Overview
Developmental Coordination Disorder is classified as a Motor Disorder under Neurodevelopmental Disorder, and is characterized by slow or inadequate motor functioning with respect to age or stage of development.
Individuals experiencing symptoms of the disorder may not be able to carry out motor activities such as walking, climbing, tying laces, getting dressed, using tools and utensils, and so on, in an adequate manner. This can cause significant dysfunction in various areas of life.
The onset of the disorder is considered to be in the early stages of development, and can often be recognized in school settings and hinder academic and social progress among children.
There is a male predominance in the prevalence of the disorder. Genetic and environmental factors are often identified as contributing risk factors, and neurodevelopmental and neuroanatomical factors are also speculated. There are significant comorbidities, the most common one being ADHD.
Treatment for Developmental Coordination Disorder is often based in behavioral and movement-based therapeutic interventions. Pharmacotherapy is determined by the presence of comorbidities.
Signs and Symptoms
The signs and symptoms of Developmental Coordination Disorder may include:
- Delay in reaching developmental milestones
- Awkward or clumsy movements
- Difficulty in carrying out motor activities such as climbing stairs, using zippers, tying laces, etc.
- Slow speed in carrying out certain motor activities
- Not being able to functionally carry out basic tasks such as getting dressed, writing legibly, eating meals, etc.
- Unintentional and uncontrollable jerking or writhing of the limbs
Risk Factors
A male preponderance is largely reported in the prevalence of Developmental Coordination Disorder. The onset of symptoms is typically in early childhood, and may be outlined by a delay in reaching developmental motor milestones such as being slow to crawl, walk, talk, and so on.
Signs may also be recognized upon entering school, when the child experiences problems with tasks such as writing, assembling puzzles, and more. In adulthood, problems with complex motor activities such as driving or making the use of tools may be experienced. The manifestation of the disorder is also largely affected by comorbidities.
Genetic patterns have highlighted to presence of a family history of Developmental Coordination Disorder or other neurodevelopmental disorders, suggesting a genetic predisposition. Preterm birth has been strongly associated as a risk factor for the disorder.
Further, there is a moderate correlation with factors such as subfertility (difficulty in conceiving) among parents, maternal smoking, and medication used to treat lung disease in premature-birth infants.
Neurodevelopmental and neuroanatomical anomalies have also been hypothesized in trying to determine an aetiology of Developmental Coordination Disorder. The inability to automatize motor activities, such as walking or balancing, has been proposed as a contributing factor in the occurrence of the disorder, which points towards the involvement of problems in the cerebellum.
Developmental Coordination Disorder is highly comorbid with speech and language disorder, specific learning disorder, autism spectrum disorder, disruptive behavior disorders and emotional dysregulation, and hypermobility syndrome.
The highest disorder that has the highest comorbidity with Developmental Coordination Disorder is ADHD (Attention-Deficit Hyperactivity Disorder), and the presence of ADHD as a co-occurring disorder also significantly alters the presentation of the disorder among individuals. Developmental Coordination Disorder patients with comorbid ADHD are likely to experience more severe impairment.
Diagnosis
The diagnosis of Developmental Coordination Disorder can be challenging due to the overlap of symptoms with other neurodevelopmental disorders. While early identification is recommended, diagnosis before the age of 5 may not be ideal due to a multiplicity of reasons.
For instance, here is a possibility of a delay and sudden catch up in development (late bloomers), and there is also a problem pertaining to the cooperation of children during motor assessments.
A thorough clinical history as well as a clinical assessment in order to rule out underlying causes causing developmental hindrance need to be carried out. Psychosocial causes, such as experiences of trauma or abuse should also be ruled out. Behavioral and cognitive assessments are also recommended.
In terms of academic achievement, handwriting is a skill that is often impacted, and may be taken into account.
The DCDQ (Developmental Coordination Parent Questionnaire) or DCDQ-R (Developmental Coordination Parent Questionnaire-Revised) may be administered, which focuses on the individual’s activity levels and has been frequently validated. Self-report scales may be administered to the child in order to assess their perception of the disorder.
