Developmental coordination disorder (DCD), also known as developmental motor coordination disorder, developmental dyspraxia or simply dyspraxia from the word 'praxis' meaning to do or act, is a
neurodevelopmental disorder characterized by impaired
coordination of physical movements as a result of brain messages not being accurately transmitted to the body. Deficits in
fine or
gross motor skill
Gross motor skills are the abilities usually acquired during childhood as part of a child's motor learning. By the time they reach two years of age, almost all children are able to stand up, walk and run, walk up stairs, etc. These skills are bu ...
s movements interfere with activities of daily living. It is often described as disorder in skill acquisition, where the learning and execution of coordinated motor skills is substantially below that expected given the individual's chronological age. Difficulties may present as clumsiness, slowness and inaccuracy of performance of motor skills (e.g., catching objects, using cutlery, handwriting, riding a bike, use of tools or participating in team sports or swimming). It is also often accompanied by difficulty with organisation and/or problems with attention, working memory and time management.
A diagnosis of DCD is reached only in the absence of other neurological impairments such as
cerebral palsy
Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sens ...
,
multiple sclerosis, or
Parkinson's disease
Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...
. Onset of the condition is in early childhood and is lifelong. It is thought to affect about 5% of the population.
Signs and symptoms
The World Health Organisation (
WHO
Who or WHO may refer to:
* Who (pronoun), an interrogative or relative pronoun
* Who?, one of the Five Ws in journalism
* World Health Organization
Arts and entertainment Fictional characters
* Who, a creature in the Dr. Seuss book '' Horton He ...
) recognise DCD as a condition, and have published their definition in the
International Classification of Diseases
The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating ...
. This describes DCD as:
The
American Psychiatric Association
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involv ...
(APA)'s Diagnostic and Statistical Manual,
DSM-5
The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatri ...
classifies Developmental Coordination Disorder (DCD) as a discrete motor disorder under the broader heading of neurodevelopmental disorders. It is often described as a disorder in skill acquisition or motor learning, where the learning and execution of coordinated motor skills is substantially below that expected given the individual's chronological age. Various areas of development can be affected by DCD and these may persist into adulthood.
In children, DCD may exhibit as delays in early development of sitting, crawling, walking; poor ability or difficulties with childhood activities such as running, jumping, hopping, catching, sports and swimming; slowness; frequent tripping and bruising; poor handwriting skills; difficulties with self care; difficulties with skills such as using cutlery or tying shoelaces; poor spatial understanding; difficulty following instructions; poor time management; and often losing objects.
In adulthood, in addition to a childhood history as above, the condition may manifest as a difficulty learning new motor skills or applying skills in a different or busy environment, poor organisation and time management skills, missed deadlines and lateness for appointments (or earliness as a coping strategy), and awkward pauses before answering in conversation. There is often a history of underachievement in education or the workplace. Although skills can be acquired, such as neat handwriting, handwriting speed will then be much lower than expected.
DCD has no cure. Often various coping strategies are developed, and these can be enhanced through occupational therapy, psychomotor therapy, physiotherapy, speech therapy, or psychological training.
Evidence from research and clinical practice indicates that DCD is not just a physical disorder, and there may be deficits in executive functions, behavioural organisation and emotional regulation that extend beyond the motor impairments and which are independent of diagnoses of co-morbidities. In addition to the physical or motor impairments, developmental coordination disorder is associated with problems with memory, especially
working memory
Working memory is a cognitive system with a limited capacity that can hold information temporarily. It is important for reasoning and the guidance of decision-making and behavior. Working memory is often used synonymously with short-term memory, ...
. This typically results in difficulty remembering instructions, difficulty organizing one's time and remembering deadlines, increased propensity to lose things or problems carrying out tasks which require remembering several steps in sequence (such as cooking). Whilst most of the general population experience these problems to some extent, they have a much more significant impact on the lives of dyspraxic people. However, many dyspraxics have excellent
long-term memories, despite poor
short-term memory. Many dyspraxics benefit from working in a structured environment, as repeating the same routine minimises difficulty with time-management and allows them to commit procedures to long-term memory.
People with developmental coordination disorder sometimes have difficulty moderating the amount of sensory information that their body is constantly sending them, so as a result these dyspraxics may be prone to
sensory overload
Sensory overload occurs when one or more of the body's senses experiences over-stimulation from the environment. There are many environmental elements that affect an individual. Examples of these elements are urbanization, crowding, noise, mass m ...
and
panic attack
Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, sweating, chest pain or chest discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a feeling of impending doom or of losing ...
s.
