eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics
Motor Skills Disorder: Treatment & Medication
Updated: Dec 12, 2006
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
No single type of treatment can be applied to all children with motor coordination disorder, nor is 1 treatment successful with all. Existing evidence does not permit the conclusion that 1 of the methods described below is generally or uniformly better than the others.
Clinicians typically attempt to (1) ascertain problem areas for a given child in a comprehensive fashion and (2) then design an intervention to promote optimal adaptive functioning or the acquisition of skills that are underdeveloped or affected or the amelioration of coordination difficulties. Several studies focused on the efficacy of therapeutic interventions and even involved comparisons of different methods. In general, these studies showed that the interventions described are helpful and that parents were satisfied with the results. However, no conclusive evidence indicates that 1 technique is better than the others.
Indeed, this research field is complex because of the different problems in each child and because of the issues of comorbidity, motivation, associated emotional difficulties, and adherence to treatment (particularly with practice sessions at home). The factors make comparisons between patients and treatments weaker than if all children had the same problem and received the same intervention. Even the issue of intervention is unclear because therapists may think they are using solely 1 method, but they may unwittingly introduce elements of further or different therapeutic interventions.
Two general approaches are used to treat motor coordination problems in children. One approach is a modular approach (top-down approach), and the other is a more global or generalized approach (bottom-up approach).
The first approach, the modular or top-down approach, attempts to remedy or improve the specific difficulty (or difficulties) with specific techniques aimed at improving the motor challenge that is observed (eg, difficulty with handwriting, catching a ball, performing fine motor tasks with fingers). This approach usually involves gradually targeting certain problem behaviors and implementing step-by-step interventions to teach the skill and to practice it. This method tends to prevent failure and rewards the child, at least in the beginning.
This approach lends itself to implementation by schoolteachers because of its circumscribed nature, for example. One of its core elements is practice (eg, prescribed practice of new skills and small steps toward mastery of the skill with success at every small increment). Examples of this general tendency are therapies such as the cognitive motor approach with task orientation or the task-oriented approaches with motor learning.
The second approach is a relatively global or generalized one that is also described as a bottom-up approach. It is based on the theoretical assumption that the motor skills problem is just a manifestation of some underlying mechanism, eg, sensory integration problems or insufficient or inaccurate kinesthetic perceptions. In this method, the therapist does not initially address the observable motor challenge. Rather, the expert focuses on how children manage their bodies, process stimulation (sensory information), and deal with problems. The expectation is that the improved sensory-motor functioning becomes generalized and eventually improves the motor skills. As children become comfortable with their bodies, they gain control of their motor (and other) functions.
Examples of this school of thought are the kinesthetic training approach, sensorimotor integration therapy, or sensory integration therapy. As with many other forms of intervention and therapy, evidence of the efficacy of these methods is limited, particularly over the long term or regarding the end result.
Cognitive motor intervention
Cognitive motor intervention consists of delineating a plan to teach movement patterns or skills to children who have a challenge in that particular task or set of tasks, for example, similar to those in the Movement ABC Manual. Therapists design a set of exercises that children practice with the assistance of the parents until the task is learned gradually or mastered. Emphasis is on motor performance and also emotional, motivational, and cognitive aspects. The trend is toward solving motor deficits. Children are taught how to plan a motor act, how to execute it, and how to evaluate the quality of the result. Motivation of the patient is essential because building self-confidence and positive reinforcement are important aspects.
Motor problems are selected, and new skills are taught 1 at a time, gradually building skills. The ability acquired in 1 context is expected to generalize to other contexts. For example, this could be used for teaching handwriting, catching balls, or increasing speed of movement. Other objectives could be teaching the child to throw a ball overhand and to kick, bounce, and catch a ball. Following the piagetian theory of learning, the therapist hopes to create a schema that children can use later in different situations.
Feedback is important at each step. Concrete, positive reinforcers are gradually de-emphasized and substituted with emotional reinforcers, eg, the satisfaction of learning new things. One of the advantages of this method is a measurable goal; therefore, obtaining objective feedback about the development of new concrete skills is possible.
Sensory integration therapy
Occupational therapists and physical therapists widely use sensory integration in the treatment of children with certain difficulties that interfere with consistent, coordinated, and effective motor function. Sensory integration therapy addresses the underlying difficulties many clumsy children have with regulating, processing, and/or integrating sensory input. Accurate, coordinated, and functional motor responses are based on well-modulated, selective, and consistent information from both internal and external sources, which the brain then adequately integrates. Treatment involves specific input for the particular child and the facilitation of desired adaptive responses. Examples of internal senses are those of posture, proprioception, and awareness of position of the body in general and of limbs and body parts in particular (ie, vestibular input).
