What is Developmental Coordination Disorder (Dyspraxia)?
Developmental Coordination Disorder (DCD), also known as dyspraxia, is a condition that affects a child’s ability to coordinate movements and learn new physical skills. Despite these difficulties, children with DCD are generally healthy and show no visible abnormalities in their nervous system. DCD can cause problems in a child’s life as it can interfere with social interaction and academic performance. Additionally, it can impact the child’s ability to learn effectively at an early age. Symptoms include slow and inaccurate movements, with both small and large motor skills affected. These symptoms, mild in childhood, are later recognized as difficulties in learning motor skills.
Handwriting can provide important insights for diagnosing DCD. Writing is a complex task that includes several elements, such as organizing ideas, structuring sentences, spelling, memory, vocabulary, and motor skills needed to write. For individuals with DCD, concentrating on writing can be challenging, which affects the quality of their writing. They may write fewer words per minute compared to those without DCD. Various approaches to understand handwriting difficulties in DCD have been proposed, including Van Galen’s model, which ties together cognitive, linguistic, and motor skills.
The process of handwriting begins with the motivation to write, this triggers the intention to write. Following this, the writer generates ideas from their vocabulary. After deciding what to write and retrieving relevant information, syntactical construction or sentence structuring is performed. These stages greatly affect the writing speed of children with DCD. The sound of the letter (phoneme) is then matched with its written representation (grapheme) – this is known as spelling. After this matching process is complete, muscular adjustment takes place allowing the signal to travel from the brain to the hand ensuring the execution of writing. For children with DCD, controlling the size, spacing and alignment of their writing can be difficult leading to a negative impact on the text’s legibility. Most children with DCD struggle with handwriting and compared to their peers, their work often exhibits decreased legibility, writing speed, and letter formation quality.
Different aspects of brain function are managed by specific areas of the cerebral cortex (cerebral cortex is the part of the brain responsible for many higher-level functions like thinking and language). It is divided into separate regions each performing a specific role. For example, the regions responsible for movement, sensing, visual and auditory processing, decision-making, planning, and social behavior, and language comprehension are all accounted for in different parts of the brain. DCD is thought to be caused by unusual processes happening in different parts of the cerebral cortex. Structural changes in the cerebellum (part of the brain that controls movement and balance) have also been implicated in DCD.
What Causes Developmental Coordination Disorder (Dyspraxia)?
The cause of DCD, or Developmental Coordination Disorder, isn’t completely understood. However, research suggests several factors might be involved. As children with this disorder are diverse in nature, it’s believed that many causes might be at play.
Some studies have pointed towards irregular brain development processes. This includes lack of appropriate activity in parts of the brain associated with learning motor skills, and unusual growth of pathways linked to movement and sensing.
Mental factors could also be involved. Successful motor function, or movement, relies on a balanced mix of strength, balance, and the ability to remember movements, spatial awareness, and understanding of body’s position in space.
Research indicates that children with DCD show unusual patterns of brain activity and brain pathways when scanned with functional MRI, a type of brain imaging. These irregularities mainly appear in areas of the brain involved in movement and coordination, such as the parietal, frontal, and cerebellar cortex.
There’s also a hypothesis that some people might be genetically predisposed to DCD. But we still don’t know what specific genes could be directly linked to this disorder. When researching, there’s a risk of getting confusing results, because the genetic factors related to DCD might overlap with those related to various mental health conditions.
Risk Factors and Frequency for Developmental Coordination Disorder (Dyspraxia)
Developmental Coordination Disorder (DCD) is a condition that affects between 1.8% and 6% of the population. It’s much more common in boys, with seven times more boys having the condition than girls. People who were born prematurely or had a low birth weight have the highest risk of developing DCD. Interestingly, children who are left-handed or can use both hands equally (ambidextrous) may be more likely to have DCD. This could suggest that the disorder might be linked to how the brain is organized for usage of our hands.
In addition, research shows that DCD often co-exists with attention-deficit hyperactivity disorder (ADHD). This is true in about 30% to 50% of cases. This finding suggests that the issues controlling attention and movement might have a similar underlying cause in the brain, which could be crucial for understanding and diagnosing both conditions.
Signs and Symptoms of Developmental Coordination Disorder (Dyspraxia)
When kids start showing signs of delayed growth or struggle academically, doctors might suspect they have Developmental Coordination Disorder (DCD). They will need to know about the child’s birth history, development, education, and any past illnesses or injuries. They will also want to know about any medications they’re taking, their diet, any allergies they have, and if they’re up to date with their vaccinations.
