When paying attention is a problem

By Dr Rassie Erasmus

Attention Deficit Hyperactivity Disorder (ADHD) is a highly co-morbid condition that affects about 2-7% of school aged children, with a male: female ratio from 2:1 to 7:1. Although there may be improvement in the long term, problems with coordinated movements continue through to adolescence in 50-70% of children.

What it means
Developmental Coordination Disorder (DCD) is a condition characterised by impairment in the development of motor skills and coordination. Poor motor proficiency interferes with an individual’s daily living and has a significant impact on self-care skills, school life and sports.

For good or for granted
Motor coordination involves the effective relationship between mental and physical processes, most of which are taken for granted when children develop without a problem in this context. It takes impressive coordination between muscular development and strength to result in functional fine motor skills. A harmony between nerve and muscle mean coordinated, rapid movements that can only exist when there are no hindrances between motor planning and sensory integration.

Causes
Environmental and genetic factors can contribute to poor development in motor functioning. Premature birth, problems during pregnancy, the consumption of alcohol and/or use of drugs will escalate the risk of motor coordination problems in that child.

Diagnostic criteria
It’s important to seek medical guidance on treatment best suited to the specifics of the patient. A patient’s unique challenges are analysed according to:

  • Motor skills substantially below the norm of the individual’s age (in the context of their opportunities based on home and school life)
  • Interference of motor skills level on daily activities (regarding productivity, leisure and play)
  • The age at which symptoms began, and
  • Where motor skills deficit can’t be attributed to intellectual disability, visual impairment, or neurological conditions that affect movement (for example cerebral palsy, muscular dystrophy, degenerative disorders)

At present, our understanding of motor development is still in its infancy, with a variety of theories being proposed.

Characteristics
Children who show any or all behaviours including a repeated failure of particular activities (which are avoided going forward), lack of motivation, decreased willingness to socialise with peers and dissatisfaction with their own ability to perform.

Treatment
So far, there have been two major approaches to intervention, under different labels, but often referred to as either process-orientated or task-orientated approaches.

Process-orientated treatment is directed by occupational therapists or physiotherapists, and includes such methods as sensory integration therapy. The aim is to pinpoint the underlying process in which the child has not developed appropriately, as required for successful performance and acquisition of motor skills.

A task-orientated approach comprises a range of methods with the approach based on the interaction between the child’s resources, the task to be learnt and the context in which it is set.

Meta-analysis of the different approaches shows the task-orientated approach as more successful.

Conclusion.
DCD has wide ranging effects on a child’s ability to physically perform sufficiently and successfully on a daily basis but it also has a major effect on motivation, self-esteem and confidence.  With the necessary support and guidance most of these children will improve and be able to structure their environment in ways they can achieve and prosper.

PHZA/CONC/0117/0005c

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