Developmental coordination disorder (DCD), also known as developmental dyspraxia or simply dyspraxia, is a chronic neurological disorder beginning in childhood that can affect planning of movements and co-ordination as a result of brain messages not being accurately transmitted to the body. Developmental coordination disorder is diagnosed in the absence of other neurological impairments like cerebral palsy,muscular dystrophy,multiple sclerosis or Parkinson's disease. It affects 5 to 6 percent of school-aged children. This disorder progresses to adulthood, therefore making it a lifelong condition.
Various areas of development can be affected by developmental coordination disorder and these will persist into adulthood, as DCD has no cure. Often various coping strategies are developed, and these can be enhanced through occupational therapy, psychomotor therapy, physiotherapy, speech therapy, or psychological training.
In addition to the physical impairments, developmental coordination disorder is associated with problems with memory, especially working memory. This typically results in difficulty remembering instructions, difficulty organizing one's time and remembering deadlines, increased propensity to lose things or problems carrying out tasks which require remembering several steps in sequence (such as cooking). Whilst most of the general population experience these problems to some extent, they have a much more significant impact on the lives of dyspraxic people. However, many dyspraxics have excellent long-term memories, despite poor short-term memory. Many dyspraxics benefit from working in a structured environment, as repeating the same routine minimises difficulty with time-management and allows them to commit procedures to long-term memory.
People with developmental coordination disorder sometimes have difficulty moderating the amount of sensory information that their body is constantly sending them, so as a result dyspraxics are prone to sensory overload and panic attacks.
Moderate to extreme difficulty doing physical tasks is experienced by some dyspraxics, and fatigue is common because so much extra energy is expended while trying to execute physical movements correctly. Some (but not all) dyspraxics suffer from hypotonia, low muscle tone, which like DCD can detrimentally affect balance.
Whole body movement and motor coordination issues mean that major developmental targets including walking, running, climbing and jumping can be affected. The difficulties vary from person to person and can include the following:
Fine-motor problems can cause difficulty with a wide variety of other tasks such as using a knife and fork, fastening buttons and shoelaces, cooking, brushing one's teeth, styling one's hair, shaving, applying cosmetics, opening jars and packets, locking and unlocking doors, and doing housework.
Difficulties with fine motor co-ordination lead to problems with handwriting, which may be due to either ideational or ideo-motor difficulties.[non-primary source needed] Problems associated with this area may include:
However, they are unlikely to have all of these conditions. The pattern of difficulty varies widely from person to person, and it is important to understand that an area of major weakness for one dyspraxic can be an area of strength or gift for another. For example, while some dyspraxics have difficulty with reading and spelling due to an overlap with dyslexia, or numeracy due to an overlap with dyscalculia, others may have brilliant reading and spelling or mathematical abilities. Some estimates show that up to 50% of dyspraxics have ADHD.
Sensory Processing Disorder (SPD) concerns having abnormal oversensitivity or undersensitivity to physical stimuli, such as touch, light, sound, and smell. This may manifest itself as an inability to tolerate certain textures such as sandpaper or certain fabrics such as wool, oral intolerance of excessively textured food (commonly known as picky eating), being touched by another individual (in the case of touch oversensitivity) or may require the consistent use of sunglasses outdoors since sunlight may be intense enough to cause discomfort to a dyspraxic (in the case of light oversensitivity). An aversion to loud music and naturally loud environments (such as clubs and bars) is typical behavior of a dyspraxic individual who suffers from auditory oversensitivity, while only being comfortable in unusually warm or cold environments is typical of a dyspraxic with temperature oversensitivity. Undersensitivity to stimuli may also cause problems. Dyspraxics who are undersensitive to pain may injure themselves without realising. Some dyspraxics may be oversensitive to some stimuli and undersensitive to others.
Specific Language Impairment (SLI), research has found that students with developmental coordination disorder and normal language skills still experience learning difficulties despite relative strengths in language. This means that for students with developmental coordination disorder their working memory abilities determine their learning difficulties. Any strength in language that they have is not able to sufficiently support their learning.
Students with developmental coordination disorder struggle most in visual-spatial memory. When compared to their peers who don’t have motor difficulties, students with developmental coordination disorder are seven times more likely than typically developing students to achieve very poor scores in visual-spatial memory. As a result of this working memory impairment, students with developmental coordination disorder have learning deficits as well.
