Motor Skills Disorder: Developmental Coordination Disorder
I.
Definition
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II.
Epidemiology
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III.
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Developmental Coordination Disorder includes both organic and
developmental factors.
Risk factors include prematurity, hypoxia, perinatal malnutrition, and low
birthweight.
Prenatal exposure to alcohol, cocaine and nicotine contribute to low
birthweight and cognitive and behavioral abnormalities.
Neurochemical abnormalities and parietal lobe lesion also contribute to this
disorder.
The cerebellum is a contributing origin of this disorder.
Pathophysiology
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V.
Developmental Coordination Disorder was noted in 5% of school-age
children.
In terms of female-to-male ratio, there tends to be a higher rate of the
disorder in the male but then schools refer the boys more often for testing
and special education evaluations.
The Male-to-female ratio is from 2:1 to 4:1.
Coordination problems are more frequently found in children with
hyperactivity syndrome and learning disorders.
Etiology
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IV.
Developmental Coordination Disorder is characterized by either clumsy gross
and/or fine motor skills which results in poor performance in sports and also
academic achievement due to poor writing skills.
In the 1930s, it was called the “Clumsy Child Syndrome” which denoted a
condition of awkward motor behaviors that could not be correlated with any
specific neurologic disorder or damage.
It is the imprecise or delayed gross and fine motor behavior in children,
resulting in subtle motor inabilities, but often significant social rejection.
It may also be known as the clumsy child syndrome, clumsiness,
developmental disorder of motor function, and congenital maladroitness
Prematurity, Hypoxia, Prenatal Malnutrition, Low birth weight, or prenatal
exposure to alcohol, cocaine and nicotine affect the development of the
cerebellum. The cerebellum is the part of the brain that plays an important
role in motor control. It sends signals from the brain to the muscles but due to
its developmental impairment, symptoms of developmental coordination
disorder arise.
Signs and Symptoms
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DSM-IV-TR Diagnostic Criteria for Developmental Coordination Disorder
o Performance in daily activities that require motor coordination is
substantially below that expected given the person’s chronological
age and measured intelligence. This may be manifested by marked
delays in achieving motor milestones (e.g. walking, crawling, sitting),
dropping things, “clumsiness”, poor performance in sports, or poor
handwriting.
o The disturbance noted above significantly interferes with academic
achievement or Activities of Daily Living.
o The disturbance is not due to general medical condition (e.g. cerebral
palsy, hemiplegia, or muscular dystrophy) and does not meet the
criteria for pervasive developmental disorder.
o
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VI.
Course and Prognosis
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VII.
If mental retardation is present, the motor difficulties are in excess of
those usually associated with it.
May develop as early as infancy
The essential clinical feature is significantly impaired performance in motor
coordination.
In infancy and early childhood, the disorder may be manifested in
developmental motor milestones delay.
The affected child can’t hold objects and drop them easily.
The gait may be unsteady.
They often trip over their own feet.
They may bump into other children when attempting to go around them.
Older children may have impaired motor coordination in table games.
Children affected with this disorder may also have speech and language
difficulties and have secondary problems like in academics and have poor
peer relationships.
Although clumsiness may continue, some can compensate by developing
interests in other skills.
Some studies suggest a favorable outcome for children who have an average
or above-average intellectual capacity since they can find strategies to
develop friendships.
Clumsiness generally persists into adolescence and adult life.
Clumsy children remained less dexterous, showed poor balance and
continued to be physically awkward.
Those affected were more likely to have academic problems and poor selfesteem.
Commonly associated features: delays in nonmotor milestones, expressive
language disorder, mixed receptive-expressive language disorder
Medical Management
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Medication has not been indicated for usage in children with DCD however, it
has been noted that children with problems in handwriting have
improvements in legibility and accuracy with the help of Methylphenidate.
Source: Kaplan and Saddock’s Synopsis of Psychiatry 10th edition, Chapter 40, p. 1170-1174
Global Developmental Delay
I. Definition
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It is a significant delay in 2 or more of the following domains:
o Gross Motor
o Vision and Fine Motor
o Speech, Hearing and Language
o Personal or Social
It is a condition that occurs during the developmental period of a child between
birth and 18 years.
The child being diagnosed with having a lower intellectual functioning than
normal.
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II. Epidemiology
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It affects about 1-3% of the population.
III. Etiology
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Chromosomal or Genetic Abnormalities
o Down’s Syndrome
o Fragile X Syndrome
Abnormalities with the structure or development of the brain or Spinal cord
o Cerebral Palsy
o Spina Bifida
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Prematurity
Infections
o Congenital Rubella
o Meningitis
IV. Pathophysiology
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Chromosomal, genetic or central nervous system development abnormalities,
prematurity or infections can lead to the delays in emergence of developmental
milestones. These milestones may emerge later in life and the child has to find
coping strategies for the lack of these skills.
V. Signs and Symptoms
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The child is unable to sit on the floor without support by 8 months.
The child is unable to crawl by 12 months.
The child can’t roll over by 6 months.
The child has poor social skills or judgment.
The child has problems with communicating.
The child has fine or gross motor difficulties.
The child uses aggressive behavior as a coping skill.
There are delays in oral language development
There are memory skills deficits
There are difficulties with problem-solving
There are delays in the development of adaptive behaviors
There are difficulties in learning social rules and lack of social inhibitors.
Osteopenia
Temper Tantrums
Aggressiveness
Inappropriate behavior
Poor Language skills
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Concentration problems
Poor attention span
Impulsiveness
Mental Retardation
Hyperkeratosis
Sweat gland anomalies
Melanocyte anomalies
VI. Course and Prognosis
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Once a child is diagnosed and a proper treatment plan is in place, many
children are still able to overcome the impact of their developmental delays.
Sometimes problems do persist into adulthood, especially if the child has a lifelong disability such as Down’s syndrome.
Generally, children who are developmentally delayed can lead independent,
productive and full lives as adults.
VII. Medical Management
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Psychiatric drugs to treat behavioral symptoms
Source: http://medacad.wikispaces.com/Global+Developmental+Delay
http://www.specialeducationalneeds.co.uk/UsefulInformation/TypesofSENDisability/GlobalDevelopmentalDelay.html
www.mychildwithoutlimits.org/?page=prognosis