Frequently Asked Questions
Developmental Coordination Disorder is a name that is used to describe children who are average to above average in intelligence but who have difficulty learning motor skills.
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.
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).
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.
If your child is managing basic tasks at home and school then you have probably modified the expectations of a task already. However, when the child is withdrawing socially or complaining that they cannot keep up with the demands at school, then you should have this checked out. There are specific accommodations that can and should be made for your child at school.
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, they are usually able to learn many fundamental motor skills. In addition, with modifications and accommodations in the classroom, it is possible that the impact of their motor difficulty is lessened significantly.
Yes, a tremendous amount of research has been conducted on DCD since the 1970's. More in the last twenty years, but the studies have been conducted all over the entire world. A sample of countries that have contributed to the scientific knowledge base include: The Netherlands, England, France, Italy, Finland, Sweden, Brazil, Japan, Singapore, Australia, Canada, Norway, USA, Belgium, Ireland, Nigeria, New Zealand, Wales, Germany, Norway, South Africa…
Unfortunately, although this is described in the DSM-IV-TR (a manual that doctors, psychiatrists and chartered 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 they haven't been trained to investigate functioning in the motor domain, they usually don't assess for difficulties in this area, and hence do not make diagnosis in this area either.
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 skills and allows for practice. Dr. Kamps offers a small group gross motor program that utilizes these exact principles. Students and parents have found that it is effective.
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 work!
Over time, research has shown that the motor difficulties impact self confidence and emotional stability. These children tend to become very anxious and if not treated before they become teenagers, children with DCD may start to display signs of depression.
So, in short, motor learning difficulties that are not caught and treated at an early age, can affect social functioning, academic achievement, emotional well-being and internalizing behaviours. 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.
In short, the answer is ‘probably’ but they are not all the same.
In an upcoming book on DCD, I explain 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 books written for parents), there continues to be very little solid research and very few articles about this topic in credible scientific journals.
Most of the research data has been generated by one man and his graduate students, and it is strangely a North American phenomenon. That alone should make people cautious.
In addition, there remains a great deal of confusion about NLD amongst professionals. There may be two different explanations for this situation.
The first description suggests that NLD may actually refer to two totally different types of children – each of which originally present as having motor and social difficulties, as well as problems with visual-spatial reasoning. However, because of a lack of knowledge about DCD and Asperger’s syndrome at that time, they were conveniently lumped together using the NLD term.
The second explanation reveals that because of certain restrictions, some professionals may be using words and phrases to describe observable conditions in young children. However, the descriptive language that these professionals use is not the ‘same’ as the diagnostic terminology used by medical doctors, psychiatrists, and chartered psychologists. Hence, major confusion among health care practitioners!
When Dr. Byron Rourke started conducting studies on children in the 1970s, 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 on 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.
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 also displayed poor skills in 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 different groups of children:
Nevertheless, after the Linguisystems book about NLD written by Sue Thompson (a speech language therapist) became popular, many other people started to use the NLD term as a diagnostic label without truly knowing differences between different psychiatric conditions. As a matter of fact, when reading The Source on Non-Verbal Learning Disabilities, many of Thompson’s examples and case studies sound very strangely like children who have Asperger’s syndrome rather than this distinct disorder known as NLD.
However, Asperger’s syndrome was not well known in North America when the Thompson book arrived on the shelves - in 1997 - and as such, many children may have been misdiagnosed as having NLD when they really have Asperger’s syndrome.
On the other hand, many of the children Rourke worked with may have had DCD rather than Asperger’s syndrome. Yet because of commonalities in the testing profiles of children with DCD and/or Asperger’s syndrome, they were ‘lumped’ into one large group of learners who were labelled as having NLD. (In a similar way, the colours ’teal’ and ‘turquoise’ are very different - but both could be lumped into a ‘green-blue’ colour spectrum.)
With the advance of science and additional research in the last 40 years, skilled clinicians are now more able to discern differences between the two diagnostic categories. However, it is difficult to find people who can tell the differences between NLD and some of the other terms listed above.
Speech-language-, occupational-, and/or physio- therapists (SLP or SLT, OT, and PT) are in a very advantageous position because they get to see and interact with children who are very young. These professionals typically spend time with children 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 Diagnostic and Statistical Manual (DSM-IV or DSM-IV-TR). 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 dysfuntion, non-verbal learning disabilities, the out-of-sync child, and other such ‘unoffical’ phrases are commonly used. This creates confusion amongst clinicians who use ‘formal’ terms such as those identified in the DSM-IV-TR. First of all, parents have a very hard time finding resources because there are very few available which use the ‘unofficial’ terminology, and later on when these parents approach their medical practitioner with someone else’s results, the doctor may not know what the previous therapist meant – and tend to dismiss it. In addition, for some clinicians who are not entirely certain about a diagnosis, they may use all-inclusive terms such as NLD because it encompasses many areas of difficulty (motor, social, and visual-spatial reasoning).
Nevertheless, children with Asperger’s syndrome, DCD, and what others refer to as NLD have many 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 children with DCD 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 social-emotional problems. Yet, there are differences. (Other than the similarities between these three conditions, I cannot tell you the differences between NLD and DCD and Asperger’s because I still have not figured that out!)
Furthermore, I am still not convinced that NLD is a distinct entity. However, differences between children with Asperger’s syndrome and DCD are very clear. For example, the primary area of difficulty in a child with Asperger’s syndrome is their social deficit – although motor problems are also evident, they are not the primary cause for concern. Children with Asperger’s syndrome are often considered ‘odd’ or ‘unusual’. They often have difficulty with proper eye-to-eye gaze, and they seem to be okay about being or playing alone. They tend to be off in their own little world and they usually 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” 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 interpersonal relationships.
In contrast, children with DCD have motor problems as their primary difficulty. Although they want to perform skills like their peers, they cannot learn or perform motor tasks as easily as others. They then withdraw and this often leads to social isolation. However, these children display very good eye-contact, 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 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”, etc. In short, however, the official name remains DCD.
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.
March 3, 2006
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