DEVELOPMENTAL COORDINATION DISORDER (DCD)

What are the common features of Developmental Coordination Disorder (DCD)?

Developmental Coordination Disorder (DCD) is a term used to describe children who demonstrate substantial difficulty in coordinating movements such as those needed to climb the playground, catch balls, complete handwriting tasks or get dressed. It is commonly referred to as dyspraxia. Children with DCD can appear clumsy and seem less developed in their life skills in comparison with other children the same age. DCD is thought to be more common in boys than Girls (3-4 times as much) and it is thought to sometime run in families.

What are the common difficulties children with Developmental Coordination Disorder (DCD) present with?

• Children with DCD can experience unique difficulties i.e. not all children with DCD diagnosis will present with the same difficulties; some may have difficulties across all areas of their daily living activates, both others may have difficulties in only specific tasks. The child may be described as “clumsy” or “awkward” in their movements and play skills in comparison with other children the same age. 
• The child may have difficulties with their body awareness and positioning. They may appear clumsy and have problems with judging distance and bumping; into things and people; knocking things over and invading other people’s personal space without an awareness of doing this.
• The child may have delayed in developing gross motor (physical) skills (e.g. running, jumping, hopping, and catching balls, climbing).
• The child may struggle with fine motor tasks (e.g. handwriting, doing up buttons, threading beads, tying shoe laces), or both.
• There may be some discrepancy between the child’s physical ability and movements compared with their academic performance, intellectual skills and language skills Movement planning difficulties.
• They may have some difficulties planning physical movements; sequencing of movements, completing new tasks, or difficulties remembering the next step in a sequence – even if provided with step by step instructions and visual cues. 
• The child may have difficulties with learning new movements. They may be able to learn a task in one location but be unable to do this new activity in a different location and have to learn it all over again. 
• The child may struggle with activities that are constantly changing e.g. football, tennis or hockey etc.
• The child may have difficulties with tasks that require coordinated use of both sides of the body e.g. cutting with scissors, running, swinging a bat, swimming etc.
• The child may have poor balance skills and postural control making them trip and fall especially when on they are unbalance e.g. stepping over an obstacle, going up a pavement or when standing on one leg to put trousers on.
• They may have reduced strength and endurance. Therefore they may require more time and effort to complete the same task as their friends, this may resulting in the child getting fatigued easily.
• The child may rush to complete tasks as doing them slowly is more difficult due to reduced control or balance. They may extra time to do tasks to ensure its accuracy.
• The child may struggle with printing, handwriting. And other intricate tasks.
• They may find some subjects in difficult especially mathematics, spelling or written language which require handwriting to be accurate and organised on the page.
• The child may have difficulties organising themselves for school e.g. difficulties organising their school desk, school bag, homework or even the space on a page.

Some emotional difficulties that may be experienced by the child with DCD.

• The child maybe uninterested in physical activities, or be difficult to engage in activities that they find difficult or in which they have experienced failure.
• They may have difficulties with socialising, or being excluded by peers, in physical games in the playground or team sports. This may lead to the child feeling insecure and worried about failure 
• The child be become frustrated easily when trying to complete tasks.
• The child may appear easily distracted and uninterested.
• The child may suffer from poor self-confidence and reduced self-esteem
• They may present with anxiety when they are asked to participate in difficult activities.
• The child may appear more comfortable playing with younger children as their skills may be more similar, therefore giving them more confidence when playing with them. 
• They may default to the ‘this is too hard’ or ‘I can’t do it’ when presented with motor activities even before attempting the task.

Strategies that can be used to support the child with Developmental Coordination Disorder (DCD:

• It is important to encouragement the child to persist and attempt tasks.
• Try to provide opportunities for the child to succeed by simplifying activities.
• When presenting new tasks, teach them in a step by step manner; keeping the environment as predictable as possible.
• Introduce new skills or environments on an individual basis before introducing peers.
• Try use simple language and make the instructions as clear as possible.
• Provide visual as well as verbal cues.
• Give the child extra time for completion of tasks.
• Remember to recognise and reinforce the child’s strengths.
• Make sure learning space is uncluttered and set up easy use.
• Try to ensure that what you are asking the child to do is realistic and achievable for them.
• Make participation in an activity the main goal not the end result…

What would Therapy do to help support the child and/or their carers?

• The Therapist would assess and report on the child’s strengths and areas they find more difficult. This includes observing them during play, informal discussions with all those involved in the child’s life and formal assessment to determine the child’s abilities with gross motor (whole body) tasks and then making recommendations for management.
• The therapist with develop specific occupational goals in  collaboration with the child, parents/carers and teachers so that therapy has a common focus beneficial to everyone involved
• The therapist will educate parents, carers and teachers about DCD, help them develop age appropriate skills and provide management strategies/ideas to assist the child in the home, at school and in the community
• The therapist will provide a program for the development of Physical skills. This will include ways/ideas to promote physical activity and how to enable participation in team/group activities.
• They will be given advice and support around the development of the underlying skills necessary to support whole body e.g. gross motor and fine motor skills. These may include
• balance and coordination
• strength and endurance
• attention and alertness
• body awareness
• movement planning
• Direct skill teaching on specific tasks that are important to the child.
• The therapist will help to develop the child’s self-confidence and self-esteem which will enable the child to have a desire to participate in social activities.
• A therapist will provide the child with education and knowledge about their difficulties and why they may be experiencing difficulties with movement, their strengths as well as their weaknesses and provide them with strategies to help them overcome obstacles their obstacles.
• They will help the child succeed in specific activities by breaking the task down into smaller steps to teach the skill and then gradually adding in new components until the skill is achievable in its entirety, they will try to help the child work out how to do this for a variety of tasks.
• Providing opportunities and strategies to complete the same skills in various environments (e.g. home versus school versus. therapy session).
• Presenting the activities at the ‘just right challenge’ level to ensure success, then gradually increase the demands of that mastered skill.
• Educating parents/carers on ways to simplify tasks to the smallest possible components and use simple and concise language.
• The therapist will help teach the best method to communicate instructions to the child, using all forms of communication e.g. the use of physical and visual cues for instructions. The more reinforcement and methods utilised the easier it will be.
• The therapist will look to improve the child’s sensory processing skills:  ensure the appropriate attention and arousal levels are present, as well as ensuring the body is receiving and interpreting the correct messages from the muscles in terms of their position and relationship to each other.
• The therapist may use a multi-sensory approach to teach new skills.
• The therapist may utilise a modelling technique – using visual cues and a hands-on adjustment techniques to aid body awareness for the child.