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Dr. Kamps has published a new book called:

"The Source for Developmental Coordination Disorder "

Call (403) 217-5749 to order your copy.

   
   
   
   
   
   

 


 

 

FAQ

What is DCD?

What type of motor difficulties would children with DCD have?

What are some of the first warning signs that something may be amiss?

Are there any other motor skills or behaviours that a parent might notice at an early age?

At what age does the possibility of DCD appear?

Does it ever go away?

I have never heard of DCD before. Is there any research on this topic?

Why isn't this very well known in Canada?

What can be done about DCD?

What other domains of behaviour are affected by DCD?

Are DCD, Asperger’s syndrome, non-verbal learning disabilities (NLD or NVLD), PDD-NOS, and other terms such as dyspraxia, sensory-integration disorder, the ‘out-of-sync’ child related in any way?

What is DCD?

Developmental Coordination Disorder (or DCD) is a name that is used to describe children who are average to above average in intelligence but who have difficulty learning motor skills. This under diagnosed condition is not well-known in North America, but recognized by the American Psychiatric Association of America in a book called the DSM-IV (Diagnostic and Statistical Manual - Fourth Edition). A very similar condition (using another name) is recognized by the World Health Organization in their manual called the ISC-10 (International Classification of Diseases - Tenth Edition). A significant amount of credible scientific research has been conducted on this topic and that is why it is worth bringing DCD to the attention of the general public.

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What type of motor difficulties would children with DCD have?

DCD can affect only gross motor skills, only fine motor skills, or it can affect both fine and gross motor skills.

•  Fine motor skills involve the use of finger and/or wrist action such as: printing, handwriting, coloring, tying shoelaces, using scissors properly, turning lids on and off bottles, spreading peanut butter, jam, etc. on sandwiches, peeling or cutting vegetables, using a knife and fork properly, etc…

•  Gross motor skills involve the larger muscles and limbs of the body such as: walking, running, throwing, kicking, catching, jumping, balancing, most sports and activities in physical education and recreational pursuits.

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What are some of the first warning signs that something may be amiss?

Although it doesn't impact all children the same way, you may become concerned if your child was slightly later in acquiring major milestones (e.g., the age of standing, walking, running, riding a bicycle). Research has shown that many of these children also have a history of speech difficulties or delays (e.g., poor oral motor control – also a motor skill), and something that frustrates parents is that many of them have toileting problems (e.g., going to the bathroom involves sequential and controlled muscle action of the bladder and bowel).

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Are there any other motor skills or behaviours that a parent might notice at an early age?

Some children with DCD do not explore their environment motorically (e.g., they do not crawl over, around, behind, and through things to learn about their world). These children tend to enjoy more sedentary types of recreation and they may display very poor rhythm when listening to music – since keeping a beat, marching, and tapping along with a song involves coordination. In my clinical work with these children, I have also noticed that many of them over-estimate their motor abilities. However, once you ask them to perform a certain skill – it is apparent that they do not display proficiency in the motor activity. There are many other factors that are difficult to describe with words; however, someone trained in the area of motor development and movement proficiency can easily identify these items.

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At what age does the possibility of DCD appear?

If children are managing basic tasks at home and school, then parents and teachers may have already modified the expectations of the motor demands and tasks. However, if and when children with DCD start withdrawing socially or complaining that they cannot keep up with the demands at school, then parents should investigate the degree of severity and cause of the motor problems. This is important to do because, once a formal diagnosis is obtained, there are specific accommodations that can and should be made for the student at school. The strategies and accommodations will be described in the student’s Individualized Program Plan (IPP). The IPP is also known as an Individualized Educational Plan in other provinces or states.

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Does it ever go away?

Research suggests that it doesn't actually go away, but that there are many things that can be done to lessen the impact of DCD on day-to-day functioning. This means that the person may never become a gifted athlete, but, using different learning approaches and opportunities for practice, he/she is usually able to learn many fundamental motor skills. In addition, with modifications and accommodations in the classroom, it is possible to significantly lessen the impact of the motor difficulties.

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I have never heard of DCD before. Is there any research on this topic?

Yes, a tremendous amount of research has been conducted on DCD since the 1970's. Within the last twenty years, a significant number of studies have been conducted all over the entire world. A sample of countries that have contributed to the scientific knowledge base include: Australia, Belgium, Brazil, Canada, England, Finland, France, Germany, Ireland, Italy, Japan, The Netherlands, New Zealand, Norway, Nigeria, Norway, Singapore, South Africa, Sweden, The USA, and Wales.

