Developmental coordination disorder

Developmental coordination disorder (DCD)
Other names	Developmental motor coordination disorder, dyspraxia
Many people with DCD have difficulty with tying shoelaces, handwriting, developmental motor skills, activities of daily living, and performing other tasks that require coordination and motor control.
Specialty	Psychiatry, neurology
Symptoms	Impaired acquisition and execution of coordinated motor skills
Complications	Academic difficulties, low self-esteem, anxiety symptoms, depressive symptoms, reduced participation in physical activities, reduced physical fitness, fatigue, increased risk of obesity and other increased cardiovascular risk factors
Usual onset	early developmental period
Duration	Often persists into adulthood
Differential diagnosis	Cerebral palsy, muscular dystrophy, neurological disorder or neuromuscular disorder affecting movement, significant visual impairment, hypermobility spectrum disorder, fetal alcohol spectrum disorder.
Treatment	Physical therapy, occupational therapy
Frequency	5–6% (of all school aged children)

Developmental coordination disorder (DCD), also known as developmental motor coordination disorder, developmental dyspraxia, or simply dyspraxia (praxis from Ancient Greek meaning 'doing', 'action', 'practice', or 'transaction'), is a neurodevelopmental motor disorder characterised by challenges with the acquisition and execution of coordinated movements and motor skills that are substantially below what would be expected given the individual's chronological age ^[1] .

The etiology of DCD is unknown. Motor function requires the coordination of neurologic, physiologic, and biologic processes, including proprioception (body awareness), strength, balance, fine and gross motor coordination, motor planning (praxis), dexterity, vestibular integration, oculomotor coordination, and visuo-motor coordination. Problems in any of these areas can result in impairment of motor skills. Deficits in fine or gross motor skills and movements interfere with activities of daily living. In addition, difficulties may present as clumsiness, slowness or inaccuracy of performance of motor skills (e.g., throwing or catching objects, using cutlery, handwriting, pointing accurately at targets, running, jumping, riding a bike, use of tools, participating in physical activity, or sport skills). A diagnosis of DCD is reached when a motor skills deficit compared to their age-matched peers is not better explained by medical conditions affecting movement, such as brain tumors, cerebral palsy, multiple sclerosis, or Parkinson's disease, metabolic conditions, intellectual disability, or visual impairment. DCD has onset in early childhood and often persists into adolescence and adulthood.

Occupational therapy and physiotherapy can help people with DCD to develop and improve their coordination and motor control to achieve things that they might otherwise find challenging to accomplish. While DCD is known to co-occur with other neurodevelopmental disorders, its related gross and fine motor impairment are not necessarily associated with lower intelligence. People with DCD may have low self-esteem because their age-related peers can often complete tasks and participate in activities that they struggle with on a daily basis. Developmental coordination disorder, like some other neurological conditions that are not immediately obvious to others but can greatly affect a person's life, is also typically a hidden disability to the general public.

Terminology

DCD was named as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) in 1987. ^[2] It is also called "developmental motor coordination disorder" in countries that use the International Classification of Diseases 11th Revision (ICD-11). ^{[3] [1] [4]}

Other terms that have been used to describe DCD are listed below. ^{[4] [5] [6]} These terms are recommended to be avoided ^{[7] [5] [6]} because they are either ambiguous or not necessarily equivalent motor disorders (however, 'dyspraxia' remains in common use, especially in the UK ^[4] ):

• Clumsy child syndrome
• Developmental dyspraxia
• Developmental apraxia
• Dyspraxia
• Apraxia (distinct from 'childhood apraxia of speech' and 'acquired apraxia')
• Sensory integrative dysfunction
• Perceptuo-motor dysfunction or perceptuo-motor difficulties
• Motor learning difficulty
• Physical awkwardness
• Movement difficulty
• Mild motor delay
• Minimal brain dysfunction
• Disorder of attention and motor perception (DAMP)

Epidemiology

The etiology of DCD is currently unknown. ^{[8] [7]} The prevalence of DCD varies between patient populations and diagnostic criteria used but in most reviews, the prevalence in the general population of school-aged children is 6% ^{[4] [9]} DCD is more often reported in boys, with a male to female ratio ranging from 2:1 to 7:1 ^[10] . Various areas of development can be affected by DCD (activities of daily living, academic performance, leisure, recreation, play, and social participation) and these may persist into adulthood. ^{[11] [4]}

