This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders.
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What is Developmental Coordination Disorder? by Kati Embry
Developmental coordination disorder (DCD) is not a new condition. Over the years, there have been a variety of terms used to describe children who exhibit motor difficulties such as childhood motor deficiency syndrome, congenital maladroitness, and the clumsy child. Despite the changes made to the name, the overall basis for the disorder has remained the same- difficulties in both gross and fine motor skills.
Developmental coordination disorder can best be defined as a motor disorder in children who exhibit impairments in motor coordination that is considered appropriate for their age and intellectual ability. Children with DCD often have difficulty performing tasks that involve the use of both large and small muscles. They may have a difficult time learning how to plan, organize, perform, or alter their movements. Overall, children with developmental coordination disorder have a hard time learning and developing new motor skills. They generally rely on feedback and are unable to predict the outcome of their movements. As a result, they have difficulties recognizing mistakes in their movements and learning how to correct their errors, which results in behavior that appears to be clumsy and awkward.
Developmental coordination disorder may first be recognized in early childhood when the child is attempting to master certain motor milestones. Young children with DCD may show delays in learning how to sit, walk, or crawl. Children with DCD may first appear to be slow learners in behaviors such as climbing stairs, feeding or playing. They may also show delays in self-care tasks like dressing themselves or using utensils. Symptoms for developmental coordination disorder can vary drastically between children and are generally noticed between the ages of 6-12 years old. Though the symptoms may vary, there are six general groups of symptoms. These include: general unsteadiness and slight shaking, below normal at-rest muscle tone, muscle tone that is consistently above normal, inability to move smoothly, difficulties producing written symbols, and problems with visual perception related to development of the eye muscles.
It can be difficult determining the differences between a child who has developmental coordination disorder and a child who is just simply clumsy and awkward. For a diagnosis of DCD to be given, there must be significant negative outcomes for the child’s clumsiness. These negative consequences may be apparent in the child’s daily functioning, academic performance, or activities that involve play. Developmental coordination disorder affects the child’s daily functioning and can have significant long term effects. DCD can result in social and academic problems. Due to their underdeveloped coordination, children may not participate in certain physical activities for fear of being stigmatized. This can lead to low self-esteem and feelings of low self worth. Children may also become frustrated and discouraged and give up on pursuing academic or artistic interests even though they possess normal intelligence.
A diagnosis for developmental coordination disorder is usually made when either the parents or teachers notice the child is behind their peers in learning new motor skills, or when the child has frequent injuries due to clumsiness. The following criteria are necessary for a diagnosis of developmental coordination disorder to be given:
- Performance in daily activities that require motor coordination is substantially below that expected, given the child’s chronological age and measured intelligence. This may be manifested by:
- marked delays in achieving motor milestones, such as walking, crawling, sitting
- dropping things
- clumsiness
- poor performance in sports
- poor handwriting
- The disturbance in Criterion A significantly interferes with academic achievement and activities of daily living
- Onset of symptoms occur during the early developmental period
- The disturbance is not due an intellectual disability or visual impairment and cannot be explained by neurological conditions that affect movement
It is estimated that 6% of children between the ages of 5 and 11 have developmental coordination disorder. The exact causes of developmental coordination disorder are still unknown. However, there are some environmental factors that may increase a child’s risks of being diagnosed with developmental coordination disorder. If a child is exposed to alcohol in utero or have a low-birth-weight, they are at risk.
There are a handful of tests that clinicians may use to help identify delays in motor coordination and development. These may include:
- Test for sustaining a position against gravity
- Test for motor sequencing
- Nose-finger test
- Moving a limb against resistance
- Test of energy investment in movement
- Test of the ability to perceive spatial relations
- Test of fine motor tasks
- Test for gross motor difficulties
Many children with developmental coordination disorder also have additional difficulties. They may have difficulties with speech such as stuttering problems with phonology, receptive language disorders, or even mixed language disorders. Additional consequences of developmental coordination disorders may include a decreased desire to participate in physical activities such as team sports or team play; poor self esteem; emotional or behavioral problems; impaired academic achievement; poor physical fitness; and reduced physical activity and obesity.
There is not one single type of treatment that can be applied to all children with developmental coordination disorder. However, there are two general treatment approaches that are used: the modular and generalized approach. In the modular approach, the goal is to improve the difficulties with specific techniques aimed at improving the motor challenge that is observed. This approach involves gradually targeting certain problem behaviors and implementing step-by-step interventions to teach the skill and to practice it. The modular approach generally prevents failure and rewards the child. The generalized is based on the theoretical assumption that the motor skills deficit is due to a manifestation of some underlying mechanism. Instead focusing on the observable motor challenge, the goal is to alter how children manage their bodies, process stimulation, and deal with problems resulting in improvements in their motor skills.