Moderate to extreme difficulty doing physical tasks is experienced by some people with dyspraxia, and fatigue is common because so much energy is expended trying to execute physical movements correctly. Some dyspraxics have
hypotonia
Hypotonia is a state of low muscle tone (the amount of tension or resistance to stretch in a muscle), often involving reduced muscle strength. Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases ...
, low muscle tone, which can also detrimentally affect balance.
Gross motor control
Whole body movement and
motor coordination issues mean that major developmental targets including walking, running, climbing and jumping can be affected. The difficulties vary from person to person and can include the following:
* Poor timing.
* Poor balance (sometimes even falling over in mid-step). Tripping over one's own feet is also common.
* Difficulty combining movements into a controlled sequence.
* Difficulty remembering the next movement in a sequence.
* Problems with spatial awareness, or
proprioception
Proprioception ( ), also referred to as kinaesthesia (or kinesthesia), is the sense of self-movement, force, and body position. It is sometimes described as the "sixth sense".
Proprioception is mediated by proprioceptors, mechanosensory neurons ...
.
* Trouble picking up and holding onto simple objects such as pencils, owing to poor muscle tone or proprioception.
* Clumsiness to the point of knocking things over, causing minor injuries to oneself and bumping into people accidentally.
* Difficulty in
determining left from right.
* Cross-laterality,
ambidexterity
Ambidexterity is the ability to use both the right and left hand equally well. When referring to objects, the term indicates that the object is equally suitable for right-handed and left-handed people. When referring to humans, it indicates that ...
, and a shift in the preferred hand are also common in people with developmental coordination disorder.
* Problems with chewing foods.
Fine motor control
Fine-motor problems can cause difficulty with a wide variety of other tasks such as using a knife and fork, fastening buttons and shoelaces, cooking, brushing teeth, styling hair, shaving, applying cosmetics, opening jars and packets, locking and unlocking doors, and doing housework.
Difficulties with fine motor co-ordination lead to problems with handwriting,
Problems associated with this area may include:
* Learning basic movement patterns.
* Developing a desired writing speed.
* Establishing the correct pencil grip.
* Handwriting that is difficult to read and may miss words in sentences or place words in the incorrect order
* The acquisition of
grapheme
In linguistics, a grapheme is the smallest functional unit of a writing system.
The word ''grapheme'' is derived and the suffix ''-eme'' by analogy with ''phoneme'' and other names of emic units. The study of graphemes is called '' graphemi ...
s – e.g. the letters of the
Latin alphabet
The Latin alphabet or Roman alphabet is the collection of letters originally used by the ancient Romans to write the Latin language. Largely unaltered with the exception of extensions (such as diacritics), it used to write English and th ...
, as well as numbers.
Developmental verbal dyspraxia
Developmental verbal dyspraxia (DVD) is a type of ideational dyspraxia, causing
speech and language impairment
Speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.
A Speech disorder, speech impairment is characterized by difficulty in articulation of words. Exam ...
s. This is the favoured term in the UK; however, it is also sometimes referred to as articulatory dyspraxia, and in the United States the usual term is childhood apraxia of speech (CAS).
Key problems include:
* Difficulties controlling the
speech organ
The field of articulatory phonetics is a subfield of phonetics that studies articulation and ways that humans produce speech. Articulatory phoneticians explain how humans produce speech sounds via the interaction of different physiological struct ...
s.
* Difficulties making speech sounds.
* Difficulty sequencing sounds within a word, and
* Difficulty sequencing sounds forming words into sentences.
* Difficulty controlling breathing, suppressing salivation and
phonation when talking or singing with lyrics.
* Slow
language development
Language development in humans is a process starting early in life. Infants start without knowing a language, yet by 10 months, babies can distinguish speech sounds and engage in babbling. Some research has shown that the earliest learning begi ...
.
Associated disorders and secondary consequences
People who have developmental coordination disorder may also have one or more of these co-morbid conditions:
*
Attention deficit hyperactivity disorder (ADHD) (inattention, hyperactivity, impulsive behaviour).
*
Fetal Alcohol Spectrum Disorder
* A condition on the
autism spectrum
The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
.
*
Dyscalculia
Dyscalculia () is a disability resulting in difficulty learning or comprehending arithmetic, such as difficulty in understanding numbers, learning how to manipulate numbers, performing mathematical calculations, and learning facts in mathematics. ...
(difficulty with numbers).
*
Dysgraphia (an inability to write neatly or draw).
*
Dyslexia (difficulty with reading and spelling).
*
Hypotonia
Hypotonia is a state of low muscle tone (the amount of tension or resistance to stretch in a muscle), often involving reduced muscle strength. Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases ...
(low muscle tone).
