Determining appropriate supports for students with
Developmental Co-ordination Disorder in third level education
Trish Ferguson
Disability Service
University of Dublin Trinity College
June 2010
Seirbhís do dhaoine faoí mhíchumas,
Seomra 2054,
Foígneamh na nEalaíon
Coláiste na Tríonóide,
Baile Átha Cliath 2, Éire
Disability Service,
Room 2054, Arts Building,
Trinity College,
Dublin 2, Ireland
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Contents
Abstract
Section 1: Literature review
1.1 Introduction
1.2 Symptoms of Developmental Coordination Disorder
1.3 Assessment
1.4 Prevalence
1.5 Co-morbidity
Section 2: DCD at third level
2.1 Applications through Disability Access Route to Education (DARE)
2.2 Students with DCD at Trinity College Dublin
2.3 Statistics
2.4 CAO: personal statements
2.5 TCD: course choice
2.6 TCD: retention
Section 3: Determining appropriate supports for third level
3.1 Specific educational impacts
3.2 Motor difficulties
3.3 Non-motor difficulties
3.4 Reasonable accommodations
3.5 Suggested teaching supports
Lectures
Seminars
Written work
3.6 Assistive Technology (AT)
3.7 Academic Support
3.8 Unilink (OT-based one-to-one support)
Section 4: Summary
4.1 Discussion
4.2 Further research
References and Bibliography
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Abstract
This presentation is a discussion of the difficulties encountered in adulthood
associated with DCD and specifically the difficulties experienced in the student
population at third level. Although the population is not homogenous DCD may
present as any number of the following difficulties: abnormalities in postural
control and/or fine motor skills; difficulties in learning motor tasks, such as
handwriting and sports; difficulties with educational tasks, such as reading
comprehension, attention and learning; poor time management.
This paper discusses aetiology, assessment and will examine trends in course
choices and retention rates within this group in recent years in Trinity College.
This study will then consider requirements within learning support and
reasonable accommodations for examinations. It will also consider appropriate
interventions for students in practical courses, considering the requirements and
possible interventions in laboratory work and placement situations. It also makes
recommendation on provision of supports at third level and suggests further
research and data collection will assist with future developments.
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Section 1: Literature review
1.1 Introduction
Developmental Coordination Disorder (DCD), also known as dyspraxia, is the
term now internationally recognised to describe ‘a specific learning difficulty in
gross and fine motor planning which is not caused by muscle/nerve damage’
(Poustie et al., 1997). Developmental Coordination Disorder is preferred over the
term ‘dyspraxia’. (Gibbs et al., 2007) The educational impact of DCD on children
is well documented but there are few studies on teenagers (Kirby 2004, Hellgren
et al., 1994a; Losse et al., 1991) or adults with DCD (Barnett and Kirby, 2009;
Kirby et al., 2008a; Kirby et al., 2008b; Colley, 2006; Cousins & Smyth, 2003;
Visser, 2003; Rasmussen and Gillberg, 2000; Cantell et al., 1994; Geuze and
Börger, 1993). This is because most often a diagnosis is made prior to school
age and in the first few years of primary school on account of obvious difficulties
with achieving age-related milestones that involve motor skills, like crawling,
eating, dressing and brushing teeth. Until recent years DCD has been the subject
of less research-based study than dyslexia. Due to this and the variability of the
disorder, which makes it more difficult to diagnose, it is expected that a
significant number of people with DCD now in adulthood have not been
diagnosed in childhood. Early case histories of children with DCD suggested that
a proportion do improve (Dare & Gordon 1970; Gubbay, 1975) but more recent
research indicates persistence and impact in adult life (Kirby et al., 2008;
Cousins & Smyth, 2003). Kirby et al. (2008) finds that ‘between 30 and 87% of
children with DCD will continue to exhibit poor co-ordination into adulthood’
(199). Recent studies on DCD in adulthood have focused on psycho-social
outcomes (Rasmussen and Gillberg, 2000) and specific motor skills, such as
handwriting and construction tested under timed conditions (Cousins & Smyth,
2003). A forum was launched in 2006 for adults with DCD
(http://www.dyspraxicadults.org.uk) and there has been a growing body of
research conducted on adults with DCD particularly in the last ten years,
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however, the experience of adults with DCD in third level education remains
under-researched. As a result of successful implementation of supports at
second level, more students are accessing third level education with a diagnosis
of DCD and seeking supports. This study aims to document the specific
educational impacts of DCD in third level education and to make
recommendations for intervention. These recommendations will then be critiqued
in terms of universal design and considered regarding the practicalities of
implementation with consideration given to resources available, funding
restrictions and fitness to practice issues.
1.2 Symptoms of Developmental Coordination Disorder
Although the population is not homogenous DCD may present as any number of
the following difficulties: abnormalities in postural control (Wann et al., 1998;
Williams and Wollacott, 1997), as well as in fine motor skills (Smits-Engelsman et
al., 2001), difficulties in learning motor tasks, such as handwriting and sports
(Losse et al., 1991); educational tasks, such as reading comprehension (Kadesjo
and Gillberg, 1999); attention and learning (Dewey et al., 2002; Landgren,
Kjellman, & Gillberg, 1998; Kadesjo & Gillberg, 1998; Hellgren, Gillberg, &
Gillberg, 1994a; Gillberg & Rasmussen, 1982; Gillberg, Rasmussen, Carlstrom,
Svenson, & Waldenstrom, 1982;); time management (Kirby, 2004; Dewey et al.,
2002); behavioural problems (Dewey, Kaplan, Crawford & Wilson, 2002; Losse et
