What is Developmental Coordination Disorder (DCD)?
Developmental Coordination Disorder (DCD) is a motor impairment that effects approximately 1 in 20 children (Blank et al., 2012). DCD was previously described as “clumsy child syndrome” or may be referred to as dyspraxia. Children with DCD may have normal motor milestones, however, may struggle with the motor planning aspect of tasks (such as working out how to climb a jungle gym, tie shoelaces, or throw and catch a ball).
DCD is rarely the sole diagnosis of a child, as it has a very high correlation with Autism and ADHD (Zwicker et al., 2013). DCD is about as common in the population as ADHD, and about half of children with ADHD also have DCD (Martin et al., 2006). Children may not struggle with simple motor tasks, but may have increasing difficulty as tasks become more complex (Bhoyroo et al., 2018).
What are the impacts of DCD?
DCD also has a big impact on a person’s quality of life, with measures of quality of life being lower than even children with chronic health conditions, such as cancer (Caçola & Killian, 2018). Children with DCD are less likely to be physically active or fit, more likely to be overweight and their risk of depression is 5 times greater than their peers (Joshi et al., 2015; Lingam et al., 2012).
Why haven’t I heard of DCD?
Like Autism and ADHD, DCD presents early in life and does not necessarily resolve when a child grows up. Approximately 6% of school aged children are found to have DCD, however, it is possible that its prevalence is somewhat underrepresented given its poor recognition amongst the healthcare community.
According to studies, only 9% of General Practitioners and 23% of Paediatricians have ever diagnosed DCD, with only 41% of the latter having knowledge of the condition and only 20% of the general population are aware that DCD exists (Wilson et al., 2013). Thus, it is understandable why DCD is likely to be an under-represented and under-diagnosed condition.
How is DCD diagnosed?
DCD is diagnosed by a health professional, using a set of criteria as outlined in the Diagnostic Statistical Manual (DSM5) to help confirm the presence of the condition:
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A
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Learning and execution of coordinated motor skills is below expected level for age, given the opportunities for skill learning
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B
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Motor skill difficulties significantly interfere with activities of daily living, impacting academic, vocational, leisure or play activities
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C
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Onset is in the early developmental period
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D
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Motor skills are not better explained by intellectual delay, visual impairment or other neurological conditions effecting movement
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Physiotherapists can use certain assessment tools to assess the skills that may be impaired in DCD and assist with the diagnosis process
How is DCD managed?
Here at Peninsula Community Physiotherapy, we utilise the “Movement Assessment Battery For Children” (MACB2) to assist in diagnosing DCD (Henderson & Sugden, 2007). The MACB2 assesses a child’s performance in 3 age-appropriate task sections: Manual Dexterity, Ball Skills and Balance.
This takes approximately 45 minutes to complete and provides an excellent insight into a child’s motor skill ability and associated ‘percentile age-grouping’. These findings from the test can be passed on to your child’s paediatrician, to determine whether a diagnosis of DCD is appropriate.
While the MACB2 is an assessment tool, it also creates a clear guide for how therapy should be focused. For example, if a child is found to have Balls Skills that are in the 10th percentile, but Balance ability that is in the 90th percentile, it is fairly apparent that Ball Skills should be the focus of their Physiotherapy. Assessment can also determine whether there are deficits in writing/drawing skills and fine motor tasks. It’s fairly common that children with DCD may be very good at some parts of assessment, and quite poor in others.
Physiotherapy seeks to address the difficulties and deficits that may be present with DCD, and your therapist may use the MABC2 tool to reassess your progress over time. This helps to know whether the interventions given have being effective.
The Big Picture
DCD is very prevalent in the community and can really impact on someone’s ability to participate in schooling, play, community and later in vocations. People with DCD can find physical exercise difficult. Here at PCP, we are passionate about helping people with DCD find the activities and exercise that they actually enjoy, and building their life around their strengths. The big goals of therapy are to assist in having a positive relationship with your body, modifying and managing the tasks that may be more difficult, and overall developing exercise that improves quality of life.
References:
Bhoyroo, R., Hands, B., Wilmut, K., Hyde, C., & Wigley, A. (2018). Investigating motor planning in children with DCD: Evidence from simple and complex grip-selection tasks. Human Movement Science, 61, 42-51. https://doi.org/https://doi.org/10.1016/j.humov.2018.07.006
Blank, R., Smits-Engelsman, B., Polatajko, H., & Wilson, P. (2012, Jan). European Academy for Childhood Disability (EACD): recommendations on the definition, diagnosis and intervention of developmental coordination disorder (long version). Dev Med Child Neurol, 54(1), 54-93. https://doi.org/10.1111/j.1469-8749.2011.04171.x
Caçola, P., & Killian, M. (2018, Apr). Health-related quality of life in children with Developmental Coordination Disorder: Association between the PedsQL and KIDSCREEN instruments and comparison with their normative samples. Res Dev Disabil, 75, 32-39. https://doi.org/10.1016/j.ridd.2018.02.009
Henderson, S. E., & Sugden, D. A. (2007). Movement assessment Battery for Children- Second Edition. Psychological Corporation.
Joshi, D., Missiuna, C., Hanna, S., Hay, J., Faught, B. E., & Cairney, J. (2015, Aug). Reprint of "Relationship between BMI, waist circumference, physical activity and probable developmental coordination disorder over time". Hum Mov Sci, 42, 307-317. https://doi.org/10.1016/j.humov.2015.06.006
Lingam, R., Jongmans, M. J., Ellis, M., Hunt, L. P., Golding, J., & Emond, A. (2012, Apr). Mental health difficulties in children with developmental coordination disorder. Pediatrics, 129(4), e882-891. https://doi.org/10.1542/peds.2011-1556
Martin, N. C., Piek, J. P., & Hay, D. (2006, 2006/02/01/). DCD and ADHD: A genetic study of their shared aetiology. Human Movement Science, 25(1), 110-124. https://doi.org/https://doi.org/10.1016/j.humov.2005.10.006
Wilson, B. N., Neil, K., Kamps, P. H., & Babcock, S. (2013, Mar). Awareness and knowledge of developmental co-ordination disorder among physicians, teachers and parents. Child Care Health Dev, 39(2), 296-300. https://doi.org/10.1111/j.1365-2214.2012.01403.x
Zwicker, J. G., Yoon, S. W., Mackay, M., Petrie-Thomas, J., Rogers, M., & Synnes, A. R. (2013, Feb). Perinatal and neonatal predictors of developmental coordination disorder in very low birthweight children. Arch Dis Child, 98(2), 118-122. https://doi.org/10.1136/archdischild-2012-302268