What if our current thinking on Developmental Coordination Disorder (DCD) is completely overlooking something so obvious? Let’s look at the logic and language involved with the diagnosis. Think critically, and you may find a solution.
Developmental– concerned with the development of someone or something.
Coordination: the organization of the different elements of a complex body or activity so as to enable them to work together effectively
Disorder: a state of confusion
So DCD is the lack of development of proper coordination. Imagine for a moment that you were responsible for coordinating a search and rescue party, or a military operation. You needed to direct all parties to particular places on a map at particular times, in order for them to meet at the appropriate point in time and space. Now what if the map that you were given looked right, but all of the measurements and scales were off? Sometimes 1cm was 1km, other times 1cm was 1.2km or 2km. You would be directing parties to travel 5km in a particular direction, when really it should have been 6, or 10. Now imagine that the mis-measurements of the map were not consistent either, the scale was different for various direction and different parts of the map. A totally distorted view of where things actually are. Your coordination efforts would be severely lacking, some would say disorderly. This is despite the fact that you could ‘see’ the map.
That’s right, the very root of the word ‘coordination’ is ‘coordinates’. Accurate coordination requires accurate coordinates. Of course you wouldn’t be the master strategist and coordinator of search parties or military might right off the bat, but it sure would be hard to develop accurate coordination and further your skill if all the underlying information you counted on was wrong. You could potentially even say it would cause disorder. This does not meant that every person with the accurate map and right coordinates would be a master planner, and that the right coordinates are all it takes. Isn’t it fair to say that without the right coordinates, the chance of becoming masterful at coordination would be very low?
Here is an example of what happens when visual coordinates are off, and affects coordination. This was the result of several head injuries as a child:
The Diagnostic and Statistics Manual of Mental Disorders 5 (DSM-5) is very clear in the diagnostic criteria. Pay close attention and we will break it down.
DSM-5 classifies DCD as a discrete motor disorder under the broader heading of neurodevelopmental disorders.  The specific DSM-5 criteria for DCD are as follows:
- 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 (eg, dropping or bumping into objects) and as slowness and inaccuracy of performance of motor skills (eg, catching an object, using scissors, handwriting, riding a bike, or participating in sports)
- The motor skills deficit significantly or persistently interferes with activities of daily living appropriate to the chronologic age (eg, self-care and self-maintenance) 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 or visual impairment and are not attributable to a neurologic condition affecting movement (eg, cerebral palsy, muscular dystrophy, or a degenerative disorder)
– https://emedicine.medscape.com/article/915251-overview#a2The first section talks about below expected ability to coordinate motor skills. The second is that it’s having an impact on their life. The third is that it has started at a young age. The fourth is where we are failing our kids. When it talks about visual impairment we assume that means that must mean that someone cannot see. The reality is that ‘seeing’ something is completely different from having an accurate idea of where it is (back to the map analogy). Further, most visual testing is not investigating the role of vision in motor coordination. The visual acuity (clarity) is tested, as well as eye health, and often whether you can see a 3D object in a small booklet. The 3D object in a small booklet is more a measurement of ability at that particular task, and potential, rather than how accurate a person is in their assessment of their environment which is critical for motor coordination.A lot about coordination and how accurate a child is at figuring out coordinates can be learned through an in depth visual examination. Watching how the eyes coordinate and how accurately a child can use them together to acquire information and then how well they can utilize this information will reveal a lot. The wonderful part about this area of testing is that it’s objective, there are norms, and there either will be a visual condition that is causing problems with coordination, or there won’t be. If visual processes involved in real world depth processing (not just the 3D books) haven’t developed accurately, then the lack of accurate coordinates will inhibit the development of normal coordination. So please, if you have a child who has been diagnosed with DCD, or know someone who does, have that child seen for a full visual assessment that looks at how the eyes track, team, focus and more.