developmental coordination disorder: hints and tips for the activities of daily living

Developmental Coordination Disorder

of related interest

Caged in ChaosA Dyspraxic Guide to Breaking Free

Victoria BiggsISBN 1 84310 347 8

The Adolescent with DevelopmentalCo-ordination Disorder (DCD)Amanda KirbyForeword by Professor David SugdenISBN 1 84310 178 5

How to Help a Clumsy ChildStrategies for Young Children with DevelopmentalMotor Concerns

Lisa A. KurtzISBN 1 84310 754 6

Stephen Harris in TroubleA Dyspraxic Drama in Several Clumsy Acts

Tim NicholISBN 1 84310 134 3

Developmental CoordinationDisorder

Hints and Tips for the Activitiesof Daily Living

Morven F. Ball

Jessica Kingsley PublishersLondon and Philadelphia

First published in the United Kingdom in 2002by Jessica Kingsley Publishers

116 Pentonville RoadLondon N1 9JB, UK

and400 Market Street, Suite 400Philadelphia, PA 19106, USA

www.jkp.com

Copyright © Morven F. Ball 2002Second impression 2006

The right of Morven F. Ball to be identified as authors of this work has beenasserted by her in accordance with the Copyright, Designs and Patents Act

1988.

All rights reserved. No part of this publication may be reproduced in anymaterial form (including photocopying or storing it in any medium by electronicmeans and whether or not transiently or incidentally to some other use of thispublication) without the written permission of the copyright owner except in

accordance with the provisions of the Copyright, Designs and Patents Act 1988or under the terms of a licence issued by the Copyright Licensing Agency Ltd,90 Tottenham Court Road, London, England W1T 4LP. Applications for thecopyright owner’s written permission to reproduce any part of this publication

should be addressed to the publisher.Warning: The doing of an unauthorised act in relation to a copyright work may

result in both a civil claim for damages and criminal prosecution.

Library of Congress Cataloging in Publication DataA CIP catalog record for this book is available from the Library of Congress

British Library Cataloguing in Publication DataA CIP catalogue record for this book is available from the British Library

ISBN-13: 978 1 84310 090 4ISBN-10: 1 84310 090 8

ISBN pdf eBook: 1 84642 176 4

Printed and Bound in Great Britain byAthenaeum Press, Gateshead, Tyne and Wear

www.jkp.com

Contents

ACKNOWLEDGEMENTS 7

1. Introduction 9

2. Developmental Coordination Disorderexplained 13

3. Posture 17

4. Writing 21

5. Scissor skills 29

6. Reading 33

7. Feeding 37

8. Personal care 41

9. Dressing 45

10. Attention 51

11. Organisation 55

12. Learning new or difficult tasks 59

13. When behaviour is a problem 61

14. Activity suggestions for developing motor skills 67

15. Final note 81

HELPFUL ADDRESSES 83

RESOURCES 85

BIBLIOGRAPHY 87

INDEX 89

Acknowledgements

Chapter 13, ‘ When Behaviour is a Problem’, was prepared byLyndal Franklin and Diane Collis, Occupational TherapyDepartment, Mater Children’s Hospital, South Brisbane, Australia.Their superb handout was adapted for this publication.

Thanks to Annabelle Tilbrook (née Nommensen) who co-wroteChapter 11, ‘Organisation’, when we worked together in 1995.Annabelle now lives and works as a Paediatric OccupationalTherapist in Southern Australia

Grateful thanks to Carol Grant (Voluntary Action, Inverness) forword processing the manuscript and Roddy Robertson for his ITassistance

Thank you to the Highland Developmental Coordination Disorders(HDCD) group for their support and encouragement in pursuing thispublication. Thank you to Emma Fraser, pupil at Glenurquhart HighSchool, for designing the HDCD logo which has been adapted foruse on the front cover.

Thanks to all the children and families that I have worked with for alltheir inspiration.

Thanks also go to ex-colleagues who have taught me all theinvaluable paediatric OT skills and knowledge I have gained.

Lastly, but not least, thanks to my husband Roger for his patienceand thoughts.

7

chapter 1

Introduction

These hints and tips are written for parents and carers ofchildren diagnosed with Developmental CoordinationDisorder (DCD). DCD includes dyspraxia, and otherassociated disorders, such as Asperger Syndrome, Dyslexia andAttention Deficit Hyperactivity Disorder (ADHD). There is alot of overlap amongst these disorders and many such childrenwill have problems with their social skills, motor-planning,attention and concentration, and coordination. DevelopmentalCoordination Disorder is the name given to the conditionwhere children have difficulty with movement and withspecific aspects of learning, and where these difficulties are notdue to any other known medical condition.

It is estimated that up to 1 in 10 children is affected byDCD. Therefore, every class teacher and many families willhave a child with this disorder, from mild to severe, making it arelatively common condition. There is no magic ‘cure’, thoughthe child may improve in some areas with growing maturityand with access to the appropriate therapy to develop skills.However, some children respond more completely to treatmentthan others.

Even when a child is receiving therapy intervention, andsupport for learning at school, there are often a number of

9

problems for parents and carers to overcome that requirepractical solutions. These include things such as behaving withsocially appropriate skills, learning new tasks and coping withday-to-day demands at home and school. This guide gives verygeneral and simple ideas to refer to on a daily basis to help withactivities of daily living (ADLs). It is hoped that the hints andtips will help improve or develop a child’s skills. Sometimeslittle changes can make huge differences in the child’s physicalskills and behaviour. It is obviously still a very good idea totreat the underlying problems (e.g. low muscle tone, poorbalance, poor eye movements) rather than focus solely onfunctional problems, unless the child and/or yourself feel thisis a priority (e.g. tying shoelaces or cutting food). What I meanby this is if the child finds the functional activity physicallyvery difficult then he or she may be reluctant to participate inthe task which in turn could lead to increased anxiety andfrustration. In these cases tackling the underlying physicalproblem becomes a priority.

It is essential that the advice of a paediatric occupationaltherapist be sought. A GP, school doctor, or a paediatrician canrefer the child to a paediatric OT working in your local childhealth service or employed by your local education authority.In some areas an educational psychologist, speech andlanguage therapist, a teacher or even a parent could refer achild. Paediatric OT’s are thin on the ground, so the child mayhave to be referred to another district or seek treatmentprivately – The National Association of Paediatric Occup-ational Therapists hold a register of private practitioners (seeHelpful Addresses). Once a paediatric OT has been found atreatment programme that involves gross motor activities tohelp increase the child’s sensory-integrative function can bedrawn up and implemented. Working on gross motor activitiesoften leads to improvements in academic and functional tasks.

10 DEVELOPMENTAL COORDINATION DISORDER

In my experience many carers of children with DCD,including dyspraxia and allied conditions, often feel poorlyequipped to deal with these children’s daily needs. I hope toprovide you with enough suggestions to select what is usefulfor your child. A lot of the ideas are common sense, but youmay or may not have thought of these ideas yourself. If youhave devised solutions of your own which help your child thisis absolutely great. Please share them with others that have achild or work with a child with DCD.

When reading this book and following the tips, pleaseremember that each DCD child is unique, with his or her ownset of difficulties. Please bear these points in mind:

INTRODUCTION 11

� Allow extra time

� Do lots of practice

� Praise successes

� Use repetition

� Do not pressure

� Allow variability

chapter 2

Developmental CoordinationDisorder Explained

What is DCD?Developmental Coordination Disorder is an impairment,immaturity or disorganisation of movement. Associated withthis there may be problems with language, eye movements,perception, thought, specific learning difficulty, personalityand behaviour, and variability.

Other names

The term DCD is now replacing ‘clumsy child syndrome’ and‘motor-learning difficulties’, often referred to as dyspraxia. Inthe past various terms have also been used, e.g. sensory-integrative dysfunction, perceptuo-motor dysfunction,minimal brain dysfunction, spatial problems, visuo-motordifficulties. They are all terms for children who have difficultywith movement and with specific aspects of learning.

13

How does DCD affect a child?Movement

Gross and fine motor skills are immature and the child findsthem hard to learn, making him or her awkward inperformance. This may affect balance.

Language

Articulation may be immature or even unintelligible in earlyyears. Language may be impaired or late to develop.

Eye movements

There may be difficulty with controlling movements of theeyes when following a moving object or difficulty lookingquickly and effectively from object to object. This may affecteye–hand coordination.

Perception

There is poor registration and interpretation of the messagesthat the senses convey and difficulty in translating thosemessages into appropriate actions.

Thought

The child may have normal intelligence, but have greatdifficulty in planning and organising thoughts. Those withmoderate learning difficulties may have these problems to agreater extent.

Specific learning difficulty

There may be problems with reading, writing, spelling,reversals (e.g. formation of numbers/letters) or reversing the


order of letters in words and/or numbers, and with numberwork/maths (e.g. concepts and rote-learning, like times tables).

Personality and behaviour

The child may display behaviour problems, e.g. restlessness,lacking controls, unhappiness, loneliness, poor self-esteem,lack of confidence and/or behaviour problems due tofrustration. Secondary emotional problems may develop (e.g.refusing to go to school, bedwetting, difficulty withfriendships, becoming easily upset), often caused by pressureson the child from other children and adults.

Variability

Children have ‘good days’ – when they can do things betterthan at other times – and ‘bad days’. It is crucial to rememberthis when working with a child with DCD, especially as thechild’s performance can vary from hour-to-hour.

DEVELOPMENTAL COORDINATION DISORDER 15

chapter 3

Posture

Posture is very important for many ADLs, e.g. for feeding,writing, games, schoolwork, homework and so on. Not only isit important for physical control of the body, but it can increaseattention and help increase control of eye movements. So –check the child’s posture!

