Physical challenges:

• Difficulty with age-appropriate daily activities – these can be gross motor skills (whole body movements), or fine motor skills (using hands), or a combination of both.
• Delay or difficulty mastering skills such as riding a bike, catching a ball, getting dressed, managing fastenings and handwriting.
• Awkward or clumsy movement: bumping into things, knocking things over or spilling drinks.
• Difficulty with sequencing tasks or completing activities with multiple stages.
• The child may show a discrepancy with his/her motor abilities and abilities in other areas – for example intellectual and language skills may be quite strong while motor skills are delayed.
• Difficulty learning new motor skills. Once mastered some motor skills may be performed quite well while others continue to be performed poorly.
• Tasks which require constant changes in body position or a need to adapt to changes in the environment (for example team games, ball games) may be more challenging.
• The child may find tasks which require co-ordinated use of both sides of the body (such as cutting with scissors, star jumps) difficult to master.
• The child may show poor balance and difficulty with activities requiring good balance and postural control such as climbing the stairs, standing when dressing or riding a bike.

Emotional/Behavioural Challenges

• The child may try to avoid physical activities which they find challenging:  motor-based tasks may require a significant effort resulting in fatigue, and repeated failure.
• The child may show a low frustration tolerance, become quickly angry or anxious, and have low self-esteem or confidence due to the struggles with daily activities which they experience.
• The child may avoid playground games or tend to play with younger children.  This may be due to a lack of self-confidence or an effort to avoid physical activities.
• The child may be resistant to change in their routine or the environment:  planning and sequencing tasks may be challenging for the child so that any change in how it is performed can be a significant problem for the child.

Other Common Challenges

• The child may struggle to balance the need for speed with the need for accuracy – for example they may be able write neatly when their focus is solely on their handwriting, but this may be extremely slow.
• They may have difficulty with school subjects which require them to lay out work accurately on the page – for example maths sums or spellings.
• The child may have difficulty with self-organisation and keeping track of belongings.

Supporting a child with motor skill difficulties

At Home:

• Encourage your child to participate in physical activities which they enjoy which provide opportunity for motor skill practice.  Enjoyment should be the goal rather than competition.
• Wherever possible try to introduce new sports or a new playground on an individual basis before the child has to manage the activity within a group.
• Encouraging the child in the activities they are good at is equally important to supporting them in the motor tasks they struggle with.  Consider clubs or activities where they can join with peers in activities they are good at or interested in (for example drama, music, choir, etc.)
• Encourage your child to participate in activities that will help improve their ability to plan and sequence motor tasks, for example laying the table, packing their school bag, preparing their packed lunch.  It may help them to have a pictorial strip showing the sequence of actions to complete the task, or having you prompt them by asking questions that help them to focus on each stage of the task (‘what do you need to do first?’)
• Try to provide school clothing that is easy to get on and off (looser fitting items, elasticated waist trousers, Velcro fastenings where possible).

Dressing skills – an example of how to use the M.A.T.C.H. Strategy. 

Try using this method when considering how to support your child with other challenging motor skill activities.

Modify the task:

Select clothing with minimal fastenings to avoid frustration;  choose larger buttons & buttonholes or Velcro, large tabs on zips, looser fitting clothing with large neck and armholes.

With hooded cardigans or coats get the child to put the hood on their head first so that the clothing hangs in a way to make it easier to put arms in sleeves.

Add visual cues:  e.g. put a coloured mark to indicate the back of clothing, put arrows in shoes – when shoes are placed side by side the arrows should point to one another.

Alter your expectations:

• Allow plenty of time – practice new skills at weekends rather than adding to school morning stresses.
• Lay out clothing in the correct sequence and orientation ready for the child to put on

Teaching Strategies:

• Use a consistent step-by-step method to make it easier for the child to learn the sequence of dressing
• A pictorial sequence may be helpful for the child to follow
• Try backward chaining:  teach the last step of the task first, then when the child has mastered this teach the previous step.  Continue adding previous steps in this way until the child has mastered the whole task.  This way the child has the satisfaction of completing the task each time.
• Encourage the idea that each hand has a different job – a helper hand and a doer hand (e.g. when doing up a zip the helper hand holds the bottom of the coat while the doer hand pulls the zip up.
• Demonstrate and explicitly teach each step of the task and use verbal cuing (for example ‘labels at the back’.

Change the environment:

• Encourage the child to sit the floor, with their back against the wall, or low chair for extra stability when dressing
• Allow plenty of space

Help by understanding:

• Work with the child to find strategies and techniques that work best for them

Encourage an ‘I can do it’ attitude by rewarding any efforts towards independence

At School

Good communication between home and school is important to ensure that the child’s specific difficulties are recognised and strategies which help are available consistently in both settings. 