al., 1991); social skills and low self-esteem. (Poulsen, Ziviani & Cuskelly, 2007;
Cousins & Smyth, 2003; Cantell, Smyth, & Ahonen, 1994)
1.3 Assessment
DCD is assessed by the DSM-IV criteria for DCD developed by the APA or by
ICD-10, developed by the World Health Organization. According to the DSM-IV
the diagnostic criteria for DCD are as follows:
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A. 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.
B. The disturbance in Criterion A significantly interferes with academic
achievement or activities of daily living.
C. The disturbance is not due to a general medical condition (e.g., cerebral
palsy, hemiplegia, or muscular dystrophy) and does not meet criteria for a
Pervasive Developmental Disorder.
D. If Mental Retardation is present, the motor difficulties are in excess of
those usually associated with it.
The following specialists make assessments for, and diagnose dyspraxia:
psychologists – educational, occupational or neurological; paediatricians who
specialise in developmental disorders, physiotherapists and occupational
therapists. Tests used for assessment should be age appropriate in all cases. In
the UK, the most commonly used test for motor-related difficulties in children is
the Movement Assessment Battery for Children-2 (Movement ABC-2)
(Henderson & Sugden, 2007). Movement ABC-2 is appropriate for assessing
children up to 12 years. The Bruininks-Oseretsky Test of Motor Proficiency-2
(2005) is a standardized, norm-referenced measure of fine and gross motor skills
that has norms up to the age of 21 years. There are two versions of this test: the
full version which takes 2 hours and a shorter form which takes 30 min to
administer (Bruininks, 1978). There is not as yet an adequate test for a range of
motor skills for adults older than 21 (Kirby at al., 2008b).
Acknowledging that adolescents have a different range of motor skill
requirements than children Kirby (2004) states: ‘In order to diagnose adolescents
we need to consider what are the unique features that highlight the co-ordination
difficulties. If we use the DSM-IV criteria as a guideline for this, in the adolescent,
6
as with the child, it is ‘impairment significantly interfering with academic
achievement or activities of daily living’ (author’s emphasis) which is the most
important to consider. We then need to highlight in this age group what they are
likely to be.’ (17) The same is true of adults and this will be considered in relation
to needs assessment in university for this group.
The Morrisby Manual Dexterity Test is used for assessment of students entering
university to assess fine motor control indicators for difficulties associated with
DCD in adults is the (Morrisby, 1991). However, this tests only fine motor actions
in one setting and will not identify gross motor or balance difficulties rather than
fine motor difficulties (Kirby et al., 2008b). Kirby (2010) notes that ‘Current tests
are able to measure motor functioning (Criterion A of the DSM-IV), but are not
able to consider how and where the difficulties impact on the adult's life (Criterion
B of the DSM-IV).’ A new screening tool is currently under development in order
to provide appropriate interventions for adult life (Kirby, 2010). Currently
recommended by Kirby (2010) is The Adult Developmental Co-ordination
Disorders/Dyspraxia Checklist (ADC) which assesses ability within home,
academic and social environments including ‘handwriting, driving, attention,
organisation in time and space abilities and social skills’ (133). Kirby (2010)
concludes: ‘this is an area for further research that has clinical implications for
service providers such as universities, colleges, and occupational therapy
services’ (137). While the Adult Developmental Co-ordination
Disorders/Dyspraxia Checklist (ADC) is a useful tool for adult diagnosis through
studying a person’s childhood history it is not a tool for determining supports in
any given environment, including university. Developing an assessment for
students entering university is difficult because of the different tasks required for
each course, some requiring more use of motor skills than others and also on
account of the heterogeneity of difficulties associated with DCD. As Politajko
(1999) notes on a study of children, ‘one child with DCD is likely to be excellent
at one motor task but poor at another.’ The same is true of adults.
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As yet there is no specific standardized assessment for academic environments
and tasks, including handwriting and exam accommodations, laboratory work or
placements. While it is useful to have a history of a person’s motor skill abilities,
the development of an assessment tool for students entering university with DCD
must also take into consideration difficulties associated with other developmental
disorders on account of the high level of co-morbidity.
1.4 Prevalence
Studies in the United Kingdom suggest that between 5 and 18 per cent of
individuals are affected by DCD (Godfrey, 1994; Hall, 1994; Marks, 1994;
Portwood, 1996, cited in Dixon and Addy, 2004, 9). The American Psychiatric
Association (APA) (2000) cites the prevalence at 6% for children in the age range
of 5–11 years. Males are more likely to be affected than females; a study of
children with DCD in Sweden, found a boy: girl ratio of 5.3:1 (Kadesjö and
Gillberg 1998). It is difficult to assess prevalence in adulthood on account of
there being no commonly used standardized screening tool for adult assessment.
The Bruininks Oseretsky Test-2 (Bruininks & Bruininks, 2005), which is normed
up to 21 years is used in the United States (Kirby 2010) but is not commonly
used in the UK or Ireland. The assessment most commonly used for adults is the
Wechsler Adult Intelligence Scales (WAIS) which can reveal a pattern of
weaknesses and strengths typical of DCD but is an assessment tool used
primarily for specific learning difficulties and not specifically DCD. It is also
difficult to assess prevalence in adulthood because of the high level of comorbidity on account of which a diagnosis is often made on another
