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CONDITION/DISORDER SYNONYMS

  • DCD

  • Clumsy child syndrome

  • Motor dyspraxia

  • Developmental dyspraxia

  • Sensory integrative dysfunction

  • Disorder of attention, motor, and perception

  • Minor coordination dysfunction

ICD-9-CM CODE

  • 315.4 Developmental coordination disorder

ICD-10-CM CODE

  • F82 Specific developmental disorder of motor function

PREFERRED PRACTICE PATTERN

  • 5C: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System—Congenital Origin or Acquired in Infancy or Childhood 1

PATIENT PRESENTATION

A 5-year-old male is referred for outpatient physical therapy for frequent falling. The parents report he takes Strattera for attention deficit hyperactivity disorder (ADHD) and gets frustrated when trying to play with his 4-year-old sister. Upon examination, the therapist notes the child has mild hypotonia especially in his trunk, has difficulty balancing on one leg, and has poor coordination with kicking or catching a ball. He has fair abdominal strength and descends stairs in a step-to-step pattern.

KEY FEATURES

Description

  • Difficulty performing complex gross or fine motor-coordination tasks

Essentials of Diagnosis

  • No cognitive or neurological dysfunction

General Considerations

  • Four criteria

    • Difficulty performing age-appropriate motor skills

    • Child has had sufficient opportunity to attain motor skills

    • No medical reason for motor difficulty

    • Difficulties impact academics or ADLs

Demographics

  • Fifty percent of children with developmental coordination disorder (DCD) also have ADHD2, 3

  • Affects 5% to 6% of all children4

  • Affects twice as many males as females4

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Decreased strength

  • Difficulty with coordination

    • Ball skills

      • Catching

      • Throwing

      • Kicking

    • Single-limb stance

    • Jumping

    • Hopping on one foot

    • Skipping

  • Ligamentous laxity

  • Hypotonia5

  • Soft neurological signs6

  • Atypical gait pattern

Functional Implications

  • Falls or trips often

  • Bumps into objects, other people

  • Difficulty using motor skills in new settings

Possible Contributing Causes

  • Premature birth4

Differential Diagnosis

  • Head injury

  • Progressive neurological disorder

  • Brain tumor

  • Autism

  • Pervasive developmental disorder7

  • Cerebral palsy8,9

  • Visual disturbances

MEANS OF CONFIRMATION OR DIAGNOSIS

Diagnostic Procedures

  • Parent–teacher questionnaires: Connors, Burks

  • Psychological testing

  • IQ testing

  • Developmental and Psychosocial evaluation

TREATMENT

Medication

  • None for DCD

  • Medications available for ADHD

    • Methylphenidate drugs

    • Amphetamines

    • Dexmethylphenidate

    • Dextroamphetamine

    • Lisdexamfetamine

FIGURE 236-1

Upper motor neuron pathways. Tracts at bottom left are shown outside the cord for clarity only. (From McPhee SJ, Hammer GD. Pathophysiology of Disease: An Introduction to Clinical Medicine. 6th ed. New York, NY:2009, McGraw Hill.)

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