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Why isn't this very well known in Canada?

Unfortunately, although this is described in the DSM-IV-TR (a manual that doctors, psychiatrists and registered psychologists use for diagnostic purposes), many medical personnel do not know this disorder because there is no ‘medical' cause for the motor difficulties (e.g., the child does not have problems with joints, muscles, or range of motion, etc…). When and if parents bring their child's clumsiness or lack of motor proficiency to the attention of their family practitioner it is often dismissed as something that the child will eventually ‘grow out of'. However, research has not shown this to be true – they do not ‘grow out of it. Thankfully, two medical doctors wrote an article in a Canadian journal in 1994 that encouraged doctors and other professionals to consider the importance of diagnosing this condition because it affects many domains of behaviour. In addition, psychologists trained in North America do not know much about this condition because the graduate level training they participate in -- typically only focuses on the cognitive and emotional domains and excludes the psycho-motor domain. Because psychologists have not been trained to investigate functioning in the motor domain, they usually don't assess for difficulties in this area. Hence they do not often make a diagnosis of DCD either.

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What can be done about DCD?

Research has shown that there are several ways to address this condition. First of all, one needs to know with certainty what is causing the motor problems. (There are many other conditions that may affect motor performances and that is why it is important to have someone trained in this area do the assessment.) Nevertheless, once you know with certainty that DCD is causing the motor difficulties, it is treatable. For example, because these children are average to above average in intelligence, you can use the child's strengths in reasoning to teach them basic bio-mechanical principles involved in motor performances. There is much more that can be described; however, the best approach to this is to have the child/student/teenager participate in a program that teaches the motor skills and allows plenty of practice. If you live in or near Calgary, Alberta, this can be done through the specialized KAMPS clinic where Dr. Paulene Kamps offers small group gross motor sessions that utilize the concepts and principles just described. Students and parents have found that it is effective.

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What other domains of behaviour are affected by DCD?

When a child is unable to perform motor skills at the same level of proficiency as most of their peers, they start to withdraw socially. Take a five year old who cannot go up and down a playground slide very quickly. He/She will likely not try the skills very often – especially when others are watching. Take this into Grade One and Two -- when they accidentally kick the soccer ball in the wrong direction! This child will soon discover that they are not invited to play very often, and so, rather than face the pain of rejection from peers, they simply start to remove themselves from settings in which sporting activities take place. As a result, these children are often seen standing by themselves against the wall of a school building during recess and lunchtime.

Academic skills are also affected. Many children with DCD have significant difficulties with handwriting. They may know the answers to questions and be able to give long and detailed descriptions, but they have a very hard time writing this down on paper. Because of their motor problems, they do not write neatly or quickly, will cover their work, or write as little as possible. They may even get in trouble for their messy work and be told to redo their assignments!

Research has shown that over time, such motor difficulties impact self confidence and emotional health and stability. These children tend to become very anxious and a few years later, children or teenagers with DCD may start to display signs of significant depression. In addition, because of their inability to perform sports and recreational skills with ease, they tend to be less 'fit' and may also develop physical health problems.

So, in short, motor learning difficulties that are not caught and treated at an early age, can affect social functioning, academic achievement, physical and mental health, and general well-being. This is why it is important to know what is causing your child's motor difficulties and then to treat it as soon as possible.

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Are DCD, Asperger’s syndrome, non-verbal learning disabilities (NLD or NVLD), PDD-NOS, and other terms such as dyspraxia, sensory-integration disorder, the ‘out-of-sync’ child related in any way?

In short, the answer is ‘probably’ -- but they are not all the same. There are likely two different explanations for this situation. The first explanation suggests that NLD may actually refer to two (or three) different types of children – each of which originally present as having motor and social difficulties, as well as problems with visual-spatial reasoning. The second explanation reveals that because of certain restrictions in various disciplines, some professionals may be using words and phrases (e.g., dyspraxia, sensory-integration or sensory processing disorder, ‘out of sync’) to describe problematic conditions in young children. In some way, these professionals are doing parents a service, because they are already identifying a 'difference' in the child. However, because these clinicians are not officially 'allowed' to make a definitive diagnosis from the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM), some of these terms may be used by occupational therapists, physio-therapists and/or speech language therapists. Unfortunately, the descriptive language that these professionals use is not the ‘same’ as the diagnostic terminology used by medical doctors, psychiatrists, and registered psychologists. As a result of the use of such different terms among various professionals and their respective disciplines, there is a great deal of confusion among many health care practitioners and clinicians! In fact, I have even come across children who have been diagnosed with “sensory-processing disorder” when in fact, a more thorough investigation indicated that they had mild to moderate cognitive delays or a form of Pervasive Developmental Delay (PDD).

