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Developmental Coordination Disorder (Dyspraxia)

Editor: Ramit Singla Updated: 2/24/2024 11:32:22 AM


Overview of Developmental Coordination Disorder 

Developmental Coordination Disorder (DCD), or dyspraxia, is a neurodevelopmental disorder characterized by poor motor coordination and difficulty learning motor skills in an otherwise healthy child with a normal gross neurological examination. This condition may negatively impact the child’s life by interfering with socialization and academic performance. Additionally, DCD can lead to executive function deficits, preventing effective learning in early childhood education. Children with DCD experience difficulty executing coordinated motor actions accurately. The patients' movements may be slow and inaccurate. DCD manifests as mild fine and gross motor delays in childhood that are later attributed to motor learning difficulties.

Handwriting and Its Importance in Diagnosing Developmental Coordination Disorder 

Handwriting is a complex skill, encompassing subtasks that include idea organization, phrase structure, spelling, grammar, memory, vocabulary, planning, revision, and the writing motor act. When attention is focused on maintaining concentration, handwriting becomes laborious, leading to a decline in the quality of written compositions. Individuals with DCD can write fewer words per minute than people without DCD. Many models have been introduced to analyze handwriting difficulties in DCD. Van Galen's model stands out as it uniquely integrates handwriting's cognitive, linguistic, and biomechanical aspects.

The first handwriting stage requires the writer’s motivation, which activates the intention to write. The semantic retrieval stage, wherein the writer develops ideas from vocabulary, occurs next. In this phase, the writer elaborates on what to write and retrieves semantic information before initiating the motor-writing task on paper. Syntactical construction is performed afterward. These 3 premotor stages are the biggest factors impacting the handwriting speed, or the number of words produced per minute, of children with DCD.

Spelling is the first phase of motor planning, and it consists of matching the phoneme, the letter's sound, with the grapheme, the symbol that represents a phoneme. The allograph selection stage occurs when the match is complete. Longer words require a longer time to convert phonemes into graphemes. Thus, individuals with DCD tend to show significant difficulty with words composed of 2 or more syllables.

Muscular adjustment is the last stage, and it occurs when the signal travels from the brain to the hand. Individuals with DCD struggle with controlling spacing and the letters' sizes and alignment, which may affect the text's legibility.[1] Up to 95% of children with DCD have handwriting difficulties, and 57% demonstrate decreased legibility, writing speed, and letter formation quality as compared to their peers.[2][3]

Functional Regions of the Cerebral Cortex

Different cortical areas are associated with specific functions (see Image. Brodmann Cytoarchitectonic Designations). The primary sensory and motor areas comprise 10% of the cortex, while the rest is composed of the association cortex. The forebrain's most widely studied functional regions are described in the table below.

Table. Functional Regions of the Cerebral Cortex 

Functional Region Anatomical Region Function
Primary motor cortex Frontal lobe Responsible for initiating and controlling voluntary movements
Primary somatosensory cortex Parietal lobe Processes sensory information from the skin, muscles, and joints

Primary visual cortex

Occipital lobe

Processes visual information

Primary auditory cortex

Temporal lobe Processes auditory information from the ears
Prefrontal cortex Frontal lobe Involved in executive functions such as decision-making, planning, and social behavior

Broca's area

Frontal lobe  Involved in speech production and language processing
Wernicke's area  Temporal lobe Language comprehension
Somatosensory association cortex  Parietal lobe Integrates and interprets sensory information from the primary somatosensory cortex
Visual association cortex Occipital lobe  Processes visual information further after the primary visual cortex
Auditory association cortex  Temporal lobe Processes and interprets auditory information beyond the primary auditory cortex
Temporal association cortex  Temporal lobe Involved in processing complex auditory and visual stimuli, memory, and emotion
Parietal association cortex  Parietal lobe Integrates sensory information and plays a role in spatial awareness, attention, and perception
Occipital association cortex Occipital lobe  Integrates visual information and is involved in visual perception and recognition
Angular gyrus Parietal lobe Plays a crucial role in various cognitive functions, including language processing, spatial cognition, and numerical processing

CDC arises from aberrant processes in various parts of the cerebral cortex. Cerebellar abnormalities have also been implicated, particularly structural variations like gray matter volume changes and altered activation patterns.[38]


