Week 7 Parent Guide: Developmental Coordination Disorder

 

Diana Pieterson, Alina Alvarez, Rufina Ewane, Chinyere Nzekwe, Ruby Odamtten

Walden University

NRNP 6660/ PMHNP Role I: Child and Adolescent

Dr. Vardah Seraphin

October 18, 2020

 

What is DCD?

 

Developmental Coordination Disorder, DCD, is a neurodevelopmental disorder in which a child’s fine or gross motor coordination is slow, less accurate, and more variable than in peers of the same age. These children are developing well intellectually but do not develop normal motor coordination.

DCD is first recognized when a child fails to reach normal developmental milestones like walking and dressing themselves.

 

Prevalence

· The prevalence of DCD ranges from 5% to 15% in the primary school population

· At a minimum, 5% to 6% of all children are affected

· Most studies of children with DCD report a higher prevalence in boys than girls. Still, the actual sex ratio is hugely variable and depends on the method used to identify children.

· The American Psychiatric Association reports a male to female prevalence ratio of 2:1.

 

 

 

 

 

 

Pathophysiology

 

Causes are multifactorial.

· Neurochemical abnormalities and parietal lobe lesions have been suggested to contribute to coordination deficits

· Environmental and developmental factors: DCD is more common following prenatal exposure to alcohol, cocaine, nicotine, and preterm and low-birth-weight children and

· children with obstetric difficulties during pregnancy (perinatal malnutrition, hypoxia) and born prematurely (rated at 50%).

What difficulties do children with DCD experience?

· Delay in achieving motor milestones like sitting, crawling, or walking

· Clumsiness like dropping and bumping into objects

· Slowness and difficulty with motor skills, including when catching a ball, writing, using scissors, or riding a bike

· Unsteady walk, tripping over feet.

· Delays in sitting up, crawling, and walking

· Problems with sucking and swallowing during the first year of life

· Difficulty getting dressed, playing games, and eating

Pre/Lower Primary School

· Difficulty coloring or drawing in a coordinated way

· Difficulty holding a pencil

· Letters are poorly formed.

· Handwriting shows poor spacing and sizing of letters and words.

· Letter forms are frequently confused

· Difficulty completing puzzles or building with blocks

· Difficulty buttoning clothes, doing up zippers, and tying shoelaces

· Difficulty using rulers and scissors accurately and efficiently

· Delays in throwing and catching, hitting and/or kicking a ball

· Difficulty negotiating playground equipment

· Poor organizational skills

· Difficulties in planning and prioritizing tasks

· Reduced general activity levels

· Reduced participation in sport

Mid/Upper Primary School 

· Handwriting is immature and slow

· Slow and inaccurate in building models

· Difficulty playing ball games (especially in teams)

· Difficulty organizing belongings when motor sequencing and coordination are required

· Trouble managing a full school day due to poor strength and endurance

· Poor organizational skills

· Difficulties in planning and prioritizing tasks

· Reduced general activity levels

· Reduced participation in sport

· Awkward or abnormal gait

High School

· Legibility and/or speed of handwriting is poor

· Slow and inaccurate typing

· Difficulty taking notes accurately and efficiently

· Poor organizational skills

· Difficulties in planning and prioritizing tasks

· Reduced general activity levels

· Reduced participation in sport

· Difficulty with grooming (combing hair, blow-drying hair)

· Difficulty using hand tools, playing piano, or sewing

 

 

How is the disorder diagnosed?

The diagnosis of developmental coordination disorder is made by a clinical synthesis of the history (developmental and medical), physical examination, school or workplace report, and individual assessment using psychometrically sound and culturally appropriate standardized tests.

The most commonly used tests of motor impairment are:

· Movement Assessment Battery for Children

· Bruininks-Oseretsky Test of Motor Proficiency

· Frostig Movement Skills Test Battery

· Bender Visual-Motor Gestalt Test

These tests have strong psychometric properties and are usually administered by an occupational or physical therapist to provide information about the extent of a child’s motor delay relative to their peers. Clinical observations made during the administration of standardized assessments are significant when assessing DCD children and may contribute more valuable information than the quantitative scores.

 

Benefits of making a definite DCD diagnosis…

The idea of labeling a child is controversial. With an under-recognized disorder, however

· A diagnosis can be enlightening and reassuring.

· Doors begin to open, and adults and children in the child’s environment can be educated and encouraged to understand and provide adaptations to assist them with DCD.

· Possibly the most essential aspect of receiving the label ‘DCD’ is that, in understanding the nature of this disorder, the secondary consequences may be prevented

 

Does it get worse with age?

