Making sense of the many challenges facing children with DCD

Besides having poor coordination, children with DCD often have a host of seemingly unrelated other learning and behavioral issues that impact on their daily lives at home and at school. This means that parents often face the daunting task of making sense of the sometimes conflicting information and recommendations contained in the assessment reports compiled by different professional.   

There are two conditions that commonly co-occur with DCD, anxiety and generalized joint hypermobility; both have a direct impact on motor control and learning.  Understanding how attention and emotion regulation difficulties associated with having a highly cautious/fearful (anxious) temperament impact on motor control and  learning,  as well as the impact of generalized joint hypermobility (when it is present) on motor control, strength and fitness allows parents to make sense of the many and varied challenges faced by children with DCD.  

Understanding the interaction and links between DCD, a fearful/highly cautious nature and generalized join hypermobility not only allows parents to make sense of  their child’s difficulties and but also helps them to create opportunities for learning new skills, training fitness levels and helping the child achieve his/her full potential.  

DCD is a motor learning condition which responds to specific training 

Focus on DCD.jpeg.jpgDCD is a specific motor learning disorder that is characterized by difficulties learning new motor skills from experience. These difficulties appear to be related to the way in which the brain creates and uses internal models. Children with DCD are able to learn new motor skills when provided with the right training. 

DCD is diagnosed when a child has difficulties with coordination difficulties that are severe enough to interfere with everyday home and school function.  In addition it is useful to confirm the diagnosis of DCD by a standardized assessment  such as the Movement ABC. Children who score at or below the 5th percentile have DCD. 

Children with a score between the 6th and 15th percentile may have DCD,  but many are do not have a specific motor learning difficulty  but rather have motor delay related to poor attention and emotion regulation which has impacted on their learning new skills. 

DCD may co-occur with a number of other specific learning difficulties, each of which have their own particular brain signature, including specific language disorder, dyslexia and ADHD.  These are separate conditions with different underlying brain mechanisms. They may also be affected by attention and emotion regulation difficulties. 

Children with global developmental delay often have difficulties with learning and performing motor tasks. However, the underlying reason for poor motor performance is linked to the child’s general capacity for learning and is not caused by a specific failure to create internal models as is the case with DCD.  

Children with autism often also have motor learning and coordination difficulties, but the nature and underlying mechanisms that underpin the motor difficulties are linked to atypcial brain development that is particular to autism (Marko 2015). 

Joint hypermobility and motor difficulties

Focus on hypermobility copy_1.jpgChildren with DCD may have a co-occurring diagnosis of generalized joint hypermobility.  The increased laxity in the joints and muscles (often referred to as low muscle tone) means that the individual has to have additional muscle strength to provide good stability for posture and movement. However, joint hypermobility does not cause poor coordination or difficulties with learning new motor skills. Many young dancers and gymnasts have joint hypermobility and also have excellent coordination.

The question then arises:  why do many children with joint hypermobility have difficulties with motor coordination?   The answer is related to the important finding that most individual with hypermobility also have a very cautious/fearful temperament, often with related attention and emotion regulation difficulties which may have a profound impact on learning new skills.

How emotion regulation, attention and executive functions support learning

roan 5y eagg and spoon_1.jpgLearning any new skill requires an ability to focus, shift  and sustain attention in a flexible manner,  stay on task for an extended period of time, persist in the face of failure, adapt performance in response to errors and recognize whether the goal has been successfully achieved.

This means that a child’s capacity for emotion regulation, skilled deployment of attention, tolerance of errors, working memory, and persistence has a strong influence on whether they learn new tasks easily or whether they give up and respond to challenge with avoidance and negative behaviors (Diamond 2013).

A cautious/fearful temperament, attention and emotion regulation

Behavioral inhibition is a specific temperament trait characterized by cautious, restrained and even fearful responses to unfamiliar people, objects and situations, as well as any task they perceive as being difficult (performance anxiety). 

Inhibited children have a very active fear system. The regions of the brain (amygdala and insula) that assess signals from within the body (such as body sensations),and information from the environment for the presence of potential threat or danger, are unusually alert and reactive. Things that are new, unfamiliar, different or difficult are interpreted as being threatening or dangerous. This creates a fear response and activates the individual's defensive (fight) or avoidance (flee or freeze) behaviors. .

