Putting a name to something goes a long way towards helping us to understand it.
But when it comes to difficulties with movement skills there is a lot of confusion.
Have you heard of DCD-Developmental Coordination Disorder? Or maybe you are more familiar with the word Dyspraxia?
What is DCD?
According to the Diagnostic and Statistical Manual (DSM) for Mental Disorders (DSM-5, APA, 2013) a diagnosis for DCD must include these 4 criteria:
- Learning and execution of coordinated motor skills is below age level given the child’s opportunity for skill learning.
- Movement difficulties significantly interfere with activities of daily living, academic productivity, prevocational and vocational activities, leisure and play.
- Onset is in the early developmental period.
- Movement difficulties are not better explained by intellectual disability, visual impairment or other neurological conditions that affect movement. (DSM-5, 2013).
What are some common symptoms of DCD?
If you notice any of the following, then it might be appropriate to visit a medical practitioner to seek further assessment:
- A child who is well behind their peers in achieving typical motor skill milestones such as sitting, rolling, standing and walking.
- An unusual or unsteady gait.
- Difficulty walking up and down stairs.
- Running into others.
- Frequently tripping over.
- Finds it difficult to tie show laces.
- Has trouble with buttons and zippers or getting dressed/undressed in general.
- Has problems with handwriting, cutting or other school activities in the classroom.
What is Dyspraxia?
The term dyspraxia has been commonly used since the early 1970s to describe movement difficulties and often presents with other development issues such as memory, speech and language and social/emotional development. Whilst there are still support agencies with the term Dyspraxia in their name and you will find articles using the term Dyspraxia, it is no longer recognised as a discrete diagnosis and doesn’t appear in any internationally recognised diagnostic manuals. (Licari, M., et al.) 2020. It is probably best practice to use the term DCD, especially if you are hoping to gain NDIS funding support for an Early Child Early Intervention Plan.
More about DCD
Criteria 3 tells us that onset is in the early years. Families, and sometimes child health nurses are the first to recognise that the child may have difficulty with motor skills or be behind with achieving motor milestones such as sitting, crawling, standing and walking when compared to other children of a similar age.
The response to this realisation is varied – some families use the “Wait and Watch” approach, others seek advice from their GP or Paediatrician and others engage an Occupational Therapist or Paediatric Physiotherapist for a formal assessment.
However, many children aren’t identified as having motor skill difficulties until they enter the more formal school setting.
Statistics tell us that 5% of children have DCD – so maybe 1-2 children in each Early Childhood Education group, kindergarten or pre-primary classroom.
Can you think of a child in your room who has low muscle tone, lacks core strength, can’t sit up, slouches on the desk, struggles to join in playground games, has difficulty with handwriting, cutting activities, has difficulty in dressing/undressing? Then maybe you are seeing a child with undiagnosed DCD.
DCD often presents in conjunction with other developmental difficulties or delays such as Speech and Language, ADHD, Autism Spectrum Disorder and mental health conditions such as anxiety.
Treatment for DCD
Early diagnosis and interventions with suitable therapies are crucial for giving children with DCD every opportunity to engage fully in family and school life. However, private therapy can be expensive and waiting lists for public services can be long.
For children under 7 in Australia, a formal diagnosis of DCD can form the basis for an Early Child Early Intervention Plan with the National Disability Insurance Scheme (NDIS). Funding through this plan may assist with the necessary therapy.
An integrated developmental assessment by a paediatrician, occupational therapist, physiotherapist, psychologist and dietician will provide a complete picture for a child suspected of having DCD. Therapies can then work in conjunction – building confidence and competence in all areas of need at the same time.
What is the impact of DCD on young children?
Difficulty with aspects of daily living such as:
- Eating with utensils.
- Self-care – for example, brushing teeth.
These aspects can take much longer to learn and to perform for the child with DCD and may result in frustration for both the child and the parents – as often these tasks need to be performed under time constraints such as getting out of the house in the morning in time for school and/or work.
TIP: Allow plenty of time + extra time to achieve these routine tasks. Give your child practice time on the weekends when you are not rushed and be flexible and realistic with your expectations. For example, if your child has difficulty with buttons on a school uniform shirt- pre-button half the shirt for them and ask them to pull it on over their head and just do the remaining 2-3 buttons themselves.
