Overview-Developmental co-ordination disorder (dyspraxia) in children

by www.nhs.uk

 

Developmental co-ordination disorder (DCD), also known as dyspraxia, is a condition affecting physical co-ordination that causes a child to perform less well than expected in daily activities for his or her age, and appear to move clumsily.

DCD is thought to be around three or four times more common in boys than girls, and the condition sometimes runs in families.

This topic is about DCD in children, although the condition often causes continued problems into adulthood. 

 

Symptoms of DCD

Early developmental milestones of crawling, walking, self-feeding and dressing may be delayed in young children with DCD, and drawing, writing and performance in sports are usually behind what is expected for their age.

Although signs of the condition are present from an early age, children vary widely in their rate of development, and DCD isn't usually definitely diagnosed until a child with the condition is around five years old or more.

Read about symptoms of DCD in children.

When to seek medical advice

Talk to your GP or health visitor – or a nurse, doctor or special educational needs co-ordinator (SENCO) at your child's school – if you have any concerns about your child's health or development.

If necessary, they can refer your child to a community paediatrician, who will assess them and try to identify any developmental problems.

Read about diagnosing DCD in children.

Causes of DCD

Carrying out co-ordinated movements is a complex process that involves many different nerves and parts of the brain.

Any problem in this process could potentially lead to difficulties with movement and co-ordination.

It's not usually clear why co-ordination doesn't develop as well as other abilities in children with DCD.

However, a number of risk factors that can increase a child's likelihood of developing DCD have been identified.

These include:

    • being born prematurely – before the 37th week of pregnancy
    • being born with a low birth weight
    • having a family history of DCD – although it is not clear exactly which genes may be involved in the condition
    • the mother drinking alcohol or taking illegal drugs while pregnant

Treating DCD

There's no cure for DCD, but a number of therapies can make it easier for children to manage their problems.

These include:

    • being taught ways of carrying out activities they find difficult – such as breaking down difficult movements into much smaller parts and practising them regularly
    • adapting tasks to make them easier – such as using special grips on pens and pencils so they are easier to hold

Although DCD doesn't affect how intelligent a child is, it can make it more difficult for them to learn and they may need extra help to keep up at school.

Treatment for DCD will be tailored to your child and usually involves a number of different healthcare professionals working together.

Although the physical co-ordination of a child with DCD will remain below average, this often becomes less of a problem as they get older.

However, difficulties in school – particularly producing written work – can become much more prominent and require extra help from parents and teachers.

Read about treating DCD in children.

Dyspraxia or DCD?

While many people in the UK use the term dyspraxia to refer to the difficulties with movement and co-ordination that first develop in young children, the term is used less often by health professionals nowadays.

Instead, most healthcare professionals use the term developmental co-ordination disorder (DCD) to describe the condition.

This term is generally preferred by healthcare professionals because, strictly speaking, dyspraxia can have several meanings.

For example, dyspraxia can be used to describe movement difficulties that occur later in life as a result of damage to the brain, such as from a stroke or head injury.

Some health professionals may also use the term specific developmental disorder of motor function (SDDMF) to refer to DCD.

 

Symptoms-Developmental co-ordination disorder (dyspraxia) in children

Developmental co-ordination disorder (DCD) can cause a wide range of problems. Some of these may be noticeable at an early age, while others may only become more obvious as your child gets older.

Problems in infants

Delays in reaching normal developmental milestones can be an early sign of DCD in young children. For example, your child may take slightly longer than expected to roll over, sit, crawl or walk.

You may also notice that your child shows unusual body positions (postures) during their first year.

Although these may come and go, they also:

    • have difficulty playing with toys that involve good co-ordination – such as stacking bricks
    • may have some difficulties learning to eat with cutlery

Problems in older children

As your child gets older, they may develop more noticeable physical difficulties in addition to a number of other problems.

Movement and co-ordination problems

Problems with movement and co-ordination are the main symptoms of DCD.

Children may have difficulties:

    • with playground activities such as hopping, jumping, running, and catching or kicking a ball – they often avoid joining in because of their lack of co-ordination and may find physical education difficult
    • walking up and down stairs
    • writing, drawing and using scissors – their handwriting and drawings may appear scribbled and more childish than other children their age
    • getting dressed, doing up buttons and tying shoelaces
    • keeping still – they may swing or move their arms and legs a lot

A child with DCD may appear awkward and clumsy as they may bump into objects, drop things and fall over a lot.

But this in itself isn't necessarily a sign of DCD, as many children who appear clumsy actually have all the normal movement (motor) skills for their age.