The doctor will also conduct a physical examination to rule out other causes of motor impairment, such as damage to the muscles and bones. Often, if the child has DCD, the doctor might notice significant signs of developmental delays in areas like movement or coordination. They’ll check to make sure that these issues aren’t due to other psychological or neurological conditions.
When looking for DCD, doctors often use standardized questionnaires and observation sheets to evaluate how well the child can perform daily activities and academic work. One of the commonly used tools is the Developmental Coordination Disorder Parent Questionnaire-Revised Version (DCDQ-R).
Children with DCD often have trouble with the parts of their brains responsible for movement. Typically, they take longer to move and aren’t as accurate as other children their age. Writing, particularly, can be a challenge. Even though they can construct sentences, children with DCD may struggle to express their thoughts when writing and may take longer to complete writing tasks.
Doctors also pay close attention to spelling mistakes and word choices when children with DCD are writing, as these issues can affect how quickly and well they write. They often use the Detailed Assessment of the Speed of Handwriting (DASH), an objective tool that evaluates the child’s handwriting speed in different contexts, including copying text and writing freely for ten minutes.
Working along with physical and occupational therapists, doctors use standardized tests like the Movement Assessment Battery for Children, 2nd edition (MABC-2) and Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2) to assess motor skills. However, it’s important to note that these tests aren’t as accurate for teenagers and adults.
It’s also critical to understand that DCD can impact a child’s daily activities and emotional well-being, as well as the people they interact with regularly, like family, teachers, and peers. Research has shown that children with DCD often face more academic and social challenges. Doctors also bear in mind that a child’s cooperation level and motivation during an examination could affect their motor performance. Additionally, early motor developmental problems can increase the risk of neuropsychiatric disorders later in life, such as attention-deficit/hyperactivity disorder (ADHD), behavioral inhibition, childhood anxiety disorder, obsessive-compulsive disorder (OCD), autism spectrum disorder (ASD), and schizophrenia.
Testing for Developmental Coordination Disorder (Dyspraxia)
The ICD-10, an international classification of diseases, describes Developmental Coordination Disorder (DCD) as a condition where serious issues with motor coordination development aren’t caused by intellectual retardation or any specific congenital or neurological disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, gives specific criteria for diagnosing DCD:
- Children with DCD have significantly poorer than average coordinated motor skills for their age and exposure to learning and using these skills.
- This poor performance consistently and significantly disrupts their daily activities, school and productivity, pre-vocational and vocational activities, and hobbies and leisure activities.
- The symptoms start to appear in early development.
This motor and expressive difficulty isn’t due to intellectual disability, visual impairment, or any other neurological or neuromuscular condition that affects movement, such as cerebral palsy, muscular dystrophy, or a degenerative disorder.
Children suspected of having DCD need to be checked by a team of experts that includes pediatricians, pediatric psychiatrists and neurologists, and physical and occupational therapists. It’s important to diagnose DCD before a child starts formal schooling. A detailed check of the child’s development history, daily activities, and academic performance is necessary, but it might be challenging to identify any other conditions that might be present alongside DCD.
DCD may also cause psychosocial and mental health issues that severely diminish their engagement in social activities and hobbies. Research emphasizes that DCD can impact different areas of a child’s quality of life, showing that it affects more than just their physical well-being.
In 2013, Peters and his team demonstrated that neuroimaging, a method that creates detailed images of the brain, is key to understanding the factors associated with DCD and figuring out its underlying causes. Assessing executive functions for two years can provide valuable information about DCD’s effects on cognition over time. One imaging technique, called near-infrared spectroscopy, offers valuable insights into DCD’s neurodevelopmental aspects as it allows the examination of brain activity during fine motor tasks.
Treatment Options for Developmental Coordination Disorder (Dyspraxia)
Research finds that most effective therapies for treating Developmental Coordination Disorder (DCD) are task-oriented methods, motor-training programs, and physical therapy. Task-oriented approaches aim to boost a patient’s capability to do daily life activities like personal care, leisure activities, arts, and academic work. These strategies are tailored to each patient, designed with specific goals in mind, and engage the patient actively. They strive towards usefulness in everyday life rather than trying to achieve ‘normality’. Involving caregivers is also essential for a smooth transfer of care.
The main objective of these therapies is to boost motor skills while also focusing on areas like sensory integration, visual-motor perception, and muscle strength. The Cognitive Orientation to daily Occupational Performance (CO-OP) method has been successful in enhancing motor skills. Neuromotor task training has also shown positive effects. Especially when applied to small patient groups, these therapies can achieve greater success.
It’s crucial for patients to have time to practice and incorporate new basic skills into their daily lives. Support and participation from caregivers ensure continuity and reinforcement. Medicine that reduces attention problems can be helpful for patients who also have neuropsychiatric problems, like Attention Deficit Hyperactivity Disorder (ADHD).