Poor posture may be caused by a multitude of things, butmost commonly in children with DCD it is due to low muscletone (lacking normal tone or tension in the muscles so the childfeels ‘floppy’), resulting in reduced joint stability. Holding acorrect fixed position is therefore extremely difficult for them,leading to slouching, restlessness/fidgeting and/or fatigue.Often children have persisting baby-hood reflexes (i.e.primitive reflexes that have not been superseded by moreskilled movements and balance reactions) and if sitting postureis not corrected, head movements can affect stability andposture also. Reduced attention span can also make sittingdifficult, so sit in a chair at a desk or table rather than sitting onthe floor.

17

Tips for achieving good posture

• Good posture is achieved by sitting with the pelvisat the back of the seat with hips, knees and anklesat 90 degrees with feet on the floor or on a footblock (see Figures 3.1 and 3.2).

• The upper arms should never be less than 30degrees from the trunk.

• A Dycem mat™ (a non-slip sticky mat that does notadhere to materials) on the seat or a ramped/wedgecushion can also be useful (see Figure 3.2).

• Stability can be increased with chairarmrests/footrests.

• The desk height should be about 2 inches abovethe level of the elbows when the elbows are bentand the child is sitting upright in the chair.


Figure 3.1 Figure 3.2

90°

footblock

rampedcushion

90°

90°

• Table height is important.Check if the table needsto be raised. A cut-outtable (a table with asemi-circle cut out –see Figure 3.3) is greatbecause the child’strunk can fit into thegap and the elbows aresupported by the sides,giving stability to thetrunk and arms andaiding a more upright posture. These specialisedtables can be bought from Rifton or G & SSmirthwaite (see Resources) or a table could beadapted.

• Beware of plastic classroom chairs – the backs tiltand the seats are too long. This results incompensatory postures that limit stability andmovement of the arms and hands.

• If you help the child to fix his or her head positionlooking directly in front, then this will help thechild fix his or her eyes in space.

• A slanted desktop or angled surface on the tabletopmay help many children avoid a lot of headmovement and will help inhibit any baby-hoodreflexes that result in altered posture. They areuseful if the child loses his or her place easily whenreading due to poor relocating.

POSTURE 19

Figure 3.3 Cut-out table

• When sitting on the floor a cross-legged position isbest. This gives more stability than long-sitting orside-sitting, which is more tiring and requires thechild to use his or her hands for support.


chapter 4

Writing

There may be numerous reasons why writing is a problem (e.g.the child cannot use his or her hands in isolation from theupper limbs) and this needs assessment from a paediatricoccupational therapist. Problems can be caused by:

• low muscle tone

• instability in joints in upper limbs

• persisting baby-hood reflexes

• type of pencil grasp used

• tremor or controlling movement in upper limbjoints, i.e. slight arm incoordination.

Poor writing is often caused by fast-fatigue of the muscleswithin the hand. (Fast-fatigue is the quick development oftiredness and pain in the muscles – most individuals do notexperience writer’s cramp unless they have written for alengthy period.) Sometimes the children grip a pencil withmore force because they do not get good proprioceptiveand/or tactile feedback. If the child has dyspraxic problemsthen layout and organisation can be poor.

21

Common problems and how to minimise themGrasping the writing implement

Holding a pencil can be a very difficult task for a child withDCD. The child may not feel the pencil in his or her handadequately due to poor tactile sensation, so he or she may notbe able to adjust their grasp, know how tightly or loosely theyare holding the pencil or know how hard they are pressing.Poor proprioception can also cause an ineffective grasp,excessive joint movement and poor detection of force.

• With low muscle tone you tend to grip tighter toget a strong grasp, so increasing shaft size reducesgripping/grasping pressure.

• Use an elastic band at the bottom of the pencil toprevent the fingersslipping down thepencil (see Figure 4.1).Put the elastic bandabout 1inch from thetip.

• Use a pencil grip (see Figure 4.2) or a triangularpencil. These are available from HOPE, GALT andNottingham Rehab (see Resources).

• Paint a ring round thepencil to indicate whereit should be held.

• Colour code places onthe pencil and the child’sfingers to indicate wherethe fingers should makecontact with the pencil.


Figure 4.1 Elastic band

Figure 4.2 Pencil grip

• Use visual and touch cues (e.g. markers) to ensurecorrect finger placement.

It is important to note that some aids (e.g. pencil grips)encourage the ‘normal’ grip pattern, which requires morefinger strength than the child is able to maintain. In this casethey will hamper the child’s ability to write, especially if usedfor extended periods.

The ‘normal’ grip pattern is called the dynamic tripodgrasp. This involves the thumb, index and middle fingers inprecise opposition. The wrist is slightly extended, the pencil isgrasped near the point and writing movements are made bymoving the finger joints, whilst the wrist is held fixed. Thisposture is usually achieved by 4-and-a-half to 6 years of age.However, the dynamic tripod grasp is not necessarily the bestposition for all hand shapes and sizes. The gripper willhopefully improve grasp pattern, although dysfunctional grasppatterns are very difficult, or almost impossible, to change asthey have become habitual. If it is functional for the child, inthat it allows fine movements of the finger joints, an open webspace and a stable hand position, then let them carry on usingthis grasp.

• Use a fibre tip pen.

• Use a pencil with soft lead.

• Use of short crayons/pencils/chalk will encouragethe tripod grasp. Whenever the correct grasp isassumed give praise to the child and place paperover a textured surface (template, rough sandpaper,wallpaper) whilst the child scribbles or makes largedrawing movements with the crayon, pencil ormarker – this helps the child ‘get the feel’ of thecorrect finger positioning.

WRITING 23

Finger control

If finger movements are awkward, use other activities todevelop finger control. Provide regular, supervised practiceperiods until correct grip position is used automatically – thismay take a long time, but plenty of daily practice willeventually pay off.

Normal movement requires normal postural tone (i.e.muscle tension that is neither too high nor too low), so preparefor any desired motor activity by normalising tone as much aspossible before presenting activity.

• Stretch a rubber band that is around the fingers byextending the fingers or get the child to stretchbands over the neck of a jar.

• Crumple up stiff paper with one hand, ensuring thechild does not do this against his or her chest.

• Pop ‘bubble wrap’ between finger and thumb.

• Squeeze clothes pegs and move them about a boardwith nails hammered in it. Perhaps use differentcoloured pegs to play solitaire, noughts and crossesor draughts.

• Hammer nails into wood, with supervision, orhammer egg trays with a small mallet. Or use apurchased game, e.g. Hammer-Tic/Tap-Tap.

• Use wind-up toys.

In addition, using putty, clay, plasticine or dough will helpincrease tone before proceeding with written work. Warm-upslike this will particularly benefit 5- or 6-year-olds beforestarting to write.


Movement in upper limb joints

Poor contol of movement in upper limb joints may be due topoor proprioception and low muscle tone in the joints. Thiscan lead to the child not knowing the position of his or herbody parts, not knowing where his or her position in space isand not being able to achieve force control. Poor control ofmovement is also influenced by inhibition (regulation ofmovement) and facilitation (speeds up our responses) in ournervous systems if there is not a balance of these elements.

• Use a weighted pen, as this may help slight armincoordination and reduce tremor and it canprovide better joint position.

• Use wrist weights/cuffs. Wrist weights can bepurchased in many sport shops or stores like Argos.

• Wrist held down by magnetic cuff on a magneticboard. Magnetic cuffs can be obtained from TfH(see Resources) or can be made by sewing magneticbars into material and velcroing them to the child’scuff.

Paper moving

This is often due to the child having difficulty coordinatingboth sides of the body. We use a leading and assistive hand formost bilateral activities, that is, one hand supporting and onehand functional. Persisting reflexes can also affect bilateralcoordination, so ensure good sitting posture and give verbaland tactile cues using a stabilising/assistive hand.

• Tape the paper to the tabletop or desk.

• Use a Dycem mat™.

WRITING 25

• Use a bulldog clip.

• Use a desk fence. This is anarrow bar of woodround the edges ofthe tabletop/deskto preventpaper/books fromslipping (see Figure 4.3).

Pencil control

Poor pencil control is when a child cannot use a writingimplement to form writing patterns that are accurate, fluid andage appropriate. This can be due to the child having physicalproblems such as poor shoulder stability (so that the whole ofthe upper limb moves, not just fingers, when writing), lowmuscle tone in the upper limbs (causing poor force detection),tremor, persisting baby-hood reflexes and poor visual-motorcoordination (the inability to coordinate vision with themovements of the body).

• Writing on alternate lines.

• Dots at either side of the page act as markers ofwhere to write from/to, or put left and right handmargins on lined paper.

• The use of wide lined paper may also help as cangridded paper.

• Lined paper turned sideways can help the child toline up numbers.


Figure 4.3 Desk fence

Final suggestions

• Focus on legibility, rather than neat appearance.

• Allow extra time.

• Use a scribe or Dictaphone™. This helps to focuson the content of a writing assignment and not somuch on the placement of letters on lines.

• Stop whenever the child is fatigued. Graduallybuild up the length of time and amount the child isrequired to write – too much at one time couldcause frustration. Continued laboured writing mayrequire further investigation – if pain, fatigue orvery laboured writing occurs word processing maybe simpler as there are less fine motor demands.However, remember to minimise visuo-motoraspects of activities whenever possible.

WRITING 27

chapter 5

Scissor Skills

Weak hands and fingers are common in children who havedifficulty with fine motor skills. These children tend to avoidsuch activities, but they then do not increase strength in theirhands at the rate of children who do engage in fine motoractivities at every opportunity. Using scissors can improvemany fine motor skills (e.g. bilateral coordination – one handholding the paper, the other using scissors) and it can increasemuscle tone if the child is encouraged to cut through stiff paperor card that provides a bit of resistance. It also encouragesmotor planning as the child will have to organise the paper andcutting action to change direction. Always tackle simplecutting tasks, such as snipping paper/straws/wool, for, say, acollage, until the child increases their skill, interest andmotivation to attempt more intricate cutting out. Ensure thechild is using the correct pair of scissors for their dominanthand.