developmental disorder in adulthood rather than DCD.
1.5 Co-morbidity
With all developmental disorders there is a high level of co-morbidity but this is
particularly so with DCD. Having DCD with only motor difficulties is the exception
8
rather than the rule (Peters & Henderson, 2008). DCD co-occurs commonly with
dyslexia and ADHD (Barnett and Kirby 2009, Visser, 2003, Dewey et al., 2002;
Dewey et al., 2000; Gillberg, 1998; Gillberg and Kadesjö, 2000; Gillberg and
Kadesjö, 1998; Kadesjö and Gillberg, 2001; Martini et al., 1999; Kaplan et al.,
1997). Also, Kirby, Salmon and Edwards (2007, 336) note that ‘there is clear
evidence of association or co-morbidity of ADHD with a number of other
psychiatric conditions, including oppositional defiant disorder, conduct disorder,
and depression and anxiety disorders (Loeber, 1982; Barkley et al., 1990; Taylor
et al., 1991), and these should be routinely considered at the time of
assessment.’ However, in their study they note that it is not known whether
clinicians routinely check other developmental disorders during assessment
despite the fact that statistics suggest that prevalence of co-morbidity with ADHD
may be up to 50% (Kadejs & Gillberg 1999) and there is also a high co-morbidity
with specific learning difficulties.
Section 2: DCD at third level
2.1 Applications through Disability Access Route to Education (DARE)
In recent years Dyspraxia has become assessed and recognised as a distinct
disability having previously been grouped under Specific Learning Difficulty in
college application processes. The application process remains the same but
evidence is now required to state a diagnosis of Developmental Co-ordination
Disorder (DCD) / Dyspraxia. Candidates applying for College through the
Disability Access Route to Education (DARE) must submit a full psychoeducational assessment from the Psychologist and the Evidence of Disability
Form which should be completed by an Occupational Therapist/Physiotherapist.
The applicant is eligible for consideration once the appropriate professionals
have provided a diagnosis of Developmental Co-ordination Disorder (DCD) /
Dyspraxia. While there is no age limit on diagnostic evidence submitted
applicants are advised to submit a recent report. Applicants who have an existing
9
report completed by the accepted Medical Consultant/Specialist may submit this
report. The report must have been completed within the appropriate timeframe
and must contain the same detail as the Evidence of Disability Form. The report
should state difficulties from childhood or evidence from a specialist that there is
historical information which evidences Developmental Co-ordination Disorder
(DCD) / Dyspraxia, and that the applicant is presenting with difficulties that has
impacted on home and school. For adult assessments the standardized
Developmental Co-ordination Disorder (DCD) / Dyspraxia Checklist should be
referenced, which is in line with the DSM IV/ICD10 (Kirby 2010). Applications
through DARE must also include the student’s personal statement which should
outline the impact of disability on their academic and educational experience to
date. An academic reference is also required which provides background
information on the student’s educational experience and can confirm challenges,
stating the educational impact of disability and describing the need for any
teaching and learning adjustments. This form also helps to determine appropriate
supports at third level.
Table 1: DARE applications: students with DCD
120
110
100
74
80
60
40
32
20
0
2008
2009
2010
2.2 Students with DCD at Trinity College Dublin
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There are currently 20 students with DCD registered with Trinity College’s
Disability Service, 15 active, 3 withdrawn and 2 graduands. 14 are male and 6
are female. This is a ratio of 7:3, compared with 5.3:1 in Kadesjö and Gillberg
(1998). The slightly higher number of females may be accounted for by the
gender breakdown of the College population as a whole, as there are a
significantly higher number of female undergraduates than males in the College
population as a whole.
2.3 Statistics
Table 2: College Standing
12
10
10
8
6
5
4
3
2
2
0
Year 1
Year 2
Year 3
Year 4
graduand
withdrawn
Table 3: Ages of students registered with DCD
11
18
17
16
14
12
10
8
6
4
2
1
2
0
19-21
22-24
25-26
26-30
31-35
35+
17 of the 20 students registered are aged between 19 and 20. This accounts for
85% of this group, which are primarily first and second years so this means that
students are coming directly to College from secondary school. It may be that
they have been well supported in school which accounts for their successful
transition in their first application. As will be shown below, a high proportion of
students with DCD entered on merit rather than via the supplementary
admissions process. It should be noted however, that the 3 students who have
withdrawn from College are all within this 19-21 age bracket, two having
withdrawn without completing first year and one other in second year.
Table 4: Breakdown by Entry Route
12
14
13
12
10
8
6
6
4
2
1
0
Merit
Supplementary
Mature
The chart above shows that 13 students (65% of this group) entered on merit, 6
students (30%) via the supplementary system and 1 student (5%) entered as a
mature student. These statistics are not particularly helpful as an indication of a
student’s experience of college due to the nature of the disability which can be
exacerbated by a change of environment and requirements and as the majority
of students are still in first year it is not yet possible to comment on
progression/retention rates for this group. As noted above, immediate
progression from school and also a high rate of entry on merit suggests success
at school level, whether on account of the nature of the environment, which is
more directive than university, or whether this is due to the success of supports
put in place at second level. Taking this into consideration emphasizes the
importance of the needs assessment stage at third level to ascertain how much
