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When an ADHD diagnosis is actually something else

Little known developmental co-ordination disorder, or DCD, co-occurs with its well-known counterpart around 50 per cent of the time.
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Dr. Paulene Kamps is a trained educational psychologist. She said she has come to learn lagging skill development, including motor skills, impacts educational achievement and success in schools. STEPHANIE JAGER/Photo

You’ve ticked off all the boxes: your child seems inattentive in class, they fidget, they get frustrated, and they struggle to find the motivation to do tasks — an ADHD diagnosis seems apt.

But is it the correct diagnosis?

It’s the age of awareness for neurodevelopmental disorders such as ADHD and if you’ve spent any time on social media you may have noticed a glut of people who have been diagnosed (self and professionally) with the disorder. But there is a risk of misdiagnosis, especially if what you’ve got isn’t trending and it isn’t really even on the radar of the professionals.

Dr. Paulene Kamps is a Calgary-based trained educational psychologist and an international expert in developmental co-ordination disorder (DCD), or dyspraxia, a neurodevelopmental disorder that Healthline describes as a lack of co-ordination between mental intentions and the ability to get the body to carry out those intentions.

DCD co-occurs with ADHD around 50 per cent of the time and shares many of the same symptoms. Kamps said a busy, hyperactive child can appear to have ADHD, but it could be any number of things.

It became real to Kamps when she worked with an eight-year-old at her testing location.

“We’re sitting nicely at the table. And he was quite focused on the task in front of him. But he was fiddling and moving around. I stared at him and I thought, it's almost like he has to move to keep his posture in control … It's like he's activating the muscles in his trunk by these movements,” she said.

Kamps said some children with co-ordination difficulties are not easily getting the messages from their muscles to their minds. They have to trigger the movements to keep their muscles alert.

Christine Brown’s son, Tyler — both of their names have been changed to protect their identities — was initially diagnosed with ADHD when he was in Grade 2. It wasn’t until Grade 6 that he was diagnosed with DCD. Brown said, though Tyler did struggle with focus sometimes, hyper was not a word she would use to describe him.

“I used to say, ‘man, I would give him a dose of hyper if I could!’” she said. “He is quite sluggish, to be honest.”

Brown asked the psychologist why he put hyper down as a symptom. His response was that one of the teachers said he couldn’t sit still.

“Tyler was very tall. He has poor core muscles … He couldn't sit up for very long. If you've got a kid who's uncomfortable in a desk and they can't sit up very well, they're going to move and adjust their position because they can't support the body. That's not hyper,” she said.

Kamps said many children with DCD have problems with fine-motor skills, gross-motor skills, and motor planning. They can also have issues with their eyes, which are part of fine-motor skills.

If their eyes aren’t working efficiently and aren’t tracking properly then their eye movements are not settled, and reading might be an issue. It may appear the child is not trying, or their eyes are hyper.

Kids with DCD also fatigue easily because their minds and muscles don't co-ordinate, and this can look like inattentive behaviour.

The child might also be frustrated and have meltdowns because they are putting 180 per cent into school all day while their peers are putting in 50 per cent and doing quite well.

“People who don't understand how that motor piece interacts with focus, attention, learning, concentration — they miss it and then these children aren't getting the proper identification, nor the proper services for their diagnosis,” Kamps explained.

Brown said Tyler was given an exercise ball at his desk to “help” him focus after he was diagnosed with ADHD.

She doesn’t know why they gave a clumsy kid with no core strength or co-ordination a ball to sit on to attempt to help with focus.

“Sometimes that stupid ball would just go flying across the room,” she said.

Kamps said she believes DCD is missed by clinicians 98 to 99 per cent of the time. The reason is a lack of awareness by professionals and the public alike.

She was in university for 10 years before she heard about the condition, even though around six per cent of the population likely has DCD — about the same as the five to nine per cent of children likely affected by ADHD.

A person who has unrecognized DCD will likely experience failure without the right supports. Proper identification is critical, said Kamps.

But very few psychologists have an in-depth understanding of human physiology, Kamps explained.

“Psychologists who are allowed to diagnose the DCD don't know about it or they don't understand how the motor domain affects other aspects of human development,” she said.

Occupational therapists, speech-language pathologists, and physiotherapists have a really good understanding of the condition, but they are not permitted to make the diagnosis because DCD is considered a mental-health condition.

“The people who can make the diagnosis don't know about it or they don't feel safe or secure in making the diagnosis. The people who actually see it and should make the diagnosis aren't permitted to make it.

“I always describe it as two ships sailing past each other completely loaded with valuable cargo or valuable knowledge, but they're not talking to each other.”