Tips for using scissors

• Use tongs to pick up things – this is a good way tobuild up strength first.

29

• Use self-opening scissors ordouble handled scissors (seeFigure 5.1), available fromHOPE, GALT andNottingham Rehab (seeResources), which allowyou to control themovement whilst the childcan still ‘feel’ it.

• Stick tape or tie yarn around the loops of ordinaryscissors so that the blades donot close all the way, or adda rubber band aroundintersection of blades tokeep snips small.

• To use scissors with control,fingers that are not involvedin holding the scissors (i.e. thelast 2 fingers) are stabilised bytouching the palm (see Figure 5.2).Practice open–close handmovements with saladtongs or kitchen tongs.

• Rest the child’s forearms on the tabletop if he orshe has reduced bilateral coordination (using bothhands together). Fatigue sets in if the arms are heldup – this provides more stability to the trunk andupper limbs.

• Lie the child on his or her tummy on the floor,resting on his or her forearms and practice


Figure 5.1 Self-opening scissors

Figure 5.2 Using scissors – ringand little finger in palm

snipping. This position keepsthe trunk, pelvis, shouldersand elbows still andaligned, and increasescontrol in the wrists andhands.

• Practice snipping and/orfringing – straight linesare easier. Use cardboard orcards or snip straws orstring into strips.

• Practice scissor skillsregularly and with items of interest that motivatethe child, such as a scrapbook or collage.

SCISSOR SKILLS 31

Figure 5.3 Reduced bilateralintegration – forearmsresting on table top

chapter 6

Reading

The DCD child may have reading problems because he or shecannot remember sounds of words or spellings, or because ofvisual perceptual difficulties (these need to be assessed by aspecialist). Often though, the child has problems with poorattention/concentration and with relocation skills (lookingquickly from one object to another). If the child loses his or herplace due to the former then reading will be difficult andprogress will be slow. It is common for children to havedifficulty crossing the body midline (an imaginary vertical linedown the middle of the body) and this not only affects usingthe hands when reaching to opposite sides of the body, but theeyes also. The child may read smoothly until the eyes cross themidline and then they ‘jump’ and lose the place. Moving theeyes quickly from one place to another is also problematic, e.g.looking from a jotter on the desktop to the blackboard andthen back to the jotter. This problem with relocation skills canbe minimised and remedialised.

Tips for improving reading skills

• Eliminate visual distractions.

33

• Present small amounts of work at a time.

• The use of an angledsurface to prop thebook on, or a book ona stand adjacent orabove the paper to

avoid losing the placeimproves eyemovements as the

child is not having to control lots of different bodyparts at the same time (see Figure 6.1). Angledsurfaces can be obtained from Posturite UK Ltd,Philip & Tacey Ltd and LDA (see Resources).

• Use a ‘window’ (anarrow rectangle cutout in a piece ofcard) to isolatesections of text. SeeFigure 6.2.

• Use a highlighterpen to makerelevant/importantareas to be readstand out. Somechildren haveproblems with figure/ground discrimination (theability to distinguish an object from itsbackground), so reading text over pictures isdifficult.


Figure 6.2 A‘window’

Figure 6.1 Using an angled surface

• The teacher or parent can divide syllables bymarking with a pencil line throughout the text.

• Use auditory information to supplement visualinformation. Read material out if necessary,although be sure to check the level of material tobe read is suitable.

• Work written on the blackboard should always besequenced and numbered, so it is easier for thechild to follow.

• Use handouts to supplement blackboard work atschool.

Under guidance from an Occupational Therapist it is alsohelpful to provide activities to improve visual perceptual skillsand to provide activities to improve eye movements.

Tips for improving visual perceptual skillsRemedial activities for visual perceptual problems varyaccording to the nature and extent of the difficulties. An OTwould use a variety of different activities in fitting with theproblem.

• Puzzles

• Sorting games

• Spotting hidden objects in pictures

• Word searches

• Aiming target games

• Matching games

READING 35

• Dominoes

• Copying pegboard designs

• ‘I Spy’

Tips for improving eye movementsEye movements are important for learning and performingskills such as reading, writing and ball games. If the child hasproblems with eye movements an OT will suggest activities toencourage the child to exercise the eye muscles.

• Computer games

• Following a marble with the eyes down a marblerun (construction game)

• Quickly spotting objects around a room


chapter 7

Feeding

Parents often seek ‘normality’ when it comes to using cutleryand feeding, but there is always room for compromise. If achild eats with his or her fingers perhaps helping them to usespecialised cutlery (see list below) is a preferable alternative. Orcutting up the child’s food – giving partial assistance – helpshim or her to eat more easily yet still with independence. Suchfeeding aids can be a great help, but it must be noted that if thechild is keen to be the same as his or her peers (e.g. whenattending school dinners) such aids might emphasis his or herdifferences, so perhaps home is where they should be tried out.

Tips for using cutlery andfeeding

• Use a Dycem mat™ tostabilise the plate or bowl.

• The use of a plate guard (aplastic barrier that clips tothe edge of the plate,available from Nottingham Rehab – see Resources)or a plate with a lip can also be helpful to prevent

37

Figure 7.1 Use a Dycem mat™

food being spilled and can aid a child when he orshe is loading up a spoon or fork.

• Moulded cutlery aids finger placement.

• An elastic band around the handles of cutlery helpsto prevent the child’s fingers from slipping.

• The use of cutlery with built up handles can behelpful if the child’s grip is weak. Foam tubingwrapped around the handles works well.

• A splade (see Figure 7.2) can be used if there is aproblem with coordinating a knife and fork.

• A sharp steak knife can be used for cutting– butonly under supervision!

• Use lightweight cutlery if the child has weakness inhis or her upper limbs.

• A lightweight beaker (plastic) is helpful forweakness in upper limbs. This can be bought (seeNottingham Rehab, in Resources) or provided byan occupational therapist.

• Heavy cutlery, weighted cuffs or wrist weights canbe helpful if the child has arm tremors.

• A heavy cup (ceramic) can help reduce a tremor orincoordination. This can be bought (see


Figure 7.2 A splade

Nottingham Rehab, in Resources) or provided byan occupational therapist.

• Double-handed cups or cups with anti-spill tops arealso useful, as are drinking straws (see NottinghamRehab in Resources).

• Coordinating a knife and fork can be very difficultfor the child and sometimes organisation of theutensils is difficult if there are dyspraxic problems.Get the child to practice cutting Playdoh™ orplasticine regularly. Cutting through material thatcauses a bit of resistance will also help to increasetheir muscle tone.

FEEDING 39

chapter 8

Personal CareToileting, Bathing and Grooming

A lot of parents do not like to ask about personal hygiene, but itis a very important and frequent daily task. It is necessary to tryand make the child as independent as possible, as they willprobably be embarrassed or ashamed to ask for adult assistancewhen away from home, so for the child’s dignity, and to avoidsoiling, here are some tips.

Tips for bathing

• If balance is a problem and equipment is requiredfor safely transferring in and out of the bath (e.g.step, bathboard, bath seat, grab bar), then a referralto a community occupational therapist may need tobe made (based at your local Social WorkDepartment). You can make a self-referral (or foryour child) or you can be referred by your GP,child OT, paediatrician, physiotherapist, speech andlanguage therapist, or, in fact, any professionalworking with your child.

41

Tips for toileting

• Ensure the child wears clothing that is easy topull-off or pull-on, (e.g. minimum of fastenings,elasticated waist, stretchy fabric), so that this lowersthe risk of soiling if there is urgency of toileting.

• Cleaning after toileting may be helped if a lowmirror is placed adjacent to the toilet, so the childcan check his or her personal hygiene.

• Wet wipes may be a help.

• Long-handled wiping aids are available (fromNottingham Rehab – see Resources), but may bemore of a hindrance than a help as your child mayhave problems coordinating and planning its use.

• Often children have bowel and/or bladderproblems. If soiling continues after an age youwould expect a child to have control, you may needto see an expert, e.g. a Paediatrician, or attend anenuresis clinic. Expert advice should also be soughtif your child has constipation.

Tips for grooming

• An electric toothbrush may help when brushingteeth.

• A toothpaste pump dispenser may be easier to usethan a tube.

• Long-handled hairbrushes and combs are availableif the child cannot reach behind their head, but


organising their use could be problematic if thechild has motor-planning difficulties

• If holding a hairbrush is difficult, use one with astrap across it, like a pet’s brush.

• Sometimes brushing the opposite side of the head isavoided due to poor midline crossing, so encouragethe child to look in a mirror to check that theyhave completely brushed his or her hair or give averbal prompt to brush the whole of the head.

PERSONAL CARE 43

chapter 9

Dressing

Dressing is a complex activity because there are so many stagesinvolved. To begin with avoid tasks that are difficult unless youor your child really wishes to do the task (e.g. tying shoelaces),as this will only cause frustration and lower the child’sconfidence. The best way to teach dressing skills is by doingone thing at a time, even if the child begins with only the laststage, e.g. pulling his or her socks up. You can increase the stepsinvolved with each garment gradually, e.g. pull sock over heeland pull up, then tackle putting the sock over the toes, thenover the heel and then pull up. By using these ‘backwardchaining’ techniques the child is attaining success, and successleads to increased self-confidence and motivation to try again.

Tips for dressingClothing

• Use loose fitting clothes – clothes with elasticwaistbands and loose pullovers are ideal.

• Clothes with a minimum of fastenings, such assweatshirts, T-shirts, jogging trousers or leggingsare easier fot the child to manage.

45

• Stitch a marker to the back of garments to helpwith orientation.

