Surveillance and Medicalization of Atypical Motor Development

STAGE	DESCRIPTIONS BY CONRAD & SCHNEIDER (1980)	MILESTONES OF ATYPICAL MOTOR DEVELOPMENT
1. Common-sense definition of behavior as deviant	Before a medical definition emerges, a particular behavior is defined as deviant. Compared to the medical definition, the common-sense definition appears vague.	Motor behaviors that are deviant from the expected level of the child’s age group may be perceived and described as clumsy, awkward, and uncoordinated.
2. Prospection: medical discovery	A medical conception of deviant behavior first appears in a professional medical journal, book, or conference presentation. The conception consists of diagnosis, etiology, and treatment. At this stage of prospecting, a limited number of professionals are involved in the new medical ‘discovery’. The conception may not be accepted until champions and moral entrepreneurs catch public attention.	Apraxia, Clumsy Child Syndrome, Dyspraxia, and physical awkwardness have been reported in medical journals and books. Some of the authors became medical or academic champions.
3. Claim-making	Champions, moral entrepreneurs, and organized interest groups make claims for the new medical designation. Medical professionals may treat the behavior or work for an institution designated for the issue. However, they are not usually involved in claim-making activities directly.	Special issue of academic journals dedicated to DCD, consensus on terms, Dyspraxia groups, DCD and Dyspraxia conferences. Parental support groups serve as moral entrepreneurs for public awareness and lobbying, supported by some medical or academic champions.
4. Legitimacy: securing medical ‘turf’	An instrumental challenge is laid to the existing deviance designation for the recognition of the medical viewpoint. There may be conflicts between the old and the new regimes. To secure assimilation into the domain of medical authority, governmental approval and support are required.	There is minor disagreement between academic researchers and the parental support groups concerning the labels. Governmental support is minimal, regardless of the labels.
5. Institutionalization	The medical designation of deviant behavior is stably institutionalized and publicly accepted.	Diagnostic manuals, national health institutes, school-based programs

Table 2

Medicalization developmental stage numbers and the first authors of milestone events and developmental motor ability tests.

NATION	1920S	1940S	1950S	1960S	1970S	1980S	1990S	2010S
USA	Stage 2. Orton (1925)				Bruininks (1978)	Stage 5. APA (1987) DSM-III-R	Stage 5. APA (1994) DSM-IV	Stage 5. APA (2013) DSM-5
Canada					Stott (1972)		Stage 3. Polatajko (1995) Consensus	Stage 5. Missiuna (2012)
UK				Stage 2. Gubbay (1965)	Stage 2. Gubbay (1975)	Stage 3. Dyspraxia Trust founded in 1987	Stage 2. Henderson (1992) Stage 3. Henderson (1994)	Henderson (2007)
Germany (Russia)	Gurewitsch (1925)			Stage 2. Kiphard (1966)	Kiphard (1974)	Stage 2. Doll-Tepper (1989)		Stage 4. Blank (2011) Stage 4. Blank (2019)
New Zealand							Stage 3. Dyspraxia Support Group of New Zealand founded in 1992
Japan			Karino 1953		Stage 2. Yamaguchi (1973)		Stage 2. Nanakida (1994)
Occupied Taiwan		Naka (1941)

[i] Note. Italics indicates publication of a developmental motor ability test. Bold indicates medicalization events with the stage number defined by Conrad and Schneider (1980).

Table 3

Medicalization impact assessment (Kaczmarek 2019).

	OVER-MEDICALIZATION-RISKS	WELL-FOUNDED MEDICALIZATION-OPPORTUNITIES	RISKS FOR DCD/DYSPRAXIA	OPPORTUNITIES FOR DCD/DYSPRAXIA
Health effects	Harm to health caused by undue treatment	Possibility of using tools of evidence-based medicine	No treatment harm has been reported. Non-inclusive individual intervention or protracted treatment may lead to stigmatization and psychosocial problems.	There are possibilities of using assessment and intervention tools of evidence-based medicine. However, at present, there is no high-quality evidence for treatment efficacy evaluated with standardized developmental motor assessment tools.
Economic effects	Suboptimal expenditure and waste of public or private money	Improvement in the financial situation of individuals whose condition has officially been recognized as a disease	Ineffective screening, assessment, diagnosis, and treatment for DCD/Dyspraxia with high costs can lead to the waste of both public and private resources.	A cost-effective DCD/Dyspraxia identification and treatment can significantly benefit the individuals with DCD, their families, and governmental budgets.
Psychological effects	Stigmatizing certain conditions, individuals, or their behavior as sick; restriction of personal freedom; pressure to adjust one’s own needs and behavior to fit the prevailing standards	De-tabooization of disease, explanatory value	The diagnosis and individual treatment of DCD/Dyspraxia can pose risks for both self and public stigma, which may lead to internalized shame, lowered self-esteem, teasing, bullying, social isolation, the feelings of helplessness and oppression, and disadvantage for entering higher schools and the workforce.	The diagnosis of DCD/Dyspraxia may make the condition more socially acceptable and provide an explanation for it.
Social effects	Ignoring the social, political, and interpersonal background of certain phenomena and inadequate reactions stemming therefrom	Raising health awareness of the public, recognizing medical grounds for particular behaviors and starting treatment instead of punishing the patient	The environmental factors in the family, school, and community that facilitate atypical motor development can be overlooked by medicalizing the condition.	The diagnosis can raise public awareness, recognize medical grounds, and initiate treatment for improving desired motor skills.

Table 4

Legitimacy of medicalization.

QUESTION	ANSWERS FOR DCD/DYSPRAXIA
1. Has X been rightly recognized as a problem?	✓ Yes, DCD/Dyspraxia has been recognized as a problem of movement skills required for daily life, as well as the risk of psychosocial issues.
2. Does recognizing X as a problem not result from unfounded, exaggerated social expectations?	– DCD/Dyspraxia can be recognized as a problem when social high expectations are unfounded and exaggerated.
3. Does medicine provide the most adequate methods of understanding X and its causes?	– By definition, DCD should not have any medical causes, and thus, medicine does not provide the most adequate method for understanding DCD and its causes.
4. Does medicalizing X ensure the most effective and safest methods of solving it?	? Medicalizing atypical motor development in terms of DCD/Dyspraxia can facilitate an effective and safe method of addressing it if the local media, educational, and social systems sufficiently accommodate the medicalized condition. Whether or not it is the most effective and safest option is open to question.