What is Developmental Coordination Disorder?

Developmental coordination disorder (DCD), occasionally referred to as dyspraxia, is a condition that impairs physical movements and presents as a lack of coordination in both fine and gross motor skills. The term, “dyspraxia” is used less often by healthcare professionals because it also refers to movement issues in adults who have suffered brain damage. In the past, the condition was sometimes referred to as “clumsy child syndrome.” DCD is 3 to 4 times more likely to occur in males than in females, and sometimes seems to have a genetic correlation.

DCD develops in early childhood and is defined as a failure to acquire appropriate developmental motor skills, such as delays in standing or walking, and issues with tying your shoes, brushing your hair, handwriting, playing sports, etc. Children with DCD often struggle at home and school, and experience difficulties with attention, organization, and planning.

People with DCD usually have normal intelligence. However, this may not be recognized if not appropriately assessed or diagnosed. In order to receive a DCD diagnosis, the symptoms cannot be better explained by an intellectual developmental disability, visual impairment, or a neurological condition. Additionally, people with DCD may have other comorbidities, such as attention-deficit disorder or autism spectrum disorder, but the disorders are not linked to DCD. Furthermore, if there is a learning difficulty present, the motor deficits are in excess of what would normally be associated with the learning difficulty. 

Signs and Symptoms

DCD can have a wide range of symptoms and often present in early childhood. The symptoms may be noticeable early on or may become more noticeable as the child gets older. Symptoms for DCD include:

In younger children

• Delays in reaching normal developmental milestones (sitting up, crawling, rolling over, standing, or walking)
• Difficulties in playing with toys or activities that require coordination
• Difficulty in fine motor skills, such as using utensils or scissors
• Abnormal body postures during their first year

In older children

• Difficulties with hopping or jumping, running, skipping, catching or kicking a ball
• May struggle to join in recess or playground activities due to difficulties in coordination and movement
• May struggle walking up and down stairs
• Difficulties in using scissors, handwriting, or drawing
• Issues with getting dressed, buttoning shirts or pants, tying shoes
• May swing their legs a lot, or find it difficult to sit still

Children with DCD may appear awkward or clumsy by tripping, falling, bumping into things, dropping things, or falling often. DCD impacts movement and coordination, and typically does not affect speech or cognition.

Additional difficulties

• Attention and focus issues
• Difficulty in planning and organizing
• May take longer to pick up new skills
• Difficulty in following instructions or copying information
• Behavioral issues
• Developing friendships with peers may be more difficult
• Low self-esteem

It is a misconception to state that children with DCD “outgrow” it in their teen and adult lives. It is more accurate to state that people with DCD who follow a treatment plan and stay consistent, may show significant improvement over time in many problem areas. However, in most cases, DCD symptoms, in varying degrees, remain present into adulthood.

Causes

No singular cause has been found for DCD. It is more likely to have a multifactor causation, with the latest research pointing to differences in certain areas of the brain. Coordinated movements is a complex process that requires optimal functionality of nerves and other areas of the brain. Further studies, using brain scans and other technology, are being conducted to determine causes and best treatment moving forward.

There are several risk factors that may increase the likelihood of developing DCD. The risk factors include:

• Premature birth (being born prior to 37 weeks)
• Low birth weight
• Family history of DCD
• If the fetus is exposed to alcohol and illegal drugs in the womb

Diagnosis

If you suspect that your child may have DCD, it is important to have them assessed by the appropriate healthcare professional. There are a range of healthcare professionals who would be able to assess for DCD. A pediatrician, pediatric occupational therapist, pediatric physiologist, pediatric neurologist, neurodevelopmental pediatrician, child psychologist, or educational psychologist would all be able to assess for DCD.

There are various assessment tools used in diagnosing DCD. Some of these assessments include:

• Norm-referenced assessments. These types of assessments can be used to determine if a child’s motor skills fall within a normal range for that specific age or population. 
• Motor ABC’s. This method uses various tests to assess both gross and fine motor skills. 
• Mental health assessments. Mental health assessments are useful in ruling out other possibilities or diagnoses for DCD symptoms.
• Family medical history. Gathering a family medical history is helpful in noting any possible genetic connections.

According to the DSM-5, in order to meet criteria for a DCD diagnosis, a child must exhibit the following:

• The development and execution of coordinated motor skills are significantly below the norm given the individual’s chronological age and opportunity for skill learning and usage
• The motor skills deficit significantly and consistently creates difficulties in daily functioning and activities appropriate to chronological age
• Onset of symptoms is in the early developmental years
• Motor skills are not better explained by intellectual disability, visual impairment, or a neurological condition affecting movement

Treatment

There are several forms of treatment for DCD. It is beneficial to identify symptoms early so that an appropriate diagnosis and treatment plan can be made. This allows your child the greatest chance at improving and adapting with DCD as they get older. Although some symptoms may improve over time, it is not typical that people simply “outgrow” DCD.

Treatment plans are developed according to your child’s specific needs, as DCD symptoms and severity of symptoms are on a spectrum. Generally, treatment plans require working with a variety of healthcare specialists and active involvement from parents and educators is crucial for effective treatment. 

There are various forms of treatments that utilize different specialists and modalities to best serve your child. Generally, your child will work with an occupational therapist, physical therapist, mental health practitioner, and an educational specialist. Regarding treatment working with motor skills, healthcare providers use a task-oriented or process-oriented approach, or a combination of both.

Task-oriented treatment

This form of treatment focuses on building the motor skills needed for a specific task. The therapy identifies the movements that are difficult for the task, and then breaks down the actions into small steps. A therapist may also help patients adapt or modify tasks to make them easier to complete, such as using Velcro instead of shoelaces, or adding pencil grips to pencils to make them easier to hold.

Process-oriented treatment. 

This form of treatment focuses more on working with your child’s motor skills, rather than focusing on specific tasks. It is based on the belief that DCD is a sensory and perception issue between the brain and the body. 

Both treatment approaches have proven effective, however task-oriented treatment seems to have a higher success rate. It has been made clear that the best form of treatment involves a multidisciplinary approach, engaging not only with healthcare professionals, but also with parents and educators.