‘Limitations are but boundaries created inside our minds’ is a saying in Eastern philosophy. This saying is very true in more than one sense when it comes to Dyspraxia or DCD (Developmental Coordination Disorder). DCD is the medical term for Dyspraxia. In essence, DCD means difficulty in planning, organising or executing movements, in the absence of neurological or intellectual impairment.
DCD is a common neurodevelopment disorder. Approximately 3-4% of children may qualify for the diagnosis of DCD. Boys are 3-4 times more likely to be affected than girls. DCD is present in all socioeconomic classes, in all age groups and across all the continents. The onset of motor coordination difficulties begins in early childhood. Diagnosis is usually made between the ages of 6 to 12 years. However, sadly a large proportion of people go through life without their coordination difficulties being identified or addressed.
Motor coordination is dependent on various factors such as attention, memory, intelligence, visual perception, proprioception, sensorimotor feedback and the ability to plan and perform an action. Impairment or difficulty in any of these areas will cause motor coordination difficulties.
Why is it essential to diagnose DCD/Dyspraxia early on?
Parents of children with DCD find them to be shy with sports, and reluctant to engage in physical activity. Children with DCD are frequently isolated, easily frustrated and socially immature. They are left out of team sports and often miss out on opportunities to form and maintain friendships. Lack of a ‘medical label’ of DCD for a child can lead to various ‘social labels’ such as ‘clumsy child’ or ‘dumb’. DCD is associated with peer victimisation and bullying. Children with DCD, especially if undiagnosed and untreated, tend to develop low self-esteem, low mood, and anxiety.
There is evidence to show that individuals with DCD undertake less physical activity, and consequently have higher body fat, an increased risk of being obese and suffer from poor cardiovascular fitness later in life. DCD is a lifelong condition, and it usually persists into adulthood. DCD is associated with poor social and occupational outcomes.
However, with early identification and early intervention, the outcome for social integration, emotional well-being, self-esteem, and educational outcomes are likely to be good. Early interventions minimise the impairments and effects of DCD.
In this article, I have listed some of the warning signs or pointers to DCD/Dyspraxia, that parents and teachers can look out for.
Warning signs of DCD/Dyspraxia?
DCD is a neurodevelopmental condition that affects social functioning, self-care activities, school functioning, academics, leisure activities, sports, and play. Hence a child with DCD or Dyspraxia is likely to present with:
- History of sucking and swallowing difficulties in the first year of life
- Delayed motor milestones of being able to sit, stand and walk
- Immature and wide-based gait well after 15 months
- Speech articulation difficulties/immature speech
- Drooling after the age of 2.5 to 3 years of age
- Frequent falls and bumps even after 3 years of age
- Delay in the ability to dress and undress
- Wears clothes inside out or back to front frequently
- Difficulty in tying shoelaces
- Difficulty in brushing teeth or having a shower
- Immature pencil/pen grasp
- Poor, slow and effortful handwriting
- Poor paper cutting skills
- Difficulty in catching and throwing a ball
- Poor at running, jumping, climbing and team sports
- Messy eating. Preference to eat with hands rather than use fork and knife
- Accident-prone, frequent collision and dropping objects
- Avoidance of sports and physical activities
- Tearful, anxious and isolated
- Physical complaints to avoid schoolwork
- Refusal to go to school
- Significant emotional and behavioural problems
There are specific criteria that need to be met, as defined by the DSM-5 (Diagnostic and Statistical Manual-5 of the APA, USA) or the ICD (International Classification of Diseases) of the WHO (World Health Organisation) before a diagnosis of DCD is made. For example, the diagnostic criteria advise that:
- The child’s coordination abilities are well below his/her peers
- The coordination abilities are poor despite sufficient opportunities to develop age-appropriate motor abilities
- The motor difficulties are affecting the child’s self-care skills, academic productivity, leisure and play
- These motor difficulties are not secondary to an underlying medical, neurological or a psychological condition
- The onset of symptoms is since infancy and childhood
Certain medical, neurological and muscle conditions can present with features similar to DCD. Moreover, DCD can co-occur with other neurodevelopmental disorders such as ADD/ADHD (Attention Deficit/Hyperactivity Disorder), ASD (Autism Spectrum Disorder), LD (Learning Disabilities), SpLD (Specific Learning Difficulties such as Dyslexia, Dyscalculia), Conduct Disorder and Oppositional Defiant Disorder.
Therefore the DSM-5 and ICD classifications recommend that the diagnosis is made by a suitable medical professional with skills and expertise in this area or a multi-disciplinary team with professionals such as Physiotherapist (PT) and Occupational Therapist (OT).
What to do if you suspect your child has DCD?
The first thing to do is don’t become nervous or worried. You should discuss your concerns with your child’s class teacher or TA (Teaching Assistant) and arrange to speak to your general practitioner (GP). Your GP may decide to refer you to a neurodevelopmental or community paediatrician.
Alternatively, you could seek an independent practitioner if you are concerned about the long wait for an assessment. You should then collate all the information you have on your child (e.g. reports from school, and any other health records) and take it to your appointment with the neurodevelopmental paediatrician.
What is the role of the neurodevelopmental paediatrician in DCD?
A neurodevelopmental paediatrician will carry out a comprehensive neurodevelopmental assessment to:
- Examine thoroughly to rule out a medical condition causing DCD like difficulties
- Assess and rule out an underlying neurological or muscle problem
- Carry out a Developmental or Motor assessment
- Assess for any associated conditions such as ADD/ADHD, ASD or LD.
- Determine whether a child needs to be assessed by an OT or a PT
- Arrange investigations if and where required
- Offer you a diagnosis of DCD or let you know the reasons for your child’s difficulties
- Provide you with a detailed management plan to address your child’s motor difficulties and
- Signpost you to essential sources of information, support and advice.
As you can see from the above, identifying the warning signs of DCD is crucial if we are to help the child and family receive the help and support, they need. Doing so would prevent unwanted social and educational outcomes for the child. This will also enable your child to attain their inherent and often unrealised potential.
- Dyspraxia Foundation, Tel: 01462 454986, https://dyspraxiafoundation.org.uk/
- Gada S. Community Paediatrics. Oxford Specialist Handbook in Paediatrics. Oxford University Press. ISBN 978 0 19 969695 6. Published Sept 2012.
- Blank R et al. International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. EACD Recommendations. Developmental Medicine & Child Neurology. John Wiley & Sons. 2019; 61: 242-285.
- Hamilton SS et al. Developmental Coordination Disorder: Clinical features and diagnosis. UpToDate, Aug 2018.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edn. Arlington, VA. 2013.
- World Health Organisation. International Statistical Classification of Diseases and Related Health Problems, 10th Revision.