DEVELOPMENTAL COORDINATION DISORDER

For years children with poor motor coordination were thought to be merely clumsy, and there was little understanding for the problems these children faced, even though poor motor coordination in children had been recognised as a developmental problem for 100 years.  Since then numerous terms have been used to try to encompass children with such a developmental problem.  The most commonly used terms have been clumsy child syndrome, developmental dyspraxia, minimal cerebral dysfunction, and so on.  Such not unified terminology has complicated the everyday work of clinicians and the investigation of the developmental problem itself.  After the 1994 International Consensus Conference on Children and Clumsiness, the term developmental coordination disorder (DCD) began to be used to describe this condition of children with incoordination.  

DEFINITION

Developmental coordination disorder (DCD) is defined as an impairment of motor coordination that interferes with a child's activities of daily living and academic achievement, but which is not a result of intellectual inability, pervasive developmental disorder or a general medical condition. 

CLINICAL PICTURE

The symptoms of developmental coordination disorder vary greatly from one child to another.  The main characteristic is abnormal development in one or more types of motor skills, taking into account the child's IQ and age. Children with developmental coordination disorder often have difficulties with tasks that include small and large muscles, for example drawing letters while writing, throwing or catching balls or fastening buttons.  

According to some authors there are different types of disorder with six general groups of symptoms.  These are as follows: 

1. general unsteadiness and slight shaking 

2. decreased muscle tone 

3. increased muscle tone

4. inability to move smoothly because of problems putting together the subunits of the whole movement 

5. inability to produce written symbols 

6. visual perception problems related to development of the eye muscles 

This disorder can lead to social and academic problems in children.  As a result of underdeveloped coordination, children do not wish to participate in activities in which they do not excel.  Avoidance can cause conflict or rejection from peers.  Moreover, children who have difficulties in writing or drawing can be discouraged and give up on academic or artistic aspirations despite their normal intelligence.  

EPIDEMIOLOGY AND ETIOLOGY

Over the years interest in and knowledge about children with DCD has increased.  Today it is assumed that DCD occurs in 5 to 8% of school-age children.  What makes an accurate evaluation of the real situation more difficult is that there is still not a unified terminology or classification, and the fact that DCD is not yet always diagnosed in each particular case. 

The cause of DCD is insufficiently clear. There are different theories that try to explain the etiology.  A few of them speculate that it is part of the continuum of cerebral palsy, that it is secondary to prenatal, perinatal or neonatal injury, or that it is secondary to neuronal damage at the cellular level in the neurotransmitter or receptor systems. 

DIAGNOSIS

A diagnosis of developmental coordination disorder is usually made when a parent or teacher notices that a child lags behind his peers in learning, has problems at school or frequently injures himself because of his clumsiness. The doctor first needs to exclude other possible disorders or conditions which could result in motor incoordination.  It is also necessary for the child to undergo an examination by a special needs educator who will exclude other types of learning difficulties. 

The key to the diagnosis lies in the child's abnormal clumsiness which is assessed by comparing the child with other children of the same age and intelligence.  The difference between a child with developmental coordination disorder and a merely clumsy child is difficult to determine.  However, in order to make the diagnosis it is necessary that the incoordination has significant negative effects.  Negative effects can be visible at school, in play or in other activities which take place every day.  Furthermore, the motor difficulties must not be caused by any other defined illness or disorder or be the result of mental retardation.  

PROGNOSIS

Despite new insights it is still widely believed that clumsy children simply "outgrow" their clumsiness and that it is not necessary to rack one's brains about it.  This might have been the case in the past, but today the demands of society are greater and more is expected of children, which in and of itself also requires good motor coordination.  In addition to that, today we know that children don't outgrow their deficiency by themselves; on the contrary, they grow with it.  There are studies that show that children who were clumsy at 6 or 7, without intervention remain like that after 10 years of age.  The children's skills themselves improve after a time; however, in comparison with their peers they remain poorer.  

In reality, instead of disappearing, we can say that the problem becomes greater.  Without intervention motor difficulties in the majority of children continue to influence everyday functions and these children can have significant educational, social, and psychological consequences up until their adolescence.   Studies have shown that poor motor coordination can influence a child's self-confidence, success within the group, success at school and in the selection of leisure activities.  A study conducted in Calgary, Canada in 2002 tested the link between children with, or with a high-risk of developing, developmental coordination disorder and problems with attention, learning, and psychological adjustment in comparison with children without motor difficulties.  The studied showed that all children with motor deviation were at risk for the above-mentioned problems.  

It is difficult to give a prognosis for a child with DCD.  DCD often overlaps with other disorders.  It is believed that DCD and ADHD (Attention-deficit hyperactivity disorder) are simultaneously present in no less than 50% of children.  Children with combined DCD and ADHD have a poorer prognosis and greater difficulties than children with only DCD.  We can say that the more complex the form of DCD, the poorer the prognosis.  We must not disregard the child's surroundings in the prognosis of the child's development.  It is certain that a child with DCD who is subjected to bullying will have considerably less self-confidence than a child who is accepted and recognised by his community.  In the same way, we must not neglect the conditions in which the child is brought up or the parents' concern for the child and his prosperity.  

THERAPY

There is no single therapy for all children with developmental coordination disorder.  It is necessary to recognise the key problems and to approach them appropriately.  For some children that means focussing on writing, while for others the main problems are related to general motor coordination.  Various specialists, for example, physiatrists, physiotherapists, occupational therapists, special needs educators, psychologists and others are included, as required. 

PREVENTION

We often hear from parents whose children exercised because of some inadequate motor development that their children are more coordinated than their children's peers who didn't have to exercise.  Therefore, although it is officially held that developmental coordination disorder cannot be prevented, we believe that recognising inadequate motor development on time and correcting it can significantly influence motor coordination.