Signs and symptoms

Childhood

While signs and symptoms of DCD can be noted before age six, most become apparent when they interfere with social development or when children enter school at approximately age six and are subsequently compared with their peers. ^{[12] [13]} In retrospective reviews, children with DCD may have had problems with sucking and swallowing in their first year of life, delayed motor milestones such as sitting, crawling, walking, running, or jumping, persistent toe-walking or abnormal gait after fourteen months of age, speech problems or persistent drooling after thirty months of age. ^{[14] [13] [7]}

Children with DCD may have difficulty with everyday tasks such as putting on shoes, tying shoelaces, dressing, self care, and using cutlery. Parents may also report difficulties with riding a bike, playing catch, dropping objects, tripping, poor pencil or crayon grasp, difficulty with finger isolation or accurate sequential pointing, difficulty pointing accurately to pictures, letters, or symbols used for communication, difficulty cutting with scissors, difficulty drawing a straight line, difficulty regulating movement speed or adjusting the amount of force used, differences in walking or running mechanics, or bumping into doorways or chairs. ^{[15] [16] [17] [12] [13] [14] [18] [19]} Such children may require longer and repeated instruction to learn new motor skills, may avoid participation in gym class or sport, or avoid physical activity and fitness, ^[20] or their motor challenges may prevent participation in particular physical activities ^[21] . Children with DCD may also have difficulty processing instructions with multiple steps as well as educational, emotional regulation, and social interaction challenges. ^{[22] [13] [16]}

Adolescence and adulthood

Motor difficulties persist into adolescence and adulthood in the majority of cases. ^{[23] [1]} DCD may present as challenges with ball handling skills, agility, handwriting, typing, using a touch screen or mouse, driving, and playing sports ^{[4] [24]} . Co-occurring speech and language difficulties may also persist into adulthood. ^[25] Individuals with DCD often have difficulty learning new motor skills or applying skills in a different environment (generalization of skills). ^[1]

Health consequences

DCD may be associated with negative short and long term health consequences including decreased participation, social isolation, obesity, low self esteem, reduced mental well being, poor physical fitness (i.e. decreased flexibility, strength, endurance), poor pulmonary function, increased cardiovascular risk factors (elevated triglycerides and high blood pressure), and fatigue or stress associated with the increased effort and demands of performing challenging motor tasks. ^{[7] [26] [27] [28] [29]}

Motor-cognitive integration challenges

In DCD, impairments in motor planning and coordination may interact with cognitive processes. ^{[30] [31]} Evidence from research and clinical practice indicates that DCD is not limited to a physical disorder, and there may be deficits in executive functions, behavioural organisation, and emotional regulation that extend beyond the motor impairments and which may occur independently of diagnoses of co-morbid conditions. ^{[32] [31] [30]}

Motor coordination and motor planning difficulties in DCD can affect the accuracy and timing of task performance, especially in activities that require sequencing or sustained attention. ^[1] Increased cognitive and motor planning demands may also place additional load on working memory and executive processes, contributing to challenges remembering the next step in the sequence or the motor plan, selecting the appropriate limb for movement, or executing movements in the correct order or at the appropriate time. ^{[31] [4] [32] [33] [34]} As a result individuals with DCD may produce incomplete, mis-sequenced, or delayed motor responses, even when they understand the task at hand. Working memory and organizational difficulties may affect the ability to remember multistep instructions, organize time, meet deadlines, keep track of belongings, or carry out activities that involve multiple steps, such as cooking. ^{[32] [35] [30]} These consequences are understood as reflecting challenges in motor–cognitive integration rather than a direct measure of underlying intellectual ability. ^{[35] [31] [4] [36]}

Emotional factors, especially anxiety regarding the ability to complete a task, may influence motor performance in individuals with DCD. Anxiety is associated with changes in movement timing, variability, and visuomotor control, ^{[37] [38]} although the direction of this relationship remains unclear.

