Overview

Developmental co-ordination disorder (DCD), also known as dyspraxia, is a condition affecting physical co-ordination. It causes a child to perform less well than expected in daily activities for their age, and appear to move clumsily.

This topic is about DCD in children, although the condition often causes continued problems into adulthood.

Find out more about DCD in adults.

Symptoms of DCD

Early developmental milestones of crawling, walking, self-feeding and dressing may be delayed in young children with DCD. Drawing, writing and performance in sports are also usually behind what is expected for their age.

Although signs of the condition are present from an early age, children vary widely in their rate of development. This means a definite diagnosis of DCD does not usually happen until a child with the condition is 5 years old or more.

Find out more about symptoms of DCD in children.

When to seek medical advice

If you're concerned about your child's health or development, talk to a GP or health visitor, or speak to a nurse, doctor or special educational needs co-ordinator (SENCO) at your child's school.

They may refer your child to an occupational therapist, paediatrician, or another health professional who can assess them and try to identify any developmental problems.

Find out more about diagnosing DCD in children.

Causes of DCD

Doing co-ordinated movements is a complex process that involves many different nerves and parts of the brain.

Any problem in this process could potentially lead to difficulties with movement and co-ordination.

It's not usually clear why co-ordination doesn't develop as well as other abilities in children with DCD.

However, a number of risk factors that can increase a child's likelihood of developing DCD have been identified.

These include:

• being born prematurely, before the 37th week of pregnancy
• being born with a low birth weight
• having a family history of DCD, although it is not clear exactly which genes may be involved in the condition
• the mother drinking alcohol or taking illegal drugs while pregnant

Treating DCD

There's no cure for DCD, but a number of therapies can help children to manage their problems.

These include:

• being taught ways to do activities they find difficult, such as breaking down difficult movements into smaller parts and practising them regularly
• adapting tasks to make them easier, such as using special grips on pens and pencils so they are easier to hold

Although DCD does not affect how intelligent a child is, it can make it more difficult for them to learn and they may need extra help to keep up at school.

Treatment for DCD will be tailored to your child and usually involves a number of different healthcare professionals working together.

Although the physical co-ordination of a child with DCD will remain below average, this often becomes less of a problem as they get older and develop coping strategies. Some children may continue to have problems.

However, difficulties in school – particularly producing written work – can become much more prominent and require extra help from parents and teachers.

Find out more about treating DCD in children.

Dyspraxia or DCD?

While many people in the UK use the term dyspraxia to refer to the difficulties with movement and co-ordination that first develop in young children, the term is used less often by health professionals.

Instead, most healthcare professionals use the term developmental co-ordination disorder (DCD) to describe the condition.

This term is generally preferred by healthcare professionals because dyspraxia can have several meanings.

For example, dyspraxia can be used to describe movement difficulties that happen later in life because of damage to the brain, such as from a stroke or head injury.

Some health professionals may also use the term specific developmental disorder of motor function (SDDMF) to refer to DCD.

Symptoms

Developmental co-ordination disorder (DCD) can cause a wide range of problems. Some of these may be noticeable at an early age, while others may only become more obvious as your child gets older.

Problems in infants

Delays in reaching normal developmental milestones can be an early sign of DCD in young children. For example, your child may take slightly longer than expected to roll over, sit, crawl or walk.

You may also notice that your child: 

• shows unusual body positions (postures) during their 1st year
• has difficulty playing with toys that involve good co-ordination, such as stacking bricks
• has some difficulties learning to eat with cutlery

These signs might come and go.

Problems in older children

As your child gets older, they may develop more noticeable physical difficulties, plus problems in other areas.

Movement and co-ordination problems

Problems with movement and co-ordination are the main symptoms of DCD.

Children may have difficulties with:

• playground activities such as hopping, jumping, running, and catching or kicking a ball. They often avoid joining in because of their lack of co-ordination and may find physical education difficult
• walking up and down stairs
• writing, drawing and using scissors – their handwriting and drawings may appear scribbled and less developed compared to other children their age
• getting dressed, doing up buttons and tying shoelaces
• keeping still – they may swing or move their arms and legs a lot

A child with DCD may appear awkward and clumsy as they may bump into objects, drop things and fall over a lot.

But this in itself isn't necessarily a sign of DCD, as many children who appear clumsy actually have all the normal movement (motor) skills for their age.

Some children with DCD may also become less fit than other children as their poor performance in sport may result in them being reluctant to exercise.

