Co-ordination Difficulties

Practical Ways Forward

Michèle G. Lee, Portwood

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781136793523
• Edition: 1
• Topic: Education
• Subtopic: Education General

Co-ordination difficulties affect every aspect of children's learning. Using the action plans in this book teachers can respond immediately and effectively to pupils who are showing signs of co-ordination difficulties. It includes: straightforward explanation of different co-ordination difficultieschecklists to facilitate accurate assessmentguidance

Chapter 1

Understanding the Problem

Defining the focal group

An increasing number of children have problems planning and executing tasks with a motor-skill component. They are described variously as having: ‘perceptual motor dysfunction’, ‘sensory integrative dysfunction’, ‘deficits in attention, motor control and perception (DAMP)’, ‘developmental dyspraxia’, ‘clumsy child syndrome’ (Missiuna and Polatajko 1995). Although the condition was first recognised in the early 1900s, increasing awareness has provided evidence that demonstrates prevalence in 5 per cent of primary-aged schoolchildren (Gubbay 1975b; Henderson and Hall 1982; Sugden and Chambers 1998; Kadesjo and Gillberg 2001). This prompted recognition by the American Psychiatric Association (1994) and the World Health Organisation of a distinct movement-skill syndrome classified as developmental co-ordination disorder (DCD). At an international consensus meeting held to debate these different labels, the definition of DCD was accepted by researchers and clinicians (Polatajko et al. 1995).

Diagnostic features of DCD (adapted from American Psychiatric Association 1994, 315.4)

The essential feature of DCD is a marked impairment in the development of motor co-ordination (criterion A). The diagnosis is made only if this impairment significantly interferes with academic achievement or activities of daily living (criterion B). The diagnosis is made if the co-ordination difficulties are not due to a general medical condition (e.g. cerebral palsy, hemiplegia or muscular dystrophy) and the criteria are not met for pervasive developmental disorder (criterion C). If mental retardation is present, the motor difficulties are in excess of those usually associated with it (criterion D). The manifestations of this disorder vary with age and development. For example, younger children may display clumsiness and delays in achieving development motor milestones (e.g. walking, crawling, sitting, tying shoelaces, buttoning shirts, zipping trousers). Older children may display difficulties with the motor aspects of assembling puzzles, building models, playing ball and printing or writing.

Associated features and disorders

Problems commonly associated with DCD include delays in other non-motor milestones; associated disorders may include phonological disorder and expressive language disorder. Prevalence of DCD has been estimated to be as high as 6 per cent for children in the age range 5–11 years. Recognition of DCD usually occurs when the child first attempts such tasks as running, holding a knife and fork, buttoning clothes, or playing ball games. Its progression is variable. In some cases, lack of co-ordination continues through adolescence and adulthood.

Differential diagnosis

DCD must be distinguished from motor impairments that are due to a general medical condition. Problems in co-ordination may be associated with specific neurological disorders (e.g. cerebral palsy, progressive lesions of the cerebellum), but in these cases there is definite neural damage and abnormal findings on neurological examination. If mental retardation is present, DCD can be diagnosed only if the motor difficulties are in excess of those usually associated with the mental retardation. A diagnosis of DCD is not given if the criteria are met for a pervasive developmental disorder. Individuals with ADHD may fall, bump into things or knock things over, but this is usually due to distractibility and impulsiveness rather than to a motor impairment. If criteria for both disorders are met, both diagnoses can be given.

Summary of diagnostic criteria for DCD

A. Performance in daily activities that require motor co-ordination 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.

Even with reference to DSM-IV (American Psychiatric Association 1994), however, the literature describing DCD includes wide-ranging terminology and criteria. Sugden and Keogh (1990) found that the characteristics of children diagnosed with DCD depended upon the source of referral, the professional background of the assessor and the type of assessment used.

Interpretation of the literature on DCD is further compounded by the lack of inclusion criteria. Geuze et al. (2001) reviewed 164 publications on the study of DCD and found that only 60 per cent were based on objective criteria as there is no ‘generally accepted’ level of motor proficiency to define clumsiness (Sugden and Keogh 1990). As a result, they recommended that a child scoring below the 15th percentile on standardised tests of motor skill (Henderson 1992: Sugden Movement ABC) and having an IQ score above 69 (Wechsler Intelligence Scales) would qualify for a diagnosis of DCD. For some children, a ‘diagnosis’ provided access to support services, often with additional funding. Standardised assessments are the focus of discussion in Chapter 3.

The treatment programmes described in Chapter 4 have been shown to benefit children with co-ordination difficulties, even when DCD is not the primary diagnosis. Improving co-ordination can relate directly to improvements in learning (Myers 2002).

Movement and learning

Developmental disorders of childhood are usually attributed to some ‘brain-related’ event (Portwood 2000). The brain controls the reaction of the body to the environment. The building block of the brain's structure is the neurone. These neurones (numbering approximately 10 billion) actively make and break connections with one another to form a neural network that becomes increasingly more complex. This forms the central nervous system, which is divided into two parts:

1. The brain stem and limbic system interpret signals from within the body. They are connected to the systems responsible for regulating heartbeat, respiration and digestion.

2. The thalamo-cortical system, which interprets signals external to the body: sight, sound, taste, smell and the body's awareness of its position in space. Higher brain function is located in the cortex.

Five weeks a...

Table of contents

• Cover
• Half Title
• Full Title
• Copyright
• Contents
• Preface
• Introduction
• 1 Understanding the Problem
• 2 Referral
• 3 Assessment
• 4 Treatment
• 5 The Effectiveness of Treatment
• Appendix 1: Standardised Tests
• Appendix 2: Questionnaires
• Appendix 3: Treatment Sheet
• Appendix 4: Case Study
• Resources
• Bibliography
• Index