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Motor Skills Disorder: Differential Diagnoses & Workup

Author: Anna Maria Wilms Floet, MD, Assistant Professor, Assistant Professor of Pediatrics, Department of Pediatrics, Behavior and Developmental, University of Maryland School of Medicine
Coauthor(s): J Martin Maldonado-Durán, MD, Principal Investigator for Child and Family Center, Department of Psychiatry, Child and Adolescent Division, Family Service and Guidance Center; Jill Glinka, OTR, Occupational Therapist; Sari Lubin, OT, Occupational Therapist, Shoam Hospital, Israel
Contributor Information and Disclosures

Updated: Dec 12, 2006

Differential Diagnoses

Learning Disorder: Written Expression
Pervasive Developmental Disorder

Other Problems to Be Considered

Cerebral palsy
Muscular dystrophy
Congenital hypotonia
Progressive metabolic disorders
Ataxia
Visual disorder
Diffuse CNS storage disease or slow virus infection

Workup

Laboratory Studies

  • No specific laboratory tests for motor skills disorder exist.
  • Comorbid conditions, such as high levels of lead, anemia, and iron deficiency, should be ruled out.

Imaging Studies

  • Because the condition is not a specific neurologic disorder per se, no imaging studies are typically used in children with motor clumsiness difficulties.

Other Tests

  • Several approaches are available to assess children with clumsy motor behavior, as listed below. Some of the assessment approaches are directly linked to proposed treatments or interventions; these are discussed in Treatment.
  • Normative functional skills approach.
    • The normative functional skills approach draws from traditional developmental theory, and remains the cornerstone of motor assessment.
    • Assessment is descriptive and concerned with acquisition of fundamental motor and functional skills, as referenced against age norms.
    • The most commonly used tests of motor impairment are the Movement Assessment Battery for Children (MABC) and the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP).
      • The MABC is the most commonly used tool for screening of DCD in research. The MABC is designed to yield a general index of motor impairment. It has 2 parts: a performance test that is designed to be administered individually and that requires the child to perform a series of motor tasks in a standard way, and a checklist that is designed to be completed by an adult familiar with the child's day-to-day motor functioning. The performance part covers manual dexterity, ball skills, and static and dynamic balance. The checklist addresses progressively complex interactions between the child and the physical environment. The MABC provides norms for children aged 4-12 years. It has good psychometric properties.
      • The BOTMP is the most commonly diagnostic instrument therapists use. The BOTMP generates a general motor ability factor. It is divided into 8 subsections, including the ability to run and general agility, how well the child can maintain balance, and coordination of bilateral movements. It is also used to assess the strength of movement, coordination, speed and dexterity of upper limbs, the speed of response, and visual motor control. The BOTMP provides norms for children and adolescents aged 4.5-14.5 years. It has good psychometric properties.
  • General abilities approach
    • The general abilities approach is based on the assumption that sensori-integrative and sensorimotor functions provide the platform for later motor and intellectual development.
    • The most commonly used test is the Sensory Integration and Praxis Tests (SIPT).
  • Neurodevelopmental theory
    • The neurodevelopmental examination includes general examination, neurologic examination, and assessment that focuses on subtle deficits in neural functioning.
    • Several batteries have been designed, examples including the Touwen test for children with MND and the Physical and Neurological Examination for Soft Signs (PANESS).
    • Normative data are lacking for these tests at this time. Advances in neuroimaging and functional imaging may possibly provide insights into hard signs of neural dysfunction.
  • Dynamical systems approach
    • This approach is based on the dynamical systems theory, describing the dynamics between perception and movement. It uses biomechanical or kinematic analysis of movement.
    • The importance of assessing contextual factors that contribute to or limit skill acquisition is emphasized.
  • Cognitive neuroscience approach
    • The cognitive neuroscientific approach provides a framework that accounts for the development of motor skills in terms of brain-behavior interactions.
    • Several hypotheses have been generated by using this framework. For example, the focus on deficits for children with DCD in an internal model of an intended but uninitiated movement (in motor control terms motor imagery) could explain the difficulties that some children with DCD have performing tasks that require accurate body-scaled (mental) transformations (eg, remembering modeled movements).
    • Neuroanatomic pathways involved in this include those in the parietal lobe and premotor cortex.
    • Other hypotheses involving the cognitive neuroscientific framework include motor timing, linking deficits of time perception, and sequential tapping to possible deficits in the cerebellum.

Histologic Findings

No specific histologic patterns exist for these conditions.

More on Motor Skills Disorder

Overview: Motor Skills Disorder
Differential Diagnoses & Workup: Motor Skills Disorder
Treatment & Medication: Motor Skills Disorder
Follow-up: Motor Skills Disorder
References
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Further Reading

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Keywords

motor skills disorder, developmental coordination disorder, DSM IV, developmental motor coordination disorder, motor clumsiness, clumsy child syndrome, developmental dyspraxia, specific developmental disorder of motor function, ICD 10, clumsiness, dyscoordination disorder, motor dyspraxia, minimal cerebral palsy, developmental coordination disorder, DCD

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Contributor Information and Disclosures

Author

Anna Maria Wilms Floet, MD, Assistant Professor, Assistant Professor of Pediatrics, Department of Pediatrics, Behavior and Developmental, University of Maryland School of Medicine
Anna Maria Wilms Floet, MD is a member of the following medical societies: American Academy of Pediatrics and Society for Developmental and Behavioral Pediatrics
Disclosure: Nothing to disclose.

Coauthor(s)

J Martin Maldonado-Durán, MD, Principal Investigator for Child and Family Center, Department of Psychiatry, Child and Adolescent Division, Family Service and Guidance Center
J Martin Maldonado-Durán, MD is a member of the following medical societies: Kansas Medical Society
Disclosure: Nothing to disclose.

Jill Glinka, OTR, Occupational Therapist
Disclosure: Nothing to disclose.

Sari Lubin, OT, Occupational Therapist, Shoam Hospital, Israel
Disclosure: Nothing to disclose.

Medical Editor

Chet Johnson, MD, Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center
Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Division Chair of Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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