While most of the general population experience these problems to some extent, they have a more significant impact on the lives of people with DCD. Many benefit from working in a structured environment ^[4] , as repeating the same routine minimises difficulty with organizational ability and self regulation, and allows them to commit procedures to long-term memory. ^{[32] [4]}

Gross motor control

Whole body movement and motor coordination issues mean that major foundational motor skills including walking, running, climbing, and jumping can be affected, which can cause challenges when more difficult movements are attempted. ^{[39] [4] [8]} These difficulties vary from person to person and may include the following:

• Poor timing ^{[33] [40]}
• Poor balance ^{[33] [4]}
• Difficulty combining movements into a controlled sequence ^{[33] [4]}
• Problems with spatial awareness and body awareness, including proprioception ^{[33] [4]}
• Clumsiness to the point of knocking things over, causing minor injuries to oneself and bumping into people accidentally ^{[4] [39]}
• Difficulty inhibiting motor responses ^[41]
• Delayed initiation of movement in some motor tasks ^{[42] [43]}
• Difficulty with bilateral alternating movements ^[33]
• Difficulty with coordination of upper and lower body movements ^{[33] [40]}
• Difficulty keeping still, sometimes accompanied by frequent movement of the arms or legs ^[44]
• Motor overflow - unintended movements accompanying a voluntary movement ^{[45] [46]}
• Difficulty maintaining a consistent rhythm during repeating movements or synchronizing movements with an external beat, ^[47] and continuing movements once started or after an external auditory cue stops ^{[47] [48]}
• Difficulty adjusting movement direction and maintaining balance when navigating obstacles or changing direction ^[49]
• Difficulty controlling movement speed and making corrections to ongoing movements when the task requires it ^{[49] [50]}
• Difficulty controlling and maintaining force production during movement ^[51]

Fine motor control

Fine-motor difficulties in DCD can affect activities of daily living, school-related tasks, communication, and other activities requiring manual dexterity and bilateral coordination. Examples include handwriting, typing, drawing, cutting with scissors, finger isolation, accurate pointing to pictures, letters or symbols used for communication, dressing and fastening clothing, using cutlery, brushing teeth, grooming, manipulating small objects, and performing cooking or household tasks. ^{[52] [25] [53] [4] [14] [54]}

Specifically, this may include:

• Difficulty forming letters accurately and consistently ^[55]
• Reduced handwriting output and increased pausing during writing ^{[56] [55]}
• Establishing or maintaining a functional and efficient pencil grip ^[56]
• Inaccurate or incomplete motor execution during handwriting or sequential targeted pointing ^{[15] [57]}
• Reduced speed or efficiency when typing on a keyboard ^[58]
• Difficulty coordinating eye and hand movements during sequential pointing ^[15]

Difficulty in determining left from right ^[33] and atypical handedness patterns, including higher rates of left-handedness or mixed-handedness, and a weaker or task-dependent hand preference, have also been reported in individuals with DCD ^{[34] [59]}

Co-occurring disorders and secondary features

DCD is known to co-occur with other neurodevelopmental disorders, Attention Deficit Hyperactivity Disorder (ADHD), and autism. Approximately 50% of those with ADHD have concomitant DCD, ^{[60] [61] [4]} although estimates vary depending on the population studied and diagnostic criteria used. Motor impairment and DCD are also highly prevalent in autism ^{[62] [63] [64] [65]} . Studies have demonstrated 79% of autistic children with definite motor impairment as measured by standardised motor assessments ^[62] and approximately 90% at risk of DCD ^{[63] [64]} or met DCD criteria, ^[65] despite the majority not receiving a formal diagnosis. ^{[66] [63]} In addition, increased severity of autism symptoms is associated with a higher risk of screening positive for DCD as well as greater severity of motor difficulties. ^[64] Other co-occurring conditions and associated features are listed below. Prosopagnosia ^[67] has also been reported in adults with probable DCD.