Additional problems

As well as difficulties related to movement and co-ordination, children with DCD can also have a range of other problems, such as:

• difficulty concentrating – they may have a poor attention span and find it difficult to focus on 1 thing for more than a few minutes
• difficulty following instructions and copying down information – they may do better at school in a 1-to-1 situation than in a group, so they can be guided through work
• being poor at organising themselves and getting things done
• being slow to pick up new skills – they need encouragement and repetition to help them learn
• difficulty making friends – they may avoid taking part in team games and may be bullied for being "different" or clumsy
• behaviour problems – often stemming from a child's frustration with their symptoms
• low self-esteem

Related conditions

Children with DCD may also have other conditions, such as:

• attention deficit hyperactivity disorder (ADHD) – a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness
• dyslexia – a common learning difficulty that mainly affects the way people read and spell words
• autism – a condition that affects social interaction, communication, interests and behaviour

Some children with DCD have difficulty co-ordinating the movements required to produce clear speech.

Diagnosis

Talk to a GP, health visitor or special educational needs co-ordinator (SENCO) if you think your child has developmental co-ordination disorder (DCD).

They may refer your child to another healthcare professional who can do an assessment.

This could be:

• a paediatrician – a doctor specialising in the care of children and babies who will usually be based locally (community paediatrician)
• a paediatric occupational therapist – a healthcare professional who can assess your child's functional abilities in daily activities, such as handling cutlery and getting dressed
• a paediatric physiotherapist – a healthcare professional who can assess a child's movement (motor) skills
• an educational psychologist – a professional who assists children who are having difficulty progressing with their education because of emotional, psychological or behavioural factors

Other doctors who may be involved in this process include a neurodevelopmental paediatrician or a paediatric neurologist.

These are paediatricians who also specialise in the development of the central nervous system, which includes the brain, nerves and spinal cord.

A neurodevelopmental paediatrician may work at a child development centre or local health clinics.

Occasionally, a neurologist is needed to help rule out other conditions that affect the brain and nervous system (neurological conditions), which may be causing your child's symptoms.

It's important to get a correct diagnosis so you can develop a better understanding of your child's problems and appropriate support can be offered.

Getting a diagnosis can also help reduce the stress experienced by both parents and children with DCD.

Assessment

The diagnosis of DCD is usually made by a paediatrician, often in collaboration with an occupational therapist.

Generally, a paediatrician is involved in the diagnosis and an occupational therapist is involved in both diagnosis and treatment.

For a diagnosis to be made, it's essential for the child to have what is called a norm-referenced assessment of their motor skills. This may be done by an occupational therapist, physiotherapist or paediatrician.

Children with suspected DCD are usually assessed using a method called the Motor ABC, which involves tests of:

• gross motor skills – their ability to use large muscles that co-ordinate significant body movements, such as moving around, jumping and balancing
• fine motor skills – their ability to use small muscles for accurate co-ordinated movements, such as drawing and placing small pegs in holes

Your child's performance on the assessment is scored and compared with the normal range of scores for a child of their age.

There also needs to be evidence that the child's mental ability is within the normal range for their age.

Sometimes your child may also have an assessment of their mental ability by a psychologist, or if they're very young, by a paediatrician.

The healthcare professional doing the assessment will take your child's medical history into account. This includes any problems that may have happened during their birth and any delays reaching developmental milestones.

Your family medical history, such as whether any family members have been diagnosed with DCD, will also be considered.

Once the assessment process is complete, the healthcare professionals involved will produce a report on your child's condition.

Diagnostic criteria

For a diagnosis of DCD to be made, your child will usually need to meet all of the following criteria:

• their motor skills are significantly below the level expected for their age and opportunities they have had to learn and use these skills
• their lack of motor skill significantly and persistently affects their day-to-day activities and achievements at school
• their symptoms first developed during an early stage of their development
• the lack of motor skills isn't better explained by long-term delay in all areas (general learning disability) or rare medical conditions, such as cerebral palsy or muscular dystrophy

DCD should only be diagnosed in children with a general learning disability if their physical co-ordination is significantly more impaired than would be expected for their mental (cognitive) ability.

Although DCD may be suspected in the pre-school years, it's not usually possible to make a definite diagnosis before a child is 5.

Treatment

Developmental co-ordination disorder (DCD) cannot be cured, but there are ways to help your child manage their problems.

