They may be labeled clumsy or lazy, but children who struggle to perform simple motor tasks may actually be unable to fully use key regions of the brain, according to research by a UBC graduate student.
Jill Zwicker, a PhD candidate in Rehabilitation Sciences, has conducted one of the first neuroimaging studies exploring motor performance of children with developmental coordination disorder (DCD), a motor learning disability seen in schoolchildren and shared by actor Daniel Radcliffe of Harry Potter fame.
Six per cent of children aged five to 11 have identified DCD – a higher prevalence than attention deficit hyperactivity disorder (ADHD). The conditions are related; about half of children with DCD also have ADHD and vice-versa. About 30 per cent of children with DCD also have a speech/language disorder or learning disability.
DCD interferes with activities such as handwriting, tying shoes and handling a knife and fork. It is not a minor disorder yet it remains under- identified, says Zwicker.
The term DCD has been recognized since 1994 but is not well-known among teachers, parents or physicians, says Zwicker. Its cause is unknown but researchers are investigating a genetic link. Zwicker has worked for 20 years as a school-based occupational therapist and has helped identify and assist students who have the disorder.
“These children are not able to meet their potential. That’s what put me on this mission,” says Zwicker, who began her doctoral studies in January 2006.
Zwicker compared motor performance and brain activation patterns of seven children with DCD. Using functional magnetic resonance imaging (fMRI), the students completed a computerized tracing task. Over a two-week period, the eight to 12-year-olds used a joystick like a pen to trace a computer image of a flower in five separate sessions, both in and out of the fMRI scanner. Accuracy and speed were measured each time and fMRI charted brain activity. A control group completed the same tasks.
Although there were few participants in the study (started in June 2008 and to be completed in early 2010) the neuroimaging results are statistically significant. Children with DCD do not seem to use their attentional and error detection brain regions to the same degree as typical children.
Also, Zwicker found that kids with DCD traced more quickly but with less accuracy than the control group whose performance showed the reverse results.
She has interviewed children to determine how these coordination challenges have affected their lives.
A 10-year-old boy said, “it’s a bit hard for me [basketball]. Nobody usually passes to me . . . It’s like I’m left out of the game usually.”
Another child “thinks [he’s] a loser” because he is unable to do things other kids can do easily. This nine-year-old boy cannot tie his shoes or ride a bike.
Vicky Liakouras is an early primary schoolteacher with 20 years’ experience and also the mother of a 12-year-old boy with DCD. Her son was diagnosed 18 months ago.
“My ‘battle’ to have him tested and then be given support has been an ongoing struggle since he was six years old,” she says. “You have to be the greatest advocate for your child . . . push to get testing, a diagnosis and the school support these children are entitled to.”
Comments from family and friends suggesting her son is lazy, messy or slow by choice have been frustrating and devastating, she adds.
As a teacher she says the greatest challenge has been not even knowing until recently that the disorder existed or how prevalent it is. She says more workshops are needed where teachers are made aware of DCD and how necessary it is to directly address the disorder.
When a teacher observes a child regularly having difficulty with motor skills, it is recommended that they meet with parents to discuss the child’s performance at school and at home. Following an examination by the family doctor to rule out causes other than DCD, a referral to an occupational therapist can yield strategies for school and home.
It was previously believed that children “grew out of“DCD, but it is now known that it persists into adulthood. Because children are often marginalized by peers and criticized by parents and teachers, they can develop mental health, social and physical problems as teens and adults. These may include anxiety and avoidance of recreational activities or jobs that require good motor performance. They may also have health issues such as obesity.
“Doctors need to know these children are different at a neurobiological level and that DCD is a legitimate disorder,” says Zwicker. She hopes if more is known about what the brain is doing, it will lead to better and earlier interventions.
These can include individualized and repeated teaching of targeted motor skills needed for typical childhood activities, such as riding a bike or using a keyboard. Effects of DCD on daily life can be minimized through such practice and through problem-solving strategies to help the child generalize motor skills from one task to another. In addition, encouraging physical activities that incorporate a repeated sequence of movement s, such as swimming or cycling, can help prevent secondary problems of lack of fitness and social isolation.
Zwicker presented her findings at an international conference this summer and drew considerable attention from DCD researchers. Following graduation next year she will start post-doctoral work at Vancouver’s Child and Family Research Institute where she will analyze neuroimaging data of pre-term infants and link these findings with motor outcomes at age 18 months to determine their risk for DCD.
Zwicker’s doctoral committee members are Asst. Prof. Lara Boyd and Prof. Emerita Susan Harris of UBC’s Dept. of Physical Therapy and Assoc. Prof. Cheryl Missiuna of McMaster University’s School of Rehabilitation Science and the Director of CanChild, Centre for Childhood Disability Research.
For more information on DCD, visit CanChild at www.canchild.ca/en/.