Reported co-occurring conditions include:

• Autism ^{[62] [63] [64] [65]}
• ADHD ^{[60] [9] [4]}
• Developmental Language Disorder ^[68]
• Developmental learning disorder ^{[4] [69] [70]}
• Speech sound disorder ^{[71] [25]}
• Anxiety Symptoms ^{[72] [4] [73]}
• Depressive symptoms ^{[4] [23] [73]}
• Dysgraphia (difficulty with handwriting) ^[74]
• Dyslexia (difficulty with reading and spelling) ^{[4] [75] [68]}

Reported associated features of DCD include:

• Oculomotor dysfunction including difficulty controlling eye movements, fixation, and visual tracking ^[49]
• Visuomotor dysfunction including difficulty coordinating visual information with motor responses ^[49]
• Visual perception and binocular vision difficulty including reduced depth perception and stereoacuity ^{[76] [50]}
• Hypermobility ^{[77] [78]}
• Altered vestibular function to support postural control ^[79]
• Sensory processing and modulation differences ^{[80] [81]}
• Mathematical learning difficulties ^{[35] [82]}

It is unlikely for a person with DCD to have all of these conditions and features. The clinical profiles of individuals with DCD vary significantly; an area of major weakness for one person with DCD can be an area of strength for another. ^{[68] [36]} For example, while some individuals with DCD have difficulty with reading and spelling due to dyslexia, or with numeracy due to dyscalculia, others may have strong or above average reading and spelling or mathematical abilities. DCD is best viewed as a heterogeneous neurodevelopmental motor disorder, with variable motor, cognitive, sensory, academic, social, and emotional profiles. ^{[75] [4]}

Speech, language, and communication difficulties

Speech and language difficulties have been reported in some individuals with DCD, ^{[69] [71] [25]} and DCD may co-occur with developmental language disorder (DLD), speech sound disorder, or childhood apraxia of speech (CAS) ^[83] (formerly known as developmental verbal dyspraxia (DVD) ^[84] in the UK) ^[84] . CAS primarily affects the planning and programming of movements for speech, whereas DCD is a broader disorder affecting the planning and execution of both fine and gross motor movements. ^{[83] [4]} When motor-speech difficulties are present, speech may be slow, effortful, inconsistent, or difficult to understand because of challenges with motor planning and coordinating the movements required for speech ^[85] . Some research suggests DCD and associated oral motor impairments as a motor-based explanation for limited functional speech in minimally speaking and nonspeaking autistic individuals ^{[86] [87]} , however the extent to which these difficulties are specifically attributed to DCD remains uncertain. Speech and language difficulties reported in people with DCD include:

• Difficulties controlling the speech organs ^[25]
• Difficulties making speech sounds ^{[25] [70]}
• When DCD co-occurs with CAS, difficulty sequencing sounds within words and connected speech ^[88]
• When DCD co-occurs with autism or other oral-motor/speech-motor conditions, additional difficulties with feeding / chewing, saliva control, and respiratory–phonatory coordination may also be present ^{[25] [89] [90]}

Some individuals with DCD have co-occurring language-development difficulties, which should be distinguished from impairments in the motor production of speech ^{[25] [70]} . Language abilities in individuals with DCD are variable. Some children meet criteria for Developmental Language Disorder (DLD), while others have age-level language skills. ^{[25] [70]} However, even when language is intact, many individuals with DCD experience difficulties with academic tasks that reflect a combination of motor coordination difficulties, increased cognitive load during task performance, differences in working memory, executive functioning, sensory processing, or visuo-perceptual differences rather than language ability alone. ^{[35] [30] [91] [92]}

Sensory processing or sensory modulation difficulties

A large proportion of children with DCD show sensory processing or sensory modulation differences, ^{[81] [93] [80]} however, the extent of concomitant sensory processing disorder as a distinct diagnosis is unclear because the latter is not consistently defined in the literature. ^{[94] [95]} Some individuals with DCD exhibit hyper- or hypo-sensitivity to sensory input, although the type and extent of these differences vary. ^{[81] [93]} These differences may involve tactile, visual, auditory, or proprioceptive processing and can thus affect motor coordination, body and spatial awareness, and interaction with the environment ^{[81] [93] [80]} . As an example, altered proprioceptive and visual processing may contribute to difficulties in judging body position and movement, while sensory modulation differences (how a person adjusts and regulates their response to sensory input) may influence a person's performance within a particular environment or in response to particular environmental stimuli ^{[81] [93]} . In addition, sensory modulating difficulties in individuals with DCD can make them more prone to sensory overload, ^[93] especially in environments with high sensory demands.

