What is DCD?
....and practical strategies to
support
Professor Amanda Kirby
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Amanda Kirby
Background to The Dyscovery Centre
Professor Amanda Kirby 2011
Background to The Dyscovery Centre
Started in 1997- interdisciplinary team, part of
University of Wals, Newport
• Clinical- all age service
• Research- DCD, BECCTS, emerging adulthood
into employment
• Training- Masters in Developmental
Disorders; PGCert in DCD and PG course in
ADHD
• Consultancy e.g. Remploy, RAF, FA
Professor Amanda Kirby 2011
Sam,14 years of age
• He has a diagnosis of Dyspraxia/DCD.
• He has a sister who is 12 years who is in the school
netball team and plays in the orchestra
• His writing is difficult for others to read.
• Sam likes playing with his dog and on his computer,
but does not have a lot of friends. He likes to go
swimming.
• He does not like doing much exercise
• He likes to go out with the family, but at the same
time gets annoyed by his family.
• He is very messy. He is not interested in being clean
or tidy. He does get anxious in new settings
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Amanda Kirby
DCD is:
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A movement disorder affecting
children and adults in more
than one setting-pervasive
Enduring
Developmental
Has multiple causes
Has more than a motor impact
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Amanda Kirby
Prevalence
The ALSPAC UK based large population study
more recently has shown a prevalence of 1.7%
with a further 3.2% of children considered as
having "probable developmental coordination
disorder" by using broader cut-offs for
coordination testing and activities of daily
living
(Lingham et al,2009).
• 3:1 boys to girls
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What is DCD/Dyspraxia?
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Developmental Co-ordination Disorder (DCD),
also known as Dyspraxia in the UK, is a
common disorder affecting motor coordination in children and for many continues
into adulthood.
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This condition is formally recognised by
international organisations including the
World Health Organisation. DCD is distinct
from other motor disorders such as cerebral
palsy and stroke. The range of intellectual
ability is in line with the general population
.Individuals may vary in how their difficulties
present.
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The co-ordination difficulties may affect
participation and functioning of everyday life
skills in education, work and employment.
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Children may present with difficulties with
writing, typing, riding a bike, self care tasks,
and recreational activities.
In adulthood many of these difficulties will
continue, as well as learning new skills at
home and work such as driving a car and DIY.
In addition individuals often have difficulties
with organisation and planning skills.
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Developmental Verbal Dyspraxia
(DVD)
DVD is a difficulty in a person’s ability to
organise their speech muscles to make the
sounds they need, to say what they would like to
say.
Also known as ‘apraxia of speech’ or CAS
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CAS
Childhood apraxia of speech (CAS) is a motor
speech disorder. Children with CAS have
problems saying sounds, syllables, and words.
This is not because of muscle weakness or
paralysis. The brain has problems planning to
move the body parts (e.g., lips, jaw, tongue)
needed for speech. The child knows what he or
she wants to say, but his/her brain has difficulty
coordinating the muscle movements necessary
to say those words.
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A day in the life
• Take any age
• Go through what happens in a day from
getting up to going to bed
• List the activities that are non motor!
The fact is that hardly anything happens
without the involvement of the motor system!
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ENVIRONMENTAL
BEHAVIOURAL
NEURAL
GENETIC
“Meshes of influence”
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Turvey,2006
DCD often associated with:
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Dyslexia- 35%
ADHD- 35-50%
Autism Spectrum Disorders (ASD)
Dyscalculia
Tourette’s Syndrome
Specific Language impairments
Anxiety and depression
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Other conditions can also cause
motor difficulties
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BECCTS
Marfans
Klinefelters Syndrome
NF1
FAS
Joint hypermobility syndrome
Developmental Verbal Dyspraxia(DVD)
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Impact also
• Self esteem- Piek et al
• Anxiety and depressionMyihara, Piek, Rasmussen
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Self esteem and DCD
• Miyihara and Piek ,2006 showed that in
studies reviewed (7) there was a medium
effect size on self esteem and DCD (greater
than in children with CP (6 studies)
• Skinner and Piek ,2001- 8-10 yr olds had
worse self perception and self worth
• Increased in 12-14 years
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Anxiety and depression
• 3.5-5 year olds - +ve correlation between motor
difficulties ( MAND) and anxious /depressed scale
( using CBCL) ( Piek, Bradbury,Elsley, Tate, 2008)
• 8-10 and 12-14 years olds had increased
state/trait anxiety cf td kids- Skinner and Piek,
2001
• Depressive symptoms in children (8-10 yrs) with
DCD were significantly worse than td children (
Francis and Piek,2001)
– Perceived athletic competency predicted depressive
symptomatology
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Individual
Outcome
Task
Environment
Presentation at different ages
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Key features of DCD
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Self care tasks
Writing – quality and speed
Tool usage
Riding a bike and balance tasks
Dual tasking
Learning new tasks
Team games
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Key features of
Developmental Verbal Dyspraxia
• A child might say:
– the sounds are out of order e.g. papnee for nappy
– errors in speech are inconsistent e.g. tup, bup and
gup for cup
– words are simplified e.g.dip for skipping
• Initiating and spontaneously using speech can
be markedly difficult for a child with DVD.