A small number of children, usually those with mild symptoms who are diagnosed early, may be able to learn how to overcome their difficulties.

However the vast majority of children need long-term help and will continue to be affected as teenagers and adults.

Once DCD has been diagnosed, a treatment plan tailored to your child's particular difficulties can be made. This plan may involve a variety of specialists.

A treatment plan, combined with extra help at school, can help your child manage many of their physical difficulties, improve their general confidence and self-esteem, and help them to become a well-adjusted adult.

Healthcare professionals

Several healthcare professionals may be involved in your child's care.

For example, your child may need help from a paediatric occupational therapist, who can assess their abilities in daily activities, such as:

• using cutlery
• dressing
• using the toilet
• playing
• fine movement activities such as writing

A therapist may work with a child, their carers and their teachers to help find ways to manage any problems.

Your child may also recieve help from a paediatric physiotherapist. They can assess their abilities and create a therapy plan especially for them, which may include activities to improve walking, running, balance and co-ordination, among others.

Other health professionals involved in your child's care may include:

• a paediatrician – a doctor who specialises in the care of babies and children
• an educational psychologist – a professional who helps children who are having trouble progressing with their education because of emotional, psychological or behavioural factors

Some of the interventions these health professionals may provide are outlined below.

Activity-oriented approach

One of the main types of intervention used to help children with DCD manage their condition is known as an activity-oriented approach.

This involves working with you and your child to identify specific activities that cause difficulties, and finding ways to overcome them.

For example, a therapist can help improve difficulties with specific movements by breaking the action down into small steps. They then teach your child to plan these individual movements and practice them regularly.

Your child may also benefit from adapting tasks to make them easier to do, such as adding special grips to pens to make them easier to hold, or wearing shoes with Velcro fasteners rather than shoelaces to make dressing easier.

Your child may be encouraged to exercise regularly as well, as this is generally considered to be beneficial for children with DCD.

Body-function-oriented approach

An alternative method to the task-oriented approach is the body-function-oriented approach. This is based on the theory that problems with your child's senses or perception of their body may be contributing to their movement difficulties.

A body-function-oriented approach may involve activities aimed at improving your child's general movement (motor) skills, rather than helping them with a particular task or activity.

However, this isn't thought to be as effective as the activity-oriented approach.

Treating other conditions

Children with DCD often have other conditions as well, which may need to be treated separately.

Attention deficit hyperactivity disorder (ADHD)

If your child also has attention deficit hyperactivity disorder (ADHD), they may benefit from taking medication to help them concentrate better, be less impulsive, feel calmer, and learn and practise new skills.

Fiind out more about treating ADHD.

Dyslexia

If your child also has dyslexia, they may benefit from special educational interventions designed to improve their reading and writing.

Find out more about treating dyslexia.

Autism

If your child also has autism, they may benefit from special programmes designed to help improve their communication, social interaction, and cognitive and academic skills.

Speech and language problems

Speech and language therapy may be useful if your child also has problems with their speech.

A speech and language therapist can assess your child's speech and help them find ways to communicate to the best of their ability.

This may involve exercises to move the lips or tongue in a certain way, practising producing certain sounds, and learning to control their breathing.

Treatment as your child gets older

Although the physical co-ordination skills of a child with DCD will remain below average, this often becomes less of a problem as they get older.

During adolescence, difficulties in school – particularly producing written work – may become much more prominent.

Further treatment with an occupational therapist for handwriting problems may be helpful when your child is a little older.

Teachers may request older children be allowed more time in exams. Having access to a computer can make homework easier, and some schools will provide a laptop.

A young person may have 1 or more of the additional symptoms associated with DCD which adversely affects their behaviour, socialisation and school achievement.

These young people often require a significant degree of parental support in addition to the treatment they receive.

Alternative therapies

Because of the limitations of available treatments for DCD and the fact it cannot be cured, some parents may look into alternative therapies that claim to cure or greatly improve the condition.

But there's usually no scientific evidence to support the use of alternative therapies, and they can be expensive and time consuming.

It's also important to bear in mind that sometimes the physical co-ordination problems associated with DCD will naturally improve over time.

Support groups

Looking after a child with DCD can be difficult. You may find it helpful to contact local or national support groups, such as the Dyspraxia Foundation.

The Dyspraxia Foundation has information and advice for parents of children with dyspraxia that covers many of the issues that may arise as your child gets older.

Contact the Foundation's helpline on 01462 454 986.