Seminar 1 –
Summary and Discussion

A. DSM IV DEFINITION

We started with and concentrating on definitions as it did provide the basis for much discussion. The notes indicate that for criterion a we did indicate that we would like something more specific and exact than the description of ‘the essential feature of DCD is a marked impairment in the development of motor coordination’ and/or ‘performance in daily activities that require motor coordination is substantially below that expected given the person’s chronological age and measured intelligence’. We did not dwell too long on this but long enough for suggestions that ‘marked impairment’ may be two standard deviations below the mean on a standardised test. This puts it in line with cut-offs on other measures of human abilities, such as IQ. It may be pertinent to point out here that of we go with this then the incidence of DCD will be very different to our figures as 2 SDs below the mean puts one roughly in the lowest two and a half percent of the population.

When we discuss assessment at the next seminar we may return to this. But a fundamental question surrounding criterion a is ‘what are the necessary and sufficient characteristics of the condition?’ Currently we do not have this and it should be a priority. See ‘taxonomy and classification’ later on.

Criterion b, interference with academic achievement or activities of daily living, provided much discussion. What constituted activities of daily living was addressed with professionals’, parents’ and children’s views all recognised as being important. Activities of daily living are contextual – with content being people and situations. This was one are that we can and ought to move forward on, as it involves the very core of the condition.

The issue of academic achievement is one that has been around for some time going back to the time when perceptual motor activities were regarded as some panacea for basic literacy skills. This literature reached its zenith in the 60s and 70s with programmes from people like Frostig, Kephart, Doman and Delecato and Barsch who proposed that perceptual motor activities provided the basis for fundamental literacy skills. These programmes exist in various forms today, but are basically based on the ideas/programmes from the 60s era.

There are areas of academic achievement that are directly affected by poor coordination skills, the most obvious being writing and members of the group are spending much of their research time devoted to this activity. The Handwriting Interest group now known as the National Handwriting Group has many members involved in the Seminar Series. In addition, we recognise that ability in motor skills often has an indirect effect on other aspects of a child’s life through an intermediary such as motivation, self-esteem, confidence etc.
I realise with the above I have drifted away from the central focus of concepts and definition; however, as I am sure all will recognise, these topics are not independent in life and we have separated them only for ease of administering the seminars into bite-sized chunks.

Criterion c raised issues such as what is meant by ‘not due to a medical condition’. This difficulty will increase as we progress with more scan studies. Do we include aetiological investigations under the term general medical condition?
What level are we discussing here? There was a recognition that medical clinical evidence is necessary and if that is the case it follows that criterion c is questionable.

Criterion d survived almost intact with most agreeing that below a certain IQ level, probably 70, we are dealing with a different population group than simply DCD. In addition there is a strong body of literature to show that as one moves below 70 OI there is a concomitant increase in the motor impairment. Roughly from 50-70 we could expect up to five times the incidence of a group 70-plus, and in the 30-50 range we would rarely find an individual scoring in the normal motor ability range. Again any evidence contrary to this let me know so it can be shared. All of this does not address this discrepancy notion as part of the definition, and I do not recollect us discussing this in detail. It may be something we return to with a look at the general developmental disabilities literature.

B. ADDITIONAL DISCUSSION POINTS

  1. There was some debate about the central defining core of the condition, namely that of motor impairment. At the moment it is pretty vague and diffuse open to different interpretations. When one examines DSM IV for a condition such as ADHD there is a list of characteristics with a child being diagnosed if they exhibit a certain number of them over a certain time period. We have nothing like that or even approaching it. There was a suggestion that we should be looking at a taxonomy or classification of motor skills. Later, there was the suggestion that a classification of skills in the three subsets of manual skills, balls skills and balance skills may be useful. These are of course the three main areas of the Movement ABC. This was extended to manual skills, balls skills and agility/balance skills. The reason was because in many day to day activities balance is subsumed under agility and as the child develops, agility skills become increasingly important. This is an area that is fruitful for more discussion and it may be that an examination of dynamical systems and the contextual nature of skills could be a way forward.
  2. Comorbidity was raised several times with discussion centring on whether DCD was a separate condition and if so was it discrete and identifiable. Again, this is a topic for another seminar (3rd one0 and suffice to say here that it will be addressed. We agreed that DCD can be a separate condition with a motor core being the primary deficit, and co concurrence or comorbidity being the norm with which we have to work.
  3. It was felt by many that the clinical expertise rather than theoretical notions seemed to drive the defining condition and although this was recognised as being a crucial element, it was felt by some that we ought to be using the vast motor behaviour literature much more than we have. Certainly when we come to intervention, it is an area that we will address. The question was raised about the process of validating a syndrome.
  4. The areas of motor learning, motor control and motor development were addressed and discussions surrounded how much influence they should have. The perception-action linkage was debated with topics such as ‘planning’ coming to the fore and the difference made between general organisation of behaviour and sequences in a motor act. This led to a proposal that the term ‘dyspraxia’ did not serve a useful function and should be discarded. Many nods showed signs of assent but it did not meet with universal approval.

Final points
I have taken the liberty of reducing the above to a number of quick points which are simply for ease of reference.

  1. Criterion a – need for more specificity on what constitutes the core – that of motor impairment; need for some classification (balls skills, manual skills, balance/agility?); need for statistical cut of (2 SDs?).
  2. Criterion b – clearer definition of activities of daily living parents, teachers/other professionals; academic achievement requires clarification concerning direct versus indirect outcomes and perceptual motor links.
  3. Criterion c – medical conditions can be recognised as long as motor impairment is primary condition and other criteria are met?
  4. Criterion d – keep but specify cut off at 70?
  5. Comorbidity is probably the norm but motor impairment is primary condition.
  6. Need for more theoretical underpinning to drive the condition drawing upon the motor control, development and learning literature.
  7. Dyspraxia as a term is less than useful?

Previous