Buttons, zips and fasteners

• The use of Velcro™ fasteners can make a bigdifference to any child that has difficulty withordinary fasteners.

• If the child is fashion conscious you could trystitching buttons on the top of the garment with aVelcro™ fastening below. This will givethe garment a ‘normal’ look so the childshould not feel that he or she iswearing anything too different.

• If the child has difficulty with zips,you could try adding a ring to the zipfastener to make it easier to pull thezip up and down (see Figure 9.1).

• Use a button size that is not toosmall.

• Stitch the top shirt button and the cuff button onwith elastic. The top shirt button will have more‘give’ to help with fastening and the cuff button canbe left fastened and will stretch to allow the handto go through.

Shoes, socks and ties

• When teaching the child to tie shoelaces, teach justone step at a time until they have mastered thatstage. Then go on to teach the next stage and so on.


Figure 9.1 Ring on zip

The use of double twists (repeating the first step oftying a shoelace – putting one lace over and underthe other twice before forming a bow) stops thelaces coming undone as some children cannot tielaces tightly.

• If laces are a problem, use Velcro™ fastening shoesor obtain elastic laces, curly laces (see Figure 9.2) ortags to keep laces fastened. These can be bought(from N G Enterprises – see Resources) or providedby an occupational therapist.

• When choosing socks, choose the tube type as theyare easier to manage because they have no heel andshould be loose fitting.

• With a tie, using elastic or clip-on fastening canmake a difference, or breakdown the task (see tipfor shoelaces). Demonstrate how to do up a tie on ateddy or doll first so that the child will be able tosee better.

General tips

• If balance is a problem then sit against a wall or ina corner to give stability. This is useful when thechild is putting on or pulling off a jacket, whentying shoes or when pulling on tights or trousers –all these things interfere with balance.

DRESSING 47

Figure 9.2 Curly laces

• Try listing the order in which clothes are put on, ordraw the order on cards (or use pictures or photos)to help show the sequence of putting on clothes.

• Practice daily, using the same set of instructionsevery time (write down the wording used). A lot ofrepetition is needed.

• Provide assistance only after the child has made aserious attempt to do the task him- or herself.Encourage him or her to complete dressing tasksindependently when there is more time, e.g. at theweekends and during the holidays.

• Remember to give a balance of help and practice sothat there is time for other things, e.g. getting toschool on time or getting out to play.

• Children with weaker arms may find progress isslower.

Some activities to helpAny activity involving pushing and pulling of arms againstsome resistance will help strengthen arm muscles (theproprioceptors in the ligaments and joints will be stimulatedcausing the muscle fibres to tense, hence increasing tone). Theactivities listed below will increase strength and providefeedback – how movement feels when the body is more stable.However, they will only increase muscle tone and joint stabilitytemporarily so they are worth doing before activities thatrequire fixing the joint in the stabilised position, or fine motordemands. Remember – the more the gross-motor activities arecarried out (on a daily basis would be great but if not, 2 to 3


times a week for a short time) the more the child’scoordination, postural control and strength will improve.

• Writing or drawing above head height, usingwhole arm movement.

• Scribbling or colouring over a template is likedoing a brass rubbing – the child is applyingpressure to create an image on the paper.

• Stirring food, kneading dough and molding puttyor clay are entertaining forms of exercise.

• Lifting, pushing, brushing, hoovering and cuttingthe grass are all good exercise.

• Use a ‘Dynaband’™. This is agraded rubber exercise bandwhich can be bought insports shops (women usethem in aerobic classes) orcan be obtained from anoccupational therapist – theyusually provide a ‘Theraband’™which is much the same (see Figure 9.3). These are

available from Nottingham Rehaband Smith & Nephew (see

Resources).

• Sitting push-ups or floorpush-ups sitting cross legged

(see Figure 9.4).

• Wall bars, monkey barsand ‘wheelbarrowswalking’ (walking on

DRESSING 49

Figure 9.4 Sitting push ups

Figure 9.3 Using aDynaband™/Theraband™

hands) all involve sustaining the body weight. Asmentioned before this will stretch muscles aroundthe joints and will thereby increase muscle tone andjoint stability. In the long term, as these thingsimprove so will coordination.


chapter 10

Attention

There are a number of reasons why children with DCD haveproblems maintaining attention. First, there could be an overalllack of inhibition in the central nervous system. This makes ithard for the child to regulate or modulate responses. Second,the child may have difficulty with screening, in that he or shefinds it hard to filter out the non-relevant and focus on therelevant. This can be visual and/or auditory, e.g. a bird flyingpast a window or the noise of other children playing outside.

Attention can also be difficult to sustain because the child isputting in far more effort to control his or her body movementsthan a child who does not have DCD. This means that the childfinds it more difficult to stay alert and interested, whilstconcentrating on thinking and doing at the same time.

Tips for improving attention

• Reduce sensory distractions in the environment –remove visual distractions, have the work area cleanand have the materials close at hand (see Figure10.1).

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• Do not use the bedroom for work activities as thisis normally associated with sleep, rest and play.

• Adapt activities – break down work periods intosmaller segments and increase the attractiveness ofthe work, e.g. use bright colours.

• Block out non-relevant sensory information – feelmovement patterns (i.e. draw/write with eyesclosed), block out sounds and use a frame/‘window’ (see Chapter 6) around work, so only theaspect of the work to be done is actually showing.

• Improve communication by seating the child nearhis or her instructor. Remind the child to focus onthe activity, avoid unnecessary words, use clear,specific language, use repetition and check that thechild is understanding what is being said.

If the child is lacking in controls (impulsive, heedless, talkative,loud, difficult to manage physically, prone to emotional


Figure 10.1 Minimise eye movements – have reference material closeat hand

outbursts and with poor attention) and hyperactive (‘on the go’all the time), then other measures may need to be taken.

Tips for improving attention in thehyperactive child

• Wrap the child up in a blanket, duvet, sleeping-bagor gym mat and press your hands firmly down ontohim or her and apply sustained pressure for anumber of minutes.

• For total body inhibition for calming the child orfocusing before fine motor activity, use a blanket towrap up the child to provide warmth (see Figure10.2) and maybe use music to help him or her torelax. Providing warmth and slow, repetitivemovements by rocking gently back and forth,side-to-side, are all very calming.

• Cuddling and/or squeezing the child tightlyagainst you, wrapped up, is also effective if deeppressure (‘holding’) is maintained. This can be donefor up to 10 to 15 minutes.

ATTENTION 53

Figure 10.2 ‘Calming’ technique

chapter 11

Organisation

Motor-planning difficulty is the inability to plan, organize andexecute an unfamiliar task. There are three components tosuccessful motor-planning:

• Forming the idea and knowing what to do.

• Organising the sequence of movement involved inthe tasks.

• Carrying out the planned movements in a smoothsequence.

The child with motor-planning problems can have difficultieswith one, two or all three of these components. Therefore thechild has difficulty figuring out how to use his or her body, andsometimes with organizing his or her behaviour. This can bequite disabling to a child with DCD, causing confusion, severedisorganisation and an illogical method of doing things. It isdifficult for many parents and teachers to understand as thechild may be very bright yet totally scatterbrained and find itdifficult to plan, initiate and execute any activity. Strategiesneed to be provided to help them with daily activities at homeand school, and carers need to have a patient approach.

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Tips for organisation

• Give clear, short instructions and give them onestep at a time.

• Have consistent, structured routines.

• Keep belongings in a particular place. Make a ‘base’so that the child only has to remember and find oneplace to retrieve books, pencils, paper, gym kit andso on.

• Encourage your child to plan his or her day thenight before, e.g. checking that books and itemsneeded for school are in his or her bag.

• Plan your week and stick to activities on the sameday and time of week, e.g. swimming on Thursdaysat 4.00pm.

• Have a revolving calendar (see Figure 11.1) that thechild changes daily, first thing in the morning, sothat they know what day and date of the week it is.A watch that displays the day and date, withoutneeding to push a button to get such information, isa good visual reminder of the time and date.


Figure 11.1 Organisers

• Get a person at school to talk through your child’sdaily routine with him or her at the beginning ofeach day.

• Encourage your child to always carry a writtentimetable with him or her to refer to.

• Keep a school diary. Make sure the child writes thisup at the end of each class, e.g. what homeworkhas to be done, page references, date for which thehomework needs to be completed by and so on.

• Encourage your child to adopt a ‘buddy’ to assisthim or her in getting from class to class, i.e. aconsistent friend or auxiliary, especially if yourchild finds the map of the school difficult to followor has difficulty with orientation.

• Decide on a mutually agreed award – perhaps foreach term – that the child should receive for beingindependent in managing his or her time,homework and so on. A simple star chart with arealistically achievable score may be a way ofmeasuring success.

• Praise successes and do not emphasise failings ordifficulties, so that the child has learned successfulbehaviour reinforced. (E.g. taking responsibility fororganising their own school books/bag is goodand if you praise the child – if they are rewardedpositively – then they will repeat this behaviour, asthey have been successful and been praised for it.)

• Compensate for difficulties by, for example,adapting clothing, using assisting devices, typing

ORGANISATION 57

instead of writing and avoiding competitiveactivities and sports.

• Explore other leisure options. Sometimes solitaryactivities, but within a group without competition,can help improve self-esteem and confidence, e.g.swimming, horse riding, photography,trampolining, using a gym (fixed weights), archeryand so on.

• Most importantly, make others (e.g. teachers, peersat school, friends’ parents, swimming instructor andso on) aware of the child’s problems withorganisation so they can provide support and helpand do not put too much pressure on the child.They need to create a structured setting for thechild also.


chapter 12

Learning New or Difficult Tasks

Learning new tasks will be problematic to the DCD child dueto his or her motor and cognitive difficulties. It may be that thechild has motor-planning problems, so learning any new taskwill be difficult. The child will need a lot more practice/repetition of a task and a lot of support, encouragement andpatience from the teacher. However, poor attention andconcentration can cause the child to have difficultyremembering and sequencing what to do when learning a newtask if they cannot stay focused visually or aurally.