support a student has had in school when recommending or granting supports
and accommodations. It will also be useful to look at personal statements given
in CAO forms for background regarding experiences in education, which can be
very diverse.
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2.4 CAO: personal statements
The following are excerpts from personal statements collated from CAO
applications from 2009:
“The main effect my disability has had is its effect on my writing and notetaking. I find that when I am under pressure to write or take notes that my
brain moves faster then my hand with the result that I sometimes skip
words or letters leave words unfinished or merge the first part of one word
with the last part of the next. It also affects my handwriting so that even
though I can usually read it other people have great difficulty reading my
writing.”
“Due to my dyspraxia I have difficulty in processing information quickly
leading to periods needed to fully understand and absorb information. My
hand writing is slower and less clear than others leading to difficulty in
exam situations for both myself and the correcting examiner. My
organisation is also affected by my disability leading to great and
significant difficulties in recilation organisation if notes and work in
prepeartion for exams etc. My dyslexia though mild means spelling and
grammer are difficult for myself thus affecting exam results.”
“In primary school I was diagnosed with Dyspraxia; during those years I
had classes in the CPI unit in Sandymount. From third year in secondary
school I attended classes in the resource department. My main problem in
class is that I cannot listen and take notes at the same time. I made the
decision just to listen in class and when I go home study the textbooks.
The resource teachers have tried to help me with note taking and
organising my thoughts.”
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These testimonies all indicate difficulties typically associated with dyslexia,
including time management, difficulty with organizing thoughts, slower
processing speed and difficulties with spelling and grammar. This highlights that
a holistic approach be taken when assessing a student with DCD as other
difficulties around producing written work may be present that are not motorrelated.
Other personal statements testify to the significance of when the diagnosis is
made and interventions put in place.
“With assistive technology I have not have encountered too many
problems. However before this was provided or allowed I had
considerable difficulties completing work on time which hindered my
potential.”
“Unfortunately I was not diagnosed with Dyspraxia until the beginning of
my final year in school. Due to this my dyspraxia had a massive negative
effect on my school work until now. All this I feel has left me behind in my
class work especially in subjects like history and english where wriiten
work compiles the bulk of the subject matter. Dyspraxia has directly
affected my motor skills especially my fine motor skills my organisation
and time management skills.”
These personal statements suggest that intervention at school level can make a
positive difference and difficulties with organization and time management skills
may be addressed through study skills and/or an occupational therapy model of
intervention at second and third level.
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2.5 TCD: course choices
The current student population registered with the Disability as having DCD
(whether or not this is co-morbid with any other disability) is as follows:
Course
College Standing
BESS (3 students)
1
Law and French
1
Business and Computing
1
Business and Polish
1
Management Science and Information Systems Studies
1
Foundation Course for Higher Education - Young Adults
1
Religions and Theology
1
Theoretical Physics
1
TSM English and Philosophy
2
TSM Religions and Theology/ Philosophy
2
History
2
Law
2
Philosophy and Political Science
2
Nursing
graduand
TSM English and History of Art and Architecture
graduand
Political Science and Geography
withdrawn
English
withdrawn
TSM Film Studies and English Literature
withdrawn
The number of students currently registered for College who are registered with
the Disability Service (DS) as having DCD (20) represents 2% of students
registered with DS.
16
Within this group of TCD students, practical courses, such as Science and Health
Science, are not represented, with the exception of one Nursing student.
Faculty breakdown (TCD 2009-10)
Arts, Humanities and Social Sciences,
18
Health Science,
1
Engineering, Mathematics and Science,
1
A study conducted by Kirby et al. (2008a) comparing course choices between
students with DCD and students with dyslexia found that no students with DCD
had chosen physical science, health courses or humanities courses in
comparison with those with a diagnosis of dyslexia (Kirby et al., 2008b). Kirby
(2004) notes that ‘DCD may affect the type of career choices the individual
makes, as he perceives himself less able than he may actually be’ (15). Further
research could be conducted into reasons for course choices. Kirby et al. (2008)
study found that a high proportion of students with DCD study Arts, media and
design; Business, Education and Social Sciences, which all come under the Arts,
Humanities and Social Sciences category in the table above. The findings are
consistent with the representation of this group in courses in Trinity College.
2.6 TCD: retention
It is difficult to assess retention rates for this student from such a small group,
particularly as a high number of students registered with DS with DCD are in their
first year of College. This is indicative of a recent increase in students with DCD
accessing third level education, as attested in recent studies. 5 students have
progressed to second year and there are two graduands but a high proportion of
this group (15%) have withdrawn from College. This small group does not allow
for an in-depth study of retention rates but notably there is a high rate of
withdrawal even in Junior Freshman year:
17

