Developmental Coordination Disorder
Developmental coordination disorder, sometimes referred to as motor clumsiness or developmental dyspraxia, is a movement condition that manifests during child development and is marked by difficulty learning fine and gross motor skills compared to children of the same age. Children with this disorder may struggle with everyday activities such as getting dressed, eating meals, and playing games with others as a result of poor motor coordination skills.
In addition to the resulting lack of physical fitness, developmental coordination disorder can also influence a child's self-esteem and social abilities. The condition usually continues into adulthood, but treatment can greatly improve motor skills and provide helpful strategies to navigate everyday tasks.
Signs of developmental coordination disorder include:
- Delay in achieving motor milestones such as sitting, crawling, or walking
- Persistent clumsiness, including dropping objects or bumping into walls or furniture
- Finding it difficult to catch a ball, participate in games or sports, or ride a bike
- Unsteady walk, tripping over feet
- May have difficulty navigating stairs or uneven ground
- Difficulty engaging in tasks that require fine motor skills such as assembling puzzles, buttoning shirts, eating with utensils, or building blocks
- May have unclear or labored handwriting
Individuals with developmental coordination disorder, or DCD, may struggle predominantly with gross motor skills or fine motor skills; they may also find both equally challenging. Children may, in some cases, be able to carry out everyday motor tasks with great effort; however, they will likely struggle to move at the same speed as their peers and may become frustrated much more easily. In other instances, children may “revert” to less developed behaviors, such as eating with their fingers rather than struggling with utensils.
A diagnosis of developmental coordination disorder may be given if the motor skill impairment interferes with activities of daily living and negatively impacts a person’s ability to participate in school, work, leisure, and play. Per the DSM-5, symptoms should first appear in early childhood and not be better explained by another condition, such as a visual impairment or dysgraphia.
About 5 percent of children between ages 5 and 11 are diagnosed with developmental coordination disorder; approximately 2 percent can be categorized as “severe.” The condition affects more boys than girls, at a ratio between 2:1 and 7:1 in severe cases.
Developmental coordination disorder is not considered a learning disability; instead, it is classified as a neurodevelopmental disorder, similar to ADHD, that primarily affects motor skills. However, challenges with motor skills can interfere with learning in many cases—for example, a child may struggle to write down her thoughts legibly without becoming frustrated. Children may also struggle in gym class or other physical activities at school.
The terms “dyspraxia” and “developmental coordination disorder” are near-synonyms and are often used interchangeably. Developmental coordination disorder is the formal diagnosis and is typically used by medical professionals; dyspraxia is often used in more casual parlance, and may be used by teachers, parents, or school officials. The latter may also sometimes encompass other symptoms such as troubles with organization or sensory processing, in addition to motor challenges.
Developmental coordination disorder is a lifelong condition. However, symptoms often improve significantly and can become manageable with age, especially with adequate treatment. Accommodations can also help children and adults learn to compensate for their difficulties, which can make symptoms less noticeable and less burdensome.
Developmental coordination disorder is typically not diagnosed before age five because the age when children develop motor skills varies. Before a diagnosis is given, children will likely undergo additional tests to rule out the possibility of a medical condition or learning disorder.
ADHD very frequently co-occurs with developmental coordination disorder; as many as 50 percent of children with DCD also meet the criteria for ADHD. Some evidence suggests that children with inattentive ADHD are more likely than those with hyperactive type to struggle with motor skills. It is not known why the two disorders so often co-occur, but deficits in executive function (the ability to regulate and coordinate attentional and inhibitory behaviors, among others), are known to play a role in both disorders. While there is some evidence that the disorders share neurological underpinnings, other researchers argue that the two disorders are entirely distinct and call for separate treatment approaches. (It's important to note that children with ADHD may also appear clumsy or uncoordinated without necessarily having DCD; close observation is often required to determine whether clumsiness is related to DCD or distractibility and/or hyperactivity.) Specific learning disabilities (such as dyslexia), autism, and emotional disturbances may also appear alongside DCD.
The root cause of developmental coordination disorder is unknown. Like other neurodevelopmental disorders, current evidence points to a combination of genes and environment. Those born into families with a history of DCD are at greater risk, and prenatal developmental setbacks—such as being born early or being small for one's gestational age—appear to play a substantial role in the later development of DCD.
Researchers also know that there is a consistent problem with rhythmic coordination and timing among children with developmental coordination disorder, as well as deficits in executive functioning that affect working memory, inhibition, and attention. Researchers have noted that dysfunction in these areas mimics that of ADHD and that the disorders frequently co-occur, suggesting a potential overlap between the two conditions, though the exact connection between the two remains the subject of debate.
Children who were exposed to alcohol in the womb, who were born preterm, or who were of low birth rate appear to be at heightened risk for DCD. Additional risk factors include being male and/or having a family history of developmental coordination disorder.
Experts believe that genetics play some role in developmental coordination disorder, as the condition tends to run in families. However, the exact cause of the disorder is not fully understood.
Children with developmental coordination disorder greatly benefit from early intervention efforts. Treatment may include occupational or physical therapy, physical education, or the implementation of helpful strategies, such as encouraging children who have trouble writing to use a computer to take notes. Perceptual motor training, which combines physical movement with math or reading tasks that require thinking, is also a common treatment for children with developmental coordination disorder. The severity of the condition plays a role in how much a child can improve.
While many children see an improvement in symptoms with treatment over the long term, 50 to 70 percent of children continue to have problems with coordinated movement through adolescence. The severity of the condition does not worsen over time, but developmental coordination disorder does continue into adulthood.
As with other neurodevelopmental disorders, there is no “cure” for DCD and the condition is considered lifelong. However, treatment—especially occupational therapy and/or physical therapy—can greatly improve fine and gross motor skills, muscle tone, and self-esteem in a child with DCD.
No medications are currently approved for the treatment of developmental coordination disorder. The condition often co-occurs with other disorders, however, such as ADHD; in some cases, treating comorbid conditions with medication may be part of a comprehensive treatment plan.
Most cases of developmental coordination disorder are treated with occupational therapy, which aims to improve a patient’s motor skills and become more adept at common, everyday tasks, such as brushing teeth or buttoning a shirt. Occupational therapists may also help children build their skills in motor planning, or the ability to think about and remember the steps necessary to engage in a particular motor task. Individuals with DCD may also benefit from physical therapy, which can help build muscle and improve balance.
Parents can best help children with DCD by initiating treatment early and seeking accommodations as necessary. Developmental coordination disorder may qualify a child for formal accommodations under the Individuals with Disabilities Education Act (IDEA); it may also be possible to secure informal accommodations by working with a child’s teacher(s) or other school administrators. Accommodations can include allowing the use of speech-to-text software; using special tools such as pencil grips, raised line paper, or scissors designed for children with motor difficulties; allowing extra time on tests where handwriting is required, and/or allowing extra time to complete motor tasks such as putting art supplies away; or giving students a “teacher’s copy” of notes so they don’t need to write information out by hand.
Treatment is thought to be most effective when initiated early. But adults with developmental coordination disorder can still benefit greatly from occupational therapy or physical therapy, which can improve coordination, improve physical fitness, and allow the individual to develop strategies to complete common, everyday motor tasks. CBT or another form of talk therapy may also be immensely beneficial for adults with DCD, as it can help them come to terms with the nature of their condition and manage the self-esteem problems that often stem from a lifetime of feeling uncoordinated.