DCD: from child to adulthood Dyscovery Centre copyright 2009/10 Professor Amanda Kirby Not to be copied without permission
Fig. 1: Concerns typically noted by parents of children with developmental coordination disorder at different ages
Missiuna, C. et al. CMAJ 2006;175:471
Signs and Symptoms
3 years Parents often report “something different” • Frequent tripping when running • Difficulty sitting at table & chair • Unable to hop on one foot • Fist grip of crayon • Poor spoon feeding
4 years • Unable to throw ball with direction • Unable to catch 12” ball • Not exploring playground equipment • Not alternating steps on descent of stairs • Can’t do up zips • Can’t cut along a line
5 years • • • • •
Can’t jump from 2 foot height Unable to catch a tennis ball Can’t walk along a line Can’t draw a stick person Needs help with dressing
6 years • Fearful and/or avoids active play • Inaccurate throw & catch • Cannot skip • Awkward/tense pencil grasp • Poor legibility/speed of handwriting • Avoids fine motor tasks e.g. crafts, creative
7 years • Limits participation in sports/extra curricular activities • Trouble with written work • Cannot ride a bike • Messy eater - can’t cut meat • Cannot tie shoes • Self care tasks- cleaning teeth/wiping bottom still difficult
8 years • Dislikes sports & active recreation • Can’t keep up with written work • Gap between verbal & written work is obvious • Limited social engagement • Aware of difficulties
9 years • Academic grades are impacted by written work • Social isolation • Decreased fitness level/weight gain • Frustration with writing/homework • Victimisation/bullying
Secondary or associated features Social and emotional implications Skinner and Piek ( 2001) 58 ( 8-10 yrs) and 51 ( 12-14 yrs) with matched controls ◦ Decreased self worth, self perception ◦ Increased stait/trait anxiety ◦ Perceived social support worse in both groups
Self perception ◦ 8-10 years- less scholastic, physical appearance ◦ 12-14 – social, athletic and physical appearance
Pla y ing
toys
Putti n
tying
r idin
that
r...
Penc il t
ask s
s
g
ns
Sci s sor
Bike
Butto
cks o n
lace
g so
Shoe
b.. .
ler y
essin g
g cut
Toil e ting/ wi pin g
Usin
Undr
Dres s ing
90 80 70 60 50 40 30 20 10 0 Under 10 years
10 years and over
10-12 years • • • •
Writing at speed Self organisation Organisation of work Still slow getting dressed/shoes etc • Social interaction with peers- emotional mismatch • Mathematics associated
73% 15-17 years continued to have difficulties ( small sample- n=15)
◦ (Losse et al (1991) 10 year follow up study)
65% Finnish 17 year olds remained having some difficulties especially in visual motor integration ◦ (Cantell et al' study,1998)
50%- 17 year olds still had difficulties ◦ ( Van Dellen and Gueuze,1988)
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Cantell et al (1994) noted in their study that: “these adolescents were functioning at a developmentally younger age level than their age peers. In an earlier phase of this study the parents had reported that the children with DCD were immature in their behaviour. This tendency might protect the adolescents from comparing themselves with their age group, and to take less responsibility for their own actions, but also to make them vulnerable when it comes to societal expectations related to young adults� pp 427 18
“I opened a bank account five years ago and last week I wanted to withdraw the money. They told me that it is not my signature. They asked me to try and sign again and again and asked me lots of questions.
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Social overlap • “He really lacks friendship, he has been very lonely since this group from secondary school dropped him, he hasn’t got a special friend”. Another parent reflected on the teen years as being “…lonely. He eventually got a group of friends about third year of secondary and they found his sense of humour good and he was just so delighted to get friends and that lasted about two years, maybe two and a half years and then they dropped him which was difficult. He was made fun of a bit.” •
“he
probably spends a great deal more time with us and that’s the time that his friends’ contemporaries will be out with their friends.”
Evidence in children with DCD : ◦ Lower general self concept-Skinner and Piek, 2001 ◦ Stigmatisation ( Segal et al, 2002) ◦ Internalisation (Sigurdsson et al, 2002)
◦ Therefore less social practice
21
Separation from parents may be later than peers ď‚— Individuation may be later as less peer-peer interaction ď‚—
22
Interaction
Parental support
Peer interaction
0 years
10 years
Typically developing Individual
18 years
20 years
DCD 23
Affects people’s way of doing things: ACTIVITY as well as their PARTICIPATION
The conceptual framework adopted by the ICF. From the International Classification of Functioning, Disability and .Health (WHO, 2001, p. 18). Copyright 2001 by the World Health Organization
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What difficulties with emerging adults with DCD have? • Less self care issues unless under time pressure • Writing neatly when having to write fast • Writing as fast as your peers • Reading your own writing • Others find it difficult to read your writing • Copying things down without making mistakes • Organizing /finding your things in your room • Finding your way around new buildings or places
bu m p/ kn oc k kn s e lf ife c wr an a re ite d s n co e a po py r a on lo i ng nd se th fa of in s le av or g gs d t a e ow be nis n in hi nd g r pa po oo m ck se in ss g io a s u ns fo ld itca in se g c du lo th e al ta s pl an sk in ni g n lo g ss ah ea of d at te nt io n
DCD
TD
• Bumping into things, spill or break things • Slower than others at getting up in the morning and getting to work or college • Avoiding hobbies that require good coordination • Choosing to spend leisure time more on own than with others • Avoiding team games/sports
• If doing a sport, is it more likely to be on your own, e.g. going to a gym, than with others • Tending to avoid going to clubs/dancing • Difficulties with packing a suitcase to go away • Difficulties with folding clothes to put them away neatly • Difficulties with money management • Difficulty performing two things at the same time (e.g., driving and listening)? • Difficulties with planning ahead • Losing attention in certain situations
Adult- DCD • Small movements with accuracy and at speed • Time and timing • Spatial awareness - knocking into things and people • Social integration - being aware of social rules • Organisational difficulties • Handwriting difficulties • Driving difficulties • Orientation in a new place
Different Strengths • “empathy he has got with people… his social skills are stunning for his age”.
“his personality, his openness, his honesty, his total utter integrity and honesty.”