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Oral Dyspraxia
• involves the lips, tongue and palate, is
difficulty in spontaneously producing
movements of the mouth.
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Executive Functioning and
DCD
• Roebers et al, 2009
– EF and Motor linked in 7 year olds
• Piek, Dawson, Smith and Gasson (2008)
– Gross motor scores at 4 yrs 4 months predicted
working memory and processing speeds at school age
EF- DCD and ADHD ( in 6-14 yr olds cf TD)
– DCD worse than all groups on working memory
– Showed an overall timing deficit
– Poorer visuospatial ability
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Components
– Activation- organising , prioritising
tasks, time estimation, initiation..
procrastinate
– Focus-sustaining and shifting.. Reading
over and over
– Effort-regulating alertness..completing
tasks, sleep pattern (can’t shut off)
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Components
› Emotion-managing frustrations and
modulating emotions..keeping things in
perspective
› Memory- using working memory and
accessing recall.. what has just been said,
remembering a sequence
› Action- monitoring and regulating self
action..impulsive, not considering the
context, can’t adjust pace
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Theories re. DCD
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Visual spatial sketchpad ( Baddeley)
Difficulties making ‘online corrections’
Motor control- speed v accuracy
Linked to executive functioning
• Not being able to learn just by showing
• Developmentally immature
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DCD: In childhood
Core symptoms and signs of DCD
3-7 year old
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Riding a tricycle/bicycle
Painting/jigsaws/ colouring/ cutting/drawing
Hopping/ jumping/ball skills/balance
Self care: untidy eater/ spills drinks/dressing/
undressing/bottom wiping/teeth cleaning
Other presentations
–Sometimes can do things but
not others
–Learning in a step wise fashion
–Prefer consistency
7-11 year olds
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Riding a bike
Handwriting – slow and untidy
Poor tool usage -scissor skills, rulers etc
Posture at the desk
Ball skills- team games
Self care tasks
Lower self esteem
Increased social isolation/difficulties making
friends
• Organisational skills
Senior school child
• More of everything in primary school
• Increased personal, social and
academic demands
• Speed
• Accuracy
• Think about what is NOW triggering
problems....
Physical and social activity
• Avoidance
• Isolation
• Differences
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Interaction
Parental support
Peer interaction
0 years
10 years
Typically developing
Individual
18 years
DCD
20 years
36
Practical strategies for home and
school
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“When it comes to the future,
there are three kinds of
people: those who let it
happen, those who make it
happen, and those who
wonder what happened.”
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M.A.T.C.H. the activity to the individual
Modify the task
Alter expectations
Teach strategies
Change the environment
Help by understanding
M.A.T.C.H. strategies available from CanChild
website http://www.canchild.ca/
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Intervention
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Practicing what you can’t do
Doing what you want to do
Doing what you need to do
Avoiding what is difficult and is likely to persist
Seeking out strengths
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Pragmatic approach
How much time have you got
What is important for now
What is important for the future
Listen to the child and what is important
Practise enough and in context
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DVD tips
• Never force the child to speak. Using negative
reinforcement with a child when he/she cannot
complete the desired task usually makes the child
resist and dislike the task in the future. For example,
do not say, “If you don’t say that you want toast,
then you won’t get anything at all.” Instead, try
binary choices. “Do you want juice or toast?” (Put
desired response in the last position.)
• Accept any response the child makes. If this is too
difficult for the child, use objects and allow the child
to point to the desired object.
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• * Be a good speaking model. Pronounce your
words correctly and speak slowly. When
working with the child, be sure to repeat the
target words in short phrases and at an
appropriate volume.
• * Read to your child, allowing him/her to
make comments about the story. Books that
have rhyming words work well for phonemic
awareness. Do not attempt to correct your
child’s speech if unintelligible.
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• * It is important to let your child express
his/her wants and needs. If he/she is so
unintelligible that you or other adults he/she
comes into contact with cannot understand, a
communication book may be appropriate.
Speak with your child’s speech therapist about
content.
• * Repetitive oral-motor movements could
help with overall motor programming.
Practice sticking the tongue out, up, down,
left, and right. Try to blow bubbles, whistles or
kazoos to increase lip movement.
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• * Singing songs with your child or using slow
music with words sometimes helps with
prosody and intelligibility.
• * Combine vowels with early developing
consonants in different positions, making a
silly song (bay, bee, bye, bow, boo)
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Start with the basics
Think about what has triggered problems
in the past and now
“ Every time” he does xxx....
Think of ‘hot spots’ in the day or with
people
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Self care
Responses
• Putting out clothes the
night before
• Alternative fasteningsvelcro etc
• Timer for teeth cleaning
• Wet wipes and practice- be
explicit
• Adapted cutlery/stable
position
• Verbal prompts
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“The clock represents our commitments,
appointments, schedules, goals and activities
– what we do with and how we manage our
time.
The compass represents our vision, values,
principles, mission, conscience, direction –
what we feel is important and how we lead
our lives.”
"The struggle comes when we sense a gap
between the clock and the compass – when
what we do doesn’t contribute to what is
most important in our lives.”