A summer camp program has shown to be beneficial in bettering motor skills in children with DCD. One important note to consider, however, is that there is currently no evidence suggesting that fatty acids or certain vitamin supplements can influence motor functions.
What else can Developmental Coordination Disorder (Dyspraxia) be?
When trying to diagnose DCD, a condition that affects movement, coordination, and learning abilities, doctors have to consider a variety of other conditions that could cause similar symptoms. These include cerebral palsy, ADHD, ASD, intellectual disability, muscular dystrophy, sensory processing disorder, specific learning disorder, anxiety, fetal alcohol spectrum disorders, metabolic disorders, neuromuscular diseases, epilepsy, brain tumors, and intellectual disability.
Doctors have to rule out other potential causes of the child’s coordination and movement problems. If a child also has abnormal physical signs such as unusual skin marks, vision problems, bone or muscle abnormalities, too much or too little muscle tone, weakness, unsteady movement, and involuntary movements, it might indicate that their symptoms are due to another condition, like a brain tumor.
There are no specific lab or imaging tests to diagnose DCD, but standard tests like thyroid function tests and MRI scans might be helpful in diagnosing other conditions.
Some studies have looked into the relationship between DCD and other disorders to help improve diagnosis and treatment. International recommendation guidelines for DCD provide valuable insights into the diagnosis, assessment, intervention, and social aspects of DCD. Apart from that, the European Academy for Childhood Disability provides suggestions on the definition, diagnosis, and treatment of DCD, underscoring the need for accurate diagnosis and treatment plans.
Understanding how other medical conditions like obesity can increase the risk of DCD is also very important. The possible overlap between DCD, language impairment, and learning disabilities highlights the complexity of diagnosing DCD.
What to expect with Developmental Coordination Disorder (Dyspraxia)
If children with mild symptoms of developmental coordination disorder (DCD) receive a quick diagnosis and treatment, they may gradually learn to manage their motor skills problems and achieve their goals. However, most kids with DCD often need ongoing medical help and a customized academic plan during their important growing years. Additionally, they could have other health conditions or mental health illnesses that could greatly affect their quality of life.
Possible Complications When Diagnosed with Developmental Coordination Disorder (Dyspraxia)
Delayed diagnosis and treatment of Developmental Coordination Disorder (DCD) can lead to health and social issues in the short and long run. Kids with DCD, for example, could fall behind their peers physically, as they may have lesser involvement in sports and team games. This could lead to a decrease in their physical flexibility, strength, and endurance. The reduced participation in group activities could also lead to social and behavioral problems that stick around till they enter their teen years.
Teenagers suffering from DCD face unique physical, emotional, and social obstacles that can heavily affect their performance in sports and hands-on tasks. They might face social isolation as a result of these challenges.
DCD in adults can show up in many different ways, often because the minor symptoms weren’t identified when they were children. Adults with DCD may struggle with gauging distances, resulting in difficulties with activities such as driving or crossing the street. Alongside, they’ll also find it hard to learn new skills, focus attention, and manage tasks efficiently.
Beyond these, DCD could lead to other health issues in adults. Listed below are a few possible complications:
- Anxiety
- Low Self-esteem
- Obsessive-Compulsive Disorder (OCD)
- Autism Spectrum Disorder (ASD)
- Schizophrenia
- Metabolic Syndrome
Preventing Developmental Coordination Disorder (Dyspraxia)
The exact reason for the occurrence of DCD, a motor skills disorder, isn’t known yet. It’s thought to arise from a mix of genetic and environmental factors. Present-day technology doesn’t allow us to prevent the onset of DCD. However, we can aim to lessen the complications associated with the disorder through preventive actions.
Spotting the signals of DCD early needs a joint effort from healthcare providers, teachers, and family members. It’s crucial for healthcare professionals to adequately educate parents of children with DCD. This information will help them understand the challenges their children may face and make wise choices about treatment.
It is important to work with the family to set personalized targets and treatment plans. Plans that are tailored to the specific needs of the individual are most effective. Nevertheless, if the child lacks motivation or doesn’t have support from their family, teachers, or coaches, the treatment may not work as well.
Urging kids with DCD to be physically active can help keep obesity and metabolic issues at bay. Occupational therapy can be quite helpful for children with DCD. It can address motor coordination problems from an early age and avoid further deterioration. Making sure that the physical setting is free from obstacles, and providing suitable tools and accommodations can assist children with DCD to overcome their coordination troubles. It can also promote self-reliance. While it may not be possible to prevent all problems caused by DCD, recognizing and addressing it early can lessen its impact and better the patient’s health outcome.