External stimuli that may facilitate or hinder performance may include auditory stimuli, lighting and visual stimulation, tactile sensations, and others. Children who are excessively affected by such stimulation (who are, therefore, hypersensitive) are helped to cope with increasing amounts of stimulation, and the environment is modified to provide an acceptable level of sensory input. By contrast, in children who are hyposensitive, the amount of stimulation is gradually increased. In all cases, signs of excessive or inappropriate stimulation are monitored. Also, techniques to help the children self-modulate and self-regulate are useful. Examples are time without stimulation with relaxation and brief periods of isolation to recuperate a state of calmness.
This therapy is effective but not necessarily better than other methods. Sensory integration approaches also provide for a variety of techniques that can be incorporated into the home and classroom to promote improved adaptive function. Examples are methods to provide the extra proprioceptive input that a particular child may seek and need, such as carrying book crates during transitions, holding heavy doors, and chair pushups. The general idea is that improved sensory integration will lead to more modulated motor responses, better perception of the movements, and improved coordination of fine and gross motor patterns.
Kinesthetic training
Kinesthetic training relies on the studies on kinesthetic development in children by Laszlo and Bairstow (1985). It deals with improving the kinesthetic sensitivity in children to improve motor control. The intent is to improve perceptual-motor dysfunction. Although popular, the approach has generated controversies about success the authors have claimed. This method tries to generate improvement in the overall functioning of children in terms of perception of motion, but it does not focus on teaching them specific skills, as other methods do. Therefore, the theory behind this training is that when general awareness of motion in space is improved, the motor skills also improve as a secondary effect.
Neurodevelopmental treatment
Karl and Bertha Bobath, 2 physical therapists in England, described the neurodevelopmental treatment approach beginning in the 1940s. The basic principles of treatment involve inhibition of primitive (persisting) reflexes and abnormal motor coordination patterns. At the same time, it promotes higher-level reactions and normal muscular tone and movement patterns. Therefore, these authors emphasize detailed evaluation of the patterns of development observed in the small child, diagnosing the child's developmental level, and designing a strategy to restore development to as normal a level as possible and to improve skills as much as possible.
Craniosacral therapy
Osteopathic physician John E. Upledger devised the technique of craniosacral therapy. Trained therapists from a variety of professional backgrounds use highly sensitive palpatory skills to address imbalances in the craniosacral system. The treatment is reported to be successful mostly in children who have the most compromised motor skills, who have some spasticity or hypertonia, and who have an abundance of health problems including motor coordination difficulties.
Visual training
Visual training is an approach some optometrists or trained occupational therapists use to address specific difficulties with oculomotor function. Some visually related difficulties or difficulties with visual-motor integration interfere with coordinated motor skill performance and equilibrium. The American Academy of Pediatrics has officially deemed this visual training of eye movements as ineffective and unacceptable.
Assistive technology
In addition to various therapies, assistive technology is used to develop adaptive methods to enhance the function of children with motor difficulties. These modifications include things as simple as special pencil grips (making the pencil easier for the child to grasp) to the use of voice computers for those with writing difficulties.
Surgical Care
No surgical procedures exist to be used in these conditions.
Consultations
- Evaluation by an occupational therapist with experience in assessing all aspects of motor functioning and sensory integration abilities is useful in characterizing the problem. An occupational therapist can also assist in developing an intervention strategy.
- A physical therapist with experience in evaluating children can help to design beneficial programs for children with coordination problems.
- In cases of comorbid learning disabilities, consultation with a specialist in psychoeducational testing (a psychologist or a teacher with this training) can assist in designing a treatment strategy.
- Problems with attention span and hyperactivity are often associated with motor skills problems, as well as difficulties in behavior and self-esteem. If these interfere with the child's academic performance, motivation, or attitude toward learning, consultation with a mental health professional is indicated.
Diet
No special diet is recommended for children with motor skills disorders, nor has any diet been described to improve the motor functioning of children.
Activity
By definition, activities and motor functioning are essential for the treatment of these children. See Medical Care. Of importance, besides the treatment occupational therapists or motor rehabilitation specialists offer, parents and other caregivers can provide considerable help for children at home with specifically designed games and activities that could assist in improving the child's motor functioning and self-esteem.