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DCD's etiology is not fully understood, but research has provided insights into potential factors contributing to the condition. Children with this disorder comprise a heterogeneous population, justifying the premise that multiple mechanisms may contribute to DCD. For example, studies suggest that DCD may be related to abnormal neurological maturation processes, including the under-activation of motor learning-associated brain regions and altered development of motor and sensory pathways. Psychological factors may also play a role.[4]

Accurate motor execution requires the harmonic integration of strength, balance, and proprioceptive, vestibular, visuospatial, and procedural learning. Studies show that children with DCD tend to present with abnormal brain activation patterns and white matter connections on functional MRI. Parietal, frontal, and cerebellar cortex areas are those mainly implicated in DCD.[5][6] 

DCD is hypothesized to have a genetic predisposition. However, the specific genes that may be linked to this condition have not been identified as shared genetic susceptibility with various neuropsychiatric disorders may lead to erroneous DNA analysis results.[7] 


DCD's prevalence ranges between 1.8% and 6%.[8] The condition is 7 times more common in boys than girls. Edwards et al found that prematurity and low birth weight are the strongest risk factors (odds ratio 6.3, 95% CI 4.4-9.0) for developing DCD.[9] The disorder has increased prevalence among lefthanded or ambidextrous children, suggesting possible incomplete lateralization.[10]

Langevin et al also reported that DCD co-occurred with attention-deficit hyperactivity disorder (ADHD) in 30% to 50% of cases, indicating a common neural substrate underlying attention and motor disorders. This co-occurrence may have both etiologic and diagnostic implications.


Children's developmental milestones are built on the correct and timely achievement of previous ones. Achieving motor milestones is typically predictable. Infants learn to roll over, sit, crawl, walk, and manipulate objects to complete tasks. The right superior parietal lobule is responsible for accurate motor task performance. Developmental dyspraxia initially presents with poor motor coordination and clumsiness in completing age-appropriate motor tasks. The condition's effect on a child's development is critical.

Neurodevelopmental tasks aim to tune the nervous system to the environment. Motor development is key to early environmental exploration and development of the child's concept of the outer world. Simple tasks, such as turning the doorknob and using a fork to eat, require a mental map of one's body parts and the environment. Such a map forms after multiple repetitive, exploratory motor acts that let the child learn about their body and peripersonal space. Motor development disturbances may bias an individual's perception of the environment and their body's boundaries.

Early signs of DCD may include delayed motor milestone achievement and difficulty completing age-appropriate everyday tasks such as brushing the teeth, catching a ball, cutting paper, and writing. The motor difficulties may persist in adolescence and be associated with attentional problems, anxiety, low self-esteem, and obesity.[11]

History and Physical

The clinician should suspect DCD in school-age kids presenting with milestone delays or academic difficulties. History should include birth, developmental, educational, and past medical history. Musculoskeletal conditions and past trauma, especially if resulting in a brain injury, should be elicited. Medications, vaccinations, allergies, and diet must be noted.[12]

The physical examination should investigate alternative motor impairment causes, such as musculoskeletal damage. A comprehensive medical examination often uncovers significant neurodevelopmental delays, including limb choreiform movements, mirror movements, and other signs indicating poor fine and gross motor coordination. The physical findings should demonstrate that motor disturbances are not due to psychosocial or neurological disorders, including corticospinal, cerebellar, extrapyramidal, neuromuscular, neurometabolic, and peripheral nerve conditions. Available standardized questionnaires and observation forms for evaluating activities of daily living (ADLs) and childhood academic activities are not specific for diagnosing DCD. However, the Developmental Coordination Disorder Parent Questionnaire-Revised Version (DCDQ-R) has evidence level 2 and may be used in DCD diagnosis.

Dysfunction in various brain areas is often the cause of motor difficulties in DCD. The neurologic examination should assess behavior, cognition, comprehension, vision, eye movements, coordination, motor activity, focal and lateralized deficits, tone, strength, and stretch reflexes. Children with DCD tend to have significantly longer movement times and less accuracy than controls. These patients also rely considerably on visual feedback and require more time to execute motor tasks, such as handwriting, to optimize accuracy.

Handwriting difficulties are particularly important to note. Handwriting is a highly complex motor skill that requires several cognitive and linguistic processes before, during, and after execution. Despite being able to construct sentences, children with DCD have impaired thought expression, which can prolong the completion of handwriting tasks. Prunty et al estimated that children with DCD took an average pause duration of over 10 seconds at a time without improving composition quality. When memory resources are focused on transcription skills, longer writing times may reduce attention to organizing ideas, constructing sentences, syntax, vocabulary choice, and spelling.  

