Developmental co-ordination disorder (DCD), also known as dyspraxia, is a condition affecting physical co-ordination that causes a child to perform less well than expected in daily activities for his or her age, and appear to move clumsily.
DCD is thought to be around three or four times more common in boys than girls, and the condition sometimes runs in families.
This topic is about DCD in children, although the condition often causes continued problems into adulthood.
Read 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, and drawing, writing and performance in sports are 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, and DCD isn't usually definitely diagnosed until a child with the condition is around five years old or more.
Read about symptoms of DCD in children.
When to seek medical advice
Talk to your GP or health visitor - or a nurse, doctor or special educational needs co-ordinator (SENCO) at your child's school - if you have any concerns about your child's health or development.
If necessary, they can refer your child to a community paediatrician, who will assess them and try to identify any developmental problems.
Read about diagnosing DCD in children.
Causes of DCD
Carrying out 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.
- 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
There's no cure for DCD, but a number of therapies can make it easier for children to manage their problems.
- being taught ways of carrying out activities they find difficult - such as breaking down difficult movements into much 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 doesn't 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.
However, difficulties in school - particularly producing written work - can become much more prominent and require extra help from parents and teachers.
Read about treating DCD in children.
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 first year.
Although these may come and go, they also:
- have difficulty playing with toys that involve good co-ordination -such as stacking bricks
- may have some difficulties learning to eat with cutlery
Problems in older children
As your child gets older, they may develop more noticeable physical difficulties in addition to a number of other problems.
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 more childish than 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.
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 one thing for more than a few minutes
- difficulty following instructions and copying down information - they may do better at school in a one-to-one situation than in a group, as they're able to be guided through work
- being poor at organising themselves and getting things done
- not automatically picking up new skills - they need encouragement and repetition to help them learn
- difficulties 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
But although children with DCD may have poor co-ordination and some of these additional problems, other aspects of development - for example, thinking and talking - are usually unaffected.
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 spectrum disorder (ASD) - 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.
Talk to your 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 professional who can help arrange an assessment.
This could be:
- a paediatrician - a doctor specialising in the care of children and babies, who will usually be based in your local community (community paediatrician)
- a paediatric occupational therapist - a healthcare professional who can assess a child's functional abilities in daily living activities, such as handling cutlery and getting dressed
- a paediatric physiotherapist - a healthcare professional who can assess a child's movement (motor) skills
- a clinical psychologist or Child and Adolescent Mental Health Services clinician - a healthcare professional who specialises in the assessment and treatment of mental health conditions to deal with emotional problems
- an educational psychologist - a professional who assists children who are having difficulty progressing with their education as a result 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.
The diagnosis of DCD is usually made by a paediatrician, often in collaboration with an occupational therapist.
Generally, the paediatrician is more involved in the diagnosis and the 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 his or her motor ability, which may be carried out 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 what is 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 his or her age.
This may be clear based on reports from the child's school obtained by a paediatrician, although sometimes the child may also have a standard assessment of mental ability done by a psychologist or, in the case of young children, a paediatrician.
As part of an assessment, your child's medical history, which includes things like any problems that occurred during their birth and whether there have been any delays reaching developmental milestones, will be taken into account.
Your family medical history, such as whether any family members have been diagnosed with DCD, may also be taken into account.
Once the assessment process is complete, the paediatrician will produce a report on the child's condition in collaboration with other professionals involved.
For a diagnosis of DCD to be made, your child usually needs 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
- this lack of motor skill significantly and persistently affects your child's day-to-day activities and achievements at school
- your child's 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 their mental abilities.
Although DCD may be suspected in the pre-school years, it's not usually possible to establish a definite diagnosis before the age of four or five as it can be difficult to be certain whether a child has DCD if they're still very young.
Developmental co-ordination disorder (DCD) can't be cured, but there are ways your child can be helped to manage their problems.
A small group of children, usually those with mild symptoms of clumsiness, may eventually "grow out" of their symptoms.
But 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 drawn up, which may involve input from a variety of specialists.
This, combined with extra help at school, can help your child manage many of their physical difficulties, improve their general confidence and self-esteem, and enable them to become a well-adjusted adult.
A number of 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:
- handling cutlery
- using the toilet
- school skills involving fine movement activities - such as writing
The therapist can then work with the child and their parents and teachers to help find ways to manage any problems.
Your child may also recieve help from a paediatric physiotherapist. They can help assess the child's abilities and create an individualised therapy plan, which may include activities to help improve walking, running, balance and co-ordination, among others.
Other health professionals that may be involved in your child's care may include:
- a paediatrician - a doctor who specialises in the care of babies and children
- a clinical psychologist - a healthcare professional who specialises in the assessment and treatment of mental health conditions
- an educational psychologist - a professional who assists children who are having trouble progressing with their education as the result of emotional, psychological or behavioural factors
Some of the interventions these health professionals may provide are outlined below.
One of the main types of intervention used to help children with DCD manage their condition is known as a task-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, and teaching your child to plan these individual movements carefully and practise them regularly.
Your child may also benefit from adapting tasks to make them easier to perform, such as adding special grips to pens to make them easier to hold, or wearing loose-fitting clothes and 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.
An alternative method to the task-oriented approach is the process-oriented approach. This approach 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 process-oriented approach may involve regular activities aimed at improving these potential problems, with the aim of trying to improve your child's more 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 task-oriented approach outlined above.
Treating other conditions
Children with DCD often have other conditions as well, which may need to be treated separately. The treatments for some of these related conditions are described below.
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.
Read about treating ADHD.
If your child also has dyslexia, they may benefit from special educational interventions designed to improve their reading and writing.
Read about treating dyslexia.
Autism spectrum disorder (ASD)
If your child also has autism spectrum disorder (ASD), they may benefit from special programmes designed to help improve their communication, social interaction, and cognitive and academic skills.
Read about treating ASD.
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, identify what problems they have, 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 of a child with DCD will remain below average, this often becomes less of a problem as they get older.
By adolescence this usually improves as they get older, although difficulties in school - particularly producing written work - can become much more prominent.
A further treatment period by 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 with DCD may also have one or more of the associated problems mentioned above, which may adversely affect their behaviour, socialisation and school achievement.
These young people often require a significant degree of parental support in addition to the treatment they receive.
Because of the potential limitations of available treatments for DCD and the fact it can't be cured, some parents may be tempted to 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 in many cases the physical co-ordination problems associated with DCD will naturally improve over time.
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.
There is also a network of local support groups, and they publish a range of leaflets, booklets and books. They can be contacted on 01462 454 986.