“Clumsy Child Syndrome”

50% of ADHD kids have Developmental Coordination Disorder(DCD)

Is your child awkward in movements, using a knife and fork, ball catching, cutting out, and colouring between the lines?

Physical Characteristics

1. The child may appear clumsy or awkward in
   their movements. S/he may bump into, spill, or knock
   things over.
2. The child may experience difficulty with gross motor
   skills (whole-body), fine motor skills (using hands), or
   both.
3. The child may be delayed developing specific motor
   skills such as tricycle or bike riding, ball catching,
   handling a knife and fork, doing up buttons, and printing.
4. The child may show a discrepancy between their motor abilities and abilities
   in other areas. For example, intellectual and language skills may be quite strong while
   motor skills are delayed.
5. The child may have difficulty learning new motor skills. Once learned, specific motor
   skills may be performed exceptionally well, while others may continue to be performed poorly.
6. The child may have more difficulty with activities that require constant changes in
   their body position or adaptation to changes in the environment (e.g., baseball, tennis
   or jumping rope).
7. The child may find activities that require the coordinated use of both sides of the body
   difficult (e.g., cutting with scissors, stride jumps, swinging a bat, or handling a hockey
   stick)
8. The child may exhibit poor balance and may avoid activities which require balance.
9. The child may have difficulty with printing or handwriting. This skill involves continually interpreting feedback about the movements of the hand while planning new movements and is a challenging task for most children with DCD.

Emotional/Behavioural Characteristics

1. The child may appear to be uninterested in or avoid particular activities, especially
   those which require a physical response. Motor skills are challenging for a child with DCD and require more effort. Repeated failure may cause the child to avoid
   participating in motor tasks.
2. The child may experience secondary emotional problems such as low frustration
   tolerance, decreased self-esteem, and lack of motivation due to problems coping with
   activities which are required in all aspects of their life.
3. The child may avoid socialising with peers, particularly on the playground. Some
   children will seek out younger children to play with, while others will go off independently.
   This may be due to decreased self-confidence or avoidance of physical activities.
4. The child may seem dissatisfied with their performance (e.g., erases written work,
   complains of performance in motor activities, shows frustration with work product).
5. The child may be resistant to changes in their routine or the environment. If the
   child has to expend a lot of effort to plan a task, then even a tiny change in how it is performed may present a significant problem. Common for parents or teachers to be told that a child will “grow out” of this
   

Other Common Characteristics

1. The child may have difficulty balancing the need for speed with the need for accuracy.
   For example, handwriting may be very neat but extremely slow.
2. The child may have difficulty with academic subjects such as mathematics, spelling, or
   written language, which require handwriting to be accurate and organised on the page.
3. The child may have difficulty with activities of daily living (e.g., dressing, using a
   knife and fork, folding clothes, tying shoelaces, doing up buttons and zippers, etc.).
4. The child may have difficulty completing work within a standard time frame. Since
   tasks require much more effort, children may be more willing to be distracted and may
   become frustrated with a task that should be straightforward.
   © Cheryl Missiuna, 2003; CanChild, Centre for Childhood Disability Research 6
5. The child may have general difficulties organising their desk, locker, homework, or
   even the space on a page.

If a child exhibits any of the above characteristics and if these problems interfere with the child’s ability to participate successfully at home, at school or on the
playground, it is essential to have the child seen by a family doctor or paediatrician.
The paediatrician may then refer the child to an occupational therapist.
It is not uncommon for parents or teachers to be told that a child will “grow out” of this
disorder (Fox & Lent, 1996; Polatajko, 1999). However, studies have shown quite
conclusively that most children do not outgrow these problems. While children learn
to perform specific motor tasks well, they will continue to have difficulty with new, age-appropriate ones. Further, they are more likely to demonstrate academic problems, poor
social competence, low self-esteem, and less likely to be physically fit or participate
voluntarily in motor activities (see Missiuna, 1999 for a review of these studies).

The Role of the Teacher and Parent
Many small modifications can make life easier for a child with DCD. Here
are a few ideas that may be useful; an occupational therapist may have additional
suggestions.
At Home

1. Encourage the child to participate in games and sports that are interesting to them
   and provide practice in, and exposure to, motor activities. Physical activity and
   enjoyment should be emphasised rather than proficiency or competition.
2. Try to introduce the child to new sports activities or a new playground individually before s/he is required to manage the activity in a group. Try to review any rules
   and routines associated with the activity (e.g., baseball rules, soccer plays) when the child is not concentrating on the motor aspects. Ask the child simple
   questions to ensure comprehension (e.g., “What do you do when you hit the ball?”).
   Private lessons may be helpful at specific points in time to teach the child-specific skills.
3. The child may prefer and perform better at individual sports (e.g.,
   swimming, running, bicycling, skiing) rather than team sports. If this is the case, then try
   to encourage the child to interact with peers through other activities that are likely to be
   successful (e.g., cubs, music, drama, or art).
4. Encourage the child to wear clothing to school that is easy to get on and off. For
   example, sweat pants, sweatshirts, t-shirts, leggings, sweaters, and Velcro shoes. When
   possible, use Velcro closures instead of buttons, snaps or shoelaces. Teach the child how
   to manage complicated fasteners when you have more time and patience (e.g., on the
   weekend or over the summer) rather than when pressured to get out the door.
5. Encourage the child to participate in practical activities that will help improve their

ability to plan and organize motor tasks. For example, setting the table, making lunch, or
organizing a knapsack. Ask questions that help the child focus on the sequence of steps
(e.g., “What do you need to do first?”). Recognize that, if your child is becoming
frustrated, it may be time to help or to give specific guidance and direction.

