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Early Identification and Intervention of Movement Problems in Children Witin the School Setting Motor development follows a predictable path as babies grow and develop into young children. Each motor skill (walking, jumping, holding toys and manipulating writing tools) requires coordination of both large and small muscles of the body. Sensory processing of information through our senses contributes to adequate motor responses when exploring one's environment through play and self-care activities. Awareness of where one's body parts are when moving in space and motor memory for executing complex motor tasks are also required of developing young bodies.by Julie Martin, OTR/L, Ivymount Outreach Programs
Movement is largely involuntary and reflexive in infancy. Gradually the infant learns that these movements are pleasurable and result in emotionally gratifying experiences (feeding, rocking, seeing a smile). Soon the infant learns to voluntarily move in order to repeat these pleasurable moments. In this way motor development is not just physical maturation but a mind-body experience. New motor skills require repetition of practice in order for children to execute movement with coordination and automaticity.
Children who lack the motivation to learn new motor skills due to physical challenges or confusing or unpleasant sensory feedback may not become proficient due to a lack of practice or lack of adequate reinforcement. This in turn may begin a cycle of delay requiring a second look.
Muscle tone influences control of movement by regulating the amount of tension at rest in a muscle. Many children with movement difficulties have either too much tension or tight muscles or too little tension or floppy muscles. These children may appear clumsy compared to other children of the same age. The lack of balance when moving, called dynamic balance, may also contribute to a lack of coordination. To compensate for these deficits children may not regulate the speed of their movements by moving too fast or too slowly. Starting a movement or stopping a movement may also be affected whereby a child may bump into obstacles or people frequently, trip easily or have difficulty changing direction when running.
Motor planning is a brain directed process where a child is able to mentally create a motor goal and think about how to achieve the goal, intentionally plan and sequence each movement, and perform the movement in a coordinated manner. Learning to print letters neatly requires the ability to motor plan complex fine movement. Learning to zip a jacket or tie one’s shoes entails complex motor planning.
When children are exposed to frustration and failure during movement activities there is a risk for a loss of self esteem, ridicule and bullying by other children in school and during social activities. Seeking professional help is advised. Parents can discuss their concerns with their pediatrician and seek a referral for occupational or physical therapy. Teachers can bring the problem to the attention of their building principal in order to initiate a referral for a screening by an occupational or physical therapist. Children under the age of 3 may meet eligibility requirements to receive services through local infants and toddler programs. Upon turning 3 children may be eligible to receive services in preschool programs. These programs are offered through the local public schools under IDEA. To initiate a referral contact Child Find with your local school district.
Therapists may or may not conduct standardized assessments in order to obtain objective information regarding your child's development delay. This can be determined in consort between the therapist and the parent although eligibility requirements may dictate the type of assessment received. Qualities of a good therapy program for parents to consider should include the following: the therapist should treat you and your child with respect, set a positive tone during therapy sessions, communicate regularly and in a way you can understand. The therapy program should include specific goals that you understand and have agreed to, including a projected time frame for achievement, and include home and school recommendations for generalization.
Therapeutic intervention of motor problems are usually addressed in consideration of underlying deficits in movement, sensory aspects of motor learning, motivational strategies, and opportunities for supervised practice. Specialized therapy approaches include sensory integration therapy, neuro-developmenal therapy, and other approaches such as aquatic therapy, auditory training, developmental optometry, therapeutic riding, and/or yoga. Most therapists are aware that no single approach works best and that a variety of techniques and approaches skillfully combined and tailored to the needs of the child produce the best outcomes.
Most occupational and physical therapists will address coordination of movement difficulties by focusing on the 3 B's: body awareness or the unconscious awareness of body position, movement and force that arise from our joints and muscles; bilateral motor integration or the gradual ability of the two sides of the body to develop skillful cooperation of movement allowing a child to develop a worker-helper system when using hands or feet; and balance or the ability to maintain postures and move through movement transitions easily.
Children with poor motor skills vary widely in their ability to cope with the social demands of home, school and community. Some can adjust with ease and take their differences in stride. Other children find this an overwhelming task and develop poor self esteem, inattention and poor self regulation which may trigger emotional outbursts during times of stress. It is important for adults to accept the child for who he or she is and what he or she can do. Creating positive emotional bonds, a nurturing environment and successful experiences for children will instill in children a positive self-concept and the motivation to overcome their difficulties with self acceptance.
Questions for parents and teachers to consider when concerned and wish to seek further assistance:
Our service providers at Ivymount Outreach Programs/Therapeutic and Educational Support Services offer these comprehensive approaches in the treatment of children with developmental coordination disorders. We have observed a significant impact in the lives of children and families when children acquire desired skills and can transfer these skills to their daily routines of work, self care and play. For more information about these and other services please contact Julie Martin at Ivymount Outreach, jmartin@ivymount.org or 301-469-0223, #141.
- Does your child complete fine and gross motor tasks similar to peers?
- Does your child avoid or have difficulty with motor activities that require balance, speed and coordination?
- Does your child avoid playground or sports activities?
- Does your child have difficulty manipulating small writing tools such as crayons, markers, pencils or paint brushes?
- Does your child demonstrate difficulty with performing self help tasks such as eating with utensils, or dressing?
- Does your child prefer repetitive movement rather than refined movement?
- Does your child seek excessive movement?
- Does your child have difficulty with changes in positions?
- Does your child require constant supervision in order to be safe?