Psychological and social consequences

Psychological domain

Children with DCD may experience lower self-efficacy and reduced self-perceived competence, especially in social and peer-interactions. ^{[96] [97]} These difficulties are often associated with being continuously challenged in motor-based and everyday activities. ^{[98] [96]}

Social domain

Children with DCD may be at increased risk of social exclusion, peer interaction challenges, and bullying, which can contribute to feelings of loneliness and reduce social participation ^{[8] [99]} .

Support domain

Adolescents and adults with DCD may face barriers in accessing appropriate educational and institutional support. ^{[100] [101]} Lack of recognition and understanding of DCD can contribute to under-identification and lack of support. ^[101]

Screening

DCD should be suspected in school-age children who have difficulty with developmental tasks and milestones such as crawling, jumping, hopping, drawing, and imitative finger movements. ^{[4] [7]} Concerns about clumsiness may originate from the parents, clinicians, teachers, or therapists.

The Developmental Coordination Disorder Questionnaire (DCDQ), intended for ages 5 years 0 months to 15 years and 0 months, and the Little DCDQ, intended for ages 3 years 0 months to 4 years 11 months, are screening tools used to identify children who are suspected to have DCD. ^{[102] [103] [104]} They can be administered by a parent, teacher, or caregiver. ^{[105] [103]} The child is rated on how they compare to peers in areas like handwriting, ball skills, coordination, dressing, running, motor speed, and general clumsiness. ^{[106] [105]} If the child is at or below the age-specific cutoff score, the next step is to carry out a formal assessment for DCD. ^{[105] [104]}

Diagnosis

A physician will take a history of the developmental period and take note of any motor learning challenges early in life. ^{[4] [89]} A physician must also rule out other possible medical or neurological explanations for the motor difficulties. Where intellectual disability is suspected, a standardized IQ test or cognitive assessment may be used to determine whether motor difficulties exceed what would be expected for the person's cognitive and intellectual ability. ^{[4] [89] [1] [107]} Research in DCD indicates that motor demands may affect performance on standardized cognitive assessments, especially in timed processing-speed tasks. ^[36] In autistic individuals with significant motor and communication impairments, sensory-motor response demands of assessments may affect the interpretation of cognitive abilities or intellect. ^{[108] [109] [110] [111]} Similar testing limitations have been documented in other conditions with known motor impairment including cerebral palsy, Rett syndrome, and spinal muscular atrophy, where motor, speech, visual, or other response demands may lead to significant underestimation of cognitive abilities or intellect ^{[112] [113] [114] [115]} . Thus standardized scores may be invalid when no reliable communication or response method is available, or when the test's sensory-motor demands cannot be accommodated. Inability to complete a test should not itself be interpreted as evidence of intellectual impairment or refusal to participate. ^{[112] [113]} .

A physiotherapist or occupational therapist may administer a standardized motor assessment such as the Movement Assessment Battery for Children (M-ABC) OR the Bruininks-Oseretsky Test of Motor Proficiency (BOT). ^{[116] [117] [4] [89]} A baseline motor assessment establishes the starting point for developmental intervention programs and comparing children to normal rates of development may help to determine areas of difficulty and support needed.

The disorder is diagnosed using DSM-5 criteria: ^{[1] [7]}

• Acquisition and execution of coordinated motor skills are substantially below what would be expected given the child’s age and opportunity for skill learning and use (clumsiness, inaccuracy, or slowness of performance of motor skills)
• The motor skills deficit significantly and persistently interferes with activities of daily living and impacts school productivity, vocational skills, leisure activities, and play
• The onset of symptoms is in the early developmental period
• The motor skills deficit is not better explained by intellectual disability, visual impairment, or a neurological or medical condition affecting movement

In children who are suspected to have DCD, other causes of motor impairment are assessed through medical history and physical examination. ^{[4] [89]} Although exclusion of other causes of impaired motor skills is necessary, it can be difficult to distinguish between conditions that may better explain the motor difficulties and conditions that may coexist with DCD. ^{[4] [89] [1]} In such cases, referral to specialist physician, physiotherapist, or occupational therapist with expertise in diagnosing and assessing DCD may be warranted. ^{[4] [89] [7]} A 2005 study of 105 teachers and 105 general practitioners in Wales found limited knowledge of DCD, in both profession groups. ^[118] The earlier these difficulties are noted and the earlier assessments occur, the sooner intervention can begin. ^{[118] [4] [89] [77]}

