Clumsy child syndrome: Description, Causes and Risk Factors:Many school-aged children struggle to learn motor skills that their peers have already mastered. Such children, often described as “clumsy,” may have difficulties with writing and self-help skills such as dressing and self-feeding.While the exact cause of clumsy child syndrome is unknown, many theories attempt to explain its etiology. Some researchers emphasize the apparent difficulty these children have in planning the execution of motor tasks. This difficulty in motor planning is termed “dyspraxia.” Researchers who have studied the difficulties with motor control in the clumsy child postulate that problems with motor execution are the primary deficit. Other researchers point to apparent difficulties in the child's ability to understand various sensory relationships and provide research demonstrating that clumsy children have deficits in proprioception, sensory integration, and visual processing.Careful study has revealed that clumsy children are a heterogeneous group, and different theories may better explain motor difficulties in individual children. Insights into the etiology of a particular child's clumsiness may help the physician tailor an appropriate treatment strategy.While epidemiologic studies estimate that significant Clumsy child syndrome affects 5 to 15 percent of school-aged children, the estimate with the most scientific basis is a prevalence of 6.4 percent. Significant Clumsy child syndrome affects boys more often than girls. Incidence is not related to the child's level of education or socioeconomic status. Affected children are usually diagnosed between the ages of six and 12 years, and rarely before age five.Having clumsy child syndrome does not change how intelligent a child is, but it does affect their learning ability. They may need extra help at school to keep up with their classmates.Symptoms:Symptoms are evident from an early age. Babies are usually irritable from birth and may exhibit significant feeding problems. They are slow to achieve expected developmental milestones. For example, by the age of eight months they still may not sit independently.Many children with clumsy child syndrome fail to go through the crawling stages, preferring to `bottom shuffle' and then walk. They usually avoid tasks which require good manual dexterity.Children with clumsy child syndrome may demonstrate some of these types of behavior:Very high levels of motor activity, including feet swinging and tapping when seated, hand-clapping or twisting. Unable to stay still.
High levels of excitability, with a loud/shrill voice.
May be easily distressed and prone to temper tantrums.
May constantly bump into objects and fall over.
Hands flap when running.
Difficulty with pedalling a tricycle or similar toy.
Lack of any sense of danger (jumping from heights, etc).
Continued messy eating. May prefer to eat with their fingers, frequently spill drinks.
Avoidance of constructional toys, such as jigsaws or building blocks.
Poor fine motor skills. Difficulty in holding a pencil or using scissors. Drawings may appear immature.
Lack of imaginative play. May show little interest in dressing up or in playing appropriately in a home corner or Wendy House.
Limited creative play.
Isolation within the peer group. Rejected by peers, children may prefer adult company.
Left- or right-handedness still not established.
Persistent language difficulties.
Sensitive to sensory stimulation, including high levels of noise, tactile defensiveness, wearing new clothes.
Limited response to verbal instruction. May be slow to respond and have problems with comprehension.
Limited concentration. Tasks are often left unfinished.
Difficulties in adapting to a structured school routine.
Difficulties in PE lessons.
Slow at dressing. Unable to tie shoe laces.
Barely legible handwriting.
Immature drawing and copying skills.
Limited concentration and poor listening skills.
Literal use of language.
Inability to remember more than two or three instructions at once.
Slow completion of class work.
Continued high levels of motor activity.
Hand flapping or clapping when excited.
Tendency to become easily distressed and emotional.
Problems with coordinating a knife and fork.
Inability to form relationships with other children.
Reporting of physical symptoms, such as migraine, headaches, feeling sick.
Diagnosis:Assessments for clumsy child syndrome typically require a developmental history, detailing ages at which significant developmental milestones, such as crawling and walking, occurred. Motor skills screening includes activities designed to indicate clumsy child syndrome, including balancing, physical sequencing, touch sensitivity, and variations on walking activities. A baseline motor assessment establishes the starting point for developmental intervention programs. Comparing children to normal rates of development may help to establish areas of significant difficulty.The earlier that difficulties are noted and timely assessments occur, the quicker intervention can begin. A teacher or GP could miss a diagnosis if they are only applying a cursory knowledge.Treatment:When diagnosing clumsiness in a child, the family physician should first demystify the condition for the family. Parents need to know that these motor difficulties are likely to persist but will probably be less troubling in adulthood. The physician may ask an older child whether he or she is teased about incoordination, while expressing recognition, sympathy, and support. Teachers should be informed that what may appear to be sloppiness or laziness is the manifestation of a disability.Clumsy children may be encouraged to participate in sports such as swimming and horseback riding to help them experience some athletic success. Some schools will alter a child's academic and physical education classes so that the activities match the child's motor abilities. While there is little evidence that occupational therapy produces sustained improvement in general motor skills, such therapy can serve to improve particular motor skills, educate parents, and address issues of self-esteem.Occupational therapy, individualized to meet the particular needs of a clumsy child, appears to be the best treatment approach based on current data. Research is producing data that may discern whether particular techniques, such as cognitive approaches, are more effective than other forms of occupational therapy. The evidence that these children suffer much more than their peers from academic, emotional, and behavioral problems should compel us to intervene on their behalf.NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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