and fine motor skills. It can be used on children 0-5 years of age.
All three of these tools can be used to assess your child across a variety of different skills and compare them against age appropriate peer performance. For most therapists, if you child score’s below the 25th percentile they should be monitored and below the 10-15th percentile they should be treated for DCD.
How can I help my child if they have DCD?
Most children with DCD get referred to either (or both) physical therapy and/or occupational therapy. If you get referred by your pediatrician or other MD, I recommend attending your evaluation and getting the opinion of the therapist on whether or not your child will need PT/OT treatment. Research currently shows that physical therapy intervention is effective at treating DCD when compared to complete inaction. (Offor et al). There are several ways to address DCD through therapy:
Task-oriented intervention: The therapist will work on the specific challenges your child has. They will work on part-task and task break down/slow down as your child builds the ability to coordination whatever they are struggling with.
This type of intervention also works on application of the task into other environments and situations in order to make sure your child can take their new movement pattern/skill “on the road” so to speak.
Assist with problem solving- identification and solution finding: The therapist will help your child reason through their different movement difficulties and help them learn to find solutions to their challenges. The therapist will teach your child tricks and techniques for assisting themselves with challenging tasks.
Address other impairments: Because your child is not moving in a typical way during play, or maybe not playing as much because the coordination of play with their peers is hard, they are likely not developing the strength and balance appropriate for their age. Your therapist will test and see where your child has deficits in strength, balance, endurance, and core activation and work on these deficits to make sure they are age appropriate. A child cannot perform skipping if they don’t have to the balance or strength to perform a single leg hop.
The biggest thing you can do to help your child is to make sure you get the right help as early as possible. If you suspect Developmental Coordination Disorder, speak with your pediatrician and discuss your concerns. Follow up with any referral you are given and attend therapy if it is recommended. With the right help, your child can overcome DCD and live a full and fulfilling childhood!
Resources:
CanChild: https://www.canchild.ca/en/diagnoses/developmental-coordination-disorder
Pearson: https://www.pearsonassessments.com/
Elon Tests and Measures: https://blogs.elon.edu/ptkids/category/tm-tools/
Offor, N., Ossom Williamson, P., & Caçola, P. (2016). Effectiveness of Interventions for Children With Developmental Coordination Disorder in Physical Therapy Contexts: A Systematic Literature Review and Meta-Analysis. Journal of Motor Learning and Development, 4(2), 169-196.