Developmental Coordination Disorder (DCD)
What is DCD?
DCD is a medical condition in which there is marked impairment in the development of motor coordination, and the impairment significantly interferes with academic achievement or activities of daily living*.
This disorder is actually a common condition that is present in about 5% of children who are school-aged, yet very few physicians know about or give this diagnosis.
In the past, a child with DCD was often considered “clumsy” or “physically awkward” and received little attention mostly since the common belief was these difficulties will diminish with time.
Children with DCD usually have average or above-average intellectual abilities, another unfortunate contributor to the “wait and see” approach.
Another important fact about DCD is that it may exist either in isolation or co-occur with other conditions such as language-based or non-verbal learning disabilities or attention deficit hyperactivity disorder (ADHD).
Signs of DCD
Children with DCD are often referred for an occupational therapy (OT) assessment because they are experiencing difficulties with handwriting and other fine motor activities at school. In most cases the OT discovers that these challenges are just “the tip of the iceberg” and the child is experiencing difficulties across many daily activities, for example:
Difficulty managing scissors or handling a ruler
Doing buttons and zippers
Participation in gym class or playing games in the schoolyard
Getting ready for recess
Participating in structured and unstructured sports and leisure activities
Why do these children have handwriting difficulties?
Is there reason for concern?
Children who struggle with learning to print or show continued difficulty and frustration with printing and handwriting are expected to experience challenges the following areas:
Receiving and integrating information from their senses;
Planning the movements that are required to perform a simple task;
Coordinating the movements that are required with the information that they are receiving from their eyes and hands;
Or figuring out how much force to use and what distance their muscles should go to complete a movement
These children often experience difficulty with any task that requires a coordinated motor action that depends upon continual feedback from their eyes or hands (e.g., using scissors, playing hockey, playing baseball). It's important that these children will probably not have as much difficulty with tasks that have a basic motor pattern that, once learned, doesn't have to keep changing (e.g., swimming, skating, running).
The simple answer is yes and no. No, since treatment is available and has been shown to improve performance of children with DCD and help them achieve their potential. Yes, because DCD shouldn't be taken lightly. Addressing DCD as early as possible can be instrumental in preventing the development of secondary problems.
There is strong empirical evidence that the motor problems of children with DCD persist at least into adolescence and lead to the development of secondary physical health, mental health and educational issues including physical fitness, poor social competence, academic problems, behavioural problems, and low self-esteem.
Prevention of these is possible if parents, teachers, health professionals and the children themselves are educated about the disorder and learn some strategies to compensate for the motor difficulties.
So... what's next?
The logical next step, after one has considered the possibility of DCD as the cause for a child's difficulties, is to have the child diagnosed by a family physician or pediatrician, ideally a developmental pediatrician.
A detailed history contributed by parents (regarding the types of tasks that a child finds to be difficult and about the amount of time and effort it takes to learn new motor skills) and a summary of the specific observations of teachers and therapists can provide physicians with the information needed to make an accurate diagnosis of DCD.
Sometimes it’s hard to make a diagnosis as many of the typical developmental milestones such as sitting and walking are still achieved by these children within normal limits. Further, children with DCD usually have difficulty learning novel motor skills, but once learnt, many of the skills are performed adequately.
Since DCD has only been recognized officially for a few years, many parents may find it helpful to tell their physician about section 315.4 of the Diagnostic and Statistical Manual (American Psychiatric Association, 1994) and to provide a copy of Fox and Lent’s (1996)** excellent article which describes the process involved in recognizing DCD and its differential diagnosis. One of the reasons that a physician should always examine the child is that there can be other reasons for coordination difficulties such as neurological and degenerative conditions and these should be ruled out.
I'm available to provide parents as well as pediatricians in the Vancouver area guidance in the area of Pediatric OT, DCD included. Please feel free to contact me if you're hesitant on the next steps or looking for a developmental pediatrician.
* Diagnostic and Statistical Manual (DSM) IV, 2000
** Fox, M., & Lent, B. (1996). Clumsy children: Primer on developmental coordination disorder. Canadian Family Physician, 42, 1965-1971.