Medication
No medications are specifically designed to improve motor functioning, coordination, or related conditions. Propranolol, like other beta-blockers, has been used to treat intense essential tremor, which sometimes is an associated condition in children with coordination problems. Medications are used to treat associated conditions, such as attention deficit disorder. Medical approaches to attentional problems are described in a separate article (see Comorbidities).
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 |
| « Previous Page | Next Page » |
References
APA. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC:. American Psychiatric Association;1994.
Adolph KE. Learning in the development of infant locomotion. Monogr Soc Res Child Dev. 1997;62(3):I-VI, 1-158. [Medline].
Ayres J. Sensory integration and the child. Los Angeles, Calif:. Western Psychological Services;1979.
Barnhart RC, Davenport MJ, Epps SB, Nordquist VM. Developmental coordination disorder. Phys Ther. Aug 2003;83(8):722-31. [Medline].
Bax M, Hart H, Jenkins SM. Developmental disorders. In: Child Development, Child Health. Blackwell Scientific;. 1990;106-48, 229-68.
Bax M, Goldstein M, Rosenbaum P, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. Aug 2005;47(8):571-6. [Medline].
Baxter P. CP or not CP?. Dev Med Child Neurol. Aug 2005;47(8):507. [Medline].
Blondis TA. Motor disorders and attention-deficit/hyperactivity disorder. Pediatr Clin North Am. Oct 1999;46(5):899-913, vi-vii. [Medline].
Bradley NS. Developmental aspects of motor control in skill acquisition. In: Campbell S, ed. Physical Therapy for Children: A Comprehensive Reference for Pediatric Practice. Philadelphia, Pa: WB Saunders;. 1994: 39-77.
Bruininks RH. Bruininks-Oseretsky Test of Motor Proficiency. Circle Pines, Mn: American Guidance Service;. 1978.
Cantell MH, Ahonen TP, Smyth MM. Clumsiness in adolescence: educational, motor and social outcomes of motor delay detected at 5 years. Adapt Phys Act Q. 1994;11:115-29.
Cermak SA, Ward EA, Ward LM. The relationship between articulation disorders and motor coordination in children. Am J Occup Ther. Aug 1986;40(8):546-50. [Medline].
Denckla MB. Revised Neurological Examination for Subtle Signs (1985). Psychopharmacol Bull. 1985;21(4):773-800. [Medline].
Egan D. The miniature toys test. In: Developmental Examination of Infants and Preschool Children. Clinics in Developmental Medicine. Blackwell Scientific;. 1990;112:75-82.
Fox AM, Lent B. Clumsy children. Primer on developmental coordination disorder. Can Fam Physician. Oct 1996;42:1965-71. [Medline].
Gillberg C, Kadesj B. Why bother about clumsiness? The implications of having Developmental Coordination Disorder. Neural Plasticity. 2003;10:59-68. [Medline].
Hadders-Algra M. The neuronal group selection theory: a framework to explain variation in normal motor development. Dev Med Child Neurol. Aug 2000;42(8):566-72. [Medline].
Henderson L, Rose P, Henderson S. Reaction time and movement time in children with a developmental coordination disorder. J Child Psychol Psychiatry. Jul 1992;33(5):895-905. [Medline].
Henderson SE. The assessment of "clumsy" children, old and new approaches. J Child Psychol Psychiatry. 1987;28:511-527. [Medline].
Henderson SE, Sugden DA. Movement assessment battery for children. London, England:. Psychological;1992.
Henderson SE, Henderson L. Toward an understanding of developmental coordination disorder: terminological and diagnostic issues. Neural Plast. 2003;10(1-2):1-13. [Medline].
Jacobson RD. Approach to the child with weakness or clumsiness. Pediatr Clin North Am. Feb 1998;45(1):145-68. [Medline].
Kadesjo B, Gillberg C. Attention deficits and clumsiness in Swedish 7-year-old children. Dev Med Child Neurol. Dec 1998;40(12):796-804. [Medline].
Landgren M, Kjellman B, Gillberg C. Attention deficit disorder with developmental coordination disorders. Arch Dis Child. Sep 1998;79(3):207-12. [Medline].
Landsown R. Clumsy children. In: Richman N, Landsown R, eds. Problems of Preschool Children. New York: John Wiley and Sons;. 1988: 75-82.
