Saidala 24: Developmental co-ordination disorder (dyspraxia) in children

Introduction

Developmental Coordination Disorder (DCD), commonly referred to as dyspraxia, is a neurodevelopmental condition that primarily affects motor coordination, planning, and execution of voluntary actions. Children with DCD have difficulties with fine and gross motor skills that cannot be explained by intellectual disability, neurological disease, or medical conditions such as cerebral palsy.

DCD interferes with activities of daily living (ADLs), school performance, and social integration. It is a lifelong condition, often persisting into adolescence and adulthood, though symptoms may change with age.

Epidemiology

Prevalence: 5–6% of school-aged children; 2% severely affected.
More common in boys than girls (ratio ~2:1).
Frequently co-occurs with:
- ADHD (30–50%)
- Dyslexia and specific learning disorders
- Autism spectrum disorder
- Speech and language impairments
Children with DCD are at higher risk of developing secondary emotional, behavioral, and social difficulties.

Etiology and Pathophysiology

The exact cause is unknown, but research highlights:

Neurological Differences
- Dysfunction in brain areas responsible for motor planning and coordination, especially the cerebellum, basal ganglia, and parietal lobes.
- Impaired integration between sensory input (visual, proprioceptive, tactile) and motor output.
Genetic and Familial Influences
- Familial clustering suggests a heritable component.
Perinatal Factors
- Prematurity, low birth weight, and perinatal hypoxia increase risk.

Clinical Features in Children

Symptoms typically emerge between ages 4 and 7, when motor tasks are expected to be mastered.

1. Motor Symptoms

Delayed motor milestones (sitting, crawling, walking).
Clumsiness: frequent tripping, bumping into objects.
Difficulty with ball skills (throwing, catching, kicking).
Poor balance and posture.
Trouble riding a bicycle, swimming, or using playground equipment.

2. Fine Motor and Daily Living Skills

Poor handwriting (illegible, slow, uneven letter spacing).
Difficulty using cutlery, scissors, or buttons.
Challenges in tying shoelaces, dressing, and grooming.
Messy eating due to poor utensil control.

3. Cognitive and Executive Functions

Problems sequencing multi-step tasks.
Difficulty with organization (packing school bag, following routines).
Poor time management.
Memory and attention challenges (especially if co-occurring ADHD).

4. Social and Emotional Aspects

Low self-esteem due to repeated failures in physical tasks.
Anxiety in sports or physical education classes.
Risk of bullying or social exclusion.
Reluctance to try new activities.

Diagnosis

1. DSM-5 Criteria

Motor skill deficits significantly below expected age level.
Difficulties interfere with daily living, academics, or leisure.
Onset in early developmental period.
Not explained by intellectual disability or neurological disorder.

2. Assessment Tools

Movement Assessment Battery for Children (MABC-2): Standardized motor assessment.
Developmental Coordination Disorder Questionnaire (DCDQ): Parent-report screening tool.
Bruininks–Oseretsky Test of Motor Proficiency (BOT-2).
Observation of functional skills at school and home.

3. Multidisciplinary Evaluation

Pediatrician, occupational therapist, physiotherapist, and psychologist involved.
Rule out cerebral palsy, muscular dystrophy, or global developmental delay.

Management

There is no cure for DCD, but early recognition and intervention improve outcomes. Treatment is multidisciplinary and individualized.

1. Occupational Therapy (OT)

Core treatment for improving daily living skills.
Task-specific practice: handwriting, dressing, eating skills.
Compensatory strategies (Velcro shoes instead of laces, adapted cutlery).

2. Physiotherapy

Improves gross motor coordination, strength, balance, and endurance.
Exercises tailored to child’s needs (jumping, hopping, ball skills).
Hydrotherapy may help children who struggle with land-based activities.

3. Educational Support

School accommodations:
- Extra time for handwriting and exams.
- Use of laptops/tablets for writing tasks.
- Seating close to teacher for better supervision.
Physical education (PE) adapted to reduce frustration.
Collaboration between teachers, parents, and therapists.

4. Speech and Language Therapy

For children with verbal dyspraxia (difficulty planning and coordinating speech movements).
Focus on articulation, phonological awareness, and communication strategies.

5. Cognitive and Behavioral Approaches

Cognitive Orientation to daily Occupational Performance (CO-OP): Problem-solving approach that teaches children strategies to achieve goals.
Behavioral therapy to address frustration and emotional issues.

6. Psychosocial Support

Counseling to address low self-esteem and anxiety.
Social skills groups to improve peer interaction.

7. Pharmacological Management

No medication directly treats DCD.
Pharmacological therapy may be used for comorbid conditions (e.g., ADHD, anxiety).
- Methylphenidate hydrochloride: 18–72 mg/day for ADHD.
- Atomoxetine hydrochloride: 40–100 mg/day for ADHD.
- Sertraline: 25–200 mg/day for anxiety or depression.

Prognosis

DCD persists into adolescence and adulthood in 50–70% of children.
Children may develop compensatory strategies but continue to experience difficulties with motor tasks, organization, and planning.
Early intervention improves long-term outcomes.
Without support, children are at increased risk of:
- Academic underachievement.
- Social isolation and bullying.
- Secondary anxiety, depression, or low self-esteem.

Future Directions

Research into neuroimaging to identify biomarkers of DCD.
Digital and VR-based therapies for motor training.
Increased integration of AI-driven educational tools to support handwriting and organizational skills.
Stronger public health focus on early screening in preschool and school systems.

Saidala 24

الصفحات

Saturday, August 16, 2025

Developmental co-ordination disorder (dyspraxia) in children