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What is it ?

Does your child feel low in confidence? Has he ceased to mix with same age peers and started avoiding social interaction? Does he perform poorly in academics which is disproportionately low to his intelligence quotient? Does he has handwriting issues? If answer to any of these questions is yes, he might be having DEVELOPMENTAL COORDINATION DISORDER and needs a detailed assessment for the same.

Developmental coordination disorder (DCD) is a common neuro-developmental disorder and is considered to be one of the major health problems among school-aged children worldwide. It is characterized by marked impairment in the development of motor coordination skills. As per literature, this condition is known to affect 5–6% of school going children aged 5 to 12. However, the prevalence might be higher due to lack of awareness of the disorder and subsequent underreporting of the condition. As per literature, boys are 1.7 to 2.8 times more likely to have this disorder as compared to girls.

This deficiency is not related to or a consequence of any specific underlying medical or neurological deficits. This condition deserves special attention because it entails significant negative impact on the child’s academic achievement or on activities of daily living.

Motor performance of children with DCD is usually slower, less accurate, and more variable than in their peers. Earlier, this condition was known by several names (e.g., dyspraxia, minor neurological dysfunction, minimal brain damage, clumsiness).

What are the presenting complaints?

            Although, these children commonly present to the clinic for academic related concerns but detailed analysis of history reveals delay in acquiring one of many motor milestones like difficulty learning to tie shoe laces, delay in or difficulty buttoning-unbuttoning of shirt, difficulty hitting shuttle with racquet while playing badminton, difficulty crossing roads alone, difficulty cutting food and in washing or combing hair. Owing to poor coordination abilities, these children do not easily keep up with their peers. No body passes ball to them while playing football or select these kids in their cricket team. As it happens, they start feeling excluded and inferior to their teammates. As a result, they do not want to participate in sports anymore. Subsequently, parents also start worrying for their kids as they see them becoming socially isolated and withdrawn. 

These kids are often poor in planning and organizational capabilities. They take more time to acquire new skills compared to their peers and might gradually develop complete disinterest in the skill being practiced owing to repeated failures. They behave so clumsy that parents cease handing over any delicate object to them. Their speed and dexterity, like in running or drawing, might also be well below age equivalents. Some might come up with history of frequent falls in childhood. 

Difficulty with copying, drawing, painting, handwriting, organizing, and finishing work on time are the common presenting complaints. Poor academic performance is often a consequence of handwriting related issues. According to a recent study conducted in a public hospital at Mumbai, out of 330 children who presented with academic issues, 53.8 % of those belonging to primary grades and 35.7% of those in middle school had difficulty with one or more aspects of the written work including handwriting, spellings, vocabulary or expressing ideas in written form. Consequently, they start expressing their reluctance to participate in usual classroom activities. Resultant academic gap starts building up affecting their comprehension and because written expression being an important parameter by which teacher's evaluate performance of their students, these kids are often promoted to the next level or require to repeat a class during their schooling years. The ever increasing challenges and their repeated failures at school adversely affect their self-esteem.

What is the cause?

There is no known single cause for DCD. Researchers implicate impairment in the evolution of underlying neurodevelopmental processes especially in visual motor skills. However, the neural basis for DCD remains unclear.

What are the possible consequences?

Inadequacy of motor proficiency is associated with an increased risk for problems in other areas like academic, social and psychological. Co-morbidities are very much known to occur in these children. These include speech and language disorder, specific learning disorder (especially reading and writing), problems of inattention including ADHD (the most frequent coexisting condition with about 50% co-occurrence), Autism spectrum disorder, disruptive and emotional behavior problems. As a result of their primary motor impairment and because of their self-perception of inadequacy to meet minimum performance expectations over imposed by the competition posed by their contemporaries, these children tend to refrain themselves from physical activities. Hence they are also at significant risk of developing poor physical fitness, obesity, anxiety, depression, low self-worth and social isolation.

What is the method of diagnosis?

It is very much possible to help these kids and early diagnosis makes a lot of difference. Establishing the formal diagnosis requires administering questionnaire by an experienced health professional to see for fulfilment of specified criteria in addition to the use of sound measurement tools. One need to initiate intervention immediately thereafter, provide necessary accommodations and set realistic expectations to ensure they are successful.

What is the method of helping the child?

All primary caretakers need to come together to frame and implement strategies in synchrony to help these kids. At school, class teacher should position the child in her direct vision, from where he/she can hear instructions clearly and copy from the board easily. One needs to provide an uncluttered personal workspace and clear, unambiguous instructions so that the child understands what is required of him/her.

We need to develop their organizational skills through activities like making lists, sequencing the events and using timetables. Help them make use of stopwatches or timers to develop an awareness of time.  They should be encouraged to use an alternative means of recording work (e.g. computer). Remember that the child with DCD may find it difficult to multi-task (e.g. tie a shoelace and follow directions simultaneously). Hence, we should avoid giving more than one worksheet at a time and allow for the worksheet to be attached to the desk. At the same time, we should help them break down the assignments into smaller components. If child presses too hard while writing, he should be made to practise writing with a towel under the page. On the other hand, if he writes very lightly allow him to practise writing using carbon paper. Encourage use of grid paper to prompt students to leave a space between words. Also, allow to stop if he/she is tired. Instead, we need to see them when the first half of classwork is completed and allow the child to take a break before continuing with the remaining work. Encourage use of highlighters to chunk information in texts. Also, use as many visual and auditory cues as possible to reinforce teaching. Improvise their environment to be as predictable as possible to facilitate their planning instinct and avoid anxiety.

Participation in different activities and not competition, should be the goal. Also, we need to encourage their relationship building with other children. We should appreciate, encourage and reward their efforts at each step.

These measures can better be implemented and yield best outcome when multidisciplinary approach is utilized wherein Developmental Pediatrician, Psychologists, Occupational Therapists and Special Educators work in synchrony.

Developmental pediatrician is often the first point of contact who takes an in-depth insight into the case history and formulates a working diagnosis. Also, he makes a tentative plan for confirmation of diagnosis and the mode of intervention and allocates roles and responsibilities to his team members and looks after their execution. He intermittently evaluates the child for improvement and counsels parents, encouraging their active participation and moral support. With such structured plan for intervention and ongoing guided efforts, these children do achieve best possible outcome.

To conclude, it is highly significant to identify these children as early as possible with the help of appropriate measurement tools so as to initiate early intervention measures and work in a multi-disciplinary team environment so that children with DCD are successful in their life.

Author information:

Dr. Dinesh Saroj

Developmental Pediatrician

PROUDS CHILD DEVELOPMENT CENTRE, Lokmat Square, Nagpur

MBBS, MD pediatrics,

F.L.D.N.D.P (Sion hospital, Mumbai)

Fellowship in Learning Disability &

Neuro-Developmental Pediatrics

09970724628, [email protected]

www.drdineshsaroj.com