Psychological domain: Children with DCD struggle with lower self-efficacy and lower self-perceived competence in peer and social relations. They demonstrate greater aggressiveness and hyperactivity.
Social domain: Children are more vulnerable to social rejection and bullying, along with higher levels of loneliness.
Assessments for developmental coordination disorder typically require a developmental history, detailing ages at which significant developmental milestones, such as crawling and walking, occurred. Motor skills screening includes activities designed to indicate developmental coordination disorder, including balancing, physical sequencing, touch sensitivity, and variations on walking activities.
Screening tests which can be used to assess developmental coordination disorder include:-
Currently there is no single gold standard assessment test.
A baseline motor assessment establishes the starting point for developmental intervention programs. Comparing children to normal rates of development may help to establish areas of significant difficulty.
However, research in the British Journal of Special Education has shown that knowledge is severely limited in many who should be trained to recognise and respond to various difficulties, including developmental coordination disorder, dyslexia and deficits in attention, motor control and perception (DAMP). The earlier that difficulties are noted and timely assessments occur, the quicker intervention can begin. A teacher or GP could miss a diagnosis if they are only applying a cursory knowledge.
"Teachers will not be able to recognise or accommodate the child with learning difficulties in class if their knowledge is limited. Similarly GPs will find it difficult to detect and appropriately refer children with learning difficulties."[non-primary source needed]
Developmental coordination disorder is a lifelong neurological condition that is more common in males than in females, with a ratio of approximately four males to every female. The exact proportion of people with the disorder is unknown since the disorder can be difficult to detect due to a lack of specific laboratory tests, thus making diagnosis of the condition one of elimination of all other possible causes/diseases. Approximately 5–6% of children are affected by this condition.[non-primary source needed]
Collier first described developmental coordination disorder as 'congenital maladroitness'. A. Jean Ayres referred to developmental coordination disorder as a disorder of sensory integration in 1972, while in 1975 Dr Sasson Gubbay called it the 'clumsy child syndrome'. Developmental coordination disorder has also been called minimal brain dysfunction although the two latter names are no longer in use.
^Polatajko, H.; Fox, M.; Missiuna, C. (1995). "An International Consensus on Children with Developmental Coordination Disorder". Canadian Journal of Occupational Therapy. 62 (1): 3–6. doi:10.1177/000841749506200101. ISSN0008-4174.
^ abBlank R, Smits-Engelsman B, Polatajko H, Wilson P (January 2012). "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. doi:10.1111/j.1469-8749.2011.04171.x. PMID22171930.
^Magalhães LC, Missiuna C, Wong S (November 2006). "Terminology used in research reports of developmental coordination disorder". Dev Med Child Neurol. 48 (11): 937–41. doi:10.1017/S0012162206002040. PMID17044965.
^ abKirby A, Edwards L, Sugden D, Rosenblum S (2010). "The development and standardization of the Adult Developmental Co-ordination Disorders/Dyspraxia Checklist (ADC)". Res Dev Disabil. 31 (1): 131–9. doi:10.1016/j.ridd.2009.08.010. PMID19819107.
^ abcBiggs, Victoria (2005). "3 A Survival Guide to School". Caged in chaos : a dyspraxic guide to breaking free. London ; Philadelphia: Jessica Kingsley Publishers. ISBN978-1-84310-347-9. OCLC57316751.
^Dziuk MA, Gidley Larson JC, Apostu A, Mahone EM, Denckla MB, Mostofsky SH (October 2007). "Dyspraxia in autism: association with motor, social, and communicative deficits". Dev Med Child Neurol. 49 (10): 734–9. doi:10.1111/j.1469-8749.2007.00734.x. PMID17880641.
^Pieters, S.; Desoete, A.; Van Waelvelde, H.; Vanderswalmen, R.; Roeyers, H. (2012). "Mathematical problems in children with developmental coordination disorder". Res Dev Disabil. 33 (4): 1128–35. doi:10.1016/j.ridd.2012.02.007. PMID22502838.
