Developmental coordination disorder (dyspraxia)

Symptoms, diagnosis and management of dyspraxia, including how to help patients find areas of strength they may develop in order to maintain self-esteem.

Children may present with difficulties in writing (Picture: iStock)
Children may present with difficulties in writing (Picture: iStock)

Developmental coordination disorder (DCD), also known as dyspraxia in the UK, is a common disorder affecting fine and/or gross motor coordination in children and adults. This condition is formally recognised by international organisations including the World Health Organization.1 DCD is distinct from other motor disorders such as cerebral palsy and stroke.

A UK study has recorded levels of severe difficulties in 2% of the population, with another 4% having moderate difficulties.1 It is generally noted that more boys than girls have DCD, but this may have been related to a greater focus on detecting boys in the past. It is now thought that some girls are not always identified. In about 70% of children, difficulties may continue into adulthood.2

The range of intellectual ability is in line with the general population. Individuals may vary in how their difficulties present; these may change over time depending on environmental demands and life experience.

Short and longer-term consequences of DCD are often greater social isolation leading to less social opportunity, low self- esteem, increased risk of bullying, weight gain and increased risk of cardiovascular disease. There is also an increased risk of anxiety and depression.

Presenting problems

There are three main motor elements to DCD: difficulties with balance, fine motor skills and gross motor skills, however non-motor skills are also affected. These elements all have subsequent impact on the wellbeing of patients with DCD. Some, but not all, children may also have visual or auditory perceptual difficulties.

Box: Areas affected by DPD and their impact on the patient





  • Climbing, eg in playground
  • Moving up and down stairs with ease
  • Walking while carrying items
  • Riding a bike

Fine motor control

  • Writing
  • Using scissors
  • Buttoning, tying shoe laces

Gross motor control

  • Kicking
  • Running
  • Catching a ball
  • Playing team games
  • Dual tasking
  • Self-organisation
  • Time management
  • Anxiety
  • Depression
  • Self-esteem
  • Weight gain
  • Social isolation
  • Bullying
  • Fatigue

Not all children or adults present with all features, but usually have a varying combination. A key aspect of DCD is a difficulty learning new or unfamiliar skills. Individuals usually take longer to become confident and competent compared with their peers. An individual’s coordination difficulties may affect participation and functioning of everyday life skills in education, work or employment.

Children may present with difficulties with self-care, writing, typing, riding a bike and play, as well as other educational and recreational activities.

In adulthood many of these difficulties will continue, as well as learning new skills at home, in education and work, such as learning to drive a car and tasks such as DIY.

There may be a range of co-occurring difficulties that can also have serious negative impacts on daily life. These include social and emotional difficulties. Commonly noted in DCD are also problems with time management, planning and organisation and these may impact an adult’s education or employment experiences. These are usually called executive functioning skills.


Early identification can result in the child receiving focused intervention either in school and/or from occupational therapists to minimise the educational and social impact. The occupational therapist will also guide the teacher and can support the parents. Adult services are limited and it may be more difficult to gain a diagnosis in some areas of the UK. Increased awareness of the condition in adulthood is helping to start to establish services.

For a diagnosis of DCD, symptoms of motor co-ordination should meet the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders-V or ICD-10 (DCD), 2,3 and be associated with at least moderate social and/or educational or occupational impairment.

A paediatrician should rule out any other reasons for motor difficulties such as cerebral palsy, or genetic conditions such as Fragile X, neurofibromatosis-1, or Klinefelter’s syndrome.

A standardised motor assessment should be used and in the UK this is commonly the Movement Assessment Battery for Children-2 test4 (M-ABC-2). The assessment is usually completed by a physiotherapist or occupational therapist. There are also screening questionnaires available, such as the DCDQ 5 and Adult DCD Checklist, 6 which can be used by schools, college and universities or by general practitioners.

Distinguishing the disorder

DCD has been commonly associated with a range of learning difficulties such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), specific language impairments, dyslexia and dyscalculia. Overlap with these conditions occurs in about 80% of cases to some degree. However, the individual may not meet all the criteria to receive a specific diagnosis and this may mean they cannot always access support.

It is important where one developmental disorder has been recognised that DCD is considered as well.

Some children may also exhibit hypermobile joints also known as joint hypermobility syndrome (JHS). Epilepsy may be associated with DCD and should also be considered where coordination difficulties present. In particular, nocturnal fits (benign epilepsy of childhood with centro-temporal spikes syndrome [BECCTs]) have been shown to be associated with motor coordination difficulties.

Successful management

In 2011 and 2012, following on from the development of the European guidelines for DCD, consensus meetings took place to adapt these for the UK setting. This was undertaken under the Movement Matters umbrella of organisations.7

This provided guidelines on assessment and management of DCD. Key aspects of intervention need to include that the individual has skills for independent and daily living, and also opportunities for social participation.

Finding a hobby or sport that the child or adult can succeed in is important, and to provide a focus for physical activity and to minimise weight gain. GPs could discuss areas of strengths that can be developed in order to maintain self-esteem. Opportunities for social interaction are important, especially in the teen years, as young people can become isolated at this stage.

Consider guidance in order to gain organisational skills. The presence of anxiety and depression needs to be considered at all ages, and treated accordingly.

Times of transition need planning and support and should be considered early so they run smoothly. Consider the overlap with other developmental disorders such as speech and language difficulties and attention difficulties as these are common.

  • Professor Kirby is a former GP who founded The Dyscovery Centre supporting children and adolescents with developmental disorders and has a chair in developmental disorders at the University of South Wales

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  1. Lingam R, Hunt L, Golding J et al. Prevalence of developmental coordination disorder Using the DSM-IV at 7 years of age: A UK population-based study. Pediatrics 2009; 123: 693-700.
  2. DSM-V Diagnostic and Statistical Manual of Mental Disorders. Washington, DC, American Psychiatric Association. 2013.
  3. World Health Organization. Classification of Mental and Behavioural Disorders: Diagnostic Criteria For Research. Geneva, WHO, 1993.
  4. Henderson SE, Sugden DA. Movement Assessment Battery for Children. 2nd Edition. London: The Psychological Corporation, 2007.
  5. Wilson B, Crawford S. DCDQ-7.
  6. Kirby A, Edwards L, Sugden DA, Rosenblum S. The development and standardization of the adult developmental co-ordination disorders/dyspraxia checklist (ADC). Research in Developmental Disabilities 2010; 31(1): 131-139.
  7. Movement Matters – UK umbrella organisation with resources –

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