It is important to remember that a child with DCD tends tothink about movement at a very conscious level, rather than itbeing automatic. The child is less able to cope with and thinkabout the more sophisticated complex parts of tasks. So if thechild is having to think about sitting erect, holding a pencil,listening to the teacher and taking notes all at the same time,then he of she will be putting in much more effort to a task thana child without DCD and he or she will fatigue much quicker.

There are three ways to help a child learn a new or difficulttask.

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1. Physical helpPlace your hand over the child’s hand and guide it through themovement. As the child ‘feels’ the movement and gets the idea,let him or her try more on his or her own. For example, help thechild to hold a pencil and draw a circle.

2. Visual cluesPoint to what has to be done. For example, point to the spotwhere the child has to paste the picture or you draw a circle andthe child draws a circle by copying what you did.

3. Verbal cluesTell the child what he or she has to do using clear, simplelanguage. For example:

‘Draw a big round circle.’

‘Stick the flower under the tree.’

It is always easier for the child if you use a combination of thesecues. Remember that physical help makes it easier for the child,and verbal prompts are more difficult for him or her tointerpret. Use the sort of cues that work best for the child.


chapter 13

When Behaviour is a Problem

Behavioural problems may be primary or secondary to theDCD child. The restlessness, fidgeting and poor performancemay be due to a lack of inhibition in the central nervous system,but the child’s behaviour may also be a direct result of his orher DCD difficulties. That is, the child may be unhappy, lonely,have poor self-esteem and lack confidence, and he or shedevelops secondary ‘behaviour’ problems, such as avoidance,refusal to do things, being withdrawn or acting the clown. Thechild’s behaviour may also be a result of frustration because hisor her cognitive ability exceeds his or her achievement.

Reasons for difficult behaviourSome children may avoid or refuse to do things because theyhave the following difficulties:

Poor attention

The child has difficulty with screening, i.e. filtering outinappropriate sensory information. The child may be too easilydistracted by outside noises, other people or objects in theroom, his or her own thoughts and so on. He or she may be

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fidgety and flit from one activity to another or one place toanother.

Poor concentration

The child has difficulty staying focused on a particular task fora reasonable amount of time and is a daydreamer. This may bedue to:

• poor attention (easily distracted)

• low muscle tone (tires easily)

• the activity is too difficult

• other activities seem more interesting at the time.

Frustration

The child is easily frustrated. This may be due to:

• poor coordination (clumsiness)

• poor motor-planning (difficulty organising him- orherself)

• poor understanding of language and instructions.

This may result in tantrums, throwing toys, being rough ordestructive with toys, or acting in a silly fashion.

Poor self-confidence

The child is so used to struggling or not succeeding, he or she isnot really motivated to try. If the child says, “I can’t do it!”before really trying, he or she is not being lazy – the child justneeds extra encouragement.


What you can do to help at homePrepare the room to reduce distractions

• Set up an activity in a quiet room in the house.

• Clear the room of as many distracting toys andobjects as possible.

• Turn off the television and radio.

• Close the door to shut out other noises.

Also refer to the section on attention (Chapter 10).

Sitting position

• Make sure the child is sitting comfortably.

• Sitting at a table helps keep the child in one placeso it is easier for you to keep him or her interestedin what he or she is doing.

• There may be times when you want to sit on thefloor, but this is difficult with the more active child.Try setting some limits, e.g. ‘This special rug isyour sitting place. You must sit on the rug if youwant me to play with you.’

Also refer to the section on posture (Chapter 3).

Give clear, simple instructions

• Keep your language simple.

• Give one simple step at a time to start with, e.g.‘First, Jimmy, sit down.’ (Help him to sit) ‘Whereare Jimmy’s pencils?’

WHEN BEHAVIOUR IS A PROBLEM 63

• Help the child to direct himself by asking himsimple questions or requests, e.g. ‘What colourpencil next?’; ‘Where will you paste the firstflower?’

Also refer to the section on organization (Chapter 11).

Redirection

• Help the child to stay with the activity byredirecting him physically, visually and/or verballyback to what he was doing.

• Observe when the child has had enough of theactivity or has become too tired.

• Help the child to finish the activity within areasonable amount of time, so he or she will beinterested in trying again on another occasion.

• If necessary, gain perseverance of an activity bydescribing the next event, e.g. ‘Come and sitdown…then we can have a new toy.’

Completing tasks

• Use turn-taking. This helps speed up the activity,encourages active participation and is important forcommunication and interaction, e.g. ‘I’ll stick onthe red flower…which one will you do?’

• Indicate when the activity is finished. If the childindicates he doesn’t want the toy or activity anymore, help him to put the toy away or to tidy up.


• Use turn-taking, e.g. ‘You do the blue ones, I’ll dothe green ones.’

• Praise the child for helping as this will make him orher feel good and want to cooperate again nexttime.

Setting limits and expectations

• If cooperation and/or attention is a problem, it mayhelp to set some simple boundaries for the child,e.g. ‘If you want to play you must sit down first.’;‘One more bead to thread, then we will finish.’;‘Which one will you do – yellow or blue?’

• Giving the child a simple choice can helpcooperation.

• Give praise for cooperation and staying within theset limits, e.g. ‘Good sitting. What do you want todo next – threading or the puzzle?’

Praising and encouragement

This is really important for developing the child’s self-confidence. If the child feels good about doing something, heor she will hopefully want to do it again.

• Verbal praise, smiles or rewards can be used, e.g.stickers or special toys or activities. The latter isoften best when behaviour is more difficult.

• Do not wait until the activity is complete beforepraising – give encouragement for each small partthe child does, e.g. ‘Good try! You did it!’

WHEN BEHAVIOUR IS A PROBLEM 65

• Give the child the opportunity to try things his wayrather than always the way you would do the task.This helps the child to develop an inner sense ofachievement.

Individual versus group

• When motivation is a problem the child might behappier to do a task with friends or other familymembers.

• The child may be motivated more by social reasonsthan by the task itself.

• You will often find the child will do things forothers but not with you at home.


chapter 14

Activity Suggestions forDeveloping Motor Skills

Children with DCD often feel floppy around joints and tirequickly with physical activity as a result of poor tone and jointstability. Any activity that provides pressure that is greater thanthe weight of the body part into a joint (joint compression) willstimulate the muscles around the joint and increase stability atthat joint, and thus will increase muscle tone.

The choice of activity depends on the problem, so getguidance from your occupational therapist. Nevertheless, thereare some general activities you could use to develop physicalskills, and the following suggestions could be carried out withindividuals or a group of children with similar difficulties. Forthe child’s safety, always supervise the child when carrying outactivities, checking for correct positioning and providingassistance if required. Make sure the child works on a paddedmat or gym mat.

The activities listed can be used by parents, by teachers orby carers of children with DCD and can be adapted for homeor classroom use. The activities should be fun and feel good tothe child and the aim is to focus attention on the outcome, notthe action required to fulfil it. For example, the object of a

67

game is to catch a ball above the head, not to think about thereaction and extending the arms.

You should try, if at all possible, not to instruct the child onhow to perform with various body parts. Self-direction is thekey. Children learn most when they ‘feel’ the body positionand do this for themselves.

Do not insist that the child does the activity if the childexpresses extreme dislike or disinterest. Avoid the activity anddo something else. Cooperation is changeable and they may bewilling to try another day. If the child is tiring with a task stopit and go on to another activity.

Try to do the activities regularly, daily or at least 3 to 4times a week, with more short periods being better than onelong period. Work at roughly the same time of the day –mornings are probably best because the child is not so fatigued.Remember to praise and encourage all efforts and achieve-ments.

Proprioceptive activitiesWhen carrying out a therapeutic programme for the child, firstuse activities providing proprioceptive input (those thatprovide information about the state and condition of themuscles, tendons and joints). Then follow it with an activitythat will use the joint in the stabilised position.

Activities providing proprioceptive input

• Tug-of-war.

• Swinging from gym bars.

• Climbing on playground equipment.

• Punchball/bag or ‘boxing’ into a pillow.


• Play fighting: push/pull the child by his or herhands and try and make the child work really hardand not fall over.

• Trampolining: on feet, inhigh-kneeling position or on anold mattress on floor.

• Jumping on a space hopper(see Figure 14.1).

• Push feet against a wall, alarge beanbag or with apartner.

• ‘Push-offs’ from a wallwith hands, from bentelbows to straight arms.

• Being pushed on a scooterboard (a flat, rectangularboard with rounded edges and four castor wheelsbeneath – available from TfH and Rompa, seeResources): lay the child in prone (on tummy) witharms and legs extended, then push him or her bythe ankles and let him or her crash into stackedcardboard boxes/soft play blocks/skittles (seeFigure 14.2).

• Building with tools and construction kits.

ACTIVITY SUGGESTIONS 69

Figure 14.1 A space hopper

Figure 14.2 Prone position on a scooterboard

• Any hammering, e.g. large egg trays – hammering‘bumps’.

• Stapling papers or using a hole punch.

Activities that use the joint in a stabilised position

• Supporting self on forearms in prone when playinga game, e.g. throwing beanbags at targets.

• Suspend an object from a rope and get the child tolie in front or to side in prone and attempt to bat itfrom this position.

• Grab a rope suspended above when lyingin prone and pull up as far as possible – theaim is to get to a standing position (see

Figure 14.3).

• Crawling activities, e.g.‘commando’, on handsand knees, obstaclecourses and relays.

• Side-sitting (seeFigure 14.4) to reador play a game totwist the trunk, e.g.knocking downskittles in an arc.

• Use a scooterboard.Self-propel in pronearound obstacles or in relays.


