Pediatric care for children with developmental coordination disorder, can we do better?

Abstract

This paper adopts a method of narrative critical review based on a non-systematic search of the literature to provide insights into the trends of developmental coordination disorder (DCD) treatment and to point out some future alternative approaches to prevent secondary health implications in children with DCD. The cause of DCD is unknown, but evidence suggests that these children have atypical brain structure and function. Interventions to help children cope with their activity limitations are effective in improving motor competence and motor skill related fitness in the short term. Although activity-orientated interventions can improve motor outcomes in children with DCD, high quality intervention trials and evaluation of long-term effects are urgently needed. Importantly, motor coordination problems associated with DCD extend to exercise-related activities leading to reduced participation in play and sports, which causes secondary problems in muscular fitness and body composition. Hence, treatment goals should not be limited to the improvement of motor skills (in ADL), but should also focus on health-related quality of life. We therefore propose when noticing motor problems in a child, already before enrolling but also during intervention, to explore ways to adapt everyday physical activities to optimally match the child's skill level. Hence, such activities will not only train the skills and improve physical fitness but will lead to positive engagement, thereby preventing the child from opting out of active play and sports. This provides the child with chances for exercise-dependent learning and will also positively impact social-emotional well-being.

Keywords: Assessment; DCD; Intervention; Neurodevelopment disorders; Physical fitness; Review.

Fig. 1

Multi-component model of motor skill development and performance – adapted from Wilson et al., 2017 [13].

Fig. 2

Vicious circle of DCD - The solid black lines depict the primary problems and their consequences; the dotted lines represent the secondary problems. Apart from the motor difficulties (black text), children with DCD may also experience social-emotional and psychological consequences (orange text). The impairments in motor coordination, postural control and balance, executive functioning and visuospatial memory result in difficulties with gross and fine motor skills needed for participation. Due to their clumsiness, children with DCD will be less accepted by peers, which may lead to exclusion, teasing and even bullying, potentially causing participation avoidance or withdrawal. Once children move less, they will have less opportunities for learning skills and their motor impairments, ADL difficulties and feelings of exclusion will become more pronounced. Additionally, they may develop secondary problems due to lack of movement, such as decreased muscular fitness, bone mineral density and could even develop exercise deficit disorder and/or dynapenia. Along these additional motor problems, their psychological well-being can be affected, amplifying the negative effects on movement.

Fig. 3

Flowchart for the diagnosis of DCD using DSM-5 criteria – adapted from Smits-Engelsman et al., 2015 [47].

Fig. 4

Treatment process with potential steps to be taken by the treating therapist.