Developmental coordination disorder

--How do I know if my child has DCD?

Children with DCD are not usually diagnosed until pre-school age, although they may be delayed in movement skills in infancy and toddlerhood. There are four specific criteria that are used to make a diagnosis for DCD.

The first is that your child’s movement skills are below that expected for their age, gender, opportunities for learning skills and practice. Children who meet this criterion tend to have gross or fine movement skills that are slow, inaccurate, awkward and inconsistent on a day-to-day basis even with instruction. They may also have difficulty generalising the skill in different settings and lack movement memory so that their performance differs between days as if they haven’t learnt how to do the task. A paediatric physiotherapist can measure your child’s movement skills and motor development using one of a number of standardised assessments.

The second criterion is that your child’s movement delay affects their daily activities, such as feeding or dressing themselves and/or their academic performance, like writing, using scissors and functioning in the classroom. Some children with immature or awkward movement skills function well in everyday tasks and in school. These children would not receive a diagnosis of DCD, but may benefit from treatments to improve their movement patterns and skills.

Criterion three states that the poor movement patterns were evident early in development. Some infants are delayed in learning to sit, crawl and walk and have ‘floppy’ postures when sitting and standing. The infant may also have trouble playing with toys, such as stacking rings or blocks. Sometimes the movement delay is not evident until toddlerhood, when the child has difficulty using playground equipment or in early running and jumping, learning to feed themselves with a spoon and helping to get dressed. As children get older, their movements become more complex—they have to make movement decisions during games that require sequencing, which can make them appear slow and awkward compared to their peers.

Criterion four asks the therapist to decide if your child’s movement problems can be better explained by some other developmental condition, such as cerebral palsy, or visual or intellectual impairments. The therapist will do a thorough examination to make sure that your child does not have any other problems that might need further investigation.

DCD is more common in boys than girls and appears to have a familial association. DCD often occurs with learning difficulties, attention deficit/hyperactivity disorder or autism spectrum disorder. The problems a child presents with in each of these conditions are different, but may be related.

Children with DCD often differ in their movement problems. Some have difficulty using vision or are very visually dependent when learning and performing movement tasks. Others have difficulty organising their trunk and the joints in their arms and legs to move efficiently when doing a movement task, even though they know what to do and can explain how they want to do a movement.

This difference in movement problems means that physiotherapists need to carefully assess and identify why your child has movement problems so that treatment is targeted to your child’s goals and needs.

--What’s the difference between coordination difficulties and DCD?

Many people across all ages have coordination difficulties, especially when learning new movement skills or doing complex tasks. All people have strengths and limitations in the type of physical activities they do and how well they do them. Some people take longer to learn movement skills and others appear to be ‘natural athletes’. The diagnosis of DCD is only made if the person meets the four criteria stated above. 

People with coordination difficulties can learn movement skills to enable them to participate in physical activity and the exercise or sport of their choice. Most importantly, people of all ages should try to meet the physical activity guidelines for their age because of the associated physical and mental health benefits. A physiotherapist can help teach movement and sport-specific skills to help people improve their movement coordination and increase their options for physical activity.

--Will my child learn to play, jump and run like his or her peers?

If your child has a diagnosis of DCD, then they have the capacity to learn movement skills, but they may still look uncoordinated and slower than their peers and will need time, opportunity and active engagement to learn tasks. It is important to focus on the child’s effort, enjoyment and participation rather than outcomes such as winning. Children like goals and challenges and are able to set these themselves, even if they can’t tell you what these are. Watching them play will give you clues as to what their goal might be. Give them physical assistance or verbal prompts to help them achieve their goal. They will pick up on your fear or anxiety, so be positive and encouraging. Consider statements like ‘you are so brave’ or ‘you are getting strong—I can see your muscles’.  

The evidence suggests that children with DCD need more time to practise and learn to problem-solve when doing movement tasks. They learn a skill better when it is task specific, practised as a whole task, not broken into bits and practised in context. For example, your child’s goal may be to join his or her friends on playground equipment. You can help by asking your child what strategies they could use on various parts of the playground and practising on each part of the equipment. Give the child physical assistance to help with balance or strength. Some children will need verbal re-assurance and self-belief talk.

Failure and mistakes are an opportunity for learning. Keep encouraging them and look for opportunities for improvement. Think of approaches like ‘never mind, try again’, ‘maybe try it this way instead’ or ‘I’ll help you with this bit, you can do the rest on your own’.

--Should I be worried about hypermobile joints?

Some children with DCD are hypermobile and others are not. A physiotherapist can assess if the hypermobility is within a clinical range where intervention strategies may be required.