Figure 14.3 Pulling self up fromprone

Figure 14.4 Side-sitting

• Wheelbarrow walking.

Always check that the child’s joints are aligned correctly, withno hyperextension of wrists or elbows.

Vestibular activitesActivities providing other sensory stimulation are also requiredto improve motor skills, such as. vestibular activities (theorientation of the body in space as it changes position). Carrythese out next.

Rolling activities

• On mats, roll from one end to the other and back.A variation on this is to roll over scatteredbeanbags and other uneven surfaces.

• A resisted roll. Hold the child at his or her hips,which means that the child’s upper trunk mustrotate before turning over.

• Rolling in a play barrel (suppliers are Rompa, NesArnold, GALT and TfH – see Resources), with thehead and neck outside, and roll down a mat and


Figure 14.5 A scooterboard. This can be covered in carpet for tactile stim-ulation , and a play barrel can be lined with carpet also.

back. A variationon this is to rollover soft skittlesor cones to knockthem down, orroll to differentparts of room.See Figure 14.6.

Balance activities

• Balance beam. Walk the length of the beam,forward, backwards and sideways (use a wide beaminitially then, as child improves, use narrow beam).

• Rocker board. Balance or rock in standing, sittingand kneeling positions and engage in variousgames, such as catching/throwing beanbags,batting a balloon, tossing quoits over pegs orplaying a magnetic fishing game with a rod, whilst

rocking back and forth.

• T-stools. Sit on thestools, performingvarious games, such asthrowing and catchingballs or beanbags orkicking them at targets.T-stools need to be madeby a handyman, technicalinstructor or shelteredworkshop.


Figure 14.7 A T-stool(approximate size- 26cm (L) x

13 cm (W) x 17cm (H))

Figure 14.6 Rolling in a play barrel

Rapid change activities

• Swinging. Sit and/or hang onto a large rope in agym, swing back and forth and pick up objectsfrom floor whilst swinging.

• ‘Hot dog’. Roll up the child in a blanket then pull itquickly so that he or she rolls out.

• ‘Parachute’. A child lies down or sits on a‘parachute’ in the centre of a group. The groupwalks around, wrapping up the child, theneveryone pulls the parachute back, causing the childto be swung around and released (available fromGALT, Nes Arnold and Rompa – see Resources).

• Trampolining. Try simple jumping, knee drops, seatdrops, quarter turns whilst standing (to the rightand left), half turns whilst standing (to the right andleft) and a full turn if possible. For motor-planning,jump and swing arms in circles and in the reversedirection. Try one arm forward and one back whenjumping or ‘swimming’ with the arms whilstjumping.

Tactile activitiesAlso carry out tactile activities (for distinguishing the self fromthe outside environment) to provide further sensorystimulation. These are also required to improve motor skills.

• Hand lotion. The child rubs lotion onto arms,hands, legs – whatever skin is available.

• Shaving foam. The child rubs foam over arms,hands and legs and then get him or her to scrapeoff the foam firmly, using a spatula or cloth.


• ‘Feely box’. Put either polystyrene chips, shreddedpaper, rice, lentils, pasta or sand in a box. Hideobjects within these materials and then the childfeels for the hidden objects. If the box is bigenough the child could climb inside – wear shortsand a T-shirt for maximum sensory input.

• Textured cloths (foam, carpet, fur, wool, sandpaper,wallpaper, velvet, bubblewrap and so on). Blindfoldthe child and get him or her to identify which itemis being rubbed over his or her skin surface.

• Blind walk. Lead the blind-folded child around theroom and present as many objects as possible forhim or her to identify.

• Imaginary painting. Pretend to paint body partswith a large brush, applying deep pressure andwipe off specific colours with different texturedmaterials.

• ‘Hamburger’. The child lies on oneblanket/mat/duvet whilst you add textures for‘relish’, ‘lettuce’ and so on, then cover with anotherblanket/mat/duvet and push down on the childwith your hands or an inflatable roll or bolster.

• ‘Swiss roll’. The child rolls up inbubblewrap/corrugated card/blanket/rug and thenunrolls him- or herself.

• ‘Caterpillar’. The child goes into a sleeping bag andthen crawls, rolls, wriggles, curls up and elongatesto make a movement like a caterpillar.


• ‘Snail’. The child‘commando crawls’with a large beanbagon his or her back,crawling under andaround things andcurling into shell.

• ‘Tank’. Join togetherthe ends of a large pieceof corrugated card to form loop. The child climbsinside and crawls or steps to make it move.

• ‘Parachute’. In a circle, one child stands or lies inthe centre of a ‘parachute’. The group lifts theirarms up and down to make the parachute billowand lightly touch child in the centre. The grouplifts the parachute, and as it billows up one or morechildren run under and quickly lie down waitingfor the parachute to descend on them.

Planned movement, hand–eye coordinationand orientation in space activitiesFollow the proprioceptive, vestibular and tactile activities withones that require planned movement, hand–eye coordinationand orientation in space. The following activities are good forimproving these skills.

• Imitating postures using arms, legs, hands andfingers. Play ‘Simon Says’.

• Animal walks, e.g. bunnyhops, crab walk, bearwalk, wiggly worm, caterpillar or donkey.


Figure 14.8 The ‘snail’

• Twister™ game (see Figure14.9).

• Obstacle courses usingchairs, table, bed,blankets – whatever isavailable for the childto go over, under,through, around,behind and so on.

• Sequencing movements,e.g. first skip, then jump, then crawl around asimple obstacle course.

• Beanbag throwing across the body into a box or ata target.

• Beanbag games, e.g. between legs, behind back,overhead and so on. Play ‘Hot Potato’ (passing thebeanbag around in a circle as fast as possible andthen reverse unexpectedly).

• Ball games. Initially catch the ball by holding a boxto catch it in, then use hands. Try throwing againsta wall, catch bouncing on floor, dribbling aroundobjects by bouncing or using feet, throwing againsta wall to hit the centre of a coloured shape (circle,triangle, square, diamond, hexagon) or knockingdown targets (e.g. bowling).

• Ball pass. In a circle, pass various sized, texturedand weighted balls around and change direction.

• Dodge ball.


Figure 14.9 Twister™

• Balloons. In a circle, hit the balloon with a bat orhand and try to keep it up in the air and prevent itfrom hitting the ground – volleyball with aballoon.

• Stepping stones, using carpet squares. The child canwalk on all fours, leap, jump and so on from squareto square. Encourage sequencing by using differentcoloured squares for different movements.

• Rope jumps. Lay a rope on floor in an irregularway, crossing the rope over itself. The child has towalk along the rope and jump with his or her feettogether over the crossed areas.

• Rope walk. Step sideways along rope, crossing onefoot over the other.

• Jumping. Two people hold a rope and one-by-onethe group jumps over the rope as it ‘snakes’ on theground. Do not land on the slithering snake! Thenjump over a taut rope and gradually increase height

with each jump.

• Skipping.

• Walking/running games, e.g.backwards, forwards, sideways,big steps, small, high, low, crawl,in all directions, like a crab, fast,slow, ‘freeze’ to hold position andso on.

• Pulling/pushing. In pairs, holdhands tightly and each child leansback and tries to pull the other


Figure 14.10 Pushing

one out of their starting spot. Then try in pairs,back to back, as above (see Figure 14.10). This canbe done in a sitting position as well.

• Mirroring. In pairs one person will move, whilst theother imagines he is a mirror. The mirror followshis partner as accurately as possible. Switch roles.

• Ball batting. Stand behind the child and pitch aball. The child holding the bat must swing aroundin order to hit the ball.

The end of the sessionEnd your session with a calming down activity. Relaxation isone option: have the child lie on his or her back, concentratingon different body parts (to develop better awareness of theirpositions) and pushing them into the floor from head to toes.Another option is to get the child to work at a tabletop activity(see list below) that requires concentration, visual attention,visual discrimination, organisational skills and hand–eyecoordination.

• Build a Lego® model, copying the diagram.

• Maze board/tray or ‘Labyrinth Game’ (availablefrom toy retailers, TfH and Rompa – seeResources).

• Puzzles.

• Board games – following rules and/or involvingmemory.


Activities for finger and hand strengthDo not forget to give the child lots of opportunity to increasefinger and hand strength also, with a variety of day-to-dayactivities:

• wringing out cloths

• using clothes pegs

• tongs/tweezers

• hammering

• tiddlywinks

• wind-up toys

• pop beads (interlocking plastic beads)

• nuts and bolts

• crumpling paper (stiff paper) – use fingers, notagainst chest

• stapling/punching paper

• clay/plasticine/wet sand – get the child to drawlines using a stick or pointed forefinger, then use asa pencil.

All these activities are only suggestions – please let the childuse his or her imagination when engaged in tasks. If you canthink of any other activities along the same lines please usethem. I hope these ideas will give all parents and carers ofchildren with DCD a head start in implementing a therapeuticprogramme, especially teachers who may wish to start a groupat school.


chapter 15

Final Note

As a final note, please remember to bear in mind the key pointsmentioned in the Introduction and remember that the childrenneed sympathy and understanding.

A child’s performance will be variable from day-to-day, evenfrom hour-to-hour. Please remember this!