1 student withdrew from College in Junior Freshman year.

1 student withdrew from College in Senior Freshman year.

1 student withdrew from College having failed to complete requirements
for passing Junior Freshman year.
3 students in this group (20%) availed of Academic Support Tuition while no
students engaged with Unilink. Both services made contact with students during
the academic year to instigate appointments/ check on progress. There was a
high incidence of missed appointments and also one student had missed exams.
This coupled with a high rate of withdrawal from College indicates that supports
for this group need to be re-evaluated.
Section 3: Determining appropriate supports for third level
3.1 Specific educational impacts
While some studies suggest that children grow out of the difficulties associated
with DCD, others, such as Kirby (2010), have noted that the difficulties may just
be hidden through persons choosing to avoid environments in which DCD is
manifest, such as sports and social activities, such as dancing. As a study by
Losse et al. (1991) has revealed a change of environment, such as a new school,
can place new demands on the student with DCD which provide new difficulties:
‘Our examination of the school reports of our subjects showed that in some
cases the academic and social demands of being in a large school had not only
increased their difficulties but had also revealed new ones.’ (66) Denckla (1984)
notes: ‘persons given the advantage of training or overpractice on essential
motor skills may enter adult life without obvious difficulty unless challenged by
new skills to learn’ (cited in Losse et al., 1991, 64). Given these observations it is
to be emphasized that third level education provides a completely new set of
demands on students, both physical and organizational.
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3.2 Motor difficulties
Colley lists the following motor difficulties that may be encountered by students
with DCD: problems using computer keyboards; frequent spills in the laboratory;
lack of organization in experiments, difficulty measuring accurately, slow and
illegible handwriting, messy presentation (2006: 91). Compensatory strategies for
motor difficulties including poor handwriting are available on an online forum
which provides useful advice for adults with a number of threads focused on
university study (www.dyspraxicadults.org.uk/forums). In many cases the advice
given on the forum by adults with DCD is that motor skills improve through
practice, reflecting the task-orientated approach, one of the approaches
advocated by Gibbs et al. (2007) This approach has been recommended for a
number of motor skills for those wishing to pursue Performing arts, sports and
music. For some to the pursuit of a particular course in which specific careerrelated motor skills need to be developed, this may be the only approach, but this
is not however, always a practical or time-efficient approach for all DCD-related
motor skill difficulties.
Handwriting is frequently an area of difficulty for students with DCD; Kirby et al.
(2008, 208) states that ‘50% of those with DCD stated handwriting specifically as
a continuing difficulty.’ A handwriting test may be used to determine the level of
supports required although as Summers and Catarro (2003) caution ‘It is difficult
to define the parameters by which the degree of disadvantage can be judged as
a number of processes may affect written output in an examination.’ (148) Their
study concludes that ‘the written output of 66 second-year university students
demonstrated that a short duration handwriting speed test was unable to predict
written output (number of words) in a 2-hour written examination. (156) There are
few standardised tests for handwriting speed. ‘SpLD Working Group 2005/DfES
guidelines’ suggest testing writing using a ‘speed of writing prose task’ and a
‘free writing task’:
19
The student’s free writing should be analysed to
provide information about ability to write
grammatically, the complexity of sentence structure,
the coherence of writing, use of vocabulary, writing
speed and legibility of handwriting. It is also important
to report handwriting speed in a copying task so that
difficulties relating to the process of composition and
to motor skills can be teased apart (25).
The DASH has UK norms for 9-16 year olds and an extension for 17-25 year olds
is due to be published in late Spring 2010 (Barnett & Kirby, 2009). This may be
used in a third level environment to assess for the need for supports for
handwriting difficulties. It must be noted that the application of the guidelines of
the SpLD Working Group 2005/DfES guidelines cited above will not give an
indication of a student’s ability to take accurate and legible lecture notes and this
should be considered if a handwriting test is introduced as part of assessment for
third level.
Although Summers and Catarro (2003, 156) found that legibility, writing style and
fatigue did not appear to influence written output, they found that poor pencil
grasp could contribute to a slower writing speed in a three-minute writing task.
Students with DCD frequently have a poor writing grip and for lecture note taking,
if a student is taking their own notes, this factor should be considered. Ergonomic
measures, such as changing furniture, such as level of desk, or using a sloping
desk may improve posture and consequently handwriting also, but this may not
be possible in a lecture environment. A better pencil grip can sometimes be
attained through use of a hand-held ‘stetro grip’ which can be fit onto a roller ball
pen. (Sawyer et al., 1993) Experimenting with different types of pen may also be
useful, for example fibre tip, rather than biro. Pascoe et al (1993) recommend
equipment to assist with pencil grip, including small grips, holders or splints,
larger diameter products and weighted or magnetic products.
20
Working on improving handwriting may not be practical for third level students
with DCD, particularly if there is a lot of note-taking involved in lectures and this
needs to be established early in the academic year. Many will have used
computers for exams at second level and may require same at college. However,
students with DCD may also have difficulty with keyboard skills and find it difficult
to type for extended periods. This may be alleviated by use of a specific
ergonomically designed keyboard and use of same in exams. Also an Anir
mouse, like a joystick, may be easier to use than a regular mouse (Colley, 2005).
Computer skills can also be assessed upon entry to college. Students with DCD
may best be supported by a scribe and a note taker during the academic year for
lectures, although there is a greater cost involved in providing these services.
Colley notes that laboratory work may pose a difficulty for students with poorer
motor skills and co-ordination. The task-based approach of improving through
practice would not be appropriate here if there were risks involved. In this case a
laboratory assistant may be assigned to a student but again this may not be
financially viable long term.
Students with DCD who undertake to study Nursing should make their Clinical
Placement Supervisor aware of any motor difficulties they experience to consider
modifications to specialist equipment and/or treatment techniques. Again, it
should be determined, ideally prior to entry, whether it is practical to pursue this
course depending on motor skills and course requirements and whether the
student can be supported sufficiently in the workplace if that would be necessary
for specific Nursing tasks.
With regard to the requirements of specific courses issues of fitness to practice
may be relevant. If a student discloses DCD a risk assessment may be
conducted with the student to establish ‘a careful and systematic account of what
can cause harm and how this can be prevented’ (TCD, Fitness to Practice
21
guidelines). This may result in the implementation of supports, such as an
assistant for laboratory or placement with due consideration given to whether this
is deemed appropriate and could be sustained in the workplace and with
consideration given to the cost involved in providing this support.
3.3 Non-motor difficulties
Third level education entails increased academic and time management
demands as students have much more independence than formerly when in
school. There are a number of demands that may provide a challenge to
students with DCD related to non-motor difficulties. Colley cites potential
difficulties with written expression, work organisation, personal organisation,
memory and attention span and visual skills, oral skills and numeracy skills.
(Colley, 2006: 92-93) Kirby (2004) describes these difficulties as ‘executive
dysfunctioning’ and in a study conducted Kirby et al. (2008) 52.4% of a group
with DCD reported this as a weakness, which was significantly more than the
group with dyslexia (17.4%). The following are the key features of ‘executive
dysfunctioning’:

