Causes & Identification

How do coordination difficulties occur?

Movement difficulties can occur for many reasons and may take place at a number of different stages as a child takes in information and uses it to perform a motor task. Children are constantly receiving and using information from the environment. A child may have difficulty making sense of information received through their senses, using this information to choose a plan of action, organizing the specific motor movements of the task, sending the right message to produce a coordinated action, or combining all of these things in order to control the movement while it is happening. The result of any of these problems is the same: the child will appear clumsy and awkward and will have difficulty learning and performing new motor tasks.

Children with DCD have been shown to have difficulties controlling their posture and with their awareness of objects or their body in space. They appear to have difficulties planning movements (e.g sitting down on a chair or figuring out how to jump), with the timing and amount of force needed during movement (e.g., using too much or too little force to pick things up, being late reaching to catch a ball), and when combining information from their sensory and motor systems (e.g., needing to use a lot of visual information when climbing stairs or fastening buttons).

What causes DCD?

Although there are many theories, it is not yet possible to offer a clear answer about what causes DCD. As children with DCD can have associated difficulties in addition to their motor difficulties, it seems unlikely that a single factor will explain the coordination problems observed in this group of children. Most recently, researchers have suggested a possible link between the cerebellum and the challenges seen with DCD, as the cerebellum is critical for developing automatic movement control and the ongoing monitoring of movements, both of which are affected in DCD.

Motor milestones or motor skills: What is the difference?

While some children with DCD are mildly delayed in the normal development of motor milestones (rolling over, sitting unsupported, walking), most are not. Children with DCD first show significant motor delay when they are required to learn movements that involve coordination or skill. These activities vary from one culture to the next but all are skills that are learned from caregivers or other children.

Early indicators of difficulty can be seen as the child tries to manage a spoon, manipulate a toy, pedal a tricycle or scribble with a crayon. Self-care skills are always delayed. 

Children will have difficulty with simple tasks, such as:

• putting on and taking off clothing
  
• tying shoelaces
  
• managing zippers, buttons and snaps
  
• feeding themselves independently
  

What does DCD look like?

DCD may be suspected if the child:

• moves awkwardly
  
• seems clumsy or poorly coordinated
  
• frequently trips, or drops things
  
• prints or writes poorly, and with much effort
  
• has trouble with daily activities such as handling utensils, catching a ball, cutting with scissors, tying shoelaces
  
• avoids participation in physical or motor-based activities
  
• has difficulty learning and transferring new motor skills
  

Are children with DCD all the same?

Children with DCD make up what is called a 'heterogeneous' group, which means that they are not all alike. Children might differ in the degree of their difficulties (mild or severe), and in how much the disorder affects daily tasks (affecting nearly every activity to affecting only specific activities). They may have challenges in gross motor and postural functions or only in fine motor skills requiring eye-hand coordination. The degree of difficulty may also appear to vary depending on the environmental and task demands placed on the child in the early years. Finally, children with DCD also differ in the degree to which they display co-occurring conditions, including non-verbal learning disabilities, speech/articulation difficulties, and attention deficit disorder.

Why is it important to identify children with DCD when they are young?

DCD can have a negative affect on many aspects of a child's life. Children with movement difficulties that are significant enough to impact upon their functional daily living skills often exhibit a number of related behavioural difficulties. They may demonstrate negative or destructive behaviour or be overly dependent and passive. Research shows that children with DCD tend to withdraw from participation in physical and social activities, and this can be due to their poor motor performance or associated social and emotional difficulties. Children with DCD have been noted to lose physical fitness over time, and appear to be at risk for many of the factors associated with a sedentary lifestyle, including cardiovascular disease and obesity. Identifying DCD at an early age and developing appropriate management strategies can help to improve the physical, social, and emotional outcomes for children with DCD.

For additional information, see Children with Developmental Coordination Disorder: At Home, at school and in the community. 

How do children with DCD present in the classroom?

Nearly every school activity, especially in the early school years, is a motor activity. For children who have coordination difficulties, participation in all school-related activities that have a motor component requires tremendous effort and is often unsuccessful. In an environment that stresses learning through "doing", children with DCD fall short of their potential because they have coordination difficulties that impact their academic, social and physical development.

When children enter preschool, kindergarten or other structured settings, they usually struggle with pre-academic activities including colouring, and cutting and pasting. In the early school grades, they may have difficulty with printing, copying notes from the board. Gross motor skills such as learning to throw and catch a ball are equally problematic. Teachers may describe children with DCD as falling off their chairs in class, or not being able to sit up at circle time.

While the motor problems are usually evident in the classroom, it is usually the child's behavioural problems that become the main concern in the classroom. Disruptions in the classroom are common as children with DCD may knock things over, drop objects or bump into other children's desks. Clumsiness, in school lineups or walking between classes, can be irritating when it leads to stumbling into and tripping over children and objects in their path. Children with DCD frequently have organizational difficulties and initiating and completing tasks can be a major issue. Avoidance of written work can result in "behaviour" such as needing to sharpen the pencil multiple times, talking and asking questions, attention-seeking and interference with other children.

As with many other developmental disorders, boys with DCD are much more likely to be identified than girls in classroom settings, which may be due in part to the fact that boys are more likely to openly display their frustrations with poor performance at motor tasks and attract the attention of their teachers. In addition, our culture has stronger expectations that boys will participate in organized sports. Less attention may be given to a girl who chooses to avoid sporting activities.

Although the motor coordination difficulties of children with DCD are easy to observe in classroom and physical education settings, children with DCD are commonly not recognized until their difficulties begin to affect their schoolwork. Classroom and special education teachers are often the initial source of referral when they notice poor skill development interfering with overall academic performance. And while teachers do identify some children with DCD, many children with motor difficulties can go unnoticed, particularly when behavioural concerns are also present.

For more information, see They're Bright But Can't Write .