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Understanding development coordination disorder

Written by Marlene Jooste • Online since 4.10.2017 • Filed under Feature • From Issue Fifteen - October to December 2017 page(s) 12-14
Understanding development coordination disorder

Development coordination disorder (DCD) is often called a ‘hidden disorder’ because children are regularly misdiagnosed, or not diagnosed at all. Marene Jooste, a Kinderkineticist, explains what DCD is and the impact it has on children’s lives and the lives of their families.

What happens if you have a clumsy child with two left feet, who seems to move slower than other children, or who takes longer to reach his milestones?

What if this lack of coordination also affects daily functioning, making it a struggle to execute simple motor activities such as fastening buttons, tying shoelaces, or using a knife and fork? We need to look at this aspect of motor development because 5 to 6% of all schoolaged children are affected by severe clumsiness, which is also known as development coordination disorder (DCD). Some research in South Africa by Kinderkineticists even suggests that up to 15% of children are affected by DCD, depending on the geographical area in which the research has been done. DCD is also more prevalent in boys than girls.

What is DCD?

DCD is not a new concept or the latest ‘craze’. Over the centuries, different terms have been used to describe children with motor difficulties. It was also believed that children would ‘outgrow’ their clumsiness. However, studies now show quite conclusively that most children do not outgrow these problems and, in 1994, an international panel of experts decided to recognise ‘clumsy’ children as having DCD. Unfortunately, many people are still unaware of DCD and the impact it has on children’s lives and the lives of their families.

DCD is a common developmental condition where children experience noteworthy difficulties in motor learning and in the performance of everyday motor tasks. These difficulties cannot be explained by physical, sensory, neurological or intellectual impairments. To be diagnosed with DCD (or dyspraxia as some professionals refer to it), a child’s motor coordination should be significantly below what is expected for the child’s age and intelligence. The motor difficulties should also interfere with academic achievement or daily activities.

Another criterion for DCD is that coordination problems should not be because of ASD (autism spectrum disorder) or a general medical condition such as cerebral palsy or epilepsy. The onset of these difficulties should also be in the early developmental period of a child’s life. Children who only begin experiencing coordination difficulties later in life, or who experience a loss of motor skills, would not be consistent with DCD. This rather suggests an underlying neurological (or other medical) disorder that the child may have.

Signs and symptoms

Now that we have a clear definition for DCD, what are the associated signs and symptoms? A child with DCD experiences problems with learning new movements and can have delayed milestone development because of this. A child may also appear clumsy or awkward. He may frequently bump into things or knock things over.

He may also have difficulty with gross motor skills such as running, hopping, skipping, initiating a jump form a small height, or climbing. Such a child may also find it difficult to figure out the amount of force and direction needed to perform an action such as opening a lid or tackling an opponent. Additionally, coordination and motor planning are huge challenges for children with DCD.

Other characteristics of DCD include poor postural control and balance, poor visual-motor abilities and ball skills, poor bilateral integration, reduced strength and endurance, fine motor difficulties (cutting, writing, colouring) and poor organisational skills. There are many more characteristics that can be added to the list, but these are the main concerns for parents and teachers. Keep in mind that children diagnosed with DCD have common symptoms, but the degree of motor difficulties varies from childhood to adolescence, and even between children.

Nevertheless, it is important to recognise these motor difficulties because children with DCD are more likely to develop academic and behavioural problems, demonstrate low self-esteem, depression and anxiety, and they are at greater risk of becoming overweight.

Causes of DCD

The causes for DCD are still largely unknown. However, children born prematurely and children with extremely low birth weights are at a significantly increased risk of demonstrating DCD. A complex relationship also exists between DCD and other developmental disorders such as ADHD, dyslexia, and a speech language impairment to name a few. The overlapping of the various disorders often prevents professionals to make a clear-cut diagnosis of DCD.

Diagnosing DCD

Is there a need to formally diagnose a child with DCD? At our paediatric development centre, we try and avoid labels as far as possible and instead provide a brief, practical description of a child’s coordination difficulties with any co-morbid problems that may exist. However, a diagnosis can sometimes be helpful to summarise problems, communicate important information to other professionals, and plan the relevant services a child requires. Remember, a diagnosis is just used to describe a specific set of symptoms that are being experienced by a child.

It can also help to access funding or services that might not otherwise be accessible. This may include tax benefits and/or concessions for school exams.

Professional help

Who can assess and diagnose a child with DCD? There are currently a few professions in South Africa that can assist with this process. A Kinderkineticist, for example, can perform various assessments using internationally-recognised tests to determine if a child’s motor skills are on par with his current developmental age. If the child’s motor development scores are significantly below expectations, additional referrals can then be made to neurologists, paediatricians, or other medical practitioners to rule out any medical or neurological causes.

However, a diagnosis alone is not the solution. It simply opens the door to getting the help needed by arming everyone involved with the relevant information.

 It also empowers parents to have more knowledge (and consequently more grace) with their child by understanding his capabilities. But the help still needs to be provided. If left untreated, a child with DCD may struggle to manage a full school day because of poor strength and endurance. Fine motor skills (writing, drawing and cutting, for example) may also persist because of poor core stability, meaning that he does not have a strong base to support the use of his arms and hands. Furthermore, anxiety and stress is often experienced because he may struggle to complete assessments, exams and other academic tasks in higher education.

For these reasons, it is important to find a professional who can help with exercises to address problem areas that are identified by parents and/ or teachers. A Kinderkineticist can provide guidelines and talk to parents about possible interventions and strategies that can be followed after a diagnosis.

A Kinderkineticist can also provide specific and appropriate task-orientated exercises to address problem areas. 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 every day.

Assisting children with DCD

It is important to understand that children with DCD may encounter more success with certain activities than with others. Lifestyle sports such as swimming, cycling, running, skating and skiing are activities that are worth the extra time and effort to learn as children with DCD can participate in these activities and reap the health benefits throughout their lifetimes. Also try to introduce a child to new sports activities or a new playground on an individual basis before he is required to manage the activity in a group. Regarding clothing, encourage your child to wear clothing that is easy to get on and off. For example, T-shirts, sweaters and Velcro shoes. When possible, use Velcro closures instead of buttons or shoelaces.

A note for teachers

Teachers can ensure that the child is positioned properly at his desk. His feet should be flat on the floor and the desk at the appropriate height so that his shoulders are relaxed and his forearms supported on the desk. Provide the child with extra time to write exams or to complete fine motor activities such as math, printing, writing a story, or artwork. If speed is required, accept a less accurate product from this child.

Also use paper that matches the child’s handwriting difficulties – well-spaced lines for a child who writes with very large letters, raised lined paper for a child who has trouble writing within the lines, or graph paper with large squares for a child who has trouble keeping numbers aligned in maths. For more information about DCD, contact our paediatric development centre or visit www.kwandakinetics. Until next time, happy moving moments!

Issue Fifteen - October to December 2017

Issue Fifteen - October to December 2017

This article was featured on page 12-14 of Babys and Beyond Issue Fifteen - October to December 2017 .

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