^Van Waelvelde, H.; Hellinckx, T.; Peersman, W.; Smits-Engelsman, BC. (Aug 2012). "SOS: a screening instrument to identify children with handwriting impairments". Phys Occup Ther Pediatr. 32 (3): 306–19. doi:10.3109/01942638.2012.678971. PMID22515913.
^ abcBiggs, Victoria (2005). "2 The Hidden People at Home". Caged in chaos : a dyspraxic guide to breaking free. London ; Philadelphia: Jessica Kingsley Publishers. ISBN978-1-84310-347-9. OCLC57316751.
^ abAlloway, TP; Archibald, L (2008). "Working Memory and Learning in Children with Developmental Coordination Disorder and Specific Language Impairment". Journal of Learning Disabilities. 41 (3): 251–62. doi:10.1177/0022219408315815. PMID18434291.
^Alloway, TP (2007). "Working Memory, Reading and Mathematical Skills in Children with Developmental Coordination Disorder". Journal of Experimental Child Psychology. 96 (1): 20–36. doi:10.1016/j.jecp.2006.07.002. PMID17010988.
^Alloway, TP; Temple, K (2007). "A Comparison of Working Memory Profiles and Learning in Children with Developmental Coordination Disorder and Moderate Learning Difficulties". Applied Cognitive Psychology. 21 (4): 473–487. doi:10.1002/acp.1284.
^Wright, HC.; Sugden, DA. (Dec 1996). "A two-step procedure for the identification of children with developmental co-ordination disorder in Singapore". Dev Med Child Neurol. 38 (12): 1099–105. doi:10.1111/j.1469-8749.1996.tb15073.x. PMID8973295.
^Venetsanou, F.; Kambas, A.; Ellinoudis, T.; Fatouros, I.; Giannakidou, D.; Kourtessis, T. (2011). "Can the movement assessment battery for children-test be the gold standard for the motor assessment of children with Developmental Coordination Disorder?". Res Dev Disabil. 32 (1): 1–10. doi:10.1016/j.ridd.2010.09.006. PMID20940096.
^Ellinoudis, T.; Evaggelinou, C.; Kourtessis, T.; Konstantinidou, Z.; Venetsanou, F.; Kambas, A. (2011). "Reliability and validity of age band 1 of the Movement Assessment Battery for Children--second edition". Res Dev Disabil. 32 (3): 1046–51. doi:10.1016/j.ridd.2011.01.035. PMID21333488.
^Schoemaker, Marina M; Niemeijer, Anuschka S; Flapper, Boudien C T; Smits-Engelsman, Bouwien C M (2012). "Validity and reliability of the Movement Assessment Battery for Children-2 Checklist for children with and without motor impairments". Developmental Medicine & Child Neurology. 54 (4): 368–375. doi:10.1111/j.1469-8749.2012.04226.x. PMID22320829.
^Venetsanou, F.; Kambas, A.; Aggeloussis, N.; Serbezis, V.; Taxildaris, K. (Nov 2007). "Use of the Bruininks-Oseretsky Test of Motor Proficiency for identifying children with motor impairment". Dev Med Child Neurol. 49 (11): 846–8. doi:10.1111/j.1469-8749.2007.00846.x. PMID17979863.
^Venetsanou, F.; Kambas, A.; Aggeloussis, N.; Fatouros, I.; Taxildaris, K. (Aug 2009). "Motor assessment of preschool aged children: A preliminary investigation of the validity of the Bruininks-Oseretsky test of motor proficiency – short form". Hum Mov Sci. 28 (4): 543–50. doi:10.1016/j.humov.2009.03.002. PMID19443065.
^Kambas, A.; Venetsanou, F.; Giannakidou, D.; Fatouros, IG.; Avloniti, A.; Chatzinikolaou, A.; Draganidis, D.; Zimmer, R. (2012). "The Motor-Proficiency-Test for children between 4 and 6 years of age (MOT 4-6): an investigation of its suitability in Greece". Res Dev Disabil. 33 (5): 1626–32. doi:10.1016/j.ridd.2012.04.002. PMID22543059.
^Kirby, Amanda; Davies, Rhys; Bryant, Amy (2005). "Do teachers know more about specific learning difficulties than general practitioners?". British Journal of Special Education. 32 (3): 122–126. doi:10.1111/j.0952-3383.2005.00384.x. ISSN0952-3383.