Specific developmental disorder of motor function Clinical features and classification

Many children to whom this category applies, were previously diagnosed as having 'minimal brain dysfunction'. This term is no longer used. The essential clinical features of the disorder include the following (ICD-10).

• An impairment of motor co-ordination that is significantly below the expected level on the basis of age and general intelligence assessed by an individually administered and standardized test.

• The difficulties in co-ordination should already have been present early in development.

• They should not be acquired and not be a direct result of deficits of vision or hearing or of any neurological disorder.

Variability of fine or gross motor co-ordination is great. The milestones of motor development are usually delayed. In many cases, there is an association with speech difficulties, especially articulation. Parents usually report that the child was slow in learning to sit, run, hop, climb stairs, and ride a bicycle. Many children also have difficulties in learning to tie shoelaces, fasten and unfasten buttons, and throw or catch balls. Some children may be generally clumsy in fine and gross movements, others tend to have their main difficulty with fine movements and co-ordination. In many cases, drawing skills are also impaired and the child's difficulties are particularly obvious during ball games, which require a considerable amount of gross motor co-ordination.

The DSM-IV criteria are similar, and emphasize a substantial backlog of motor co-ordination, significant interference with academic achievement, and require general medical conditions and pervasive developmental disorders to be ruled out.

There is growing evidence that specific developmental disorders of motor function are a quite heterogeneous group that needs to be subclassified. (44) Diagnosis and differential diagnosis

Diagnosis is made according to the criteria and guidelines in ICD-10 and DSM-IV. Differential diagnosis should rule out specific neurological disorders, which can be done with a careful history and neurological examination, pervasive developmental disorders, which can be distinguished by the criteria of these disorders, or attention-deficit hyperactivity disorder. The latter can be distinguished by their pronounced distractibility and impulsivity rather than impairment of motor co-ordination.

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