Poor cognitive flexibility – difficulty leaping from one idea to another

Lack of adjustment of behaviour using environmental feedback – being
able to learn from experiences around you

Difficulty extracting social rules from experiences – seeing the implied rule
rather than the explicit one) the individual may have been in a similar
situation before but does not seem to learn from it and ends up making the
same mistakes)

Difficulty in selecting essential from non-essential information – the
individual sees all the information at the same level of importance and
finds it hard to ‘sieve’ it according to priority or see what may be risky
22

Impaired working memory – this may make it harder to hold on to several
pieces of information at one time and juggle information – the individual
also can’t juggle several different tasks at once

Difficulty in organisation and completing tasks may prevent the individual
even trying to begin the task. (76-77)
In a presentation at Trinity College Dublin (March 2010) Kirby outlined how the
study skills interventions at third level for students with Dyslexia may not be
appropriate for difficulties related to the production of written work, because
students with DCD may have further difficulties with ‘executive function tasks’
including time management and organization skills, which can be significantly
poorer in students with DCD. Kirby et al. (2008b) carried out a study on three
groups of students; those with a self-reported diagnosis of DCD, those with DCD
and dyslexia and a third group with dyslexia. This study found the DCD group
(54.2%) reported executive functioning as a weakness significantly more than the
dyslexia group; problems cited related to organization and memory (208).
However, there was no difference in the type of support being given between the
three groups. (209) Students with DCD may receive the same supports as those
with dyslexia in many cases as often students with DCD received a diagnosis of
dyslexia because of lack of standardised assessment tool for DCD. Kirby et al.
(2008b) noted that students with DCD often are assessed using tools for dyslexia
and the dyslexia-related issues that they experience in addition to any others are
sufficient to give a diagnosis of dyslexia, although this results in them perhaps
being under-supported or given inappropriate supports.
While students with DCD often experience dyslexia-related difficulties a holistic
approach that appreciates all the possible motor and organization difficulties
associated with DCD should be taken into consideration during assessment. This
is particularly relevant in relation to executive dysfunction, the difficulties
associated with this being experienced at a higher level by those with just a
diagnosis of DCD and dyslexia, and at a much higher level than those with a
23
diagnosis of dyslexia (Kirby et al., 2008b). Kirby has noted that the supports often
given to enhance organization skills for this group can be ineffective if they do not
easily become automatic skills through habitual use. A support worker may feel
that they are supporting a student by giving suggestions around time
management and organization but they are of no use if the student forgets to use
them. She also noted that time concept was an increased difficulty experienced
by students with DCD: ‘The inner clock does not always seem to tick in the same
way for the young person with DCD. He may not seem to be aware of time
passing. […] The more routine activities are, the less effort they become; this
helps to improve time management – see what elements of the day are repeated
and create a routine that frees the adolescent to concentrate on the variables in
his day’ (Kirby, 2004, 98).
Kirby suggested incorporating technology commonly used by young adults as a
means of assisting students with organization skills (Kirby, Trinity College, March
2010). Tools such as an iPhone can be utilised for students to access a calendar
on a daily basis as it is more likely that this would become habitual and would be
something a student would remember to carry with them, rather than a diary.
Kirby (2004, 81) notes that a tendency to lose or break things is common with
this group and this must be remembered when suggesting or providing supports.
The use of a Watch Minder which can be prompted to go off with reminders may
be useful (Colley, 2005). The Unilink service in Trinity College Dublin is currently
developing a self-management tool in the form of a fold-up booklet that could be
utilised for a check-list of daily tasks, which can be wiped clean and re-used. This
may be useful as an alternative to technological equipment for this group of
students. Kirby noted that a laptop is an expensive piece of equipment to lose or
break. It may be advisable to have a note taker attending lectures for students
with DCD who find it difficult to take notes or to re-read their handwriting. A
Dictaphone may also be useful for recording lectures if suitable for the course,
depending on the nature of the material being delivered and also the number of
hours of lectures. Poor sense of direction is often associated with DCD and
24
orientation around a new college environment prior to beginning a course may be
beneficial to this group.
3.4 Reasonable accommodations
A reasonable accommodation is an adjustment to alleviate a disadvantage that a
student experiences in the academic environment on account of their disability.
This may include any of the following:

adjustment to course delivery


adjustment to assessment procedures
provision of additional services (e.g. notetaker in lectures, extra time in
exams)
These reasonable accommodations are determined during a detailed needs
assessment that is carried out when a student registers with the Disability
Service in Trinity College. For students with DCD this should consider the
individual, the tasks required in the course selected and the environment in which
the student will be learning. A Learning Educational Needs Summary (LENS) is
written during the needs assessment which outlines the student’s
accommodations provided by the Disability Service and those that are required
from the student’s department(s). These may include the following:

Provide details of assignment deadlines well in advance.

