Understanding The Clumsy Child - How To Recognize And Help A Child With DCD

In the previous blog, we had a look at various exercises that can help children develop their fundamental motor skills to the full. These skills include stability, locomotor and manipulation skills. Developing these skills correctly will ensure a solid foundation on which small children can build in order for them to successfully partake in future sporting activities where the focus will shift to sport-specific skills.

However, what happens if you have a clumsy child with two left feet? A child that seems to move slower than other children or who takes longer to reach his milestones as an infant? What if this lack of coordination also affects your child's daily functioning up to a point where he struggles to execute simple motor activities such as fastening buttons, tying shoelaces, or using a knife and fork?

We definitely need to look into this aspect of motor development as 5 - 6 % of all school-aged children are affected by severe clumsiness, or better known as development coordination disorder (DCD).

Some research in South Africa by Kinderkineticists even suggests that up to 15 % of children are affected by DCD, depending on the geographical area in which the research has been done. DCD is also more prevalent in boys than girls. However, DCD is often called a 'hidden disorder' as children are regularly misdiagnosed, or not diagnosed at all.

What Is DCD?

Is DCD a new acronym thrown into the mix of all the other conditions that has received attention over the last few years? No, DCD is not a new concept or the latest craze. Over the centuries different terms have been used to describe children with motor difficulties. It was also believed that children will 'outgrow' their clumsiness.

However, studies have now shown quite conclusively that most children do not outgrow these problems. Therefore an international panel of experts made the decision in 1994 to recognize 'clumsy' children as having DCD. Unfortunately, many people are still unaware of DCD and the impact is has on children's lives and their families. We see this playing out in our paediatric development centre on a weekly basis.

Development coordination disorder (DCD) is a common developmental condition where children experience noteworthy difficulties in motor learning and in the performance of everyday motor tasks.

These difficulties cannot be explained by physical, sensory, neurological or intellectual impairments. In order to be diagnosed with DCD (or dyspraxia as some professionals refer to it), a child's motor coordination should be significantly below that of the child's expected age and intelligence. The motor difficulties should also interfere with academic achievement or activities of daily living.

Another criteria for DCD is the fact that coordination problems should not be due to ASD (autism spectrum disorder) or a general medical condition such as cerebral palsy or epilepsy.

The onset of these difficulties should also be in the early developmental period of a child's life. Children who only started experiencing coordination difficulties later in life, or who experienced a loss of motor skills, would not be consistent with DCD. This rather suggests an underlying neurological (or other medical) disorder that the child may have.

Signs And Symptoms Of DCD

Now that we have a clear definition for DCD, what are the signs and symptoms associated with it? A child with DCD experiences problems with learning new movements and can have delayed milestone development as a result of it. A child may also appear clumsy or awkward. He may bump into things or knock things over frequently.

He may also experience difficulty with gross motor skills such as running, hopping, skipping, initiating a jump form a small height or climbing. Such a child may further find it difficult to figure out the amount of force and direction needed to perform an action such as opening a lid or tackling an opponent. In addition, coordination and motor planning is a huge challenge for children with DCD.

Other characteristics of DCD include: poor postural control and balance, poor visual-motor abilities and ball skills, poor bilateral integration, reduced strength and endurance, fine motor difficulties (cutting, writing, colouring) and poor organizational skills.

There are many more characteristics that can be added to the list, but these are the main concerns for a lot or parents and teachers. Just keep in mind that children diagnosed with DCD have common symptoms, but the degree of motor difficulties varies from childhood to adolescence, and even between children themselves.

Nevertheless, it is important to recognize these motor difficulties because children with DCD are more likely to develop academic and behavioural problems, demonstrate low self-esteem, depression and anxiety, and they are at greater risk of becoming overweight.

Causes of DCD

The causes for DCD are still largely unknown. However, children born prematurely and children with extremely low birth weights are at a significantly increased risk of demonstrating DCD. A complex relationship also exists between DCD and other developmental disorders such as ADHD, dyslexia and a speech language impairment, to name but a few. The overlapping of the various disorders often prevents professionals to make a clear-cut diagnosis of DCD.

Is A DCD Diagnoses Really Necessary?

