Inexperienced child, what shall I do?

Lille, France __ The “clumsy” child is matched to a child whose motor development usually proceeds without warning or abnormalities in the neurological examination. However, he has difficulty in the activities of daily life, struggling to perform certain tasks or gradually with significant variability over time and / or a laborious learning process.

At the Annual Congress of the Pediatric Society (Lille, June 1-3, 2022) [1]Pediatrician Thiabout-Noel Willig (Disorders of neurodevelopment, Clinique Ambroise Paré, Occitadys and Eventail31, Toulouse) Verified by a “step by step”French Ambulatory Pediatrics Association (AFPA) And French Society of Pediatric Neurology (SFNP)[2]. He gives French version of Medscape 10 key points of his care.

Thiabout-Noel Willig

1. Inexperienced child complaints may be related to very variable domains : Running, jumping, jumping (total motor skills), cycling, balancing on one leg, walking in a line (fixed or dynamic balance), ball or racquet play (eye-hand combination), swimming (lower / upper limb adjustment) )), Drawing, writing, tinkering (fine motor skills), precise cutting, drawing with a compass (visuomotor precision). It can be difficult to identify yourself in the time or place of the baby. Perception of line and topography ratio orientation, perception of geometric figures and construction of curves (visual construction in 2 or 3D) can create problems.

2. Clinical examination is informative This is because the child can have good communication skills, be lively and communicate with others through oral language or facial expressions. Some minor symptoms may still be present (pinching fingers, hooping, walking in a line, etc.).

3. It starts with a detailed analysis of all the complaints, Including feedback from the child, his parents, people in his normal environment. For all children, the analysis of sensory abilities (hearing, sight) must precede oral language, non-verbal domains, neuromotor examination, social skills, learning, and attention. This anamnesis makes it possible to identify complaints and identify attention deficit disorder with or without potential autism spectrum disorder (ASD), hyperactivity disorder (ADHD). A complex disorder related to the care physician, or the second line of care, or with a particular care channel.

4. Referral to a neuropediatrics team in the context of pyramidal or cerebellar syndrome or in case of neuromuscular disease. Difficulties in the rules of conversation and realism (adjust the speech according to the context and the beginning of the communication, to explain the underlying information) lead directly to a disorder of social interactions. For Autism Spectrum Disorder the child needs to be referred to a special second tier team or a Coordination and Adaptation Platform (PCO). Prematurity, fetal growth retardation, fetal alcohol, valproate intake, in particular, a care network for vulnerable children (RSEV), even a CAMSP (Primary Medico-Social Action Center) require initial preventive support.

The Reference Center for Language and Learning Disorders (CRTLA) and the Autism Resource Center (CRA) are reserved for very complex situations.

For all children, the analysis of sensory abilities (hearing, sight) must precede oral language, non-verbal domains, neuromotor examination, social skills, learning, and attention.

5. In the face of an isolated motor complaint, identify developmental coordination disorder (DCD) using an online questionnaire.

Adjustment and adaptation platforms for Neurodevelopmental Disorders (PCOTND) provide access to the possibility of financing by health insurance for the necessary assessment and rehabilitation of children under 7 years of age (soon up to 12 years). This is through an orientation questionnaire available online[3].

Between the ages of 5 and 6, the normal period for diagnosing developmental coordination disorder (DCD), 3 negative reactions in 2 sections (especially in the warning signs that affect fine motor skills and overall motor skills) allow the primary care physician to instruct you. In your department coordination and orientation platform (PCO).

Also, an effective self-assessment questionnaire allows families to assess motor impairment in daily life from the age of 5: DCD QFE 5-15 (Developmental Coordination Disorder Questionnaire French Europe) [4]. A cautionary threshold below 56 (within 75) allows the primary care physician to justify his prescription for additional evaluation.

6. A standardized assessment of motor efficiency (especially thanks to MABC-2) And through visuo-spatial, psychomotricity or occupational therapy assessmentsIn the absence of other elements of adaptation, the analysis of complaints, clinical examination and evaluation (dysmorphia, neural examination abnormalities, caffeine-out-light spots, etc.), are indicated in cases of functional difficulties.

It is necessary to regularly search for comrades on oral language, attention, learning (reading, writing, arithmetic) or social relationships. Indeed, depending on the presence of sexual intercourse, rehabilitation and housing priorities may be reviewed, or even a request for recognition by the Department of Home Affairs (MDPH) for the disabled may be supported if the child needs a specific implementation device (school life assistant, adaptive educational material).

7. Developmental Coordination Disorder (DCD) , In a child 5 years of age or older, it is manifested by a significant functional impairment affecting their daily life.. The primary care physician can diagnose the disease after assessing functional impairment, its chronic nature, and its severity (parental questions) and evaluating anesthetic data that testify to the developmental nature of the disorder; This is in the absence of significant clinical abnormalities or specific contexts. Symptoms of dyspraxia are one of the manifestations of DCT, which validates the diagnostic criteria of DSM-5 or ICD-11.

Rehabilitation care, with a focus on concrete and priority objectives in the child’s life, is achievable by both psychomotorians and occupational therapists.

8. Dysgraphia may be isolated or part of an inability to learn a particular written language, a Developmental coordination disorder (CDD) and / or Attention Deficit Hyperactivity Disorder (ADHD). Rehabilitation from a large section of kindergarten may be associated with a severity related to a more general context of praxic impairment, or in CE1, if, after a normal reading / writing age, motor impairment predominates. From CM1 / CM2, the rehabilitation method is supplemented by a rehabilitation method that develops according to mature requirements and class, with the implementation of other tools to compensate for the disadvantages (ergonomic pen, prone to writing plane, a tool to digitize the text), writing A downward revision of teacher or parent expectations, even a computer transition.

In addition to evaluating complaints, the role of the pediatrician is to identify congenital diseases and evaluate the impact of these difficulties.

9. If the complaint persists or worsens, you need to know how to repeat the questions / assessments. It is also wise to ask a high-level structure if rehabilitation continues without a purpose or without a clear and qualitative reassessment.

10. The pediatrician acts as the coordinator of the child follow-up. In addition to assessing complaints, the role of the pediatrician is to identify comorbidities (verbal language, writing, counting, attention) and assess the impact of these difficulties (anxiety, loss of self-esteem, depression, problems with his or her comrades). To establish arrangements and / or compensation.

To learn more:

– INSERM 2019 Summary on Developmental Coordination Disorder (DCD):

Arnaud C, Albaret JM, Assaiante C, et al. Developmental Coordination Disorder or Dyspraxia – INSERM, Synthesis and Recommendation 2019 is a collective skill. p. 140.

– The validity of the French population of questions related to praxis disorder: Ray-Caesar S, Thamen E, Martini R, et al. Psychometric Assessment (DCDQ-FE) of the French European Development Coordination Disorder Questionnaire. PLOS One 2019; 14 (5): e0217280.

– How to improve a child’s health course with specific language and learning disabilities? Health course guide. Paris: High Authority for Health; 2017. p. 61.

– High authority of health. Autism Spectrum Disorder. Warning signs, detection, diagnosis and evaluation in children and adolescents. Paris, France: High Authority for Health; 2018. p. 45.

Thiabout-Noel Willig declares that he has no conflict of interest with the subject matter of the article.

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