6. Recognize and reinforce the child’s strengths. Many children with DCD demonstrate
   strong abilities in other areas such as: advanced reading skills, creative imaginations,
   sensitivity to the needs of others, and/or strong oral communication skills.

At School
Teachers and parents can work together to ensure that the child with DCD experiences
success at school. Parents may find it helpful to meet with the teacher near the beginning
of the school year to discuss their child’s specific difficulties and to make suggestions
about strategies that have worked well. An Individualized Education Plan may be needed
for some children; however, the following modifications may be sufficient for others.
In the Classroom:

1. Ensure that the child is positioned properly to begin
   table work. Make sure that the child’s feet are flat on the
   floor, that the desk is at the appropriate height, and that
   forearms are comfortably supported on the desk.
2. Try to set realistic short-term goals. This will ensure
   that both the child and teacher continue to be motivated.
3. Try to provide the child with extra time to complete
   fine motor activities such as math, printing, writing a
   story, practical science tasks, and artwork. If speed is
   necessary, be willing to accept a less accurate product.
4. When copying is not the emphasis, try to provide the child with prepared worksheets
   that will allow him/her to focus on the task. For example, provide children with prepared
   math sheets, pages with questions already printed, or ‘fill in the blank’ for reading
   comprehension questions. For study purposes, photocopy notes written by another child.
5. Introduce computers as early as possible to reduce the amount of handwriting that will
   be required in higher grades. Although keyboarding may be difficult initially, it is a very
   beneficial skill and is one at which children with movement problems can become quite
   proficient.
6. Teach children specific handwriting strategies that encourage them to print or write
   letters in a consistent manner. Use thin magic markers or pencil grips if they seem to help
   the child improve pencil grasp or to reduce pencil pressure on the page.
   © Cheryl Missiuna, 2003; CanChild, Centre for Childhood Disability Research 9
7. Use paper that matches the child’s handwriting difficulties. For example:
   i) Widely spaced lines for a child who writes very large;
   ii) Raised, lined paper for a child who has trouble writing within the lines;
   iii) Graph paper for a child whose writing is too large or improperly spaced;
   iv) Graph paper with large squares for a child who has trouble keeping numbers
   aligned in mathematics.
8. Try to focus on the purpose of the lesson. If a creative story is the goal, then ignore
   messy handwriting, uneven spacing and multiple erasures. If the goal is to have the child
   learn to set up a math problem correctly, then allow time to do it even if the math
   problem does not get solved.
9. Consider using alternative methods of presentation in order for the child to
   demonstrate comprehension of a subject. For example, children may present a report
   orally, use drawings to illustrate their thoughts, type a story or report on the computer,
   record a story or exam on a tape recorder.
10. Consider allowing the child to use the computer for draft and final copies of reports,
    stories and other assignments. If the teacher wants to see the “non-edited” product, ask
    the child to submit both the draft and final versions.
11. When possible, allow the child to dictate stories, book reports, or answers to
    comprehension questions to the teacher, a volunteer or another child. For older children,
    voice recognition software can be introduced as soon as the child’s voice patterns have
    matured enough that they are consistent.
12. Provide additional time, and/or computer access, for tests and exams that require a
    lot of written output.
    In Physical Education:
13. Break down the gym activity into smaller parts while
    ensuring that each part is meaningful and achievable.
14. Try to choose activities that will ensure success for the
    child at least 50% of the time. Reward effort, not skill.
15. Try to incorporate activities which require a
    coordinated response from arms and/or legs (e.g.,
    skipping, bouncing and catching a large ball). Also
    encourage children to develop skills using their hands in a
    dominant/assistant fashion (e.g., using a baseball bat or a
    hockey stick).
    © Cheryl Missiuna, 2003; CanChild, Centre for Childhood Disability Research 10
16. Keep the environment as predictable as possible when teaching a new skill (e.g., place
    a ball on a T-ball stand). Introduce changes gradually after each part of the skill has been
    mastered.
17. Make participation, not competition, the major goals. With fitness and skill-building
    activities, encourage children to compete with themselves, not others.
18. Allow the child to take on a leadership role in gym activities (e.g., captain of the team,
    umpire). The child may develop organizational or managerial skills that are also useful.
19. Modify equipment to decrease the stress and risk of injury to children who are learning
    a new skill. For example, Nerf balls in graduated sizes can be used to develop catching
    and throwing skills.
20. When possible, provide hand-over-hand guidance to help the child get the feel of the
    movement. This can be done, for example, by asking the child to help the teacher
    demonstrate a new skill to the class. Also, talk aloud when teaching a new skill,
    describing each step clearly.
21. Focus on understanding the purpose and the rules of various sports or physical
    activities. When a child understands clearly what s/he needs to do, it is easier to plan the
    movement.
22. Give positive, encouraging feedback whenever possible. If providing instruction,
    describe the movement changes specifically (e.g., you need to lift your arms higher).