· The condition continues throughout adulthood, but treatment can improve motor skills and provide helpful strategies to navigate everyday tasks.

 

 

 

 

Are other developmental disorders involved?

· 50% of children who have ADHD, learning disabilities, and specific language impairment also have DCD. It is unclear how many children with DCD have other comorbidities because there are no epidemiological studies that begin by first identifying children as having a motor impairment and then examining them for other disorders.

· Emotional and social problems such as low self-esteem and poor social acceptance are often reported to co-occur.

· Anxiety and depression have also been noted, but it is not yet known whether these conditions are secondary to social isolation and low self-worth.

Will my child ‘grow out’ of this problem?

· DCD and its consequences have a long-term impact.

· DCD does not merely disappear as children grow older.

· The motor difficulties of childhood are retained into adult life and can keep adults from performing essential daily living activities

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· These activities may include reduced participation in self-care, leisure, academic activities, and higher rates of cardiovascular disease and challenges to mental health.

 

How can I help my child with DCD with daily frustrations? 

· Free educational materials providing evidence-based tips and strategies are available on the Can Child Web site (<www.canchild.ca>).

· Many parents become empowered to access and distribute these materials to significant others (e.g., extended family members, teachers, coaches, sports instructors) in their child’s life.

· Support groups

 

 

 

 

 

Two approaches to treatment

Deficit oriented Approach: This includes sensory integrative therapy, process-oriented treatment and sensorimotor-oriented treatment.

Task specific interventions: Which include neuromotor task training and cognitive orientation to daily occupational performance.

Treatment options…

· If children with DCD are not identified or offered any sort of intervention or management for their difficulties, there is an increased likelihood of secondary consequences that include behavioral problems, emotional distress, low self-worth, poor perceived competence, anxiety, depression, bullying and obesity.

· Early identification, effective intervention and vocational counselling are important for children diagnosed with DCD to avoid the negative experiences that can affect their academic and social life

· Occupational therapists for self-care difficulties to help kids learn to do key tasks, from writing to getting dressed. The therapist can also administer sensory integration programs. It consists of physical activities that increase awareness of motor and sensory function. e.g. a child who bumps into things may be given a task to balance on a scooter to master a skill.

 

· Physical therapists for more severe motor impairments, including problems with balance, strength or endurance; delays in the development of gross motor skills; and safety issues. It can help with muscle strength, balance and coordination.

· Speech/language pathologists for receptive and/or expressive language delays, and articulation problems.

· Psychologists for comorbid conditions such as attentional or learning problems, hyperactivity, and learning disabilities.

· Educators for functional difficulties in the classroom setting, as well as for making adjustments to the child’s environment to promote learning and social integration.

 

 

 

 

 

 

 

 

Pharmacotherapy

 

· Methylphenidate: positive effect on both behavioral ADHD symptoms and fine‐motor performance (i.e. handwriting) in children with combined DCD and ADHD.

· Fatty acids with vitamin E: Can improve academic skills like reading and spelling as well as behavior.

 

 

 

 

 

 

 

 

 

 

References

Allen, S., & Casey, J. (2017). Developmental coordination disorders and sensory processing and integration: Incidence, associations and co-morbidities. British Journal of Occupational Therapy, 80(9), 549-557. doi:10.1177/0308022617709183

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Author.

Du, W., Ke, L., Wang, Y., Hua, J., Duan, W., & Barnett, A. L. (2020). The prenatal, postnatal,

neonatal, and family environmental risk factors for Developmental Coordination

Disorder: A study with a national representative sample. Research in Developmental Disabilities,

104, N.PAG. https://doi-org.ezp.waldenulibrary.org/10.1016/j.ridd.2020.103699

Missiuna, C., Gaines, R., Soucie, H., & McLean, J. (2006). Parental questions about developmental coordination disorder: A synopsis of current evidence. Paediatrics & child health, 11(8), 507–512. https://doi.org/10.1093/pch/11.8.507

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry:

Behavioral sciences/clinical psychiatry (11th ed.). Wolters Kluwer.

Smits-Engelsman BC, Blank R, VAN DER Kaay AC, Mosterd-VAN DER Meijs R, Vlugt-VAN

DEN Brand E, Polatajko HJ, & Wilson PH. (2013). Efficacy of interventions to improve

motor performance in children with developmental coordination disorder: a combined

systematic review and meta-analysis. Developmental Medicine & Child Neurology,

55(3), 229–237. https://doi-org.ezp.waldenulibrary.org/10.1111/dmcn.12008

 

 

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