Comparing the quantity and quality of verbal production during writing is crucial when evaluating a child diagnosed with DCD. Spelling errors and vocabulary choices may affect production speed and content quality. Letter formation is the most important legibility predictor. Difficulties in these areas may significantly impact academic performance, and academic struggles may produce emotional problems.

The Detailed Assessment of the Speed of Handwriting (DASH) is an objective tool used for evaluating 4 handwriting speed aspects: copying in the child's best handwriting, copying quickly, alphabet writing, and free writing for 10 minutes. Handwriting evaluation in children with DCD should also include spelling and composition skills. Combining multiple methods and objective tools helps identify various aspects of the patient's neurologic problem and guide treatment.[13]

Collaboration with physical and occupational therapists allows physicians to determine the patients' motor competence using standardized tests. Assessment tools such as the Movement Assessment Battery for Children, 2nd edition (MABC-2) and Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2) are useful.[14][15] However, the application of these tests to the adolescent and adult populations is limited.[16]

Children with suspected DCD must be assessed for the functional and emotional impact of the disorder on daily activities. The condition may indirectly affect family, teachers, and peers with whom the child interacts. Longitudinal studies show that children with DCD experience greater academic and sociobehavioral problems.[17] Clinicians should likewise be aware that the degree of cooperation and motivation during the examination may impact motor performance. Children with early motor developmental problems are at much greater risk for later neuropsychiatric disorders, such as attention-deficit/hyperactivity disorder (ADHD), behavioral inhibition, childhood anxiety disorder, obsessive-compulsive disorder (OCD), autism spectrum disorder (ASD), and schizophrenia.[18][19][20]


The ICD-10 defines DCD as a disorder characterized by seriously impaired motor coordination development not solely accounted for by general intellectual retardation or any specific congenital or acquired neurological disorder. Meanwhile, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) defines the criteria for diagnosing DCD, which are as follows:

  • The achievement and performance of coordinated motor skills are substantially below what is expected, given the child's chronological age and opportunity for skill learning and use.
  • The poor performance persistently and significantly interferes with ADLs appropriate to chronologic age and impacts academic and school productivity, prevocational and vocational activities, leisure, and play.
  • The symptoms began in the early developmental period.
  • The motor and expressive difficulties are not better explained by intellectual disability or visual impairment and cannot be attributed to another neurologic or neuromuscular condition affecting movement (eg, cerebral palsy, muscular dystrophy, degenerative disorder).

Evaluating children with suspected DCD requires an interprofessional approach involving pediatricians, pediatric psychiatrists and neurologists, and physical and occupational therapists. DCD must be diagnosed before formal school entry. Developmental history, ADLs, and academic performance must be thoroughly assessed. However, differentiating and identifying associated comorbidities, if present, may be particularly challenging.[21]

Psychosocial and mental health issues may also arise with DCD and severely impact participation in leisure and social activities. A systematic review highlights the quality of life domains affected in children with DCD, shedding light on the condition's broader impact on their well-being.[22]

Peters et al demonstrated in 2013 that neuroimaging studies are crucial for understanding DCD's correlates and unraveling its underlying pathophysiology. Additionally, assessing executive functions over 2 years provides insights into the condition's long-term cognitive impact.[23] Near-infrared spectroscopy offers valuable information about DCD's neurodevelopmental aspects, as it allows the investigation of cortical activity when executing fine motor tasks.[24]

Treatment / Management

Recent meta-analyses reveal that the most effective DCD therapies are task-oriented approaches, motor-training programs, and physical therapy.[25] Task-oriented approaches are therapeutic interventions that help improve independence in performing ADLs, such as personal care, leisure activities, arts, and academic activities. These task-oriented approaches are designed—(A1)

  • Specifically for the patient.
  • To be goal-oriented.
  • To be task- and context-specific.
  • To actively involve the patient.
  • To reach functionality, not normality.
  • To involve the caregiver to enable transfer of care.

The goal of care is to enhance the learning of motor skills while focusing on global functions like sensory integration, visual-motor perception, and muscle strength.

