Developmental Coordination Disorder – often associated with ADHD and Autism Spectrum Disorder.
Developmental Coordination Disorder (DCD) is a common motor skills disorder which affects the fine and gross motor skills coordination and motor planning of a child. This has impacts on both academic and social development of a child.
DCD often coexists with other neurodevelopmental conditions such as Austism Spectrum disorder and Attention Deficit Hyperactivity Disorder (ADHD). There is also a higher risk in babies and kids who were prematurely born or had a low birth weight.
Signs and symptoms:
- Reduced fine and gross motor skills
- Difficulties with handwriting
- Difficulties with daily age appropriate activities such as lacing shoes, buttoning up shirts and feeding themselves.
- Poor organisation and scheduling, preferring their own personal space
In the Podiatry world we may see this through reduced coordination, being more clumsy and tripping more frequently than appropriate for their age, having low muscle tone, having a delay in gross motor skills and development and difficulty with sports, hypermobility (fatigue with walking/running and increased ankle sprains and pain). A little patient may present saying “I can only run so far before I get tired and I have to sit out of the game with my friends.”
How common is this?
GDD is traditionally thought to impact more boys than girls with an Australian study in 2009 finding 8% of kids at age 8 have this condition (Goyen and Liu). There is an accepted prevalence of 5-6% of school aged children.
Long term effects of DCD:
- may have higher risk of obesity – due to reduced physical activity and ability to participate in sports with their peers
- Increased risk of mental health difficulties (Harrowell et al.2017) with higher levels of self reports anxiety and depression into adulthood (Kirby et al. 2013)
We find that motor difficulties carry on into adulthood as kids pick activities, hobbies and careers that don’t require large gross motor skills.
How is DCD diagnosed?
Using standardised motor assessments by the childs Paediatrician or Paediatric Physiotherapist. Whilst it is not the role of a Podiatrist to diagnose DCD, it is our role to work with other health professionals in identidying, flagging and referring to appropriate health professionals. We also have a really important role in a childs allied health care team with treatment intervention, monitoring and educating patients and families.
Who is commonly in the Health care team of a child with DCD?
- Paediatrician
- Occupation therapist
- GP
- Psychologist
- Physiotherapist
- Podiatrist – children with DCD often present to us with concerns of tripping, clumsiness, flat feet and fatigue. We can assess this through a visual gait assessment and analysis, muscle strength testing, balance tests, range of motion studies, hypermobility testing and through a thorough subjective history taking with both child and parent(s).
The main differences are noticed during the gait or walking assessment with temporospatial parameters – differences in walking stride length, running stride length, walking speed, stride time. The 6 minute walk test is a good objective measure designed to assess muscular endurance. Your child may be asked to walk a particular distance for a total of 6 minutes. This has been shown to be a reliable and valid measure in typically developing children as well as children with various conditions such as cerebral palsy and muscular dystrophy.
Possible Podiatry intervention for children with DCD:
- Podiatry intervention is benficial for kids with DCD
- More evidence to suggest focusing on acctivity and participation improves quality of life for these children
- Importance of determining the childs goals and creating treatment plans to meet these. What does this child actually want to do and achieve?
- Planning, execution and reflection is important when teaching a motor skill (not just practicing it).
3 step process for learning a new motor skill:
- Planning – chat about what’s it’s involved? Plan out how. Riding a bike
- Execute it – do it!
- Reflection How did it go?
- Multidisciplinary team involvement is key
There is, unfortunately, limited Podiatry specific evidence for specific interventions however we know through clinical experience that we can provide additional stability and motion control with footwear and orthotics. If a child has a flat foot with hypermobilty then we can help improve cadence and double support time during gait/walking. There is also some evidence for strength and balance training.
Early intervention is critical as support will become more difficult to access once older. Early intervention is critical.
If you have any questions or wish to have one of our Podiatrists join your child’s allied health team please get in touch with us today.