Some children with DCD may also become less fit than other children as their poor performance in sport may result in them being reluctant to exercise.

Additional problems

As well as difficulties related to movement and co-ordination, children with DCD can also have a range of other problems, such as:

    • difficulty concentrating – they may have a poor attention span and find it difficult to focus on one thing for more than a few minutes
    • difficulty following instructions and copying down information – they may do better at school in a one-to-one situation than in a group, as they're able to be guided through work
    • being poor at organising themselves and getting things done
    • not automatically picking up new skills  – they need encouragement and repetition to help them learn
    • difficulties making friends – they may avoid taking part in team games and may be bullied for being "different" or clumsy
    • behaviour problems – often stemming from a child's frustration with their symptoms
    • low self-esteem

But although children with DCD may have poor co-ordination and some of these additional problems, other aspects of development – for example, thinking and talking – are usually unaffected.

Diagnosis-Developmental co-ordination disorder (dyspraxia) in children

Talk to your GP, health visitor or special educational needs co-ordinator (SENCO) if you think your child has developmental co-ordination disorder (DCD).

They may refer your child to another professional who can help arrange an assessment.

This could be:

    • a paediatrician – a doctor specialising in the care of children and babies, who will usually be based in your local community (community paediatrician)
    • a paediatric occupational therapist – a healthcare professional who can assess a child's functional abilities in daily living activities, such as handling cutlery and getting dressed
    • a paediatric physiotherapist – a healthcare professional who can assess a child's movement (motor) skills
    • a clinical psychologist or Child and Adolescent Mental Health Services clinician – a healthcare professional who specialises in the assessment and treatment of mental health conditions to deal with emotional problems
    • an educational psychologist – a professional who assists children who are having difficulty progressing with their education as a result of emotional, psychological or behavioural factors

Other doctors who may be involved in this process include a neurodevelopmental paediatrician or a paediatric neurologist.

These are paediatricians who also specialise in the development of the central nervous system, which includes the brain, nerves and spinal cord.

A neurodevelopmental paediatrician may work at a child development centre or local health clinics.

Occasionally, a neurologist is needed to help rule out other conditions that affect the brain and nervous system (neurological conditions), which may be causing your child's symptoms.

It's important to get a correct diagnosis so you can develop a better understanding of your child's problems and appropriate support can be offered.

Getting a diagnosis can also help reduce the stress experienced by both parents and children with DCD.

Assessment

The diagnosis of DCD is usually made by a paediatrician, often in collaboration with an occupational therapist.

Generally, the paediatrician is more involved in the diagnosis and the occupational therapist is involved in both diagnosis and treatment.

For a diagnosis to be made, it's essential for the child to have what is called a norm-referenced assessment of his or her motor ability, which may be carried out by an occupational therapist, physiotherapist or paediatrician.

Children with suspected DCD are usually assessed using a method called the Motor ABC, which involves tests of:

    • gross motor skills – their ability to use large muscles that co-ordinate significant body movements, such as moving around, jumping and balancing
    • fine motor skills – their ability to use small muscles for accurate co-ordinated movements, such as drawing and placing small pegs in holes

Your child's performance on the assessment is scored and compared with what is the normal range of scores for a child of their age.

There also needs to be evidence that the child's mental ability is within the normal range for his or her age.

This may be clear based on reports from the child's school obtained by a paediatrician, although sometimes the child may also have a standard assessment of mental ability done by a psychologist or, in the case of young children, a paediatrician.

As part of an assessment, your child's medical history, which includes things like any problems that occurred during their birth and whether there have been any delays reaching developmental milestones, will be taken into account.

Your family medical history, such as whether any family members have been diagnosed with DCD, may also be taken into account.

Once the assessment process is complete, the paediatrician will produce a report on the child's condition in collaboration with other professionals involved.

Diagnostic criteria

For a diagnosis of DCD to be made, your child usually needs to meet all of the following criteria:

    • their motor skills are significantly below the level expected for their age and opportunities they have had to learn and use these skills
    • this lack of motor skill significantly and persistently affects your child's day-to-day activities and achievements at school
    • your child's symptoms first developed during an early stage of their development
    • the lack of motor skills isn't better explained by long-term delay in all areas (general learning disability) or rare medical conditions, such as cerebral palsy or muscular dystrophy

DCD should only be diagnosed in children with a general learning disability if their physical co-ordination is significantly more impaired than their mental abilities.

Although DCD may be suspected in the pre-school years, it's not usually possible to establish a definite diagnosis before the age of four or five as it can be difficult to be certain whether a child has DCD if they're still very young.