81

� Allow extra time

� Do lots of practice

� Praise successes

� Use repetition

� Do not pressure

� Allow variability

HelpfulAddresses

AFASIC69–85 Old StreetLondonEC4 9HX

Tel: 020 7841 8900

British Dyslexia Association98 London RoadReadingRG1 5AU

Tel: 0118 966 8271/2

Children in the HighlandsInformation Point (CHIP)Birnie Child DevelopmentCentreRaigmore Hospital GroundsInvernessIV1 3UJ

Tel: 01463 711 189

Contact A Family (CAF)209–211 City RoadLondonEC4 1JN

Tel: 020 7608 8700

Contact a Family (CAF)ScotlandNorton Park57 Albion RoadEdinburghEH7 5QY

Tel: 0131 475 2608

Dyspraxia Foundation8 West AlleyHitchinHertsSG5 1EG

Tel: 01462 454 986

ENQUIRE (IndependentAdvice on SpecialEducational Needs)Children in ScotlandPrinces House5 Shandwick PlaceEdinburghEH2 4RG

Tel: 0131 222 2424

Independent SpecialEducational Advice (ISEA)164 High StreetDalkeithLH22 1AY

Tel: 0131 454 0096

National Association forPaediatric OccupationalTherapists65 Prestbury Road

83

WilmslowCheshireSK9 2LL

Tel: 01625 549 266Fax: 01625 530 680

National Autistic Society393 City RoadLondonEC4 1NG

Tel: 020 7833 2299

Scottish DyslexiaAssociationStirling Business CentreWellgreenStirlingF88 9D2

Tel: 01786 446 650

Scottish Society for AutisticChildrenHilton HouseAlloa Business ParkWhins RoadAlloaFK10 3SA

Tel: 01259 720 044

Scottish Support forLearning Association (SSLA)Bill Sadler4 Woodside AvenueGrantown-on-SpeyPH26 3JN

Tel: 01479 872 480


Resources

GALTCulvert StreetOldhamLancashireOL4 2GE

Tel: 0161 627 5086

E-mail:[email protected]

G & S Smirthwaite Ltd16 Wentworth RoadHeathfieldNewton AbbotDevonTQ12 6TL

HOPE EDUCATIONOrb MillHuddersfield RoadWateheadOldhamLancashireOL4 2ST

LDADuke StreetWisbechCambridgeshirePE13 2AE

NES ARNOLD LtdLudlow Hill RoadWest BridgefordNottinghamNG2 6HD

Tel: 0115 971 7700

NG Enterprises4 Swan MeadRingwoodHantsBH24 3RD

Nottingham Rehab SuppliesA Division of Novara Group LtdNovara HouseExcelsior RoadAshby de la ZouchLeicestershireLE65 1NG

Tel: 0870 6000 197

E-mail: www.nrs-uk.co.uk

Philip & Tacey LtdNorth WayAndoverHantsSP10 5BA

Posturite UK LtdP.O. Box 468HailshamEast SussexBN27 4LZ

85

Rifton EquipmentRobertsbridgeEast SussexTN32 5DR

RompaGoyt Side RoadChesterfieldDerbyshireS40 2PH

Tel: 0800 056 2323

E-mail: [email protected]

www.rompa.com

Smith & NephewHomecraft Ltd.P.O.Box 5665Kirby-in-AshfieldNottsNG17 7QX

Tfh5-7 Severnside Business ParkStourport-on-SevernDY13 9HT

Tel: 01299 827 820

E-mail: [email protected]

www.tfhuk.com


Bibliography

Ayres, A.J. (1987) Sensory Integration and the Child. Los Angeles:Western Psychological Services.

Dyspraxia Foundation (1998) Recognising Developmental CoordinationDisorders: Developmental Dyspraxia Explained. Hitchin, UK:Dyspraxia Foundation.

Fink, B.E. (1989) Sensory-Motor Integration Activities. Arizona:Therapy Skills Builders; a Division of the PsychologicalCorporation.

Levine, K.J. (1991) Fine Motor Dysfunction: Therapeutic Strategies in theClassroom. Arizona: Therapy Skill Builders; a Division of thePsychological Corporation.

Stephenson, E., in association with The Scottish OccupationalTherapy DCD Clinical Network (2000) The Child withDevelopmental Coordination Disorder (Motor/Learning Difficultiesincluding Dyspraxia): A Guide for Parents and Teachers. Aberdeen:Waverly Press.

87

Index

active participation 64activities of daily living (ADLs) 10,

17activity suggestions for developing

motor skills 67–79activities for finger and hand

strength 79end of session 78planned movement, hand–eye

coordination and orientationin space activities 75–8

proprioceptive activities 68–71vestibular activities 71–5

aerobics 49AFASIC 83angled surface 19, 34animal walks 75archery 58arm(s)

movements 19strengthening muscles 48

armrests, chair 18Asperger Sydrome (AS) 9assistance, rationing of 48attention

problems 33, 51–3, 59, 61–2, 65span, reduced 17tips for improving 51–3tips for improving attention in

hyperactive child 53Attention Deficit Hyperactivity

Disorder (ADHD) 9tips for improving attention in

hyperactive child 53auxiliaries 57avoidance 61award system 57Ayres, A.J. 87

baby-hood reflexes, persisting 17,19, 21, 26

backward chaining techniques 45balance

activities 72beam 72

problems 14, 41, 47Ball, R. 7ball

batting 78dodge 76games 76pass 76

balloon, batting 72, 77bath 41bathboard 41bathing, tips for 41bath seat 41beanbags 69, 70, 71

games 76throwing/catching 72, 76

bear walk 75bedroom 52behavioural problems 13, 15, 61–6

reasons for difficult behaviour61–2frustration 62poor attention 61–2poor concentration 62poor self-confidence 62

what you can do to help at home63–6completing tasks 64–5give clear, simple instructions

63–4individual versus group 66praising and encouragement

65–6prepare room to reduce

distractions 63redirection 64setting limits and

expectations 65sitting position 63

belongings, keep in particular place56

bilateral coordination 25, 29, 30, 31blanket, wrapping child in 53, 73blind walk 74board games 78body inhibition for calming or

focusing child 53body midline crossing 33boundaries, setting 65bowel/bladder problems 42‘boxing’ into pillow 68

89

British Dyslexia Association 83brushing 49bubble wrap, popping 24buddy, adopting a 57building with tools and construction

kits 69bulldog clip 26bunnyhops 75buttons 46

calendar, revolving 56calming 53

activity 78card 29, 31caterpillar 74, 75central nervous system, lack of

inhibition in 51, 61chair armrests/footrests 18Children in the Highlands

Information Point (CHIP) 83clay 24, 49, 79cleaning 42climbing on playground equipment

68clothes pegs, squeezing 24, 79clothing 42

loose-fitting 45clumsiness 62‘clumsy child syndrome’ 13

see also DevelopmentalCoordination Disorder

cognitive ability exceedingachievement 61

cognitive difficulties 59collage 29, 31Collis, D. 7colour(s)

bright 52coding on pencil 22

communication, improving 52, 64community occupational therapists

41compensating for difficulties 57–8competitive activities and sports 58completing tasks 64–5computer games 35concentration 78

problems 33, 51, 59, 62confidence

improving 58

lack of 15, 45, 61confusion 53constipation 42Contact A Family (CAF) 83Contact A Family (CAF) Scotland 83controls, lack of 15, 52–3cooperation 65, 68coordination problems 13, 14, 25,

29, 30, 31, 38, 62see also Developmental

Coordination Disorder (DCD)crab walk 75crawling activities 70, 75cross-legged, sitting 20, 49crumpling stiff paper 24, 79cuddling child 53curly laces 47cutlery 37

tips for using 37–9cut-out table 19cutting

grass 49material 29–31, 39

daydreaming 62DCD see Developmental

Coordination Disorderdeep pressure 53desk fence 26desk height 18detention of force 22Developmental Coordination

Disorder (DCD)activity suggestions for

developing motor skills67–79

and attention 51–3and dressing 45–50explanation of 13–15and feeding 37–9and ‘floppiness’ 17, 67how does it affect a child? 14–15introduction 9–11and learning new or difficult tasks

59–60and organisation 55–8and personal care 41–3and posture 17–20and reading 33–5and scissor skills 29–31


what is it? 13when behaviour is a problem

61–6and writing 21–7

diary, school 57DictaphoneTM 27distractions 33, 51, 61, 62

prepare room to reduce 63dominoes 36donkey walks 75doubled-handed cups 39doubled-handed scissors 30double twists in shoelaces 47dough 24draughts 24drawing

above head height 49with eyes closed 52

dressing 45–50some activities to help 48–50tips for 45–8

drinking straws 39duvet, wrapping child in 53Dycem matTM 18, 25, 37DynabandTM 49dynamic tripod grasp 23dyslexia 9dyspraxia 9, 11, 13, 21, 39


Dyspraxia Foundation 83, 87

educational psychologists 10elastic band see rubber bandelastic laces 47elbows 18, 19, 31electric toothbrush 42emotional outbursts 53emotional problems 15encouragement 59, 62, 65–6, 68ENQUIRE (Independent Advice on

Special Educational Needs) 83enuresis clinic 42exercise 49expectations, setting 65extra time, allow 81eye–hand coordination 14eye movement(s) 17

minimising 52problems 13, 14, 33, 34

tips for improving 35

facilitation of nervous system 25family members 66fastenings 46, 47

clothes with minimum of 45fast-fatigue of muscles 21fatigue 17, 27, 30, 59, 64, 68feeding 17, 37–9

tips for using cutlery and 37–9feeling movement patterns 52, 60feely box 74fibre tip pen 23fidgeting 17, 61, 62figure/ground discrimination 34filtering out unnecessary sensory

information, problems with 51,61

fine motor skills/activities 48, 53difficulties with 29

finger(s)control 24strength, activities for 79weak 29

Fink, B.E. 87fixed weights 58floor

push-ups 49sitting on 63

‘floppiness’ in children with DCD17, 67

foam tubing 38focusing child 53food, cutting up 37footrests, chair 18force control 25force detection, poor 26forearms, supporting self on 70Franklin, L. 7friends 58, 66frustration 15, 27, 45, 62full turns 73

G & S Smirthwaite Ltd 85Galt 85games 17, 35, 68, 72, 78‘good days and bad days’ 15GPs 10, 41grab bar 41Grant, C. 7grasp, problems with 22–3

