Motor Skills Disorder

Autism can affect the development of motor skills in children.

What is the medical definition of motor skills disorder?

Motor skills disorder, also called motor coordination disorder or motor dyspraxia, is a common disorder in childhood.

What are examples of fine motor skills?

• Children with this disorder have associated problems including difficulty in processing visuospatial information needed to guide the motor actions they may not be able to recall or plan complex motor activities such as:
  • dancing,
  • doing gymnastics,
  • catching or throwing a ball with accuracy, or
  • producing fluent legible handwriting.
• Often there is a history of early delay in the development of motor skills. This may present as a delay in the ability to sit up or learning to walk well.
• Often, these children are described as clumsy or forgetful, (for example, they may never turn the water faucet or lights off).
• These children may have difficulty using a cup, spoon, or fork to eat.
• They may have the tendency to drop items or run into walls/furniture and have frequent accidents due to motor planning difficulties.
• They may have trouble with tasks requiring hand-eye coordination and dexterity (hammering a nail, connecting wires, etc.).
• These children may also have difficulty holding a pencil and learning to write.

How does dyspraxia affect a person?

Motor skills disorder can be extremely disabling both in academic settings (school) as well as in everyday life due to impairment of functioning. Children and adults with this disorder are at risk for obesity, due to the higher rates of physical inactivity, and often suffer from low self-esteem as well as academic underachievement.

Children with this disorder have variable symptoms, depending on the age of diagnosis (as with most childhood disorders).

• Young infants may present with non-specific findings, such as hypotonia (floppy baby) or hypertonia (rigid baby).
• Older infants may be delayed in their ability to sit, stand or walk.
• Toddlers may have difficulty feeding themselves.
• Older children may have a hard time learning to hold a pencil, and tend to knock over drinking glasses more often than expected.

As children with this disorder age, they often avoid physical activities, especially those requiring complex motor behaviors such as:

• dancing,
• gymnastics,
• swimming,
• catching or throwing a ball,
• writing, or
• drawing.

This is due to the individual's propensity to fall or trip more often than others and their inability to complete motor tasks adequately. These individuals may have more bruises or superficial skin injuries due to being "clumsy". They may often feel unable to judge spatial distances and have difficulty with shutting off faucets, turning off devices, and tend to have trouble putting together puzzles or toys.

There is no known exact cause of this disorder; however, it is often associated with physiological or developmental abnormalities such as:

• prematurity,
• developmental disabilities (cognitive deficits),
• attention deficit hyperactivity disorder (ADHD), and
• mathematics or reading learning disorders.

It should be differentiated from other motor disorders, such as:

• cerebral palsy,
• muscular dystrophy, and
• inherited metabolic disorders.

Children with this disorder should receive treatment as early as possible to prevent secondary complications such as academic failure or social withdrawal, which are all well described but preventable consequences if intervention occurs at an early age.

Any neurological or motor abnormality should be investigated fully; however, it is important to remember that different children develop normally at different rates. For example the vast majority of children who refuse to walk by 18 months of age are normal, and only a very few are diagnosed with true motor delays.

1. Have other medical conditions that may cause my child's symptoms been ruled out?
2. What kind of therapy is available for my child? What is your experience with patients who have received this type of therapy? What specific measures do you recommend?
3. What is my child's long-term prognosis (outlook)?
4. What kind of measures can we implement at home to improve long-term functioning and well-being?
5. Where can I find more information about this condition and how to best help my child?

A referral for occupational and physical therapy services may be needed when local educational authorities do not have sufficient staffing to provide appropriate services.

It is important to emphasize that one size does not fit all when designing a therapeutic intervention for children with motor skills disorder. It is also important to understand that although many interventions are offered, very few have been rigorously tested and proven to be effective.

Generally, most children respond to multimodal treatment. This involves an occupational therapist and physical therapist working with the child, often with the assistance of educational professionals using "perceptual motor training" techniques to help the person to improve their motor clumsiness.

• Practice and repetition are often helpful in improving handwriting; however, "bypass" methods are utilized as well. These may involve allowing for unlimited testing times, and using assistive writing devices.
• Other therapies that have been recommended include cognitive and sensory integration therapy and kinesthetic training.
• Many other therapies have been touted as effective, but have not been researched enough to be recommended.
• Some therapies, such as "visual training" have been outright discounted through scientific evaluation.
• It is important to discuss therapeutic options with your child's physician. There are many modalities which have been shown to be effective, yet have not been fully tested in a large enough study to be recommended without reservations.

An occupational therapy examination usually includes the Bruininks-Oseretsky Test of Motor Proficiency (BOT). This is a standardized instrument that is used to measure both gross motor and fine motor skills in children. The test takes about an hour and involves a series of game-like challenges that assess a range of motor skills.

Individuals with this disorder should be vigilant about maintenance of normal body weight to prevent obesity, which generally involves a healthy eating plan (sometimes designed with the assistance of a health care professional) to compensate for the general tendency to avoid physical activity.

Athletic pursuits that are less competitive (swimming, walking, yoga, chair exercise, noncompetitive martial arts) tend to be more tolerable to individuals with this disorder and therefore may be more likely to result in life long pursuits.

Medical treatment includes screening for potential comorbid (occurring at the same time) conditions such as:

• speech and language disorders,
• Tourette's syndrome,
• ADHD,
• mood disorders,
• psychosis,
• autism spectrum disorders,
• developmental disabilities, and
• learning disorders.

The amount of frustration engendered in trying to achieve competency with motor activities should be balanced against the potential gain in proficiency.

• For children with this disorder, it is important for parents to regulate and monitor activities to avoid frustration or overstimulation.
• Children who cannot yet tie their shoelaces should be allowed to use assistive devices, slip-on, or Velcro shoes; the same principle should be applied to adolescents or adults with this disorder.
• In adolescence, it is more realistic and helpful to use assistive technology (for example, using a keyboard) rather than trying to achieve handwriting legibility if not already achieved during the elementary school period.

Local educational authorities may require reevaluations every six months; reevaluations in older children may be less often (yearly or every other year).

It is essential to recognize motor problems early. Early intervention services for preschoolers should be aggressively implemented to prevent comorbid disorders as well as to achieve possible resolution of symptoms in some individuals.

Prognosis is generally good as individuals develop adaptive approaches to living with this disorder.

• The National Child Development Institute as well as the National Institutes of Health and local educational authorities can provide more information on diagnostic and treatment approaches to this disorder.
• Individuals with this disorder are covered by the Education for All Handicapped Children Act of 1975, IDEA (The Individuals with Disabilities Act) as well as by the December 2004 amendments to the Public Law 94-142 and the "SLIP" law Public Law 108-446 and HR 1350 (the Individuals with Disabilities Education Improvement Act of 2004)
• "Disability is a natural part of the human experience and in no way diminishes the right of individuals to participate in or contribute to society. Improving educational results for children with disabilities is an essential element of our national policy of ensuring equality of opportunity, full participation, independent living, and economic self-sufficiency for individuals with disabilities." (U.S. Department of Education)
• Learning Disabilities Online
• The Learning Disabilities Association of America
• The National Center for Learning Disabilities