Motor skills: What’s normal and what’s not?

Lydia Rothman* still can’t snap her fingers. As a child, the 40-year-old Toronto mom struggled with certain skills her peers seemed to pick up easily. She had a hard time holding her pencil properly. She was often too embarrassed by her lack of coordination to jump rope on the playground. Shoelaces were a challenge. In home economics, Rothman had trouble operating the sewing machine. “I sort of stumbled my way through childhood,” she recalls. “I have vivid memories of falling at very awkward moments. I would wave to someone and fall at the same time.”

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Thirty years ago, kids like Rothman may have been labelled the “class klutz.” But we now know that up to six percent of school-aged children have trouble with the motor skills required to do everything from getting dressed and brushing their teeth, to riding a bike and climbing stairs. Across the country, that means at least one child in every classroom could be struggling with age-appropriate motor skills required for daily functioning at school and at home.

In some cases, kids are diagnosed with Developmental Coordination Disorder (DCD), which is a common, yet under-recognized, neural-development movement-skills disorder affecting about twice as many boys as girls. Researchers aren’t completely sure what causes general clumsiness, including DCD, but they know something isn’t working properly in the brain. And DCD isn’t just a physical problem; without support, these kids are at greater risk of developing social, emotional and academic issues down the road.

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Knowing when to worry, however, can be tricky. After all, what parent hasn’t seen her toddler bump into the wall or his preschooler struggle to tie her shoes? “Clumsiness when they’re young, or first trying out a new skill, is very normal because they’re just sort of finding their way around,” says Cheryl Missiuna, a professor and scientist at McMaster University’s CanChild Centre for Childhood Disability Research in Hamilton, Ont. “But when they have difficulty and get frustrated performing motor activities that are age appropriate – given they’re motivated and have had adequate opportunity to practise – those are the kids we’re concerned about.”

Not all “clumsy” kids will be diagnosed with DCD. Some children simply take a little longer to learn certain skills. Others just aren’t as athletically inclined as their friends. “When we start to learn something new, we have to pay a lot of attention to exactly where our body is,” says Missiuna. “We get the feel of the movement very quickly. It’s kind of like we’re making a blueprint. Kids with DCD have trouble making that blueprint.” It’s why, for example, so many children with the disorder have difficulty learning to ride a bicycle. “They have to think about pushing their foot down every time they pedal, which makes it harder to focus on the steering,” she says.

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Surprisingly, many kids with coordination challenges reach most of their very early motor milestones on track. They sit up, walk and may run within normal limits. It’s not until they hit age two or three — around the same time they’re expected to begin using their hands in a coordinated manner — that they begin to stand out from their peers. At school age, they’ll likely struggle with self-care tasks, like teeth brushing and doing up snaps and buttons. At the dinner table, they spill their milk and can’t cut their meat. In class, they might use their arms to prop their head up on the desk or have trouble grasping a pencil properly. They also tend to shy away from team sports. “I like to use an analogy from The Wizard of Oz,” says Missiuna. “They either look like the Scarecrow, all floppy and squirmy, or they make all of their joints stiff like the Tin Man.”

It’s a familiar story for Toronto mom Jenny Durst,* who realized there was something different about her then-four-year-old son when she saw him on the soccer field for the first time. “It was the way he ran. His arms and legs were everywhere — kind of like spaghetti. He didn’t have the ability to bring them in close to his body,” she says. Her son was diagnosed with DCD after being referred to a team of specialists by his doctor. His preschool teacher suggested he get an assessment after she noticed he was also struggling with several fine motor tasks.

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Many uncoordinated children also have trouble with reading, writing and math, despite having average to above-average intellectual ability. “They’re not physically able to write and keep up,” says Jim Christopher, head of school at Kenneth Gordon Maplewood School in North Vancouver, BC, an educational facility for kids with learning disabilities, many of whom also struggle with lack of coordination. “You see students who are falling off the chair, but their eyes are slipping off the page, too.”

Early identification is best, but not only to help with physical coordination. Most of these kids are very aware of their difficulties, even from a young age, says Missiuna, and without appropriate management strategies, they’re at risk of secondary consequences, including obesity, anxiety and depression (often brought on by withdrawal from physical and social activities).

Christopher says that boys in particular can be made fun of and marginalized by their peers. “What appears to be defiant or silly behaviour is, in reality, something beyond their control, something they need to develop strategies for, or else they’ll be dealing with this for the rest of their life.”

It’s something Rothman remembers well. “No one wanted me on their team. It really did affect my confidence,” she recalls, explaining that even now she’s anxious about teaching her six-year-old daughter how to tie her shoelaces because of the angst it caused her as a child.

The good news? There are plenty of options available for uncoordinated children, regardless of whether they receive a DCD diagnosis. Treatment is not about “fixing” the awkward child, but about removing the frustration by offering workarounds that allow these kids to participate successfully in the same day-to-day activities as their peers. At home, it might mean getting pants that pull up instead of ones with zippers, shoes with Velcro instead of laces, and seats with traction that provide support at the dinner table. (Of course, it’s good to try and teach kids with DCD the motor skills they’ll need in life, with plenty of patience and support.) At school, kids have found success using iPads instead of pencils, sitting on yoga balls rather than chairs, and having their lunch packed in easy-to-open containers. Team sports can be challenging for these kids because the environment keeps moving and changing, so encouraging individual sports, like swimming and karate, which are more continuous and predictable, and where they can work at their own pace, can provide a big confidence boost.

“I teach kids how to break down the steps,” says Carol Vickery, an occupational therapist in Calgary who works with kids with special needs and motor-planning difficulties. “If I’m teaching a child how to jump, I tell him that first he needs to bend his knees, and then he needs to push. That’s way easier to plan than just instructing him to throw his body into the air.”

Although most kids with DCD don’t outgrow their diagnosis, they do grow into it, says Missiuna. Durst’s son, for example? “He’s not going to be the kid who’s on the soccer or basketball team,” she says. “But he’s incredible with building blocks. He has a 3-D mind. I just have to give him the rope when he wants to try things and know when to pull back when it’s not working. All that matters is that he’s happy.”

*names have been changed

A version of this story appeared in our January 2014 issue with the headline "Motor skills: What's normal and what's not?" pp.28-29.