Stephen Covey
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Organisation
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Same place
Same time
All equipment ready
Home- school diary
Create a plan
Use an essay planner
Parent buddy
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Social currency
Social rules
Social currency
Creating
Social networks
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Social opportunity
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Sport
Music
Cooking
Martial arts
Local clubs
With family
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Preparing for school
Challenges
• What needs to be
prepared for.....
Responses
• List of what to do
• Night before by the front
door
• List in bag/kitchen etc
• Timer with an alarm
• Practice new journeys
• Practice sorting.. To do lists
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Preparing for school
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Lunch box/lunch money
Lunch choices
List of items – for the day
Labelled clothes
Right and left shoes
Preparing for periods
Pack for sport
Good rucksack
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Map of the School
Using colours, key features, reference points
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Lunch and break times
• Encourage lunch time clubs
where there are “ formalised”
opportunities for socialising
• Peer mentor schemes
• Play ‘what if’
• Play’ canteen chaos game’
• Get weekly menu from school
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In the canteen
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Queuing and choosing
Paying
Using cutlery
Spills
Where to sit
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In class
Response
Challenge
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Recording from the board
Listening
Planning out tasks
Using tools- scissors /rulers
Maths
Posture
Position
Task
Motivation
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Facing the front
Angle board
Adapted tools
ICT
Minimise writing
Being able to ask
again
• Time out/toilet
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Mathematics
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Language of maths
Visualisation of maths
Learning times tables
Recording in class
Using tools
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Learn functional maths
Cookery
Weights and measures
Shape- geometry
Half and quarters
Language
Planning
Motor skills
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Amanda Kirby
“The clock represents our commitments,
appointments, schedules, goals and activities
– what we do with and how we manage our
time.
The compass represents our vision, values,
principles, mission, conscience, direction –
what we feel is important and how we lead
our lives.”
"The struggle comes when we sense a gap
between the clock and the compass – when
what we do doesn’t contribute to what is
most important in our lives.”
Stephen Covey
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Amanda Kirby
Homework- school approaches
• Consistency between home and
school
• Colour coding and filing systems
• PA system of checks at start and end
of day
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Think of the whole family
• Siblings
• Family occasions
• Times of transition
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Unstructured times
• Create a time table
• Provide a framework to the week
• Consider opportunities for practicing
skills –led by individual/child goals
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Plan holidays
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Calendar
Travel time
Smells, tastes
Climate
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Individual
Outcome
Task
Environment
Individual
Environment
Outc
ome
Task
Environm
ent
ACTIVITY and PARTICIPATION
Individual
Speed of others
interacting with
you
e.g. yoga or
football
Size of
environment
Outc
ome
e.g. pitch size
Number of
people e.g.
tennis v football
team
Task
Changing
environmental
conditions e.g .
Cross country
wet weather,
badminton court
Choice of
activity and
participation
Reaction time
e.g. clay pigeon
shooting
Speed of yourunner
Manual dexterity
Strength e.g.
.weight lifting
Sewing , violinist
Use of an object
e.g. tennis
racquet.,cello
Flexibility or
stability e.g.
gymnast or
footballer
Visual Accuracy
e.g.
Archery ,
computer games
Environm
ent
Individual
Speed of others
interacting with
you
e.g. yoga or
football
Size of
environment
Outc
ome
e.g. pitch size
Number of
people e.g.
tennis v football
team
Task
Changing
environmental
conditions e.g .
Cross country
wet weather,
badminton court
Choice of
Motivation
activity andand
participation
interests
e.g. likes horses,
computers
Reaction time
e.g. clay pigeon
shooting
Speed of yourunner
Manual dexterity
Strength e.g.
.weight lifting
Sewing , violinist
Use of an object
e.g. tennis
racquet.,cello
Flexibility or
stability e.g.
gymnast or
footballer
Visual Accuracy
e.g.
Archery ,
computer games
Environm
ent
Seek out hobbies for confidence
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Swimming
Horse riding
Trampolining
Canoeing
Music- drums
Photography
Cookery
Rambling
Badminton
Fencing
Archery
Golf
Gym work
Orienteering
Wall climbing
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TASK
Do
Avoid
Adapt
Individual
Outco
me
Task
Environment
Useful resources
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www.boxofideas.org
www.move627.org
www.spldtransitions.co.uk
www.dyscovery.org
http://www.asha.org/public/speech/disorders/chil
dhoodapraxia.htm
• 100 ideas Dyspraxia and DCD- Kirby and Peters
• Dyspraxia and DCD- Kirby- Souvenir Press
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Amanda Kirby
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Amanda Kirby
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Amanda Kirby
Useful websites
• http://www.bbc.co.uk/schools/typing/-free
• www.handwritinginterestgroup.org.uk
• http://tuxtype.sourceforge.net/
• http://www.crazymonkeygames.com/QWERTY-Warriors-2.html
• http://www.typefastertypingtutor.com/index.html
• http://www.touch-typing-tutor.com/TypingInvadersFreeTypingGame.htm
• http://www.goodtyping.com/
• www.sparklebox.co.uk
Dyscovery Centre copyright 2011
Amanda Kirby