A more detailed description of the first explanation follows. In a recently published Linguisystems book about DCD, I described that although many people currently use NLD as a diagnostic term and much has been written about NLD in the last years (especially on the web and in some books written for parents), there continues to be very little international research on the NLD topic and very few articles about this ‘phenomenon’ in credible scientific journals. In fact, most of the research data has been generated by one man (Dr. Rourke) and his graduate students, and NLD tends to be a term used primarily in North America. The NLD ‘condition’ is not recognized by the American Psychiatric Association nor is included in the Diagnostic and Statistical Manual used by most professionals. These factors should make people cautious.

Nevertheless, Dr. Byron Rourke started conducting studies on children in the 1970s and during that time, he found that some of them displayed learning profiles that were significantly different than children who were diagnosed with a learning disability in reading, oral language, and other similar areas. Most of the work in learning disabilities (LD) at that time was focused on students who had trouble with word retrieval, vocabulary development, oral communication, decoding and comprehending words, etc. – primarily language-based skills requiring ‘verbal’ communication. So, instead of focusing his attention on the children with LD, Rourke was quite interested in learning more about children who had difficulties in the ‘non-verbal’ areas such as visual spatial understanding, motor skills, and social skills. As a result, he referred to these children as having a learning disability in non-verbal areas – hence the term ‘non-verbal learning disabilities’ (NLD).

Additional research done by Rourke and his students determined that many of the children he identified with NLD displayed higher scores on the Verbal Scale than the Performance Scale in the then and now commonly used Weschler intelligence tests. He also found that they displayed poor motor coordination and weak social skills, and, as they got older, they developed anxiety and other similar problems. However, he may have actually been working with two (or three) different groups of children:

  • those now more commonly recognized as having Asperger Syndrome or Pervasive Developmental Disorder – Not otherwise specified. (PDD-NOS)
  • those with undiagnosed Developmental Coordination Disorder

It is very possible that because of a lack of scientific knowledge about DCD and Asperger Syndrome (and PDD or PDD-NOS) in the 1970’s, all of these children may have been conveniently lumped together using the NLD term. One way or another, there remains a great deal of confusion about NLD amongst professionals – because there is no clear diagnositic criteria for the NLD ‘disorder’ and it is a term that is not officially recognized in current practices of the American Psychiatric Association (APA).

Nevertheless, after the Linguisystems book about NLD written by Sue Thompson (a speech language therapist) became popular, many people started to use the term as a diagnostic label even though there was no formal recognition of this condition. Unfortunately, DCD, Asperger Syndrome, or PDD, were also not very well-known in North America when Thompson’s book arrived on the shelves - in 1997 - and as such, many children may have been misdiagnosed as having NLD when they may actually have Asperger Syndrome, another form of Pervasive Developmental Disorder, or DCD. Indeed, when reading The Source for Non-Verbal Learning Disabilities, many of Thompson’s examples and case studies sound very strangely like children who have Asperger Syndrome or PDD-NOS.

Thankfully, with the advance of science and additional research in the last 30 years, skilled clinicians are now more able to discern differences between the three diagnostic categories. However, for many people who do not yet know about DCD, they may still have difficulty determining the exact differences between NLD and some of the other terms listed above.

Nevertheless, children with Asperger Syndrome, PDD, DCD, and what others refer to as NLD have some similarities but they are also very different. Those with keen skills in the area of observation, assessment, and diagnosis can determine the differences. For example, research has shown that most children with DCD, PDD, and Asperger Syndrome (and NLD?) all have problems performing motor skills efficiently, they have some difficulty with visual spatial tasks, and they have social delays. Over time they tend to develop emotional problems. Yet, there are differences between the various conditions. For example, the primary area of difficulty in a child with Asperger Syndrome (or other PDD spectrum disorder) is their social deficit – although motor problems are also evident, they are not the primary cause for concern. Children with PDD or Asperger Syndrome may be considered ‘odd’, 'quirky', or ‘unusual’. They often have difficulty with proper eye-to-eye gaze and they seem okay when playing alone. They may be off in their ‘own world’ and usually these children have very distinct and restricted pattern of interests. It is not uncommon for these children to have a previous diagnosis of “Sensory Integration Disorder”, “Sensory Integration Dysfunction”, “Sensory Processing Disorder”, or Sensory-Motor Problems”. They can become very anxious over time because they cannot make sense of the unwritten rules of social interactions, facial gestures, and other non-verbal information. Over time, they may become anxious and/or depressed because they do not understand how to connect with others and/or make meaning of various social situations. However, some people with PDD or Aspergers do not care to become involved in social settings and do not experience the frustration and sadness evident in others.

