Developmental Coordination Disorder (DCD) is a term used to describe children who demonstrate substantial difficulty in coordinating movements such as those needed to climb the playground, catch balls, complete handwriting tasks or get dressed. As a result these movement difficulties interfere with a child’s ability to perform everyday tasks and have an impact on academic achievement. Children described using the term DCD cannot have their difficulties with movement explained by a general medical condition (Cerebral Palsy, Hemiplegia or Muscular Dystrophy) and the criteria are not met for Pervasive Developmental Disorder – not otherwise specified (PDD-NOS).
What are the common features of Developmental Coordination Disorder (DCD)?
Children with DCD may experience difficulties in a variety of areas, while others may only have difficulties in specific areas. If your child demonstrates a number of the below features and has not been formally diagnosed as having DCD by a medical doctor, it is important that your child also see a Paediatrician to rule out any other general medical conditions.
Appears clumsy or awkward in movements compared to friends of similar age (e.g. running awkwardly or holding scissors awkwardly).
Poor body awareness: Trouble determining the distance between themselves and objects and hence bumping into objects or knocking things over and invading other people’s personal space without recognising this.
Difficulty with or delayed in developing gross motor (physical) skills (e.g. running, jumping, hopping, catching balls, climbing), fine motor skills (e.g. handwriting, doing up buttons, threading beads, tying shoe laces), or both.
May show a discrepancy between motor abilities and abilities in other areas. For example, intellectual and language skills may be quite strong while motor skills are delayed.
Movement planning difficulties: Difficulty planning physical movements into a controlled sequence to complete a task, or difficulty remembering the next movement in a sequence despite being shown or told how.
Movement learning difficulties: Difficulty learning new movement skills and once learned in one environment (e.g. school) may continue to have difficulty performing the task in another environment (e.g. home). Consequently, the child needs to be taught the task again in each new environment.
Difficulty with activities that require constant changes (e.g. baseball, tennis).
Difficulty with activities that require the coordinated use of both sides of the body (e.g. cutting with scissors, running, swinging a bat).
Reduced balance and postural control (e.g. unsteady when stepping over a height or when standing while dressing).
Reduced strength and endurance, requiring significantly more effort to complete the same task as their friends, resulting in rapid fatigue.
Rushing through tasks as completing them slowly is difficult due to reduced control or balance.
Taking extra time to do tasks to ensure accuracy.
Difficulty with printing or handwriting.
Difficulty with academic subjects such as mathematics, spelling or written language which require handwriting to be accurate and organised on the page.
Difficulties organising their school desk, school bag, homework or even the space on a page.
Common difficulties often (but not always) experienced by the child with Developmental Coordination Disorder (DCD):
May lack interest/motivation in physical activity or be hard to engage in activities they find difficult or in which they have experienced failure.
May avoid socialising with peers, or not be included by peers, in physical games (e.g. on the playground) for fear of failure or experience with repeated failure.
Frustrated easily when completing tasks.
Anxiety when asked to participate in difficult activities.
Tends to seek out younger children to play with as their skills are of a similar level and they feel more confident playing with them.
May complain that ‘this is too hard’ or ‘I can’t do it’ when presented with motor activities.
May be resistant to changes in how or when tasks are done as changes present new situations/tasks that require planning and new learning.
Management strategies that support the child with Developmental Coordination Disorder (DCD) (at preschool, school and/or home):
Encouragement to persist and attempt tasks.
Provide opportunities to succeed by simplifying activities.
Teach new skills in a step by step manner and keep the environment as predictable as possible during teaching.
Introduce new skills or environments on an individual basis before introducing peers.
Use simple language and instructions.
Provide visual as well as verbal cues.
Provide extra time to complete tasks.
Recognise and reinforce the child’s strengths.
Appropriate set up for school desk.
Set realistic and achievable goals for all task performance and completion.
Make participation, not competition, the goal.
Occupational Therapy approaches and activities that can support the child with Developmental Coordination Disorder (DCD) and/or their carers include:
Observing the child during play and formal assessment to determine the child’s abilities with gross motor (whole body) tasks and then making recommendations for management.
Devise goals: Setting functional goals in collaboration with the child, parents and teachers so that therapy has a common focus beneficial to everyone involved.
Educating parents, carers and teachers about DCD, age appropriate skills a child should be demonstrating and providing management strategies/ideas to assist the child in the home, at school and in the community.
