Do you work with children who find it difficult to coordinate their physical selves, as well as their academic work and time management?
These are the children who fall over themselves when the path is seemingly clear, manage to always be late or lost, and have hand-writing that seems below their age expectancy. In the classroom, they can have great difficulty paying attention for any length of time, are often tired or lethargic, and struggle to integrate information from different modalities.
Developmental Coordination Disorder (DCD), also known as Dyspraxia, is a neurodevelopmental condition characterised by motor performance impairments unrelated to other physical and intellectual disorders (APA, 2000).
Despite the high prevalence rate of between 5 and 15% (eg. Hay & Missiuna, 1998; Kadesjo & Gillberg, 1999; Polatajko & Cantin, 2005; Wilson, 2005; Zoia, et al, 2009), DCD often goes undiagnosed in school-aged children (Cairney, Hay, Faught, & Hawes, 2005).
The reasons for this include the low level of general awareness and the relative “contemporariness” of the psychological diagnostic term/s “Developmental Coordination Disorder/DCD” and/or “Dyspraxia”, which are now internationally and formally recognised.
Although the term “clumsy child syndrome” (Gubbay, 1975) has been used to describe children who had motor difficulties, the official terms were only coined more recently (Kirby, Sugden, & Edwards, 2011). Just to note, there is no difference between DCD and Dyspraxia – they are used interchangeably.
A diagnosis is made under the conditions that:
a) the child presents with significant impairment in the development of motor coordination
b) this impairment interferes with academic achievement or activities of daily living
c) the coordination difficulties are not due to a general medical disorder (such as cerebral palsy/muscular dystrophy/paralysis/visual impairment)
d) where the child has a general learning disability, the motor coordination difficulties are in excess of those usually associated with this disability (APA, 2013).
However, because DCD is such a complex condition, receiving a diagnosis means meeting with a multi-disciplinary team, usually consisting of an occupational therapist or physiotherapist to assess the child’s fine and gross motor, coordination and balance skills; a speech and language therapist to assess speech development; an educational psychologist to assess learning and cognitive abilities; and a paediatrician to ensure that any of the above issues are not due to a medical disorder. Dyspraxia is characterized by a failure to learn fine and gross motor skills, which is in contrast to “Apraxia”, an acquired disorder defined by the loss of the ability to perform previously learned skills (Vaivre-Douret et al., 2011) Despite its high prevalence, DCD is not readily recognized by either health care professionals or the general public (Hamilton, 2002). The cause of DCD is unknown, although links have been made to maturational processes in the central nervous system (Vaivre-Douret et al., 2011).
This disorder affects fine motor movements (eg. handwriting) and gross motor movements (eg. balance), which can lead to complex psychological problems such as poor self-concept (Skinner & Piek, 2001), low physical self-perception (Piek, Dworcan, Barrett, & Coleman, 2000), chronic anxiety (Kirby, Williams, Thomas, & Hill, 2013) and socialisation difficulties (Hoare & Larkin, 1991). Within the context of participation in everyday activities, children with DCD have a lower sense of coherence, hope and effort compared to their peers (Liberman, Ratzon & Bart, 2013).
In general, children with DCD engage in significantly higher levels of internalising behaviours (anxiety, depression and withdrawn behaviour) and externalizing behaviours (aggression and hyperactivity), compared to their peers (Tseng et al. 2007). There has been increasing awareness that DCD co-occurs with anxiety (Sigurdsson, Van Os, & Fombonne, 2002). Research has shown that children aged between 8-10 years with DCD had significantly greater levels of both state and trait anxiety (eg. Skinner and Piek, 2001). Pratt and Hills’ (2011) study of children with a clinical diagnosis of DCD found they experienced significantly higher levels of general anxiety, as well as significantly greater levels of panic and/or agoraphobic anxiety, social phobia, and obsessive compulsive anxiety than their typically developing peers. Unfortunately, a diagnosis of DCD usually occurs in mid-primary school when socioemotional difficulties, such as anxiety, have already emerged (Piek, Bradbury, Elsley, & Tate, 2008). Research by Piek and colleagues (2008) found that children with DCD aged 3.5 to 5.5 years scored significantly higher on the anxious-depressed scale compared with typically developing children. This relationship has also been found in older children and adolescents (e.g., Francis & Piek, 2003; Skinner & Piek, 2001); however, it is alarming children this young may be at risk of developing anxiety.
Research has also found a strong correlation between DCD and depression (Kadesjo & Gillberg, 1998; Rasmussen & Gillberg, 2000; Francis & Piek, 2003; Piek et al., 2008). Empirical evidence pertaining to the exact links between DCD and depression is evolving as secondary of issues of DCD are being investigated more thoroughly (Campbell et al., 2012). For instance, participation in physical activity on a regular basis by children leads to positive physical and psychological health results (Ma, 2000); nonetheless, children with DCD show continued and significant disengagement from involvement in physical activity due to their below average motor proficiency (Cairney et al., 2005). The average childhood involves various leisure activities which include many motor skills (eg. soccer, dancing, knitting, yoga). As such, withdrawal from these activities may have long-lasting ramifications for these children’s social network (Dewey, Kaplan, Crawford, & Wilson, 2002).
Social exclusion/isolation may well be a contributing factors to the higher levels of depression reported for children with DCD (Campbell et al., 2012). Both teachers and parents have reported that children with DCD have fewer friends, are more socially isolated than their peers (Piek, Barrett, Allen, Jones, & Louise, 2005), and are less sociable (Dunn & Watkinson, 1996). According to Cairney, Veldhuizen, and Szatmari (2010), DCD may act as a primary stressor that exposes these children to secondary stressors including social isolation and these, in turn, may lead to negative self-valuations that are troublesome and later exhibit as mental health problems (Campbell et al., 2012). Parents of children with DCD have also reported that they regard bullying as a serious concern for their children (Missiuna, Gaines, Soucie, & McLean, 2006), which may add to the likelihood of developing depressive symptoms.
Because children with DCD are prone to isolation, social withdrawal, bullying and peer conflict, it is vital that education and health professionals working with these children fully understand the condition and learn effective strategies to meet their varying needs. In my clinical experience, children with DCD are among the most sensitive and empathetic; despite the challenges they face, there are so many strengths associated with DCD which must be harnessed – resilience, passion, motivation and endurance. We must learn to advocate for these children who are working so hard on a daily basis just to function – invisible struggles which we take for granted like dressing ourselves, organising our books and kicking a ball.
If you would like to learn more about Dyspraxia and other related topics, go to www.lorrainelynchconsulting.ie for online CPD training courses, including Understanding Dyspraxia and Managing Dyspraxia in the Classroom.