From childhood onwards, we acquire information about how to perform specific tasks unconsciously and from experience. This information is stored and consolidated in our implicit (or procedural) memory to be retrieved when we face the same task again.

But, what happens when there is a deficit in this automatic processing? The fact is that children with DCD have serious difficulties in acquiring perceptual-motor habits and cognitive strategies that are essential for their daily development.

What is developmental coordination disorder?

Developmental Coordination Disorder (DCD) is a chronic and prevalent neurodevelopmental condition that not only interferes with academic achievement but also has a significant impact on the child’s ability to learn and manage daily activities with ease.

DCD is characterized by impairment in the development of motor coordination and cognitive and psychosocial skills. At first, it leads to subtle difficulties in participating successfully in the tasks presented in the first years of life. With the passage of time, and if not addressed properly, DCD can have a negative effectonmany aspects of life.

The main concerns of families often revolve around the secondary consequences resulting from the loss of motor coordination. These include an increased risk for childhood depression and anxiety, greater risk of being overweight or obese, and low self-esteem.

DCD is also considered a learning disability due to delayed automatization of information acquisition procedures, which interferes with academic achievement. It affects about 5-6% of school-aged children, and it is therefore recommended to start treatment as soon as possible to minimize the impact of these difficulties on the performance of younger children.

Children with DCD have significant limitations in their ability to plan and control motor skills.

Associated problems

As a result, children with DCD may experience difficulties in many processes such as:

• Slow processing speed.
• Problems with developing effective strategies to achieve objectives.
• Difficulty with action representation.
• Trouble sustaining attention.

At school, all these difficulties are usually evident in the automatization deficits regarding reading, writing and mathematics, which in turn affect many other activities.

Characteristic features of developmental coordination disorder

The main features of this condition are deficits in motor coordination, learning disabilities and difficulties in social relationships.

Over the years, developmental coordination disorder has been described under a variety of labels including specific developmental disorder of motor function, developmental dyspraxia, DAMP (deficits in attention, motor control, and perception), right hemisphere syndrome, and non-verbal learning disorder. In 2009, in the research by Narbona, Crespo-Eguílaz and Magallón, DCD was described as procedural learning disorder (PLD). However, the latest editions of two major international diagnostic manuals (DSM-5 and ICD-11) have used the term developmental coordination disorder for this set of features.

DSM-5 Diagnostic criteria for developmental coordination disorder

According to the DSM-5, the following criteria must be met to receive a diagnosis of DCD:

• 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).

Diagnosis and treatment for developmental coordination disorder

According to recommendations from the European Academy of Childhood Disability (EACD), the ideal multidisciplinary team of professionals to diagnose DCD, after having examined the specific DSM-5 criteria for the disorder, should include a child neurologist and an occupational therapist or physical therapist trained in the standardized motor assessment tools used to assess children suspected of having this disorder (such as the MABC-2).

However, for improving management of the impact of this disorder in other areas—with a broader multidisciplinary approach and a task-oriented approach—it is recommended to include other professionals such as neuropsychologists and educational psychologists, without forgetting the fundamental role of the family, so that educational,

Thus, after a thorough and rigorous individualized evaluation of the child, realistic goals can be set according to the needs of everyenvironment.

In any comprehensive rehabilitation treatment approach for DCD, we find the following disciplines:

• Family.
• Neuropsychologist.
• Physiotherapist.
• Educational psychologist.
• Occupational therapist.
• Child neurologist.

Roles

Pediatric neurology

Diagnosis and follow-up of the child with DCD. If there is comorbidity with attention deficit disorder (ADD), assess the possibility of including medication. Monitoring progress and guidance for parents.

Neuropsychology 

Emotionand behavior regulation, and improvement in self-esteem. Developing strategies to cope with their difficulties and to face and overcome situations that cause them frustration.

At the cognitive level, problems resulting from DCD affect not only reading and writing skills and mathematical calculation, but also have an impact on attention, executive functions (such as processing speed, flexibility and planning), and visuospatial integration.

Other problems commonly associated with DCD are psychosocial difficulties, sedentary behavior, and decreased participation in physical and social activities.

In a recent review on the influence of this disorder on physical, psychological and social functioning, the authors concluded that “children with DCD report lower self-efficacy and competence in physical and social domains, experience greater symptoms of depression and anxiety, and display more externalizing behaviours (e.g., physical aggression, deceitfulness, theft or property destruction, and violation of rules) when compared to typically developing children.”

Activities for improving developmental coordination disorder (DCD)

Below are some examples of activities included in the NeuronUP platform to train from a neuropsychological perspective:

Visuospatial integration + planning

Language and social cognition

Reasoning and executive functions

Occupational therapy

Occupational therapists’ goals are centered around improving motor skills, participation and independence with activities of daily living. In addition, they aim to work directly with the children by means of constant communication with the schools and families to make specific adaptations or modifications.

It is very important to train sequencing to promote the automatization of routines at home and at school.

Below are some examples to train and improve the performance of activities of daily living:

Dressing and play

These tasks can also be performed with paper and pencil (e.g., making a list of the sportswear to play sports) and at home, in a real-life context (e.g., the child wakes up one morning and puts on his/her sports clothing because he/she has physical education at school).

In addition to training activities of daily living, from the perspective of occupational therapy and by using a sensory integration approach, it is important to take into account the sensory profile of the child since poor sensory processing (how the child processes stimuli from body parts as well as from the outside world) can affect the child’s functional performance in daily activities.

Physical therapy 

Motor skills training

Physical therapists work with children with DCD to improve coordination, gross motor skills, physical exercise and body awareness. Physical therapists focus on combating overweight or obesity, hypermobility of joints, compromised physical fitness and decreased participation in physical activities.

Educational psychology

Educational psychologists work in academic settings and focus on improving learning, especially reading, writing, and mathematics.

Family

Throughout the process, it is very important to work together with the families. Children spend most of the day between school and home, so it is in these two settings where professionals and families need to help the children with strategies and by creating the right environment to enhance their skills. It is essential to involve them as much as possible in this process, in addition to informing and training them, in trying to make them understand the implications of this disorder and turning them into an active part of rehabilitation.

New technologies such as virtual reality and cognitive stimulation platforms such as  NeuronUP open up a new path in the rehabilitation of neurodevelopmental disorders. These help us motivate children and improve adherence to treatment, and consequently, success and progress in their daily difficulties.

The platform NeuronUP allows us, in a simple and categorized manner, to stimulate and improve the different components that are being targeted in the rehabilitation of developmental coordination disorder.

Authors

• Loinaz Guridi Antón (occupational therapist)
• Ramón Fernández de Bobadilla (neuropsychologist)
• Neurobidea (Center for Neuro-rehabilitation in Pamplona, Spain)

Bibliography

1. American PsychiatricAssociation (2014). Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5), 5ª Ed. Madrid: Editorial Médica Panamericana
2. Crespo-Eguílaz, N. y Narbona, J. (2009) Trastorno del aprendizaje procedimental: características neuropsicológicas. Revista de Neurología 49 (8): 409-416
3. Magallón, S. y Narbona J. (2009) Detección y estudios específicos en el trastorno del aprendizaje procesal. Revista de Neurología 48 (Supl 2): S71-S76.
4. Harris, S. R., Mickelson, E. C., & Zwicker, J. G. (2015). Diagnosis and management of developmental coordination disorder. CMAJ : Canadian Medical Associationjournal, 187(9), 659-65.
5. Miyahara M, Hillier SL, Pridham L, Nakagawa S. Task-oriented interventions for children with developmental coordination disorder. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD010914. DOI: 10.1002/14651858.CD010914.pub2