*
Nonverbal learning disorder
Nonverbal learning disability (NVLD) is a neurodevelopmental disorder characterized by core deficits in visual-spatial processing in the presence of intact verbal ability. Additional diagnostic criteria include Average to Superior verbal intell ...
.
*
Sensory processing disorder
Sensory processing disorder (SPD, formerly known as sensory integration dysfunction) is a condition in which multisensory input is not adequately processed in order to provide appropriate responses to the demands of the environment. Sensory proces ...
.
*
Developmental Language Disorder (DLD).
*
Visual perception
Visual perception is the ability to interpret the surrounding Biophysical environment, environment through photopic vision (daytime vision), color vision, scotopic vision (night vision), and mesopic vision (twilight vision), using light in the ...
deficits.
However, a person with DCD is unlikely to have all of these conditions. The pattern of difficulty varies widely from person to person; an area of major weakness for one dyspraxic can be an area of strength or gift for another. For example, while some dyspraxics have difficulty with reading and spelling due to dyslexia, or with numeracy due to dyscalculia, others may have brilliant reading and spelling or mathematical abilities. Co-morbidity between ADHD and DCD is particularly high; the overlap between the two disorders is believed to be about 50% (approximately half of people with DCD have ADHD, and approximately half of people with ADHD have DCD).
Sensory processing disorder
Sensory processing disorder (SPD) concerns having oversensitivity or undersensitivity to physical stimuli, such as touch, light, sound, and smell. This may manifest itself as an inability to tolerate certain textures such as
sandpaper
upright=1.35, Sheets of sandpaper with different grit sizes (40 (coarse), 80, 150, 240, 600 (fine)).
Sandpaper and glasspaper are names used for a type of coated abrasive that consists of sheets of paper or cloth with abrasive material glued to ...
or certain fabrics such as wool, oral intolerance of excessively textured food (commonly known as picky eating), being touched by another individual (in the case of touch oversensitivity) or it may require the consistent use of sunglasses outdoors since sunlight may be intense enough to cause discomfort to a dyspraxic person (in the case of light oversensitivity). An aversion to loud music and naturally loud environments (such as clubs and bars) is typical behavior of individuals with dyspraxia who have
auditory oversensitivity, while only being comfortable in unusually warm or cold environments is typical of a dyspraxic with temperature oversensitivity. Undersensitivity to stimuli may also cause problems, as individuals do not receive the sensory input they need to understand where their bodies are in space. This can make it even more challenging to complete tasks. Dyspraxics who are undersensitive to pain may injure themselves without realising it. Some dyspraxics may be oversensitive to some stimuli and undersensitive to others.
Developmental Language Disorder
Developmental Language Disorder (DLD) research has found that students with developmental coordination disorder and normal language skills still experience learning difficulties despite relative strengths in language. This means that, for students with developmental coordination disorder, their working memory abilities determine their learning difficulties. Any strength in language that they have is not able to sufficiently support their learning.
Students with developmental coordination disorder struggle most in visual-spatial memory. When compared to their peers without motor difficulties, students with developmental coordination disorder are seven times more likely than typically developing students to achieve very poor scores in visual-spatial memory. As a result of this working memory impairment, students with developmental coordination disorder have learning deficits as well.
Psychological and social consequences
Psychological domain: Children with DCD may struggle with lower
self-efficacy and lower self-perceived competence in peer and social relations. Some demonstrate greater aggressiveness and hyperactivity.
Social domain: Children may be more vulnerable to social rejection and bullying, possibly resulting in higher levels of loneliness.
Diagnosis
Assessments for developmental coordination disorder typically require a developmental history, detailing ages at which significant
developmental milestones
Child development stages are the theoretical milestones of child development, some of which are asserted in nativist theories. This article discusses the most widely accepted developmental stages in children. There exists a wide variation i ...
, such as
crawling and
walking
Walking (also known as ambulation) is one of the main gaits of terrestrial locomotion among legged animals. Walking is typically slower than running and other gaits. Walking is defined by an ' inverted pendulum' gait in which the body vaults ...
, occurred. Motor skills screening includes activities designed to indicate developmental coordination disorder, including balancing, physical sequencing, touch sensitivity, and variations on walking activities.
The
American Psychiatric Association
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involv ...
has four primary inclusive diagnostic criteria for determining if a child has developmental coordination disorder.
The criteria are as follows:
# Motor coordination will be greatly reduced, although the intelligence of the child is normal for the age.
# The difficulties the child experiences with motor coordination or planning interfere with the child's daily life.
# The difficulties with coordination are not due to any other medical condition
# If the child does also experience comorbidities such as intellectual or other developmental disability; motor coordination is still disproportionally affected.
Screening tests
Currently there is no single "gold standard" assessment test for DCD. Various screening tests may be used, including the following.
