Is My Child Clumsy or Could it be Developmental Coordination Disorder?

I have to admit, I’m not the most coordinated person.  You may have noticed the same about yourself or your child.

The big question parents often ask me is whether their child is on the clumsy end or is there another explanation for it.

The biggest question to ask yourself is whether your child’s clumsiness is impacting their everyday life.  Is it making them a wallflower on the playground?  Is it making it difficult to make it through a meal without spilling or dropping something?  Is the child tripping frequently or bumping into things?

Partially because clumsiness has been the butt of so many jokes in media, its often not taken seriously.  The truth is that clumsiness doesn’t naturally improve and can have a really big impact on a child’s confidence and self-esteem.

Plus, therapy can help!  So if there’s a big problem impacting a child’s everyday life that is making them feel bad and we have the power to improve it, we can’t overlook it!

Let’s take a look at 2 different people with Developmental Coordination Disorder (DCD), how it impacts their lives, and then we can talk more about how to know when to seek help.

Meet Jane

Jane is a very warm and friendly seven-year-old girl diagnosed with developmental coordination disorder and dyspraxia. She has never had success with academic, gross motor or fine motor activities, and prefers to talk her way out of challenges. Talking she is good at, but only with adults. She has struggled to make and keep friends.

Jane started a PT program at Kid PT and after two months of participating in a program working on her visual-motor and rhythmic movement skills, her mom reported that not only was she moving better, but she was having so much more success socially.. Mom said, “I can imagine that if you can’t keep up with the kids on the playground, that’s going to affect your confidence playing with the other kids.”

Mom’s observation was so true and impacts so many children everyday. Our innate sense of rhythm runs in the background of everything we do. It affects how we interact with others and how we multitask emptying a backpack at school while saying hello to a friend while smiling and remembering everything you need for the day. The consistent and reliable rhythm of our brain and body supports all of these seemingly mundane tasks that can be overwhelming if you have to think about them every step of the way!

Meet Jimmy

After 17 years of struggling with his body to get through daily life, Jimmy came to Kid PT.

For years, Jimmy’s pediatrician told his mom that he would grow out of his clumsiness and to just keep him active. He played rec soccer and baseball, but he was always lagging behind and by the time he entered middle school he just gave up on sports altogether. He was a talented artist and loved video games, so he kept himself very busy with those activities.

Jimmy’s mental health was suffering though and he was struggling to get enough energy to get through each day. His mom had a friend that said to come to Kid PT and see if we could help.

During his evaluation, I identified many sensory and motor deficits that were greatly impacting all of his movement skills.   His vestibular function (inner ear) was impaired, particularly the vestibular ocular reflex, which keeps vision steady as we move through space. His vision was working too hard trying to make up for vestibular impairments, so his balance was decreased at night when vision couldn’t be relied on as much.

He also had postural asymmetries that he was likely relying on for years that were causing musculoskeletal issues, in addition to affecting body awareness. His movement system had never gone on autopilot. He had to focus so much on moving his body to get through his daily routines, that it was zapping up so much of his energy, leaving him fatigued and frustrated.

Understanding the building blocks of development of the movement system for a teen, who has only experienced failure with the practice, practice, practice approach, can change one’s perspective dramatically.

Instead of blaming yourself for not trying harder, you can own your challenges, empower your strengths, and begin to move forward. Awareness of his challenges didn’t change his body immediately, but it did change his perception of himself.

What is Developmental Coordination Disorder?

Children with Developmental Coordination Disorder (DCD) are not simply clumsy. DCD is a motor skills disorder that affects approximately five to six percent of all school-aged children. DCD has been described in many ways over the years, including dyspraxia, minimal brain dysfunction, and clumsy child syndrome. The medical community has chosen to use the term DCD as the preferred diagnostic term. DCD occurs when a delay in the development of motor skills, or difficulty coordinating movements, results in a child being unable to perform common everyday tasks. They often have difficulty keeping up with their peers during gross motor play, have frequent falls, and have a hard time doing daily skills, such as zipping and tying shoe laces.

The biggest challenge is often with learning a new movement-based skill, which is a challenge that is experienced throughout childhood. These children are often labeled as lazy (read more about how NOT lazy these kids are here!). They’re often told that if they would just try harder they could do it. In the past, it was often assumed that children would outgrow these challenges, but research has demonstrated that children with coordination problems do not simply outgrow these problems. In fact, these children are at greater risk for being sedentary and less healthy as adults than their peers. These children are also at greater risk for mental health problems. We cannot risk overlooking the struggles of these children. There is too much at risk for their futures!

Children with DCD are constant victims of imperfect practice. These children blend in with their peers well and are often not even diagnosed. Goal-oriented methods help with the practice component, but this is not enough. Life will constantly present new skills, so this creates a constant challenge, especially throughout childhood. In addition to working towards specific skills, we can work on developing a child’s building blocks of movement in order to also “teach the child how to fish.” Building the foundations of movement, rather than just teaching gross or fine motor splinter skills, improves the child’s learning abilities and decreases their reliance on others.

Children with DCD often have low tone, as well. Due to the low tone, it is generally assumed that these children are flexible everywhere. However, when you look closely at their core, the opposite is often discovered. Children with low tone typically don’t develop sufficient three-dimensional control in their core. Without the development of core control, asymmetries often remain and limit the development of core control. Often parents will tell us their kids will just randomly fall out of their seats in school (learn more about why here!).

Children with coordination disorders can vary in their vestibular responses. The vestibular system can be underactive, limiting the child’s ability to develop a strong sense of where they are in space, or the vestibular system can be oversensitive, leading to fear of movement. Low tone and hypermobility can lead to less information going from the joints and muscles (proprioception) and traveling to the brain to tell us where we are in space. Commonly, the visual system will work hard to make up for less teammates in the balance team.