Very inhibited children (high BI) display difficult behaviors that range from negative hyper-arousal and poor emotional regulation to fearfulness coupled with avoidance of certain tasks, meltdowns and tantrums, a fear of making errors, a perfectionist tendency, strong responses to certain sensory events and separation anxiety.

Interestingly inhibited children are also more prone to allergies which may impact on behavior. Allergic rhinitis may cause sleep apnea which leads to a range of behavior difficulties including  poor concentration, aggressiveness, hyperactivity and daytime sleepiness.

More information about BI and motor learning: BI, anxious temperament and physical therapy

BI or Sensory Processing Disorder?  

Many children with movement difficulties also have a diagnosis of SPD.  If you look at any list of symptoms of SPD you will notice the overlap with behaviors that are linked to having cautious/fearful temperament along with poor attention and emotion regulation abilities.

A therapist that provides an SPD diagnosis will implement a sensory based intervention program, which often involves many months of therapy sessions.

On the other hand, using the BI, emotion regulation and attention framework, suggests a range of cognitive behavioral approaches to helping the child develop better regulation. In addition a the BI, emotion regulation, attention framework highlights to way in which training fitness, along with goal directed task training and mindfulness training can play a role in developing better coping strategies.

Importantly all these strategies for improving behavior regulation can, and indeed should, be implemented by parents and teachers.

Importantly, Gillian Ferguson’s research using Neuromotor Task Training for groups of children over a period of just 8 weeks improved not only motor coordination, but also fitness levels and had an impact on classroom behavior (Ferguson et al 2013)  (Follow Gillian’s research on DCD on her Research Gate page)

Read more, including references:  Sensory processing disorder or BI and an anxious temperament? 

How you can help their child with DCD

Parents play a vital role in helping their children to overcome the challenges they face and ensuring that they achieve their full potential.  

1 Learn how to coach your child 

Children with DCD can learn new skills but need additional training. Parents play a crucial role in providing their DCD child with the opportunities for improving their skills.  

Parents need to acquire the coaching skills for promoting optimal learning. Read more 

2 Help your child to develop good emotion and attention regulation skills

A child’s capacity for learning can be improved by paying attention to developing the emotion regulation and attention skills needed not only for learning but also for navigating the many challenges the child faces in his or her everyday and school life.

Parents play a crucial role in helping their child with DCD to learn to regulate his/her  emotional responses to challenging situations and in training the important attention regulation skills needed for good function and participation.

3 Fitness training is important

Fitness levels impact on a child’s cognitive performance at school, as well as their ability to fully participate in playground and sporting activities. Strength and flexibility training are particularly important for children who have co-occurring generalized joint hypermobility.

Fitness training, when it is tied to achieving goals and taking on challenges, also plays a role in improving a child’s capacity for the emotion regulation and attention control, essential skills for managing behavior and optimal learning. 

There is mounting evidence that goal directed training of different types improves performance on tasks that were not practiced in training sessions. This transfer is thought to happen because children improve their ability to use attention for planning, predicting and anticipating their actions (Farhat et al 2015). (Go here for a list of the latest research on intervention for DCD)

SfA Fitness and Coordination Training Guide
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Selected Bibliography

Diamond, A. (2013). Executive Functions. Annual Review of Psychology, 64, 135–168. http://doi.org/10.1146/annurev-psych-113011-143750

Farhat F, Hsairi I, Baati H, Smits-Engelsman BC, Masmoudi K, Mchirgui R, Triki C, Moalla W. The effect of a motor skills training program in the improvement of practiced and non-practiced tasks performance in children with developmental coordination disorder (DCD). Hum Mov Sci. 2016 Apr;46:10-22. doi:
10.1016/j.humov.2015.12.001. Epub 2015 Dec 17. PubMed PMID: 26703915.

Ferguson, G. D., Jelsma, D., Jelsma, J., & Smits-Engelsman, B. C. M. (2013). The efficacy of two task-orientated interventions for children with Developmental Coordination Disorder: Neuromotor Task Training and Nintendo Wii Fit Training. Research in Developmental Disabilities, 34(9), 2449–61. doi:10.1016/j.ridd.2013.05.007

Marko, M. K., Crocetti, D., Hulst, T., Donchin, O., Shadmehr, R., & Mostofsky, S. H. (2015). Behavioural and neural basis of anomalous motor learning in children with autism. Brain, 138(3), 784–797. http://doi.org/10.1093/brain/awu394