Laszlo JL, Bairstow PJ. Perceptual-Motor Behavior: Developmental Assessment and Therapy. Austin, Tx:. Holt, Rinehart and Winston;1985.
Laszlo JL, Bairstow PJ, Bartrip J. Clumsiness or perceptuo-motor dysfunction? In: Colley A, Beech J, eds. Cognition and Action in Skilled Behaviour. Amsterdam: North-Holland;. 1986:293-316.
Losse A, Henderson SE, Elliman D, et al. Clumsiness in children--do they grow out of it? A 10-year follow-up study. Dev Med Child Neurol. Jan 1991;33(1):55-68. [Medline].
Maeland AF. Identification of children with motor coordination problems. Phys Act Q. 1992;9:330-42.
Mattielo D, Woollacott J. Posture control in children. Neurophysiol Neuropsychol Motor Dev. 1997;54-77.
McPhillips M, Hepper PG, Mulhern G. Effects of replicating primary-reflex movements on specific reading difficulties in children: a randomised, double-blind, controlled trial. Lancet. Feb 12 2000;355(9203):537-41. [Medline].
Ottenbacher KJ, Msall ME, Lyon N, et al. Functional assessment and care of children with neurodevelopmental disabilities. Am J Phys Med Rehabil. Mar-Apr 2000;79(2):114-23. [Medline].
Piek JP, Edwards K. The identification of children with developmental coordination disorder by class and physical education teachers. Br J Educ Psychol. Mar 1997;67 (pt 1):55-67. [Medline].
Piek JP, Pitcher TM, Hay DA. Motor coordination and kinaesthesis in boys with attention deficit- hyperactivity disorder. Dev Med Child Neurol. Mar 1999;41(3):159-65. [Medline].
Polatajko HJ, Macnab JJ, Anstett B, et al. A clinical trial of the process-oriented treatment approach for children with developmental co-ordination disorder. Dev Med Child Neurol. Apr 1995;37(4):310-9. [Medline].
Polatajko HJ. Developmental coordination disorder (DCD): alias the clumsy child syndrome. In: Whitmore K, Hart H, Willems G, eds. A Neurodevelopmental Approach to Specific Learning Disorders. London: Mac Keith;. 1999: 119-33.
Raggio DJ. Visuomotor perception in children with attention deficit hyperactivity disorder--combined type. Percept Mot Skills. Apr 1999;88(2):448-50. [Medline].
Schoemaker MM, Kalverboer AF. Social and affective problems of children who are clumsy: how early do they begin?. Adapt Phys Act Q. 1994;11:130-40.
Sigmundsson H, Pedersen AV, Whiting HT, Ingvaldsen RP. We can cure your child's clumsiness! A review of intervention methods. Scand J Rehabil Med. Jun 1998;30(2):101-6. [Medline].
Sporns O, Edelman GM. Solving Bernstein''s problem: a proposal for the development of coordinated movement by selection. Child Dev. Aug 1993;64(4):960-81. [Medline].
Stott DH, Moyes FA, Henderson SE. The Test of Motor Impairment: Henderson revision. San Antonio, Tx: Psychological Corporation;. 1984.
Sugden DA, Wright HC. Motor coordination disorders in children. Dev Clin Psychol Psychiatry. 1998:39.
Sveistrup H, Burtner PA, Woolacott MH. Two motor control approaches that may help to identify and teach children with motor impairments. Pediatri Exerc Sci. 1992;4:249-69.
Thelen E. Motor development. A new synthesis. Am Psychol. Feb 1995;50(2):79-95. [Medline].
Touwen BCL. Examination of the child. Clin Dev Med. 1979: 1-79.
WHO. Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. 10th ed. Geneva, Switzerland: World Health Organization;. 1993.
Willoughby C, Polatajko HJ. Motor problems in children with developmental coordination disorder: review of the literature. Am J Occup Ther. Sep 1995;49(8):787-94. [Medline].
Wilson PH, McKenzie BE. Information processing deficits associated with developmental coordination disorder: a meta-analysis of research findings. J Child Psychol Psychiatry. Sep 1998;39(6):829-40. [Medline].
Wilson PH. Practitioner review: approaches to assessment and treatment of children with DCD: an evaluative review. J Child Psychol Psychiatry. Aug 2005;46(8):806-23. [Medline].
Wright HC, Sugden DA. A two-step procedure for the identification of children with developmental co-ordination disorder in Singapore. Dev Med Child Neurol. Dec 1996;38(12):1099-105. [Medline].
Further Reading
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