In contrast, children with DCD have motor problems as their primary difficulty. Although they want to perform physical skills like their peers, they cannot learn or perform motor tasks as easily as others. As a result of not being able to perform the skills, they withdraw and this often leads to social isolation. However, these children usually display very good eye-contact (except when they are so ashamed and embarrassed that they cannot perform certain skills), they desperately want to be part of a social group, they do not have ‘narrow and restricted’ areas of interest, and they are not referred to as ‘odd’, ‘different’, or ‘unique’. Over time they also develop feelings of anxiety and depression because they feel left out, miss social contact with their peers, and don’t understand why they can not learn and perform physical skills the same way as their peers. Other professionals such as OTs, PTs, and SLPs may refer to these children as having “dyspraxia”, “apraxia”, “gross and/or fine motor difficulties”, “motor planning problems”, “difficulty with motor memory”,”perceptual-motor dysfunction”, “clumsy child syndrome” etc. However, the official name remains DCD. (Unfortunately, some of these children may also be incorrectly identified with 'sensory issues' but not as commonly as the child with PDD or Aspergers syndrome.)

In summary, I am still not convinced that NLD is a distinct entity. And, while I can understand and explain differences between Aspergers, PDD, and DCD, I cannot tell you how NLD varies from Asperger Syndrome, and/or PDD-NOS. That is because I still have not found a resource that describes the differences succinctly and in a way that I can easily figure out!

Next, a more detailed description explaining why alternative terms such as the ‘out of sync’ child, and/or sensory integration or sensory-processing disorder may be used to describe children with similar problems as those with DCD.

First of all, speech-language, occupational, and/or physio therapists (SLP or SLT, OT, and PT) are in a very privileged position because they get to see and interact with children who are very young. These professionals typically spend time with youngsters who are having some type of difficulty in the development of speech, motor, or social skills.

Unfortunately, because of professional restrictions, SLPs, OTs, and PTs are not permitted to make an ‘official’ diagnosis that falls within the guidelines of the APA’s Diagnostic and Statistical Manual (DSM). Yet, as a result of parents wanting to know what their child’s difficulty is, and these professionals recognizing that something is distinctly different about the child they are working with, new terminology seems to have developed over the years.

For example, dyspraxia, sensory integration dysfunction, non-verbal learning disabilities, the out-of-sync child, and other such ‘unofficial’ phrases are commonly used. This creates confusion amongst clinicians who use ‘formal’ terms such as those identified in the DSM. Furthermore, parents may have difficulty finding resources which use this terminology – especially from different disciplines -- because few exist.

Historically, children were given the diagnosis of Sensory Processing or Sensory Integration Disorder/Dysfunction by practitioners who were trained using theoretical perspectives developed by Jean Ayres. However, as with NLD, these were (and still are) not currently considered official ‘conditions’; nor are they recognized by the American Psychiatric Association or the World Health Organization. Even though there is no 'official' diagnostic criteria outlined that one must meet before being ‘out of sync’, or having sensory processing or sensory integration dysfunction – many children still receive this identification. This means that medical doctors, psychologists, and psychiatrists do not always know what is meant by another clinician when a child arrives at their office with such a diagnosis. The parents may become confused because they have been told their child has it, but the doctors don't know what to do with this diagnosis – so they may dismiss the preliminary findings and start the investigative process all over again.

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If you have other questions you would like Dr. Kamps to answer, please contact her. If the questions come up frequently, they will be added to this list of Frequently Asked Questions.

 

 

 

  "KAMPS: Kids Actively Making Progress in Sports, School, and Socialization Skills"

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Contact Information:

Dr. Kamps is located in Calgary, Alberta, Canada.

Phone: 403.217.5749

E-mail:drkamps@telusplanet.net