Developmental Dyspraxia by Any Other Name: Are They All Just Clumsy Children? Cheryl Missiuna, Helene Polatajko The recent introduction 0/ the diagnostic categon' de- velopmental coordination disorder ([JCD) (Americon Psychiatric Association (APAJ, 1987, 1994). has gener- ai.ed confusion among researchers and clinicians il1 many/ields, including occupational therapy. Although the diagnostic criteria appear to be similar to those used to define clumsy children, children with develop- mental dyspraxia, or children with sen::.ory integrative dysfunction, we are leji with the question. Are children who receiue the diagnosis o/DCD the same as those who receiue the other diagnoses, a subgroup. or an entirelv distinct group a/children? This article ll'ill e.Y- amine the theoretical and empirical literature and use the results to support the thesis that these terms are not interchangeable and yet ore not heinf!, used iii the literature in a wav that dead]' defines each subgroup 0/ children. Clear definitions charaeteri.stie fea- tures need to be identified and associated I/'ith each term to gUide occupationol therapl' assessment and intemention and clinical research. Cheryl Missiuna. Phi), OI(C). IS ASSIStanl School of Occupational Therapy and Physiotherapy. IvlcMastcr- Universi· ty, OT/PT Building, 12HO Malrl Street West. rlal11ilton. Ontano. l.HS 4Kl and an Associate Member of the Neurodevelopl11en- tal Clinical Research llnil. Helene PoJatajko, rhO. 0'1'(;). i::. Professor and Chair, Depart- ment of Occupational Therapy, Faculty of Applied Health Sci- ences. University of Western OntariO. I.ondon, Ontario. fbis article I{'as accepledjor publiculion NOl'emiler --I. 19CN. D evelopmental and sensor)! integrative dysfunction are terms that have been used by occupational therapists during the past 20 years to describe and explain the motor learning and coordination problems experienced by many young chil- dren. Children with developmental dyspraxia typically are referred to occupational therapists for remediation of handwriting difficulties, problems with independent management of self-care activities, or the social isolation that results from clumsiness during or lack of participa- tion in sporting and playground activities. Although large numbers of school-age children are presumed to experi- ence functional problems as a result of their clumsiness, theoretical papers and clinical research reports in occu- pational therapy, medical, and educational journals have been few. Interest in and research with this population has increased recently, however, due to the publication of longitudinal studies suggesting that clumsiness in the ear- ly school years was strongly associated with later learning difficulties, school failure, and psychological problems (Cantell, Smyth, & Ahonen, 1994; Cermak, Trimble, Cor- yell, & Drake, 1990; Geuze & Borger, 1993; GiJlberg & Gillberg, 1989: Losse et aL, 1991) Just when more comprehensive studies of children with developmental dyspraxia were beginning to devel- or. the waters became muddied by the introduction of a diagnostic category in the Diagnostic and Statistical iV/anual o(k/ental Disorders (DSM). del'elopmental co- ordination disorder COCO) (American Psychiatric Asso- ciation IAPAI, 1987, 1994). This term has become the focus of debate among clinicians and researchers in the field. Although it is promising to see official recognition given to tl1(' occupational performance problems of a child who is clumsy, it is not clear whether children with DCD are the same as, a subgrour of, or entirely distinCt from children with developmental or children with sensor]' integraliue dJ'-'!imction. In this article, we outline the origin of various terms that have been used to describe children with motor coordination difficulties, review empirical studies, and compare the performance component problems associated with four of the most common terms to develop the argument that the terms are not interchangeable and that the distinction is impor- tant for occupational therapists to make when determin- ing clinical intervention methods and selecting subjeCts for research. What Do We Call the Child Who Is Clumsy? The tei'mino]ubry that has been used over (he years to describe children who are clumsy reflects the diverse theoretical positions and different levels of analysis that have charaeterized both the descriptive and empirical literature in the field The historical development, defini- tion, and use of four key terms that describe deve!opmen- 7he Alliericall jOllrllal oj' Occupatiollal lbeJ'upl' 619 Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/930172/ on 06/16/2017 Terms of Use: http://AOTA.org/terms