What is DCD and the criteria for diagnosis?
DCD encompasses a diverse spectrum of difficulties that affect a child's ability to learn and carry out coordinated motor skills. In addition to this marked impairment in the development of motor coordination, a child must also meet the following criteria for diagnosis as defined by the American Psychiatric Association (DSM-IV):
- the impairment must significantly interfere with academic achievement or activities of daily living;
- the coordination problem is not due to a general medical condition (e.g. cerebral palsy, hemiplegia, or muscular dystrophy) and the criteria are not met for a pervasive developmental disorder;
- if mental retardation is present, the motor difficulties must be in excess of those usually associated with it.
How can I tell if my child may have DCD?
Medical practitioners, therapists, and psychologists often characterize DCD more specifically by difficulties in one or more of the following areas:
- Gross motor skill difficulties - problems performing movements that typically involve the large muscles in the body and require balance and coordination. Examples of gross motor skills are running, jumping, climbing, ball skills (throwing, catching, and kicking), as well as postural control.
- Fine motor skill difficulties - problems performing small scale movements that involve the fingers. Some examples of these types of skills are writing neatly with a pencil, tying shoelaces, and manipulating small objects such as buttons or zippers. These fine motor skills can be a large source of frustration because they require a large amount of muscle control and eye-hand coordination.
- Sensory perception and integration difficulties - problems utilizing information from the sensory systems (vision, hearing, touch, and general body awareness) to produce skillful movement. For example, a child may have problems using visual and proprioceptive information to catch a ball in the air.
- Motor planning difficulties- difficulty developing a plan to perform movements. New or highly complicated motor skills are difficult for a child to learn and perform because he or she will have trouble understanding the correct sequence of actions (what steps come in what order). Such motor planning problems are also possibly related to difficulties incorporating information from the body senses (see #3 above) and managing his or her body in space to fit the task demands.
What are the implications of these deficits?
As a result of their movement difficulties, it is likely that these children will avoid physical activity. In fact, several studies suggest that children with movement coordination problems do not participate in physical activity as much as typically developing children. Observational analyzes of 6- to 9-year-old children at recess found the children with DCD were less vigorously active and played less often with the large playground equipment (Bouffard et al., 1996). Anaerobic performance of children with DCD has also been found to be significantly lower than a group of matched controls (O'Beirne, Larkin & Cable, 1994). The long-term effects of low-levels of activity place these children at higher risk for problems in the motor, musculoskeletal, and cardiopulmonary systems later in life.
In addition, motor skill deficits have tremendous bearing on various other areas of everyday life. Difficulties are manifested in the classroom, in that poor fine-motor skills such as handwriting or typing will hinder academic achievement (Roussounis, Gaussen & Stratton, 1987) but, also because modern teaching methods in mathematics and science involve much more "hands on" work than ever before. Poor spatial/temporal coordination (visual-motor skills) may interfere with academic learning in more direct ways than has been seen in the past.
An increasing number of studies also confirm socio-emotional implications. Children with DCD often have low self-esteem (Shaw, Levine, & Belfer, 1982), low evaluation of their competence in academics (Rose, Larkin, & Berger, 1997), judge themselves less socially competent (Rose et al, 1997), are more introverted, and more anxious than their well coordinated peers (Schoemaker & Kalverboer, 1994). They often are the ones bullied by their peers and have more behavioral problems than matched controls (Losse et al., 1991).
Who is affected by DCD?
Approximately 6% of all school-aged children (about one child in every primary school classroom) are diagnosed with DCD (APA, 1994). However, these prevalence estimates may increase as DCD awareness becomes more widespread and actions are taken by parents and practitioners to seek treatment for children and patients affected by the disorder.
Is it possible to outgrow DCD?
Current research strongly indicates that children with motor coordination disorders do not outgrow their problems. In fact, many children experience deficits well into adolescents and even adulthood. In light of these issues and the heightened risk of complications in various other aspects of everyday life (see above), it is imperative that parents seek early diagnosis if their child demonstrates characteristics of a motor coordination or motor learning deficit. Early diagnosis and therapeutic interventions may lead to improvements in motor skill development early on, and it may also serve as a way to build a child's self-confidence and willingness to engage in physical activities throughout adolescence and adulthood.
What types of treatment options are available for children with DCD?
Children with DCD demonstrate the significant improvements from therapies that are task and context specific. Such interventions include educational skills training (i.e. handwriting or speech therapy) or teaching functional skills necessary for independence (i.e. tying shoes, buttoning clothing, etc). However, studies have not yet demonstrated that specific skill training or if other techniques focused primarily on motor aspects of skill acquisition are generalizable. Recently, the use of cognitively-based interventions designed to help children develop problem-solving strategies show greater transfer to other areas of skill development than traditional physical and occupational therapies (Miller et al., 2001).