Activities of daily living (ADL) and motor function assessment

Clinical judgment is required to interpret the degree to which performance in daily activities is affected by motor function impairment and found to be significantly lower than that of age matched peers. ^{[4] [89]} The Leeds Consensus Statement identified scores of at or below the 5th percentile as evidence of abnormal motor skills and recommends to monitor children between the 5th and 15th. ^[119] More recent clinical practice recommendations suggest total scores of at or below the 16th percentile as indicative of potential DCD in children six years and older, but with results interpreted alongside of developmental history, functional impact, and the other diagnostic criteria for DCD. ^[4]

Assessment in individuals with motor and communication challenges

The M-ABC or BOT may have limitations when used with individuals who have significant communication and motor planning challenges. ^{[120] [4] [89] [121]} These assessments rely on imitation, task comprehension, and structured motoric responses, while factors such as anxiety, physical readiness, attention, information processing, and sensory sensitivities may affect performance independently of underlying motor ability. ^{[122] [4] [121] [120]} As a result, test scores may show limited sensitivity at lower levels of performance, or not fully capture an individual's motor performance, areas of challenge, needed support, and motor learning potential. ^{[120] [122] [4]} This highlights the need for cautious interpretation and, in some cases, adaptations to assessment procedures or supplementary assessments. ^{[107] [4] [89]} An observational study of 85 Australian physiotherapists assessing motor function in young autistic children found that parent reports, clinical observations, and movement analysis were used more frequently than standardized motor assessments. ^[123]

Intervention

There is no cure for the condition ^{[124] [125]} . Instead, it is managed through therapy. Management and treatment of DCD include: ^{[126] [4] [89]}

• Individualised approaches
• Actively involve the child
• Prioritise functional skills that are relevant to everyday activities and participation, and are important to the child and parents
• Teach specific functional motor skills and provide opportunities to practise and to generalise across different activities and settings

• Involve multiple individuals in treatment plans (e.g. parents, teachers, health care professionals)
• Address the child's physical fitness (e.g. strength, endurance, flexibility)

Research supports Physical Therapy and Occupational Therapy for improving functional motor performance and participation as effective interventions for DCD. ^{[4] [89] [107]} International clinical practice recommendations for DCD emphasise interventions that improve functional participation, motor performance, physical health, and quality of life, rather than focusing solely on impairment reduction. ^{[4] [89]}

Occupational therapy interventions for DCD can include targeting functional daily activities, fine motor skills, motor planning, self-care, school participation, sensory accommodations, keyboarding and written communication, functional pointing for communication, and participation in meaningful occupations. ^{[127] [4] [89] [128] [54]} One of the evidence based OT approaches for DCD is the Cognitive Orientation to daily Occupational Performance (CO-OP) approach, a task-oriented intervention designed to help children develop cognitive and problem-solving strategies for motor tasks that are selected by the child. ^{[129] [130] [4]}

Physiotherapy interventions for DCD often focus on gross motor coordination, balance, gait, postural control, strength, endurance, motor learning, proprioception, and participation in physical activity and sport. ^{[131] [132]} Clinical practice guidelines for physical therapists recommend task-oriented motor training, motor skill practice, strength and balance interventions, and physical activity participation as central components of intervention. ^{[131] [133]} Neuromotor Task Training may also be used by PTs and OTs. ^{[134] [135]}

Research has shown that exercise, adapted physical activity, and sport-based interventions have positive effects on motor function and functional participation in DCD. ^{[136] [126] [4]} Studies have reported improvements in balance, hand-eye coordination, physical fitness, motor coordination with interventions such as aquatic therapy, martial arts, active video gaming, fundamental movement skill programs, balance training, movement-based therapy, and school-based physical activity programs. ^{[137] [138] [139] [140] [126] [136]} Evidence for improvement of psychosocial outcomes is less conclusive.

Types of therapy

The types of occupational and physical therapy for DCD can be classified according to the primary target of the intervention: ^{[126] [4]}

• Activity-oriented and participation-oriented interventions: these target performance or participation in the activity in real world situations; they are called “task-oriented” interventions. ^{[126] [137]} Task-oriented interventions focus on teaching movements and motor skills involved in activities of daily living and communication as well as working on the skill gaps in their motor milestone development such as rolling, jumping, ball skills, climbing, reaching and targeted pointing ^[141] etc., and play or sport-related skill training.