The Cognitive Orientation to daily Occupational Performance (CO-OP) intervention has proven effective in improving motor skills and satisfaction with child-chosen motor goals for children with DCD.[26] Neuromotor task training has also produced promising results as a child-centered and task-oriented treatment program for children with DCD.[27] The delivery approach of these therapies is essential, as recent studies suggest greater effectiveness when the techniques are administered to smaller groups of patients.(A1)

The patient should also be given time to practice and integrate newly acquired basic skills into their daily routine. Caregiver participation is crucial in ensuring consistency and learning reinforcement. Pharmacologic therapies reduce attentional challenges and may be beneficial to patients with coexisting neuropsychiatric disorders such as ADHD.

A summer camp intervention has proven effective in improving motor skills in children with DCD, highlighting the potential benefits of such approaches.[28] Notably, no evidence exists that fatty acids and any particular vitamin supplements may affect motor functions.

Differential Diagnosis

DCD's differential diagnosis is vast and includes conditions presenting with both motor, coordination, and academic difficulties such as cerebral palsy, ADHD, ASD, intellectual disability, muscular dystrophy, sensory processing disorder, specific learning disorder, anxiety, fetal alcohol spectrum disorders, inborn errors of metabolism, neuromuscular diseases, epilepsy, brain tumors, and intellectual disability. A thorough clinical assessment and appropriate use of neurologic assessment tools can distinguish DCD from these common conditions.

Other disorders that may cause incoordination and clumsiness in children must be ruled out. Abnormal physical findings such as neurocutaneous marks, visual deficits, musculoskeletal abnormalities, hypotonia or hypertonia, weakness, ataxia, and adventitious movements should raise concerns for other disorders such as tumors.[29] No specific laboratory or imaging tests are recommended for diagnosing DCD. However, standard modalities such as thyroid function tests and magnetic resonance imaging may help evaluate alternative or coexisting conditions.

Several studies have addressed DCD's relationship with other disorders. International clinical practice recommendations for DCD offer valuable insights into its diagnosis, assessment, intervention, and psychosocial aspects, aiding in its differential diagnosis and addressing key clinical questions. Additionally, the European Academy for Childhood Disability (EACD) has offered recommendations on DCD's definition, diagnosis, and treatment, emphasizing the need for accurate differential diagnosis and intervention strategies.[30]

The influence of comorbidities like obesity on DCD's development must be examined.[31] DCD's potential overlap with language impairment and learning disabilities underscores the complexity of the DCD diagnostic process.[32]


Children with mild DCD symptoms who are promptly diagnosed and treated may learn to overcome their motor performance difficulties and achieve their goals over time. However, most children with DCD require long-term medical assistance and a tailored academic plan during critical developmental periods. Associated comorbidities and mental health diseases may severely impact the quality of life of patients with DCD.


Delayed diagnosis and treatment of DCD may lead to short- and long-term health and psychosocial complications. Motor milestone delays may affect the child's physical fitness. Children with DCD participate less in team sports and may develop decreased flexibility, strength, and endurance. DCD's negative effect on a child's participation in group activities may cause sociobehavioral problems that may persist in adolescence.

Adolescents with DCD report unique physical, social, and emotional challenges that severely impact their performance in sports and manual labor. Such difficulties may cause social marginalization.[33]

DCD in adults usually presents more heterogeneously and often results from failure to recognize subtle symptoms during childhood. Adults with DCD tend to experience motor challenges with estimating distances. Such impairments may manifest, for example, when driving or crossing the road. Adults also report difficulty with executive functioning, attention, and learning new skills.[34] DCD may lead to medical problems such as anxiety, low self-esteem, OCD, ASD, schizophrenia, and metabolic syndrome in adults.

Deterrence and Patient Education

DCD's cause is unknown, though it may have genetic and environmental sources. Preventing disease development is impossible with current technology. However, preventive measures may address DCD's potential complications. Early recognition requires an interprofessional approach that includes healthcare specialists, teachers, and family members. Healthcare practitioners should thoroughly counsel parents of children with DCD to recognize the problems these patients experience and make informed decisions about their treatment.

Individualized goals and therapeutic plans must be established in collaboration with the family. Task-oriented approaches are the most effective interventions because they account for individual variation. However, a lack of motivation and support from family members, teachers, and coaches may severely impact the treatments' effectiveness.

Promoting physical activity helps reduce obesity and metabolic syndrome in patients with DCD. Occupational therapy services for children with DCD can help address motor coordination difficulties early on and prevent further impairment. Minimizing physical barriers and providing appropriate equipment and accommodations for patients with DCD help overcome motor coordination difficulties and promote functional independence. While preventing all DCD complications may not be possible, early identification and intervention can help mitigate its impact and improve patient outcomes.