In the Classroom:

• Ensure chair and table height are correct:  the child’s feet should be flat on the floor and the table height should be approximately elbow height so that the forearms are comfortably supported on the table.
• For children who struggle to maintain their posture allow frequent changes of position and allow the child to rest against a wall or furniture during carpet time.
• Have a supply of the following equipment in each classroom:  rulers with handles (make it easier to hold a ruler steady); writing slopes (put paper in a more comfortable position for writing and can help to discourage a flexed wrist writing posture); a range of pencils/pens – for example triangular-shaped, thicker barrels, non-slip grip (so that children can see which works best for them). 
• Provide extra time to complete fine motor activities or tasks which involve handwriting.  If speed is necessary, remember that the child may not be able to be as accurate.
• When handwriting is not the emphasis provide ‘fill in the blank’ worksheets so that the child can focus on the learning task rather than organising their work on the page.
• Introduce laptops or tablets early on so that the child can develop keyboard skills in order to have a viable alternative to handwriting as the quantity of written work increases and when tidy presentation is essential.
• Have paper to match the child’s handwriting abilities.  For example widely spaced lines for a child whose writing is very large; graph paper for a child who has difficulty with spacing or with keeping numbers aligned in maths.
• Consider alternative ways for a child to demonstrate their learning – for example presenting a piece of work orally or using voice recording technology, typing a story on the computer, using drawings or photos to illustrate their thinking.
• Consider the goal of the lesson:  if a creative story is the goal then accept messier presentation; if the goal is for the child to correctly lay out a maths problem on the page then allow extra time or accept that the maths problem may not also be solved.
• Where appropriate ensure that special access arrangements are in place for tests and exams which require a lot of written work.

In Physical Education

• Break down the physical activity into smaller, achievable parts, and introduce next steps gradually.
• Involve the child in activities that will allow them to be successful at least 50% of the time.
• Aim for participation, not competition and reward effort not skill.  Encourage children to work to improve their own personal best rather than compete with others.
• Modify equipment for children who are learning a new skill.  For example, using larger balls initially to develop throwing and catching skills.
• Providing hand-over-hand guidance can help the child get a feel for the movement.
• Explain any rules for the activity or sport at a time when the child is not concentrating on the motor aspects.  Ensure that they understand clearly what they need to do as this will make it easier for them to plan the movement.
• Give clear demonstration and point out important elements of the movement.  For example, keeping feet wide apart to help balance when aiming to a target.

In the community

• Encourage the child in physical activities for fun, participation and fitness
• Help coaches, sports instructors and activity leaders to understand the child’s strengths and challenges so that they can support them to be successful in the activity.  This could be done through the use of a One Page Profile.
• Keep in mind that the child may sometimes need extra support or individual lessons to help them master a sport or physical activity.
• Ensure protective gear is used when appropriate with physical activities (for example helmets, knee/elbow pads).
• Promote social participation in activities which the child enjoys and which do not present so much of a motor challenge, for example drama, clubs, music.

Teaching a Cognitive Approach to Support Motor Skill Development

Helping the child to use a ‘Goal, Plan, Do, Check’ approach can support their learning of new motor skills.

GOAL: What do I want to do?

This might need to be a small element of the final task, gradually building each stage of the task into its entirety.

For example:

• Learning to skip – Goal: To jump over a static rope on the floor
• Riding a bike – Goal: To walk next to the bike and stop the bike by using the brakes at the line.
• Tying laces – Goal: To be able to form the loop to make a bow

PLAN: How am I going to do it?

It is essential that the person doing the task makes the plan, although they may need help to work this out.  The plan may include one of the following strategies:

• How they position their body – How should you position your bottom on a chair? “I will sit on my chair with my back ‘glued’ to the back of the chair”
• How they attend to the task – Where are you looking when you are catching the ball? “I will keep my eyes on the ball”
• Modify the task – “Lets put tape on the floor so you know where to stand” – “I will stand on the tape when drawing on the board”
• Feel the movement – Verbalise the feeling of a particular movement as it is being carried out – “I will feel the bumps in B when I draw it in the air”
• Verbal Motor Mnemonic – “Lets notice how strong your hold is” – “I need to use my Alligator grip” or “1,2,3,4 are my feet on the floor; 5,6,7,8 am I sitting up straight”
• Verbal Rote Script – The child identifies a pattern of words to guide a movement sequence – “Dribble, dribble, shoot” or “Push, glide, push glide”

DO: Do it (carry out the plan)

CHECK: How well did my plan work?

Reflect on the plan and adjust the plan next time if necessary

Remember to:

• Change one thing at a time
• Ask the child – don’t tell
• Demonstrate emphasising the key element of the task – What am I doing?

(Ref: The Cognitive Orientation to Occupational Performance by Polatajko et al, 2001)