Here is a great idea for those who have difficulty with their shoe laces
Impacts on Physical Health
- Withdrawing from physical activity.
- Increased sedentary behaviours.
It is pretty normal to avoid things that we find difficult – so it is easy to understand why children with DCD avoid sports and physically active play – it is just too hard.
These children tend to choose more sedentary activities such as playing video games or watching TV and this can lead to other health issues such as increased risk of obesity.
- Difficulty with handwriting and cutting.
- Increased fatigue.
- Slow to complete tasks.
So much effort is involved for children with DCD to complete everyday tasks within the classroom. Poor core strength and muscle tone can mean that it is extremely tiring to sit on a mat and pay attention. Issues with mixed dominance, poor pencil grip, lack of motor control make executing handwriting and cutting difficult. So much energy is expended on the pure mechanics of the exercise that there is little brain energy left over for considering the overall picture.
Challenge: Try writing a sentence backwards in mirror image with your non-preferred hand and you will get a feeling of the levels of concentration that children with DCD need to use to perform what most would consider a fairly simple task.
- Difficulties making friends.
- Playground Isolation.
Many children with DCD feel isolated on the playground and excluded from games with their friends. This can lead to feelings of low self-worth and anxious and depressive symptomatology (Piek, JP> et al, 2005, 2010).
If you are noticing children being excluded on the playground – do something about it! By occasionally initiating or showing children how to play a game that includes others such as hopscotch, you can take the opportunity to model good behaviours by demonstrating asking to join in a game, or perhaps taking a secondary or helping role to begin with such as being a fielder rather than a bowler or a batsman in a game of cricket and praising more competent children for their kindness with inclusion of others.
How can the Animal Fun Program help kids with DCD?
Animal Fun is a universal program which is suitable for ALL children but is especially useful for children with DCD. The program makes the practice of motor skills, motor planning and sequencing skills fun for kids in a non-competitive social play environment– so great to use as part of therapy for occupational therapists and physiotherapists in their clinical practice but also for teachers to use as part of the everyday routines of the school day.
The program meets Australian Curriculum guidelines for Health & Physical Education for the Foundation Year and also many of the outcomes of the Early Years Learning Framework and National Quality Standards. Visit the Animal Fun Online Shop if you haven’t already, to check out the fantastic program, professional development opportunities and resources we have available for you.
Animal Fun can also offer motor skill assessments for children using the Movement Assessment Battery for Children (MABC) test which provides not only an overall Motor Skill Assessment Score but also a break down score for Manual Dexterity, Aiming and Catching and Balance Skills. The MABC is an internationally recognised diagnostic tool and provides a great baseline assessment for children which can be used to monitor the progress and effectiveness of intervention programs such as Animal Fun.
For more information please email Sue McLaren [email protected]
DCD is a lifelong condition. The impact on the child is affected by so many variables but having a supportive family, knowledgeable teachers, access to therapies and awareness of the condition by the wider community will definitely assist every child to reach their unique and wonderful potential.
For more information about DCD check out these useful resources:
Movement Matters: www.movementmattersuk.org
To download the Impact for DCD report from Telethon Kids Institute click here
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association, 2013.
Licari, M., Williams, J. and the Impact for DCD Team, (2020). National Survey Evaluating The Impact of Developmental Coordination Disorder in Australia: Summary of Results. Telethon Kids Institute, Perth, Western Australia.
Lil Peeps OT for Kids. (2020, January) Tips for tying your shoelaces! [Video File] Retrieved from https://m.youtube.com/watch?v=VmiVol4qkkM
Piek, JP., Barrett NC, Allen, LS., Jones, A., Louise, M. the relationship between bullying and self-worth in children with movement coordination problems. British Journal of Educational Psychology. 2005, 75: 453-63.
Piek, JP., Barrett, NC., Smith, LM., Digoli, D., Gasson, N. Do motor skills in infancy and early childhood predict anxious and depressive symptomatology at school age? Human Movement Science. 2010, 29(5): 777-86.