Many children with coordination disorders will have difficulty getting their bodies stacked up with good alignment in order to turn their power on. These kids will often hold their bodies in an alignment that feeds into chest breathing, with their chest shifted up and their back appearing to be arched. This position and breathing pattern feeds into the child’s fight-or-flight system, or sympathetic nervous system, and gives them less ability to use their calming parasympathetic nervous system.

Children with coordination disorders struggle to put all of the pieces of their movement skills and sensory feedback together to be able to combine it with timing, sequencing, and multitasking. Being able to do this is demanded from a student, even in kindergarten! Because of this, beginning school is often the turning point for parents to seek out extra help for their child.

We move through daily life without consciously thinking about how we are moving our bodies. We can walk while daydreaming without bumping into a street sign, and we can sit in a chair without falling off while reading and writing. This may sound natural for many of us, but children with postural deficits use excessive energy, attention, and focus to fulfill all of the expectations they face each day. When our gears are synchronized, movement is automatic and children can focus on higher level skills, whether it is moving through the classroom without bumping into things or learning algebra. Filling in or strengthening these missing building blocks to develop a child’s sensory-motor system can build automaticity in order to multitask and to free the child up for higher cognitive skills. That’s where we can help!

Children with coordination disorders are often called lazy and told they’re not meeting their potential. People assume things will get better as the child gets older and that these are delays that will “catch up.” In the meantime, the child struggles with their self-worth, self-esteem, and mental health. As we said before, research supports that children do not grow out of these struggles, and that children with coordination challenges are typically more sedentary adults with increased risk of cardiovascular and mental health problems.

Supporting a child’s ability to learn the skills they need in daily life is important, but we cannot fall into the work harder and try harder pit, without also working towards long-lasting change. We can help these children fill in those missing and weakened foundational skills. There are so many ways we can help these children meet their personal potential and protect their mental health, all at the same time. They are working so hard, day in and day out- let’s acknowledge that, support their efforts, and improve their building blocks so that they are building their houses with the strongest foundation as can be.

Top 10 Tips for Parents of Children with DCD

1. Martial arts and swimming are individual sports that help improve body awareness, sensory processing, and balance. They are sensory rich and can be modified for individual differences.
2. Explore movement in fun, social, and noncompetitive ways, such as hiking, yoga, and creative movement.
3. Identify postural imbalances that may be limiting the development of core strength and learn ways to improve postural symmetry..
4. Provide supports for sitting if the child has difficulty sitting upright, such as a yoga wedge or a towel roll.
5. Encourage the development of timing using music and movement opportunities.
6. Adapt the environment for success. Some adaptations include picture schedules, written lists, and typing instead of writing.
7. Practice listening, looking, and moving at the same time. Play walking and looking games, such as “I spy,” while going for a walk.
8. Model the use of feedback during play. For example, if you throw a ball and it lands short of the basketball hoop, say “I threw it too soft.” Discuss what you could do differently, try it and discuss whether it was successful. Bring awareness to this process.
9. Backward chaining is a way to learn how to complete a task by working backwards from completion. The child first does the last step to complete the task. Next, they would try the last two steps. The child can build this until they are independent with the entire task.
10. Team up with a PT or OT specialist to work on the foundations of movement so that practice is more effective and successful!

Getting Help

If you see your child is working harder than other kids to get through their daily activities, don’t wait to look for help. You also don’t need an official diagnosis to get help. Reach out to us at KidPT and come in for a Discovery Visit. We will listen to your concerns, do a screening of your child and their movement skills, and help you make a plan. We’re here for you!

References

1. Zwicker JG, Suto M, Harris SR, Vlasakova N, Missiuna C. Developmental coordination disorder is more than a motor problem: children describe the impact of daily struggles on their quality of life. Brit J Occup Ther. 2017:030802261773504. 10.1177/0308022617735046.
2. Sugden, D A, Chambers, M, & Utley, A. Leeds Consensus Statement 2006.
3. Cousins M, Smyth MM. Developmental coordination impairments in adulthood. Hum Move Sci. 2003;22(4):433–459. doi: 10.1016/j.humov.2003.09.003.
4. Wilmut K, Du W, Barnett AL. Navigating through apertures: perceptual judgements and actions of children with developmental coordination disorder. Dev Sci. 2017:20(6). doi: 10.1111/desc.12462.
5. Missiuna C, Moll S, King G, Stewart D, Macdonald K. Life experiences of young adults who have coordination difficulties. Can J Occup Ther. 2008;75(3):157–166. doi: 10.1177/000841740807500307.
6. Fitzpatrick DA, Watkinson EJ. The lived experience of physical awkwardness: adults’ retrospective views. Adapt Phys Act Q. 2003;20(3):279–297. doi: 10.1123/apaq.20.3.279.
7. Lingam R, Jongmans MJ, Ellis M, Hunt LP, Golding J, Emond A. Mental health difficulties in children with developmental coordination disorder. Pediatrics. 2012;129: E882–91.
8. Hill EL, Brown D. Mood impairments in adults previously diagnosed with developmental coordination disorder. J Ment Health. 2013;22:334–40.
9. Harrowell I, Hollén L, Lingam R, Emond A. Mental health outcomes of developmental coordination disorder in late adolescence. Dev Med Child Neurol. 2017;59(9):973‐979. doi:10.1111/dmcn.13469.
10. Cairney J, Hay J, Veldhuizen S, et al. Trajectories of cardiorespiratory fitness in children with and without developmental coordination disorder: a longitudinal analysis. Brit J Sport Med. 2011;45:1196-1201. 406/mojsm.2018.02.00054.