Pearls and Other Issues

Key points to remember about dyspraxia evaluation and management include the following:

  • DCD usually affects school-aged children. One of the condition's most common signs is difficulty with handwriting. DCD may be aggravated by other neurodevelopmental disorders affecting attention, language, and reading, such as (ADHD) and dyslexia.[35][36]
  • The most common presenting symptoms of DCD include difficulties with motor coordination that can affect various aspects of daily life, including fine and gross motor skills, organization, planning, and executing movements.
  • Early identification and intervention are essential for individuals with DCD to receive appropriate support and accommodations to help them succeed academically, socially, and in daily activities.
  • Individuals with DCD benefit from personalized interventions tailored to their needs and challenges. Occupational, speech, and physical therapy and educational support can all play important roles in addressing the condition's diverse aspects.[37]
  • Individuals with dyspraxia often have unique strengths, such as creativity, problem-solving skills, and resilience. Focusing on these strengths can help boost confidence and self-esteem.
  • Dyspraxia is a lifelong condition. However, individuals can learn strategies to manage difficulties and lead fulfilling lives with appropriate support and accommodations.
  • Raising awareness about DCD among educators, healthcare professionals, and the general public is crucial for promoting understanding, acceptance, and access to support services for individuals with this condition.

These points highlight some key aspects of DCD and emphasize the importance of early identification, individualized support, and a strengths-based approach in addressing the challenges associated with the condition.

Enhancing Healthcare Team Outcomes

Evaluating and treating DCD requires an interprofessional approach that includes pediatricians, pediatric psychiatrists and neurologists, and physical and occupational therapists. Children diagnosed with DCD should be screened for potentially associated conditions such as ADHD, ASD, language disorders, and social, emotional, and behavioral disorders. Identifying a weakness in a specific domain may be pivotal to determining overlapping difficulties in another, which may present years later. For example, preschool motor coordination difficulties may precede attention deficit manifesting during schooling age. Therefore, a multidimensional diagnostic protocol is essential to designing an effective therapeutic plan.

Given DCD's considerable health consequences, an integrated approach is necessary to address the varied health needs of children with this condition. DCD's high prevalence and significant impact on daily activities, including academic performance, represent a substantial social and economic burden. Interprofessional team strategies should be implemented to assist the child in achieving the best possible educational and social outcomes. Caregivers' active collaboration with healthcare professionals in decision-making is essential to patient-centered care.



Fitjar CL, Rønneberg V, Nottbusch G, Torrance M. Learning Handwriting: Factors Affecting Pen-Movement Fluency in Beginning Writers. Frontiers in psychology. 2021:12():663829. doi: 10.3389/fpsyg.2021.663829. Epub 2021 May 20     [PubMed PMID: 34093359]


Prunty MM, Barnett AL, Wilmut K, Plumb MS. Handwriting speed in children with Developmental Coordination Disorder: are they really slower? Research in developmental disabilities. 2013 Sep:34(9):2927-36. doi: 10.1016/j.ridd.2013.06.005. Epub 2013 Jun 29     [PubMed PMID: 23816628]


Prunty M, Barnett AL. Understanding handwriting difficulties: A comparison of children with and without motor impairment. Cognitive neuropsychology. 2017 May-Jun:34(3-4):205-218. doi: 10.1080/02643294.2017.1376630. Epub 2017 Sep 26     [PubMed PMID: 28948860]

Level 3 (low-level) evidence


Blank R, Barnett AL, Cairney J, Green D, Kirby A, Polatajko H, Rosenblum S, Smits-Engelsman B, Sugden D, Wilson P, Vinçon S. International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. Developmental medicine and child neurology. 2019 Mar:61(3):242-285. doi: 10.1111/dmcn.14132. Epub 2019 Jan 22     [PubMed PMID: 30671947]


Wilson PH, Smits-Engelsman B, Caeyenberghs K, Steenbergen B, Sugden D, Clark J, Mumford N, Blank R. Cognitive and neuroimaging findings in developmental coordination disorder: new insights from a systematic review of recent research. Developmental medicine and child neurology. 2017 Nov:59(11):1117-1129. doi: 10.1111/dmcn.13530. Epub 2017 Sep 5     [PubMed PMID: 28872667]

