HELP FOR PARENTS OF CHILDREN WITH ASPERGER'S & HIGH-FUNCTIONING AUTISM

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Developmental Coordination Disorder in Children on the Autism Spectrum

Initial accounts of Asperger’s (high functioning autism) include descriptions of Developmental Coordination Disorder (DCD). Kids on the autism spectrum are often delayed in acquiring motor skills that require motor dexterity (e.g., bicycle riding, hand writing, tying shoe laces, opening a jar, etc.) and may appear clumsy. Many of these young people exhibit an odd gait or posture, poor coordination, problems with conceptual learning, difficulty with visual-motor integration, and trouble with visual-perceptual skills.

DCD is a chronic neurological disorder beginning in childhood that can affect planning of movements and coordination due to brain messages not being accurately transmitted to the body, and is diagnosed in the absence of other neurological impairments (e.g., Parkinson's disease, muscular dystrophy, multiple sclerosis, and cerebral palsy). DCD is more common in boys than girls (approximately 4 males to every 1 female).

In addition to physical impairments, DCD is associated with memory problems (e.g., problems with organizing one's time and remembering deadlines, problems carrying out tasks that require remembering several steps in sequence, increased tendency to lose things, and difficulty remembering instructions).

Other problems that Asperger’s children with DCD may experience include:
  • struggling to distinguish left from right
  • problems with balance 
  • poor sense of direction 
  • moderate to extreme difficulty performing physical tasks 
  • low muscle tone
  • fatigue due to so much extra energy being expended while trying to execute physical movements correctly
  • difficulty moderating the amount of sensory information that their body is constantly sending them, and as a result, they are prone to sensory overload and panic attacks

In the preschool youngster with DCD, common traits reported by moms and dads include a history of delayed developmental milestones, especially crawling, difficulty making friends, difficulty with dressing, immature art work, poor ball skills, speech, and walking.

In the elementary school youngster, common traits include difficulties in copying from the blackboard, slow/immature/laborious handwriting, and persistence of (and no improvement in) the problems noted in the preschool years.

DCD affects both fine and gross motor control. Let’s look at each of these in turn:

Fine-motor problems can cause difficulty with a wide variety of tasks (e.g., brushing one's teeth, doing chores, fastening buttons, locking and unlocking doors, brushing one's hair, using a knife or fork, etc.). As mentioned previously, there tends to be problems with handwriting (e.g., the acquisition of graphemes such as letters of the alphabet and numbers, learning basic movement patterns, establishing the correct pencil grip, developing a desired writing speed, etc.).

Gross motor control is the ability to make large, general movements. Body image issues, motor coordination, and whole body movement mean that major developmental targets (e.g., climbing, jumping, running, walking, etc.) can be affected. The problems vary from child to child and can include:
  • bumping into people accidentally
  • clumsiness to the point of knocking things over
  • cross-laterality, ambidexterity, and a shift in the preferred hand 
  • difficulty combining movements into a controlled sequence
  • difficulty in determining left from right
  • difficulty remembering the next movement in a sequence
  • poor balance 
  • poor muscle tone and/or proprioception
  • poor timing
  • problems with chewing foods
  • problems with spatial awareness
  • tripping over one's own feet
  • trouble picking up and holding onto simple objects

Developmental Verbal Dyspraxia—

Developmental Verbal Dyspraxia (DVD), sometimes referred to as “childhood apraxia of speech,” is a type of DCD that can cause speech and language impairments. The key difficulties include: 
  • controlling the speech organs
  • making speech sounds
  • sequencing sounds within a word or forming words into sentences
  • controlling breathing
  • suppressing salivation and phonation when talking or singing 
  • slow language development

Research has found that children with DCD and normal language skills still experience learning difficulties despite relative strengths in language. This means that for a student with DCD, her working memory abilities determine her learning difficulties. Any strength in language that she has is not able to sufficiently support her learning.

Assessment—

When the issue is raised, the child’s doctor is likely to make a referral to a physiotherapist and/or occupational therapist to help in the diagnosis of DCD, and may involve educational, clinical or neuropsychologists in the assessment of associated problems.

The two main questions to be answered when assessing a child with possible DCD are, first, does he or she have significant coordination difficulties compatible with DCD and, second, is there an underlying neurological or physical disorder? An underlying neurological or medical disorder should always be considered and excluded.

Assessments for DCD typically require a developmental history, detailing ages at which significant developmental milestones occurred (e.g., crawling, walking, etc.). Motor skills screening includes activities designed to indicate DCD (e.g., variations on walking activities, touch sensitivity, physical sequencing, and balancing). Screening tests that can be used to assess DCD include:
  • Bruininks-Oseretsky Test of Motor Proficiency
  • Movement Assessment Battery for Children
  • Peabody Developmental Motor Scales
  • Test of Gross Motor Development

Therapists use a range of activities to assess the youngster's level of ability in certain crucial areas (e.g., body awareness, cerebral integration, kinesthetic awareness, limb girdle stability, and motor skills).

Treatment—

In general, therapists use two main methods of treatment: process orientated and task orientated. Process‐orientated therapy concentrates on developing sensory modalities involved in motor performance (e.g., the sensory integration approach). The task‐orientated approach aims to improve specific tasks through practice.

Other approaches have focused on improving the child’s self‐esteem rather than the core problems of coordination. Some clinics offer transitional programs to help kids with DCD meet the increasing physical and educational demands when moving from primary to secondary education.

Although kids with DCD usually benefit from physical therapies, many receive as much benefit from psychological support to help them develop compensatory strategies, and cope with their motor impairment and loss of self‐esteem.

Although there is currently no cure for DCD, early intervention may help to reduce the physical, emotional, and social consequences that are often associated with this condition. Without intervention, Asperger’s kids with DCD will continue to exhibit poor motor skills – and show deficits in other areas as well. These young people can - and do - learn to perform certain motor tasks, but they have difficulty when faced with new, age-appropriate ones and are at risk for secondary difficulties that result from their motor challenges. Also, it is important to note that kids with DCD often experience considerable difficulties at school; therefore, it is necessary for parents to educate their child’s teachers about this disorder.

The Aspergers Comprehensive Handbook

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