At our paediatric development centre, we try and avoid labels as far as possible and instead provide a brief, practical description of a child's coordination difficulties together with any co-morbid problems that may exist.

However, a diagnoses can sometimes be helpful in summarising the problems, communicating important information to other professionals and in planning the relevant services that a child will require. Remember, a diagnoses is just used to describe a specific set of symptoms that are being experienced by a child.

A diagnoses can also help to access funding or services that might not otherwise be accessible. This may include tax benefits and/or concession for exams when a child is still at school . You can read through the "Guide on the Determination of Medical Tax Credits" (Issue 7) as provided by SARS for more information on medical tax credits.

When your child receives a diagnoses from professionals, you can also speak to his school if you think that he will benefit from special consideration when writing exams. This may include the following support as allowed according to government regulations: additional time, typewriting or using a computer, rest periods, handwriting "flags" to allow untidy writing and specialized seating.

Who Can Diagnose DCD?

Who can assess and diagnose a child with DCD? There are currently a few professions in South Africa that can assist with this process. A Kinderkineticist, for example, can perform various assessments using international recognized test batteries to determine if a child's motor skills are on par with his current developmental age.

If the motor development of this child scores significantly below expected for his age, additional referrals can then be made to neurologists, paediatricians or other medical practitioners to rule out any medical or neurological cause for the difficulties experienced by this child.

All of the above being said, diagnosis alone is NOT the solution. It simply opens the door to getting the help that a child needs by arming everyone involved with the relevant information. It also empowers parents to have more knowledge (and consequently more grace) with their child by understanding his capabilities. However, the ‘help’ still needs to be provided.

If left untreated the child with DCD may struggle to manage a full school day due to poor strength and endurance. Fine motor skills (e.g. writing, drawing and cutting) may also persist due to poor core stability, meaning that he does not have a strong base to support the use of his arms and hands. Furthermore, anxiety and stress is often times experienced as a child may struggle to complete assessments, exams and other academic tasks in higher education.

It is thus important to find a professional who can help with exercises to address the problem areas that were identified by the parent and/or teacher. A Kinderkineticist can provide guidelines and consult with a parent over the possible interventions and strategies that can be followed after a diagnoses.

A Kinderkineticist can also provide the appropriate task-orientated exercises to address the problem areas that are specific to that child. Coordination difficulties do not usually go away. But children can learn how to successfully execute many of the motor tasks that they need to perform everyday.

DCD Strategies And Interventions

Parents

What can you as a parent do to assist a child with DCD or motor difficulties? It is important to understand that children with DCD may encounter more success with certain activities than with others.

Lifestyle sports such as swimming, cycling, running, skating and skiing are activities that are worth the extra time and effort to learn as children with DCD can participate in these activities and reap the health benefits throughout their lifetime.

Also try to introduce a child to new sports activities or a new playground on an individual basis before he is required to manage the activity in a group. With regards to clothing: encourage the child to wear clothing that is easy to get on and off. For example, T-shirts, sweaters and Velcro shoes. When possible, use Velcro closures instead of buttons or shoelaces.

Teachers

What can a teacher do to assist a child with DCD or motor difficulties? Start by ensuring that the child is positioned properly at his desk. His feet should be flat on the floor and the desk at the appropriate height so that his shoulders can be relaxed and the forearms supported on the desk.

Provide the child with extra time to write exams or to complete fine motor activities such as math, printing, writing a story or artwork. If speed is required, accept a less accurate product from the child.

Also use paper that matches the child's handwriting difficulties: well-spaced lines for a child who writes with very large letters, raised lined paper for a child who has trouble writing within the lines or graph paper with large squares for a child who has trouble keeping numbers aligned in mathematics.

Summary

Struggling with motor skill on a daily basis, can be frustrating for children and parents alike. The good news is that life can be made easier for children with coordination difficulties. There is so much that we as adults can do to assist and help a child reach their full potential!

For more information or help with regards to DCD, please contact our paediatric development centre to speak to one of our Kinderkineticists. We will be happy to help wherever we can. We also have an excellent course accredited by the HPCSA, if you are interested in learning more about DCD - either as a parent or teacher. Until next time, happy moving moments!