Physical skills: Providing ways/ideas to promote physical activity and participation in team/group activities.
Underlying skills: Developing the underlying skills necessary to support whole body (gross motor) and hand dexterity (fine motor) skills, such as providing activities to support:
balance and coordination
strength and endurance
attention and alertness
Direct skill teaching through a task based approach.
Confidence: Building self-confidence to enable a child to willingly participate (it is common for these children to shut down when they perceive the task to be too hard) in activities by:
Providing the child with education about why they may be experiencing difficulties with movement, their strengths as well as their weaknesses and providing them with and teaching them strategies to overcome obstacles they may face.
Breaking down specific physical skills into one or two step components to teach the skill and then gradually adding in new components until the skill is doable in its entirety (e.g. skipping – start with a step, then a hop).
Providing opportunities and strategies to master the same skill in differing environments (e.g. home versus school versus. therapy session).
Presenting the activities at the ‘just right challenge’ level to provide success and then gradually increasing the demands of a mastered skill.
Educating parents and carers on ways to simplify tasks to the smallest possible components and use simple and concise language.
Non-verbal cues: Using physical and visual models or instructions, wherever possible, not just verbal.
Sensory processing: Improving sensory processing to ensure appropriate attention and arousal to attempt the tasks as well as ensuring the body is receiving and interpreting the correct messages from the muscles in terms of their position and relationship to each other.
Multi-sensory approach: Using a multi-sensory approach to learning new skills.
Modelling tasks visually and using hands-on adjustment techniques to aid body awareness for the child.
Strategies for Teaching Handwriting
To help kids form and place letters correctly and make them the right size, OTs might:
Use sensory feedback to help kids practice letter formation. The therapist might have them trace the letter in sandpaper or form letters with a finger in shaving cream. Kids might also use a tracing app on a tablet with a stylus. (See more multisensory techniques for teaching handwriting.)
Try various types of specialty paper to help kids position letters on the line. Some paper has raised, bumpy baselines. There’s also paper that has the bottom half of the writing space highlighted.
Use handwriting instruction that goes from the easiest task to the hardest. Kids start by forming capital letters with straight lines. Later, they move on to more complicated lowercase letters.
Strategies for Cutting With Scissors
To help kids cut shapes accurately, OTs might:
Try using different kinds of scissors. These include loop scissors, hinge scissors and smaller scissors that can help increase control for kids who struggle with coordination or hand strength.
Trim and remove excess paper around the shape. That helps kids more easily approach the line and cut with accuracy while their other hand supports and turns the page.
Place the scissors in kids’ hands at first, then work up to suggesting how kids can position the scissors on their own (with their “thumbs up”).
Use different colored paper, as well as paper with varying thicknesses. Those “cues” can help kids who rush to slow down and cut with accuracy on the line.
Teach in order of difficulty. Start with cutting straight lines. Then move on to more complicated tasks like cutting curved lines, jagged lines, circles and other shapes.
Strategies for Fastening Clothing
To help kids learn to manipulate buttons, zippers and snaps, OTs might:
Use dressing vests or dressing boards to practice skills step-by-step. Kids work with these tools on a table, rather than working with actual clothing on their body.
Use verbal cues like “put the train in the station then pull it up the tracks” to help kids remember how to hook and position the zipper.
Use resistive putty to improve kids’ hand strength and coordination for working with snaps. Kids pinch the putty with their thumb, index and middle finger, in the same position they’d use for snapping.
Align the buttons and holes on the vest, and push the buttons partway through the holes. Kids complete the final step of pulling each button through.
Strategies for Tying Shoes
To help kids work on the complicated task of tying their shoes, OTs might:
Use a lacing board with two different colored laces to teach the steps. That way kids can clearly see how the laces connect and intertwine.
Use a shoe positioned on the table first because it’s easier to see the steps, rather than tying with the shoe on the child’s foot.
Lace a shoe with long laces that will increase success of the bows staying intact, rather than shorter laces that quickly come undone and require more precision.
OTs can also work with kids to improve gross motor skills, balance and coordination in general. For instance, OTs might have kids practice jumping jacks, catch balls of different sizes and weights, or run obstacle courses. Some activities like this can also be helpful for kids with sensory processing issues who struggle with motor skills.
There are many ways you can help your child build skills, too. Ask the therapist if there are exercises you can do with your child at home. Discover fun ways to help your child build fine motor skills and gross motor skills.