Unless your child has pain or is having joint problems when doing physical activity, being hypermobile should not limit them from being active. Physiotherapists will modify physical activity and exercise if necessary. Some children with joint pain may benefit from seeing a paediatric orthopaedic surgeon or paediatric rheumatologist—this is best discussed with the physiotherapist.

--How can physiotherapy help with DCD?

There is lots of research on trying to find the best way to assist a child with DCD. Because the condition is slightly different in each person, one treatment strategy will not work for everyone. 

Strength

There has been some evidence for doing a strength training program, targeting specific big muscles in the trunk (abdominals and back extensors), arms (pectoralis major, deltoids, biceps, triceps) and legs (gluteus maximus, gluteus medius, quadriceps, hamstrings, gastrocnemius). Strength training builds muscle, which is important for protecting joints and increasing bone density. Increases in strength should be translated into improving functional tasks.

With children, it is often possible to create games for strengthening activities. Some ideas for strengthening can be animal movements. For example, bear walking (on hands and feet, arm and leg on same side move together), duck walks (squat walk with hands on hips), frog jumps (start and end from a squat position), kangaroo jumps (upright, feet together), dog walk (crawling position, wag tail, scratch ear), wheelbarrows (straight trunk, no saggy tummy), swinging from monkey bars, (walking one arm at a time on the monkey bars) and flying fox. You can also look at programs such as Animal Fun, which is designed to improve movement, balance and social-emotional health in young children—particularly those with movement problems.

Sensory systems

Children with DCD often have difficulty using sensory information from their visual, tactile (touch), proprioception (joint position sense) and vestibular (speed and direction of body movement) systems. They can usually detect the sensation but do not interpret or analyse the sensory information accurately to make good movement choices. Making the child aware of individual or combined sensory input may be beneficial, but again this needs to be part of functional tasks.  Games to play include shadows using hands and a torch, finger puppets (isolated finger movements), feely box (find small toys by touch only), trampoline (controlled jump and landing), clapping games and Twister® (body awareness). If the child has difficulty with writing, dressing or eating, then they also need to practise these skills specifically to get better at them.

Active electronic games

There is some evidence that children with DCD may be more inclined to practise active games at home without competition or being watched and judged by peers. Nintendo Wii, Microsoft Xbox Kinect and Sony Playstation Eye and Move have been shown to increase a child’s energy expenditure. The use of active electronic games to improve movement skills for children with DCD is in its early stages, so the evidence is not yet compelling. However, one study has shown that the children with DCD reported higher self-belief after taking part in active gaming and were more inclined to be physically active, even though they were not better at performing the movement tasks in real life.

Task-specific training

Children with DCD learn movement skills best if they have specific training, instruction, feedback and opportunities to problem-solve when learning new skills.  A task-specific approach is favoured by physiotherapists; however, they may also use strength training, sensory awareness, balance and muscle lengthening techniques to make movement tasks easier. 

Physiotherapists are also aware that some children with DCD may have problems with muscle weakness and tightness as they grow, which can affect their standing and sitting postures. It is therefore important to build strength and flexibility to prevent long-term problems.

--How effective is physiotherapy for treating DCD?

Strength training programs, task-orientated approaches and active electronic games have all been shown to provide benefits for children with DCD. In one study, strength training was shown to improve strength, proprioception (joint awareness) and gross motor skills. Active gaming can help to improve movement skills, while providing enjoyment and motivation for children to practise movement activities.

--What can we do at home?

Many children with DCD enjoy swimming, especially if they have generalised weakness and poor balance. Some children do well with martial arts or dance. The sports teacher or trainer may need advice on how to work with a child with DCD. The CanChild website (developed by McMaster University, Toronto, Canada) has a range of resources and information for parents, teachers and physical education teachers to help them better understand DCD and how they can help the child.

Advice from a paediatric physiotherapist will be specific and individualised to your child’s sensory or movement problems. The most important consideration is to identify what your child enjoys doing so that they are more likely to persevere with the sport or activity. Some children prefer doing activities that do not have a competitive aspect, as this can make them anxious if they feel they are letting the team down.

Family activities like bush walks and adventure playgrounds are fun options. Other options include games such as balloon tennis, hitting or kicking a suspended ball, totem tennis, homemade skittles (drink bottles filled with water) and supervised gardening (pushing/pulling/digging/carrying). These activities can help your child enjoy physical activity while learning movement skills. 

--Can I access funding with the National Disability Services Scheme (NDIS)?

Currently, children with DCD are unable to access NDIS funding.