Staff who correct assignments or examinations should refer to
Notes on Correcting Scripts written by Students with Specific
Learning Difficulties for further information. This information is
available on the Disability Service website.

Where possible, prioritise reading lists.

Provide copies of lecture notes, PowerPoint and overhead
slides.
These adjustments are designed to make the curriculum more accessible
to students and will not confer any added advantage.
25
3.5 Suggested teaching supports
Lectures

Give clear handouts and Powerpoint presentations following Clear Print
guidelines

Allow lectures to be recorded

Use on-line teaching forums such as WebCT, Blackboard or Moodle.

Put lectures up on i-Tunes U.

Provided prioritized and annotated reading lists
Seminars and Tutorials

Be clear as to what will be covered at the beginning of the term. Provide
written outline in week one of topics to be covered each week.

Be clear as to expectations regarding work to be done for seminars and
tutorials.

Encourage all students to prepare written notes to bring with them to class
to help prompt memory and organize thoughts for discussion.
Written work

Students may require extra time on account of organization difficulties, but
bear in mind that extensions can cause an endless backlog of work.

Give sensitive feedback if there is a lot of difficulty evident with written
expression.

Existing essays and reports can be offered as examples to students.
3.6 Assistive technology (AT)
In Trinity College at the beginning of the academic year an Assistive Technology
needs assessment is carried out following which the following supports may be
suggested/provided:
26

Word processors with good spell and grammar checks.

