Developmental Coordination Disorder Workup
- Author: Stephen L Nelson, Jr, MD, PhD, FAAP; Chief Editor: Caroly Pataki, MD more...
No specific laboratory tests for motor skills disorder exist; however, male children should have a creatine kinase (CK) level checked to evaluate for Duchenne muscular dystrophy. Comorbid conditions (eg, high levels of lead, anemia, iron deficiency, and hypothyroidism) should be ruled out.
Because the condition is not a specific neurologic disorder per se, no imaging studies are typically used in children with motor clumsiness difficulties, provided that the neurologic examination findings are otherwise normal and that nothing in the history or the physical examination suggests an underlying structural or medical/metabolic etiology.
If an underlying etiology is suggested, brain imaging (preferably magnetic resonance imaging [MRI]) is warranted). This is an area currently undergoing active research. A study using diffusion tensor imaging and functional MRI demonstrated subtle differences between children with developmental coordination disorder (DCD) and control subjects.
Several approaches to the assessment of children with clumsy motor behavior are available (see below). Some of these assessment approaches are directly linked to proposed treatments or interventions (see Treatment).
No specific histologic patterns exist for these conditions.
Normative Assessment of Functional Skills
The normative functional skills approach draws from traditional developmental theory and remains the cornerstone of motor assessment. Assessment is descriptive and is concerned with acquisition of fundamental motor and functional skills, as referenced against age norms. The most commonly used tests of motor impairment are as follows[37, 38] :
Movement Assessment Battery for Children (MABC or M-ABC)
Bruininks-Oseretsky Test of Motor Proficiency (BOTMP)
Test for Gross Motor Development (TGMD-2)
The original MABC was validated as a reliable method in multiple studies and is the tool most commonly used to screen for DCD in research settings. Designed to yield a general index of motor impairment, the MABC has the following 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
A checklist that is designed to be completed by an adult familiar with the child’s day-to-day motor functioning
The performance part of the MABC covers manual dexterity, ball skills, and static and dynamic balance. The checklist addresses progressively complex interactions between the child and the physical environment; it also has good psychometric properties. The revised version of the MABC, the MABC-2, extended the age range from 4-12 years to 3-16 years.
The BOTMP generates a general motor ability factor and is the diagnostic instrument most commonly used by therapists. It is divided into the following 8 subsections:
Fine motor precision (eg, cutting out a circle or connecting dots)
Fine motor integration (eg, copying a star or a square)
Manual dexterity (eg, transferring pennies, sorting cards, or stringing blocks)
Bilateral coordination (eg, tapping a foot or finger or jumping jacks)
Balance (eg, walking forward on a line or standing on one leg on a balance beam)
Running speed and agility (eg, shuttle run or one-legged side hop)
Upper-limb coordination (eg, throwing a ball at a target or catching a tossed ball)
Strength (eg, standing long jump or situps)
The BOTMP has good psychometric properties. It provides norms for children and adolescents aged 4.5-14.5 years, though the revised version (BOT-2) can be used for children aged 4-21 years.
The TGMD-2 looks at 12 gross motor skills, divided into locomotor and object control subtests, and can be used for children aged 3-10 years. Compared with the other tests mentioned above, it is more easily and rapidly administered, but fewer data are available on its use in children with DCD.
Assessment of General Abilities
The general abilities approach is based on the assumption that sensori-integrative and sensorimotor functions provide the platform for later motor and intellectual development. With this approach, the most commonly used test is the Sensory Integration and Praxis Tests (SIPT). However, less than 50% of the SIPT is related to motor function, and this evaluation is much more commonly studied and cited in the sensory integration literature.
The neurodevelopmental evaluation includes both a general examination and a neurologic examination, as well as an assessment that focuses on subtle deficits in neural functioning. Several batteries have been designed, including the Touwen test for children with minor neurologic dysfunction (MND) and the Physical and Neurological Examination for Soft Signs (PANESS).
At present, normative data for these tests are lacking. Neurologic soft signs are common in children and adults with schizophrenia, attention deficit hyperactivity disorder (ADHD), and other conditions, and they vary in prevalence according to the age, sex, and culture of the population being considered.[11, 39]
Dynamic Systems Analysis
The dynamic systems approach to evaluation is based on dynamic systems theory, which describes the dynamic relation 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 Neuroscientific Evaluation
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 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 with 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. Advances in neuroimaging and functional imaging may provide insights into hard signs of neural dysfunction.
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