• Body function-oriented interventions: Body function-oriented interventions target body functions needed to perform activities (eg, hand eye coordination); they are sometimes called “process-oriented” interventions. ^{[126] [4]} Examples of body function-oriented approaches in DCD include oculomotor and visuomotor training, biofeedback, balance training, mobility and flexibility training, agility training, strength training, and aerobic fitness training, spatial-orientation training, and proprioceptive training. ^{[142] [143] [144] [131] [145] [146]}

Task-oriented approaches have stronger evidence for functional skill improvement than isolated body-function training. ^[4]

History

In the early twentieth century, Collier described childhood motor coordination difficulties as "congenital maladroitness". ^[33] In 1972, an occupational therapist named A. Jean Ayres wrote about sensory integration and learning disorders, which contributed to the understanding of sensory and perceptual-motor difficulties in children ^{[39] [147]} . Subsequent descriptions included "clumsiness" and "clumsy child syndrome", with Sasson Gubbay publishing research on 'clumsy children' in 1975 ^{[148] [149] [5]} . The term 'developmental coordination disorder' (DCD) was introduced in the DSM-III-R in 1987 and endorsed at an international consensus meeting in London, Ontario, in 1994 to standardize the terminology across clinical practice and research ^{[56] [5] [4]} . The 2006 Leeds Consensus Statement further clarified the definition and diagnostic criteria for DCD. ^[119]

Society and culture

Actor Daniel Radcliffe has dyspraxia.

Public figures and notable people

People who have publicly stated they have DCD or related term:

• David Bailey, photographer ^[150]
• John "TotalBiscuit" Bain, games critic ^[151]
• Cara Delevingne, model ^[152]
• Ellis Genge, Rugby Union player ^[153]
• Tom Hunt, politician ^[154]
• Gage Golightly, actress ^[155]
• Olive Gray, actor ^[156]
• Harriet Kemsley, comedian ^[157]
• Emma Lewell-Buck, politician ^{[158] [159]}
• Mel B, singer ^[160]
• Will Poulter, actor ^[161]
• Daniel Radcliffe, actor ^[162]
• Holly Smale, author ^[163]
• Florence Welch, singer ^[164]
• Toyah Willcox, musician ^[165]

Fictional characters

• Ryan Sinclair, a character in the BBC science fiction television programme Doctor Who . ^[166]
• Dr. Tony Hill, a character from the ITV television show Wire in the Blood . ^[167]

See also

• Autism
• Deficits in attention, motor control and perception
• Fetal alcohol spectrum disorder
• Global developmental delay
• Hypermobility
• Motor control
• Motor coordination
• Childhood apraxia of speech
• Dysgraphia
• Multisensory integration
• Nonverbal learning disorder
• Sensory-motor coupling
• Apraxia
• Attention deficit hyperactivity disorder

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Further reading

• Polatajko H, Fox M, Missiuna C (1995). "An International Consensus on Children with Developmental Coordination Disorder". Canadian Journal of Occupational Therapy. 62 (1): 3–6. doi:10.1177/000841749506200101.
• Mandich A, Polatajko HJ (November 2003). "Developmental coordination disorder: mechanisms, measurement and management". Human Movement Science. 22 (4–5): 407–11. doi:10.1016/j.humov.2003.09.001. PMID   14624825.
• Talukdar, A (2012). Dyspraxia/DCD pocketbook (PDF). Teachers' Pocketbooks. Hampshire; UK: Management Pocketbooks. ISBN   978-1-906610-38-8. OCLC   1162296987.
• "6A04 Developmental motor coordination disorder". Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. World Health Organization. 2024. pp. 139–142. hdl: 10665/375767 . ISBN   978-92-4-007726-3.
• Sutton Hamilton, S. "Developmental coordination disorder: Management and outcome". UpToDate.
• Ronald D. Davis, Eldon M. Braun: The Gift of Learning: Proven New Methods for Correcting ADD, Math & Handwriting Problems. New York: Tarcher/Perigee, 2003. ISBN   978-0-399-52809-5.