DCD Flashcards
what is the 4 criteria for diagnosis DCD?
Diagnostic Characteristics In DSM-5 (need all 4)
A. Learning and execution of coordinated motor skills is below age level given the child’s opportunity for skill learning
B. Motor difficulties significantly interfere with ADL’s, academic productivity, prevocational and vocational activities, leisure and play.
C. Onset is in the early developmental period.
D. Motor coordination difficulties are not better explained by intellectual delay, visual impairment, or other neurological conditions that affect movement
what are other terms that are used for DCD?
Clumsy child syndrome
Developmental clumsiness
Dyscoordination
Developmental apraxia or dyspraxia
Motor apraxia or dyspraxia
Sensory-Based Motor Disorder (SBMD)
Dyspraxia
Postural Disorders
what is the prevalence of DCD?
5 to 10 percent
About 2:1, boys:girls
More prevalent in very low birth weight, premature infants (<32 weeks)
what are the common co morbidities for DCD?
Comorbid condition:
Attention deficit hyperactivity disorder (~50%)
Learning disability
Speech/language impairments
Sensory differences
Autism Spectrum disorder (new with DSM-5)
what parts of the brain are affected in a child that has DCD?
Multiple brain areas implicated
Cerebellum, basal ganglia, parietal lobe, parts of frontal lobe
poor internal models- cerebellum
what is the best management for a child with DCD?
No medications have proven effective
Medical management includes rehab team examination and intervention, including Psychology, PT, OT, Speech, and some possible medical management for co-existing conditions like ADHD
what are the primary body function and structure impairments in a child with DCD?
Poor strength
Poor coordination and motor planning
Joint laxity
Poor visual perception
Poor or slower processing
Poor sequencing
Poor feedback and feedforward
what are the primary activity presentations for a child with DCD?
Awkward gait
Delayed or poor quality of motor skills
what are the primary participation limitations for a child with DCD?
Difficulties at school and home (takes more time, messy)
Longer term social emotional and fitness consequences
what are the 5 characteristics of DCD?
See the chart on slide 10
- communication issues
- social implications
- school challenges
- ADL limitations
- Gross motor skill delay
questions to consider
How would you describe DCD to a parent?
What do you think are gross motor tasks that may be most difficult for children with DCD?
What do you think may be a challenging task to learn for teens with DCD?
what is the prognosis or functional consequences for a child with DCD as they transition to being a teen or adult?
Don’t usually outgrow DCD, but learn to adapt
Poor fitness
Obesity
Decreased physical activity (encourage individual sports)
Poor self-esteem and self-worth
Emotional and behavioral problems
Impaired academic achievement
At risk for being bullied
Look over the CPG on slide 13
Look over the Algorithm on slide 14?
what movement observations should drive your examination for a child with DCD?
Observe a few basic tasks such as ball throwing/catching, going up and down stairs
Children with DCD present with a variety of co-morbidities and body structure and function impairments, so observation is important to hypothesize about other tests and measures to consider
what are the two specific DIAGNOSTIC test for DCD?
1) DCD-Q
parent reported questionnaire
ages 5-15 years
2) Movement Assessment Battery for children
Administered by clinicians
Ages 3-16 years
Describe some of the components of the DCD-Q?
Parent-report questionnaire
Considered screening of participation and ADL’s – Criteria B
15-item tool, 5-point scale
Includes children from 5-15
High sensitivity and specificity, and validity
what are the 15 items tested during the DCD-Q?
- Throw ball
- Catch ball
- Hit ball
- Jump over
- Run and stop
- Plan activity
- Writing speed
- Writing legibly
- Pencil pressure
- Cutting
- Team sports
- Learns skills
- Quick, competent with ADL’s
- Clumsy
- Fatigues easily
what is the gold standard test for a child with DCD?
Movement ABC
what are the components of the movement ABC?
3 age bands (8 items):
3-6 years
7-10 years
11-16 years
3 sections:
Manual Dexterity
Ball Skills
Static and Dynamic Balance
If a child scores in the 4th percentile are they suspect for DCD?
they would be probable for DCD
the cut offs:
Probable DCD: <5th percentile
Suspect for DCD: 5-15th percentile
what are the possible impairments that can be examined in a child with DCD?
Strength
Coordination/Balance
Joint laxity/flexibility
Posture
Timing and sequencing
Feedback and feedforward motor control
Cardiopulmonary fitness
what are some good approaches to interventions for a child with DCD mentioned in action statement #8 and #9
Task/Activity-oriented approaches plus Body function/structure interventions – most effective
Individual PT for children < 5-6 years
Individual or Group therapy >6 years based on ability to attend and follow directions.
What do Task-Oriented interventions have in common?
Task/Activity-oriented
Goal-directed
Motor-learning and motor planning strategies
Feedback
Self-assessment of movements
what are the motor learning concepts for task-oriented training for a person with DCD?
Enhance Expectancies
Autonomy
External focus of attention
Motor learning principles such as parts practice then whole practice, multiple reps, variable environments, increase task demand, etc.
what would “I think you can do ____,” “You did it in __ seconds last time, I think you can do it un under that next time.” be an example of?
enhance expectations
what would “I wonder what would happen if you might try _____,” or “Here’s a tip I would suggest,” rather than “Do it this way.”
autonomy
what is the “Do you think it would work to make the jumprope loop smaller?,” rather than, “hold you’re elbows closer to your body.” be an example of?
external focus of attention
what are some interventions and home suggestions for body structure and function from action statements #8 and #11?
Trunk strengthening exercises
Endurance exercises
Coordination exercises
Some positive evidence for taekwondo
For Home – Encourage individual sports or team sports with skilled coach
Based off of action statement 12 what is the appropriate dosage for a child?
high frequency practice scheduled for 2-5 times per week. Usually takes an average of 9 weeks depending on the complexity of the goal.
what are the possible school needs a child with DCD might need?
Children with DCD may qualify for a 504 plan or an IEP
They may need:
More time to complete assignments
Less handwriting and more keyboard
More time for testing
Auditory or visual recording of stories or papers
Adapted PE or modifications/adaptations to PE
Assistance with organizational issues
School counseling
Key take away: what are the four criteria for the diagnosis of DCD?
Diagnostic Characteristics In DSM-5 (need all 4)
A. Learning and execution of coordinated motor skills is below age level given the child’s opportunity for skill learning
B. Motor difficulties significantly interfere with ADL’s, academic productivity, prevocational and vocational activities, leisure and play.
C. Onset is in the early developmental period.
D. Motor coordination difficulties are not better explained by intellectual delay, visual impairment, or other neurological conditions that affect movement
Key take away: what are the 2 common tools used with a child with DCD?
DCD-Q and MABC-2
Key take away: Combine task-oriented and body function/structure interventions for increased effectiveness
key take away: what can you use to guide your interventions
Use observational movement analysis to guide interventions
Key takeaway: Motor learning and motor planning principles are key!