:
A baseline motor assessment establishes the starting point for developmental intervention programs. Comparing children to normal rates of development may help to establish areas of significant difficulty.
However, research in the ''
British Journal of Special Education'' has shown that knowledge is severely limited in many who should be trained to recognise and respond to various difficulties, including developmental coordination disorder,
dyslexia and
deficits in attention, motor control and perception (DAMP). The earlier that difficulties are noted and timely assessments occur, the quicker intervention can begin. A teacher or
GP could miss a diagnosis if they are only applying a cursory knowledge.
A diagnosis of DCD is reached only in the absence of other neurological impairments such as
cerebral palsy
Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sens ...
,
multiple sclerosis, or
Parkinson's disease
Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...
.
Classification
Developmental coordination disorder is classified in the fifth revision of the ''Diagnostic and Statistical Manual of Mental Disorders'' (
DSM-5
The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatri ...
) as a
motor disorder
Motor disorders are disorders of the nervous system that cause abnormal and involuntary movements. They can result from damage to the motor system.
Motor disorders are defined in the fifth edition of the '' Diagnostic and Statistical Manual of Men ...
, in the category of
neurodevelopmental disorders.
Prevalence
The exact proportion of people with the disorder is unknown since the disorder can be difficult to detect due to a lack of specific laboratory tests, thus making diagnosis of the condition one of elimination of all other possible causes/diseases. Approximately 5–6% of
children and adults are affected by this condition. and approximately 2% are severely affected.
DCD is a lifelong
neurological
Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal c ...
condition that is expected to be as common in
males
Male (symbol: ♂) is the sex of an organism that produces the gamete (sex cell) known as sperm, which fuses with the larger female gamete, or ovum, in the process of fertilization.
A male organism cannot reproduce sexually without access to ...
as it is in
females
Female (symbol: ♀) is the sex of an organism that produces the large non-motile ova (egg cells), the type of gamete (sex cell) that fuses with the male gamete during sexual reproduction.
A female has larger gametes than a male. Females ...
. Currently however, the diagnosis criteria favours males which results in over 80% of males being diagnosed before the age of 16 compared to only 22% for females.
Management
There is no cure for the condition. Instead, it is managed through therapy.
Physical therapy or
occupational therapy can help those living with the condition.
Some people with the condition find it helpful to find alternative ways of carrying out tasks or organizing themselves, such as typing on a laptop instead of writing by hand, or using diaries and calendars to keep organized. A review completed in 2017 by Cochrane of task-oriented interventions for DCD resulted in inconsistent findings and a call for further research and randomized controlled trials.
Co-occurring conditions
DCD is know to co-occur with other Neurodevelopmental Disorders. Most commonly,
Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inap ...
(ADHD) co-occurs in an estimated 50% of cases, but other co-occurring conditions are
Autistic Spectrum Disorder
The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
(ASD), Developmental Speech and Language Disorder and Developmental Learning Disorder.
History
Collier first described developmental coordination disorder as "congenital maladroitness".
A. Jean Ayres referred to developmental coordination disorder as a disorder of sensory integration in 1972, while in 1975 Sasson Gubbay, MD, called it the "clumsy child syndrome". Developmental coordination disorder has also been called "minimal brain dysfunction", although the two latter names are no longer in use.
Other names include developmental apraxia,
disorder of attention and motor perception (DAMP) dyspraxia, developmental dyspraxia, "motor learning difficulties", perceptuo-motor dysfunction, and sensorimotor dysfunction.
The
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...
currently lists developmental coordination disorder as "Specific Developmental Disorder of Motor Function".
In popular culture
* Helen Burns, a character from
Charlotte Bronte's Jane Eyre
''Jane Eyre'' ( ; originally published as ''Jane Eyre: An Autobiography'') is a novel by the English writer Charlotte Brontë. It was published under her pen name "Currer Bell" on 19 October 1847 by Smith, Elder & Co. of London. The first ...
, is alleged to have been based on the author's dyspraxic elder sister
Maria Bronte.
*
Ryan Sinclair
Ryan Sinclair is a fictional character created by Chris Chibnall and portrayed by Tosin Cole in the long-running British science fiction television series '' Doctor Who''. Introduced in the first episode of Series 11, Ryan was a companion of J ...
, a companion of
the Doctor in the
BBC #REDIRECT BBC #REDIRECT BBC
Here i going to introduce about the best teacher of my life b BALAJI sir. He is the precious gift that I got befor 2yrs . How has helped and thought all the concept and made my success in the 10th board exam. ...
...
'', has the disorder. The character debuted in 2018.
People who have publicly stated they have been diagnosed with developmental coordination disorder include:
* ''
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