Large monitors

Larger, ergonomic mice and keyboards

Cushions

Pencil grips

Screen clamps to move monitor

Wrist pad

Voice-activated software

Text-to-speech software
As noted above, some students with DCD find using a keyboard difficult and if
handwriting is also difficult it is important for students to develop keyboard skills.
Trinity College’s Disability Service runs Touch-Typing Read and Spell (TTRS)
course which is a multi-sensory computer-aided course to build touch typing
skills while also aiding spelling and writing difficulties. As noted above, there are
also larger monitors, ergonomic mice and keyboards with large keys that aid
students with difficulties with the fine motor skills necessary for using a computer.
An AT assessment will consider the whole study environment for a student and
suggest ergonomic supports and equipment to reduce physical fatigue or
repetitive strain. These include, chairs with back supports or cushions, wrist
supports, screen clamps that can adjust the position of the monitor. These are
also available if needed for exams, as are the adaptive equipment for computers
(larger screen/keyboard or ergonomic mouse).
3.7 Academic Support
A number of studies have shown that students with DCD have difficulties with
reading and writing skills; a study conducted by Dewey et al. (2002) found that
the DCD group scored significantly lower than the comparison group on all 4
measures of reading skills (Letter Word Identification, Passage Comprehension,
Reading Vocabulary, Word Attack) and all 7 measures of writing skills (Dictation,
Writing Samples, Proofreading, Writing Fluency, Punctuation and Capitalization,
27
Spelling and Word Usage). Their study was conducted on children but it is likely
that difficulties in these areas are likely to continue to adulthood and that
students should be given the opportunity of working on these skills with a tutor on
an ongoing basis. As noted above the provision of support in this area needs to
be carefully tailored to meet the needs of individual and assessed during regular
meetings with the student. In Academic Support currently, the practice to date
has been to carry out a needs assessment which identifies areas that the student
foresees as being difficulties. This includes analysis of the student’s learning
style by carrying out an on-line learning style survey such as VARK or the DVC
Learning Style Survey. Areas of prospective difficulty are discussed and
prioritized and a subsequent appointment is made to begin to work on these. The
onus is on the student to make appointments subsequently. In future during the
needs assessment the Academic Support Tutor will focus on the course
requirements as per student handbook and identify when coursework and exams
are due. Subsequently, the Academic Support Tutor will make contact with the
student to arrange half-hour appointments and take a more task-based approach
to providing support, focusing on specific areas, such as using the Library, note
taking, referencing, database research, essay structure. Regular follow up
contact will be made.
3.8 Unilink (OT-based one-to-one support)
Unilink is an OT-run one-to-one support service for students with disabilities.
Unilink 1 supports students with mental health difficulties, while Unilink 2 caters
for students with physical, sensory, chronic health or specific learning disabilities.
Students with a primary diagnosis of Dyspraxia/DCD can be referred to the
Unilink 2 service for support in meeting the varying demands placed upon them
in their student role. An initial appointment will establish the tasks required of the
students in College using a profile form to assess self-care, productivity and
leisure tasks and goals. The student will identify and prioritize areas of difficulty
on which they wish to work and follow up meetings will identify and prioritize
28
weekly tasks. Where tasks are specifically related to research skills, use of
Library or producing written work a referral to AST may be made. As noted
above, there is a high rate of no show/cancellation. It is not considered practical
to require students to meet weekly but in order to minimise no shows and
cancellations Unilink staff will email next appointment when it has been agreed
and also text reminders in advance to students of appointment times at the
beginning of the day of the appointment.
Kirby identified that executive functioning is one significant difficulty. Kirby also
cautions that when implementing supports it is important to consider what can be
easily made habitual for students with DCD. It is proposed that in future Unilink
will suggest various strategies for time management, including (where
appropriate) using an iPhone calendar, myzone calendar, wall planner or Unilink
2 handbook. The approach taken will give the student more involvement in their
self-management and regular follow-up appointments will assess how well this
has been taken up by the student and change strategy if necessary. Unilink will
also address ergonomic issues with students with DCD if there are issues with
posture, handwriting or use of technological equipment that could be causing
pain or fatigue.
Gibbs et al. (2007) emphasize the psychological and social issues associated
with DCD in childhood and recommend psychological supports particularly for
transitional times such as the move from primary to secondary education. In
adulthood it is more likely that students accessing third level education have
developed social skills and a study conducted by Kirby et al. (2008) found that
45.8% of the group with DCD reported social skills as a perceived strength. It
must, however, be remembered that many social aspects of third level involve
physical activity; many societies are sports related and dancing and drinking
alcohol are often key social elements for this age-group. Many of these activities
provide or exacerbate difficulties for students with DCD and this should be
considered during assessment upon entry to college. A meeting with an OT-
29
based support service may be appropriate to find ways of helping students with
DCD integrate socially into college life. If a College does not have this kind of
service Learning Support should adopt the same approach and ensure that they
maintain regular contact with students with DCD and re-evaluate the supports
provided or suggested, as necessary. Difficulties in this area could be a
significant contributory factor to a student’s decision to withdraw from college.
Unilink staff take this aspect of College life into consideration during the first
meeting with a student and will consider with the student with DCD various social
options in College, including gym, sports, societies and social activities that do
not tax motor skills or may involve a task that can be mastered.
Summary of recommended interventions (AT, Learning Support and OT
service)
Motor skill difficulties
Interventions
Handwriting
Pencil grips
Experiment with different pens
Computer and use of keyboard
Build computer and touch typing skills
Provide ergonomic supports, such as
cushions, wrist supports, back supports,
screen clamps, ergonomic keyboard
and/or mouse
30
Writing skills
Interventions
Structure and writing skills
Prioritize areas of difficulty in the
production of written work
Provide carefully tailored academic support
building on the student’s learning style and
strengths as indicated by on-line test, such
as VARK or DVC Learning Style Survey
Organization and Social Skills
Interventions
Organization
Analyse options for organising timetabling
using a calendar or diary, incorporating
technology where appropriate and where it
can best be made habitual.
Social Skills
Discuss social options available to student
within and without College that may avoid
the student’s motor difficulties and build on
their strengths.
Section 4: Summary
4.1 Discussion
Developmental Co-ordination Disorder (DCD) has only recently been
distinguished in the CAO application process as a distinct group from Specific
Learning Difficulty. This emerging population at third level has a set of needs
which frequently overlap with other developmental disorders but should also be
considered as distinct from the difficulties traditionally associated with Specific
Learning Difficulty (eg. Dyslexia). This study recommends that a holistic
31
approach be taken at needs assessment and by those providing supports to
consider motor and non-motor difficulties and, as stressed by Kirby, difficulties
with executive functioning (organizational tasks). It should be remembered that
supports that are traditionally recommended by learning support tutors for
students with Specific Learning Difficulties may not be appropriate on account of
the fact that they may not be learned by students with Developmental Coordination Disorder. It is recommended that appropriate AT supports be used as
interventions but that this be supplemented with regular, timetabled one-to-one
tuition to assess the suitability of supports and consider not only their
appropriateness but whether or not use can be made habitual.
Currently there is a strong trend of students with DCD at Trinity College pursuing
Arts and Humanities courses but as this is an increasing population thought
should be given to supporting students with DCD who wish to pursue more
practical courses that may involve tasks that require a high level of manual
dexterity, such as using Nursing equipment or laboratory work. Supporting these
students may be against the student’s interest on account of fitness to practice
requirements for the career that the course leads to and the costs involved in
supporting the student, for example, the provision of a laboratory assistant.
4.1. Further Research
As noted in this study, it is difficult within the present group in TCD to study
progress and retention on account of the low number of students with DCD
currently registered with the College Disability Service. Students with DCD may
have entered College with a report confirming Specific Learning Difficulty as it is
only in 2008 that the DCD group was distinguished as a distinct group by the
DARE process of application. Further research could be conducted in the future
or with a wider population to study progress and retention of students with DCD
at third level.
32
Regarding course choices, TCD shows a similar trend to the findings of a study
by Kirby et al. (2008a). There is a strong trend toward Arts and Humanities
subjects, but given that it is now recognized as a distinct group and that this
emerging population is growing rapidly, it is more likely that in future students
with DCD will be applying and accepted for a wider spectrum of courses and this
may include courses with a manual element that requires physical dexterity that
could challenge students with DCD who have motor difficulties. Further research
could be undertaken to consider how to support students in courses with
laboratory or placement work as the provision of a personal assistant would be
difficult to implement on account of funding constraints. This is also an area of
study to consider under issues of fitness to practice.
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