[Posted on 22 August, 2017 by Christopher Gillberg]
When I was in primary school and later in lower secondary school there was always one kid, sometimes two (out of the thirty to thirty-five in the class), whom everybody shunned or made fun of. When I think back now on those years and those kids I believe I can recognize a common theme (other than the obvious one of bullying). They were clumsy, often overweight and most of them were boys. They were always chosen last – if at all – for any kind of ballgame, they would score own goals, lose the ball or fall over when hit by a ball. They looked funny on the ice-rink, never managing to properly skate. They never really got the knack of riding a bicycle. The way they could not handle a knife and fork at lunchtime, spilling their drink or food onto their clothes, the floor or on other people caused laughter, irritation or anger. They fell down when trying to climb a rope or tripped on the feet of other kids or fell down from the pavement and sprained their ankle. They were usually poor at drawing or writing with a pen or pencil. Many of them did their best to avoid physical education and developed headaches or allergies that got the school doctor to issue a statement freeing them from attendance during crafts or PE lessons. – They were constantly scolded, not just by peers, but often by teachers too.
Today we have a name and a diagnostic label for such clumsiness: developmental coordination disorder or DCD. This diagnosis rests on the following criteria:
- Acquisition and execution of coordinated motor skills are below what would be expected at a given chronologic age and opportunity for skill learning and use; difficulties are manifested as clumsiness
- The motor skills deficit significantly or persistently interferes with activities of daily living and impacts academic/school productivity, prevocational and vocational activities, leisure, and play
- The onset of symptoms is in the early developmental period
- The motor skills deficits cannot be better explained by intellectual disability, visual impairment or another named neurologic condition affecting movement
There are usually co-existing problems that can be assigned other diagnostic labels, including speech and language disorder (sometimes followed by dyslexia), ADHD and autistic features (sometimes amounting to the clinical diagnosis of autism). These are usually present already in the early years. With time, many, indeed the majority, develop depressive and anxiety symptoms, particularly if the DCD has remained undiagnosed or unrecognised for many years. Some of the anxiety symptoms seem to be part of the DCD itself (such as high anxiety which is often associated with mild to moderate motor coordination and balance problems), but many of the depressive symptoms (and even suicidal thoughts) appear to develop after rejection and bullying from peers and teachers.
DCD occurs in one in twenty children and is probably equally common in different parts of the world. Girls are affected but not as often as boys, meaning that about 8 per cent of boys and 2 per cent of girls have DCD. Unlike autism and ADHD that are currently very often diagnosed in young children, DCD is heavily underdiagnosed all over the world. Given that there are effective interventions including psychoeducation and targeted task training, it is essential that the diagnosis is made as early as possible, at least not later than the first school years. Given that many children with autism, ADHD, speech/language disorder, dyslexia, depression and anxiety have (usually undiagnosed) DCD it is important that all child specialists become acquainted with this specific ESSENCE-diagnosis, its assessment and intervention.
I wish children could be taught about ESSENCE, and particularly about DCD, in primary school. If I had known about DCD when I was young I would have been a better pal (I hope) to some of my schoolmates. And I think this is true of most people; with knowledge bullying and scolding abate.