Developmental Coordination Disorder (D.C.D.) is a relatively new diagnosis given to children with significant longstanding, non-progressive problems with fine and gross motor skills. The condition is not attributable to any other known medical or psychosocial diagnosis, although there is significant overlap seen with children with Developmental Delay (D.D.), Autism Spectrum Disorder (A.S.D.) and Attention Deficit Hyperactivity Disorder (A.D.H.D.).1 D.C.D. exists on a continuum of mild to severe. The child’s motor skills fall below their peers, and this can impact on their life at home, school and in the community.
D.C.D. is relatively common, with various studies finding it’s prevalence to be between 2% and 6% of school aged children. It is slightly more common in boys than girls.2
In the past, these children were sometimes classified as having ‘Dyspraxia’, or were simply labelled as ‘clumsy kids’. It was thought that there was little that could be done to help them, and that they would just ‘grow out of it’. Research now indicates that without specific intervention the majority of these children do not grow out of it.3 Problems with both fine and gross motor skills can remain well into teens and early adult lives, affecting participation in sport and exercise, study and/or work. This has consequences for both physical and mental health.
Experts now believe that D.C.D. is a neurodevelopmental condition4 affecting motor learning, and one that can be improved with skilled assessment and intervention. Early intervention is very important, as children around the age of 4-5 go through a phase of increased neuroplasticity, meaning large gains can be made and retained during this period.5 With accurate assessment and individualised intervention, these children can catch up to their peers.6
D.C.D. can be formally diagnosed from the age of 3 if the impairment is severe. Younger than this there is too much natural variation in gross and fine motor skill development to diagnose a significant issue. Most commonly, children will be between 5 and 10 when problems with their gross and fine motor skills will become obvious.
Younger children may achieve all of their motor milestones within the ‘normal’ age range, but concerns may be raised regarding the quality of these newly acquired motor skills. For example, they may learn to walk at an age appropriate time, but may then display poor balance, possibly tripping/falling more often than normal. Older children may have trouble throwing and catching a ball, riding a bike or running in a coordinated fashion. They may seem poorly coordinated in terms of dressing themselves or tying shoelaces. Often they struggle with handwriting. Very commonly these children have great difficulty learning a new skill.
Best practice management for these children starts with an accurate, age referenced assessment. From this assessment, more detail can be learned in terms of what the child’s biggest issues are, from strength, balance or coordination to motor planning. Formal assessment results can be used to apply for N.D.I.S. funding for this condition.
An individualised exercise program can then be devised by the physiotherapist. Communication with families, kindergartens and schools is essential so that all of the key people involved with the child can assist with things such as home based exercises or setting up the classroom or PE class in ways that will help the child develop their motor skills.
I will be offering assessment and 1:1 exercise based programs from Offspring Child Health, Hawthorn, on Monday afternoons and Saturday mornings. I will also offer offsite sessions at agreed locations such as local parks to work on skills such as running or bike riding. No referral is necessary unless planning to access a Medicare rebate through a Chronic Disease Management plan, in which case a G.P. referral is required.
For more information about D.C.D. or the program offered at Offspring Child Health, contact Kate Cowlishaw on 1800 545 737
1 ‘International clinical practice recommendations on the definition, diagnosis, assessment, intervention and psychosocial aspects of Developmental Coordination Disorder’ Blank et al, Developmental Medicine and Child Neurology, 2018
2 As above
3 ‘Clumsiness in children – do they grow out of it? A 10 year follow up study’ Losse et al, Developmental Medicine and Child Neurology, 1991
4 As per #1
5 ‘Assessment of Motor Functioning in the Pre-school Period’, Piek et al, Neuropsychology Review, 2012
6 As for #1