The clumsy child

(Part One)

THE word clumsy is derived from Middle English (English language during the 12th-14th century) meaning awkward, unskilled, without dexterity or grace. A clumsy child refers "to a boy or girl who performs fine and gross motor tasks in an immature, disorganized erratic slow, irregular or inconsistent fashion."

Clumsiness in children are of two types: The primary type, the cause of clumsiness is unknown and secondary clumsiness as one of the symptoms of several abnormalities or diseases such as mental retardation, visual impairment, children who are loose jointed, children with skeletal abnormalities or children with muscular dystrophy (muscle wasting), etc.

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Sometimes, it is difficult to differentiate a child with mild cerebral palsy from a child with primary clumsiness. Mild cerebral palsy may masquerade as clumsiness since unsteady gait, shaky movements or resistance to passive movements of extremity seen in mild cerebral palsy may appear clumsy.

However, children with cerebral palsy often have history of prematurity, low birth weight, respiratory problems at birth or abnormal birth history that may lead one to suspect that the clumsiness of the child is due to cerebral palsy.

Also difficult to differentiate is the clumsiness of attention deficit hyperactivity disorder (ADHD) of childhood. ADHD may be an associated problem in a child with primary clumsiness. The clumsiness maybe due to impulsiveness and attention deficiency rather than problems in coordination. Apparently as the child with ADHD grows the clumsiness disappears.

Overall in children with secondary clumsiness, the clumsiness is often overshadowed by the other clinical features of the secondary abnormalities or diseases. Clumsiness is often relegated to the background and no longer the main concern.

Primary clumsiness in children, on the other hand, also known as developmental coordination disorder describes children of normal or above normal intelligence who without an identifiable medical or neurologic condition have difficulties in coordination that interferes with daily activities, academic performance and or socialization.

The reported incidence of primary clumsiness is 6.4 per cent in school aged children and an estimated range from five percent to 20 percent. It is a life-long problem that affects more males than females; about two percent are severely affected.

The Problem:

In children with clumsiness, the desired motor activity is not properly accomplished. The problem is poor coordination between the intended action and its execution. The results are motor activities that are disorganized, erratic, irregular, inconsistent and uncoordinated. The child will be awkward.

The problem is developmental. There is delay in the development of motor coordination. History will reveal problems in swallowing and sucking as early as during infancy. Delay onset in setting up, standing, taking steps, walking, climbing stairs, or persistent drooling of saliva past three years of age. These children will have difficulties in learning new skills and are slow in speech development. A clumsy child will not be able to tie his shoe laces or dress alone and button up his clothes at a time when he is expected to. These children are poor in balance, often drop things and make a mess of their food when eating. A clumsy child often trips over his feet, bumps with people and objects like tables or furniture.

Although parents are aware of this development they are not concerned as they are often assured by friendly neighbors that this problem is only temporary and will get over this as the child grows up. However, the problem will continue especially as the child enters school. Because of his sloppy, untidy handwriting, poor reading skills, problems in following instructions, self expression and speech, the child often fails in class. Teachers and parents will blame the child for not trying hard enough and often brand him as lazy or with some behavior problems.

Even at play the child will have problems. He will have difficulties in hopping, skipping, running, riding a bike and in throwing and catching a ball. Other children will refuse to play with him or include him in team efforts. (To be continued)