INDEX 91

gridded paper 26grooming, tips for 42–3gross motor activities 48gym 58gym bars, swinging from 68gym mat 67

wrapping child in 53

hair 42–3hairbrushes 42–3half turns 73‘hamburger’ 74hammering 79

egg trays 24, 70nails into wood 24

Hammer-Tic/Tap-Tap 24handles, built up 38hand(s)

control of 31–eye coordination 75–8lotion 73movements 19strength, activities for 79weak 29

headmovements 17, 19position 19

heavy cutlery 38heedlessness 52Highland Developmental

Coordination Disorders(HDCD) group 7

highlighter pen 34holding 53hole punch 70homework 17, 57Hope Education 85horse riding 58‘hot dog’ 73‘hot potato’ 76hovering 49hygiene, personal 39hyperactivity 53

tips for improving attention inhyperactive child 53

imaginary painting 74imitating postures 75impulsiveness 52incoordination 38

arm 21

Independent Special EducationalAdvice (ISEA) 83

individual versus group 66inhibition of central nervous system

25lack of 51

instructionsclear, short and simple 56, 63–4poor understanding of 62

interaction 64‘I Spy’ 36

jointactivities that use joint in

stabilised position 70–1compression 67floppiness around 67movement 22stability

increased 48, 50reduced 17, 21, 67

jumping 73, 77on space hopper 69

kitchen tongs 30kneading dough 49knee drops 73knife and fork coordination 38

laboured writing 27‘Labyrinth Game’ 78language

problems 13, 14, 62using clear, simple, specific 52,

60, 63LDA 85learning

difficulties 13,14new or difficult tasks 59–60

physical help 60verbal clues 60visual clues 60

legibility 27Lego® 78leisure 58Levine, K.J. 87lifting 49lightweight cutlery 38limits, setting 65lined paper 26loneliness 15, 61


long-handled hairbrushes and combs42

long-handled wiping aids 42loose-fitting clothes 45loudness 52

magnetic fishing game 72magnetic wrist cuffs 25marble run 35margins on lined paper 26markers 23

stitched to back of clothes 46maths 15mats, rolling on 71maze board/tray 78midline crossing, poor 33, 43minimal brain dysfunction 13mirroring 78mirrors 42, 43monkey bars 49motivation 29, 45, 66‘motor-learning difficulties’ 13


motor-planning 29, 73difficulties 43, 55, 59, 62

motor skills, activity suggestions fordeveloping 67–79

moulded cutlery 38moulding putty or clay 49movement 14

consciously thinking about, inchild with DCD 59

in upper limb joints 25muscle(s)

fast-fatigue of 21strengthening 48stretching 50tone

increasing 24, 29, 39, 48, 50low 17, 19, 22, 25, 26, 62,

67normal postural 24

music 53

National Association of PaediatricOccupational Therapists 10,83–4

National Autistic Society 84nervous system 25NES ARNOLD Ltd 85

NG Enterprises 85noises

closing door to shut out 63problems with blocking out 52,

61Nommensen, A. 7‘normality’ 37Nottingham Rehab Supplies 37, 38,

39, 41, 47, 88noughts and crosses 24number work 15nuts and bolts 79

obstacle courses 70, 76occupational therapists (OTs) 10, 35,

39, 41, 47, 49, 67order of getting dressed, listing 48organisation

poor 21, 55–8skills 78tips for 56–8

organisers 56orientation in space activities 75–8orientation problems 57

paediatricians 10, 41, 42paediatric occupational therapists 10,

35, 41see also occupational therapists

painting, imaginary 74paper

moving problems 25–6and scissor skills 29

‘parachute’ 73, 75parents 58, 67patience 59peers 58pelvis 31pen, weighted 25pencil

control 26grasp 21, 22–3grip (support) 22–3holding 60

perception problems 13, 14perceptuo-motor dysfunction 13performance, poor 61persisting reflexes 25personal care 41–3

tips for bathing 41personality problems 13, 15

INDEX 93

Philip & Tacey Ltd 85photography 58physical help in learning new or

difficult tasks 60physiotherapists 41pillow, ‘boxing’ into 68planned movement 75–8planning of day and week 56plastic classroom chairs 19plasticine 24, 39, 79plate guard 37play 52play barrel, rolling in 71–2PlaydohTM 39play fighting 69playground equipment, climbing on

68pop beads 79position of body parts, knowing 25posture 17–20

tips for achieving good 18–20Posturite UK Ltd 85practice 59, 81praise and encouragement 65–6, 68,

81prepare room to reduce distractions

63pressure, avoid 81prone position on scooterboard 69proprioceptive activities 68–71

activities providing proprioceptiveinput 68–70

activities that use joint instabilised position 70–1

proprioceptive feedbackimproving 48poor 21, 22, 25

pulling self up from prone 70punchball/bag 68punching paper 79pushing/pulling 77–8

of arms against resistance 48, 49push-offs from wall 69push-ups 49putty 24, 49puzzles 78

quarter turns 73quoits, tossing over pegs 72

rapid change activities 73

readingproblems 14, 19, 33–5tips for improving eye movements

35tips for improving skills 33–5

refusal to do things 61relaxation 78relays 70relocation skills 33remembering, difficulties in 59repetition 52, 59, 81resisted roll 71responses, regulation or modulation

of 51rest 52restlessness 15, 17, 61reversals (formation of

numbers/letters) 14–15rewarding good behaviour 57, 65Rifton Equipment 86Robertson, R. 7rocker board 72rocking 53, 72rolling activities 71–2, 73Rompa 69, 78, 86rope

jumps 77walk 77

rote learning 15routines

daily 56, 57structured 56

rubber band 22, 24, 30, 38, 49rug, sitting on 63

safety 41, 67salad tongs 30scatterbrained child 53school

diary 57dinners 37work 17

scooterboard 69, 70, 71Scottish Dyslexia Association 84Scottish Occupational Therapy DCD

Clinical Network 87Scottish Society for Autistic Children

84Scottish Support for Learning

Association (SSLA) 84


scissor skills 29–31scrapbook 31screening difficulties 51, 61scribbling 49scribe 27seat drops 73self-confidence

increased 45poor 63

self-direction 68self-esteem

improving 58poor 15, 61

self-opening scissors 30sensory distractions in environment,

reducing 51, 61sensory information, blocking out

non-relevant 52sensory-integrative dysfunction 13sensory stimulation 73sequence movements, variation in 76sequencing 77

difficulties in 59shaving foam 73shoelaces 47shoes 46–7shoulder(s) 31

stability, poor 26side-sitting 70‘Simon Says’ 75sitting

position 63posture 17, 20, 25push-ups 49

skipping 77skittles 69, 70, 72slanted desktop 19, 34sleep 52sleeping-bag, wrapping child in 53slouching 17Smith & Nephew 86‘snail’ 75snipping 29–31socks 45, 47soiling 42solitaire 24solitary activities 58sounds, problems with blocking out

52, 61space

activities, orientation in 75–8knowing position in 25

space hopper, jumping on 69spatial problems 13specific learning difficulties 13, 14speech and language therapists 10,

41spelling problems 14, 33splade 38spotting objects quickly 35stability 18, 19, 20, 30stapling papers 70, 79star chart 57steak knife 38Stephenson, E. 87stepping stones 77stiff paper

crumpling up 24cutting 29

stirring food 49straws, cutting 29, 31string, cutting 31success, awarding and praising 57,

81support 58, 59suspending object from rope 70swimming 58swinging

from gym bars 68from rope 73

‘swiss roll’ 74syllables, dividing 35

tableheight 19sitting at 63

tactile activities 73–5tactile cues 25tactile feedback, poor 21, 22talkativeness 52‘tank’ 75tantrums 62teachers 10, 58, 59, 67television and radio, turning off 63textured cloths 74TfH 25, 69, 78, 86TherabandTM 49throwing/catching beanbags 72thought, problems with 13, 14tiddlywinks 79

INDEX 95

tidying up 64ties 47Tillbrook, A. 7timetable, written 57tiring easily 62, 67toileting, tips for 42tongs 29, 79toothpaste pump dispenser 42touch cues 23toys

being destructive with 62clearing room of distracting 63

trampolining 58, 69, 73tremor 21, 25, 26, 38triangular pencil 22tripod grasp 23trunk 31T-stools 72tube socks 47tug-of-war 68turn-taking 64–5tweezers 79TwisterTM 76typing 58

understanding 52poor 62

unhappiness 15, 61upper limb joints, movement in 25

variability 13, 15, 81VelcroTM 25, 46, 47verbal cues 25

in learning new or difficult tasks60

vestibular activities 71–5balance activities 72rapid change activities 73rolling activities 71–2tactile activities 73–5

visuo-motor difficulties 13, 26, 27visual attention 78visual cues 23

in learning new or difficult tasks60

visual discrimination 78visual distractions 33

reducing 51visual perceptual difficulties 33volleyball with balloon 77Voluntary Action, Inverness 7

walking/running games 77wall bars 49warm-ups before writing 24watch displaying day and date 56weighted pen 25wet sand 79wet wipes 42wheelbarrows walking 49, 71wide lined paper 26wiggly worm 75‘window’ (narrow rectangle cut out

in card) 34, 52wind-up toys 24, 79withdrawn behaviour 61wool, cutting 29word processing 27words, avoiding unnecessary 52wrapping child in blanket 53wringing out cloths 79wrist(s)

control of 31cuffs 25weights 25

writer’s cramp 21writing

above head height 49laboured 27legibility 27on alternate lines 26problems 14, 17, 21–7

finger control 24gripping writing implement

22–3how to minimise 22–6movement in upper limb

joints 25paper moving 25–6pencil control 26

with eyes closed 52

zips 46


developmental coordination disorder: hints and tips for the activities of daily living

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