The DSM-5 mentions the following diagnostic criteria for Developmental Coordination Disorder:
- The acquisition and execution of coordinated motor skills is substantially below that expected given the individual’s chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness (e.g., dropping or bumping into objects) as well as slowness and inaccuracy of performance of motor skills (e.g., catching an object, using scissors or cutlery, handwriting, riding a bike, or participating in sports).
- The motor skills deficit in Criterion A significantly and persistently interferes with activities of daily living appropriate to chronological age (e.g., self-care and self-maintenance) and impacts academic/school productivity, prevocational and vocational activities, leisure, and play.
- Onset of symptoms is in the early developmental period.
- The motor skills deficits are not better explained by intellectual disability (Intellectual developmental disorder) or visual impairment and are not attributable to a neurological condition affecting movement (e.g., cerebral palsy, muscular dystrophy, degenerative disorder)
Treatment
Treatment interventions for Developmental Coordination Disorder are largely based in therapeutic and movement-based approaches. Intervention planning is dependent on the individual’s personal lifestyle, environment, as well as the severity of and dysfunctionality caused by symptoms.
Group settings may also be considered in terms of interventions. Parent/caregiver and teacher education should also be prioritized.
Approaches to treatment may deal with body function, and are focused on improving the quality and control of bodily functions, as well as playing a preventative role in reducing loss of body functionality.
Strength training, muscle training with biofeedback, visual training, and aerobic fitness training may be some methods used in specific situations.
Activity oriented may include general trainings, task oriented interventions, sports or play related skill training, as well as virtual reality training, and works by familiarizing the individual with the environment wherein a particular activity might take place and eliminating limitations.
Treatment modes that target participation focus on identifying areas of importance according to the individual, and conducting trainings based in those situations by removing restrictions to participation after considering all the personal, environmental, and social factors influencing the individual’s life.
Pharmacotherapy may be based on comorbid disorders. In cases of Developmental Coordination Disorder presenting with comorbid ADHD, methyphenidate has shown some efficacy in alleviating symptoms.
Diagnostic Criteria
1. Motor impairments due to another medical condition: Problems in coordination may be associated with visual function impairment and specific neurological disorders. Cerebral palsy and neuromuscular disorders are some examples. In such cases, neurological examinations are a must.
2. Intellectual disability: If intellectual disability is present, motor competences may be impaired in accordance with the intellectual disability. However, if the motor difficulties are in excess of what could be accounted for by the intellectual disability, and criteria for developmental coordination disorder are met, developmental coordination disorder can be diagnosed as well.
3. Attention-deficit/hyperactivity disorder: Individuals with ADHD may fall, bump into objects, or knock things over. Careful observation across different contexts is required to ascertain if lack of motor competence is attributable to distractibility and impulsiveness rather than to developmental coordination disorder. If criteria for both ADHD and developmental coordination disorder are met, both diagnoses can be given.
4. Autism spectrum disorder: Individuals with autism spectrum disorder may be uninterested in participating in tasks that require complex coordination skills. Occurrence of developmental coordination disorder and autism spectrum disorder simultaneously is common. If criteria for both disorders are met, both diagnoses can be given.
5. Joint hypermobility syndrome: Individuals with syndromes causing hyperextensible joints may present with symptoms similar to those of developmental coordination disorder.
Comorbidity
Disorders that commonly co-occur with developmental coordination disorder include speech and language disorder; specific learning disorder; problems of inattention, including ADHD, autism spectrum disorder; disruptive and emotional behavior problems; and joint hypermobility syndrome
Specialist
The diagnostic process for Developmental Coordination Disorder may involve the help of multiple professionals. Educational professionals, such as educational or school psychologists may be involved in the identification of symptoms. Healthcare professionals may refer to the help of neurodevelopmental specialists in order to rule out potential underlying causes for symptoms. Depending on the mode of intervention, specialists with adequate training may be involved in the treatment process.
In Conclusion
The roots of developmental coordination disorder are usually observed during childhood when a child fails to develop physical skills according to its age. Intelligence is not impacted by developmental coordination. It may have an impact on coordination abilities that are necessary for activities requiring balance, playing sports, or learning to drive.
Consult a professional before the symptoms start impacting an adults day to day activities. Even though therapy does not assure a cure, early treatment helps in reducing symptoms.
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