Level 1 (high-level) evidence


Zwicker JG, Missiuna C, Harris SR, Boyd LA. Brain activation of children with developmental coordination disorder is different than peers. Pediatrics. 2010 Sep:126(3):e678-86. doi: 10.1542/peds.2010-0059. Epub 2010 Aug 16     [PubMed PMID: 20713484]


Mosca SJ, Langevin LM, Dewey D, Innes AM, Lionel AC, Marshall CC, Scherer SW, Parboosingh JS, Bernier FP. Copy-number variations are enriched for neurodevelopmental genes in children with developmental coordination disorder. Journal of medical genetics. 2016 Dec:53(12):812-819. doi: 10.1136/jmedgenet-2016-103818. Epub 2016 Aug 3     [PubMed PMID: 27489308]


Lingam R, Hunt L, Golding J, Jongmans M, Emond A. Prevalence of developmental coordination disorder using the DSM-IV at 7 years of age: a UK population-based study. Pediatrics. 2009 Apr:123(4):e693-700. doi: 10.1542/peds.2008-1770. Epub     [PubMed PMID: 19336359]


Edwards J, Berube M, Erlandson K, Haug S, Johnstone H, Meagher M, Sarkodee-Adoo S, Zwicker JG. Developmental coordination disorder in school-aged children born very preterm and/or at very low birth weight: a systematic review. Journal of developmental and behavioral pediatrics : JDBP. 2011 Nov:32(9):678-87. doi: 10.1097/DBP.0b013e31822a396a. Epub     [PubMed PMID: 21900828]

Level 1 (high-level) evidence


Goez H, Zelnik N. Handedness in patients with developmental coordination disorder. Journal of child neurology. 2008 Feb:23(2):151-4     [PubMed PMID: 18079311]

Level 2 (mid-level) evidence


Losse A, Henderson SE, Elliman D, Hall D, Knight E, Jongmans M. Clumsiness in children--do they grow out of it? A 10-year follow-up study. Developmental medicine and child neurology. 1991 Jan:33(1):55-68     [PubMed PMID: 1704864]


Harris SR, Mickelson ECR, Zwicker JG. Diagnosis and management of developmental coordination disorder. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2015 Jun 16:187(9):659-665. doi: 10.1503/cmaj.140994. Epub 2015 May 25     [PubMed PMID: 26009588]


Prunty MM, Barnett AL, Wilmut K, Plumb MS. The impact of handwriting difficulties on compositional quality in children with developmental coordination disorder. The British journal of occupational therapy. 2016 Oct:79(10):591-597     [PubMed PMID: 27807392]

Level 2 (mid-level) evidence


Nazario PF, Ferreira L, Both J, Vieira JLL. MOVEMENT ASSESSMENT BATTERY FOR CHILDREN-SECOND EDITION: THEORETICAL ADEQUACY OF A MOTOR ASSESSMENT INSTRUMENT. Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo. 2021:40():e2020205. doi: 10.1590/1984-0462/2022/40/2020205. Epub 2021 Apr 2     [PubMed PMID: 33825767]


Deitz JC, Kartin D, Kopp K. Review of the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2). Physical & occupational therapy in pediatrics. 2007:27(4):87-102     [PubMed PMID: 18032151]


Saban MT, Ornoy A, Grotto I, Parush S. Adolescents and adults coordination questionnaire: development and psychometric properties. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2012 Jul-Aug:66(4):406-13. doi: 10.5014/ajot.2012.003251. Epub     [PubMed PMID: 22742688]


Blondis TA, Snow JH, Roizen NJ, Opacich KJ, Accardo PJ. Early maturation of motor-delayed children at school age. Journal of child neurology. 1993 Oct:8(4):323-9     [PubMed PMID: 7693797]


Martin NC, Piek JP, Hay D. DCD and ADHD: a genetic study of their shared aetiology. Human movement science. 2006 Feb:25(1):110-24     [PubMed PMID: 16442650]


Fliers E, Rommelse N, Vermeulen SH, Altink M, Buschgens CJ, Faraone SV, Sergeant JA, Franke B, Buitelaar JK. Motor coordination problems in children and adolescents with ADHD rated by parents and teachers: effects of age and gender. Journal of neural transmission (Vienna, Austria : 1996). 2008:115(2):211-20     [PubMed PMID: 17994185]


Flapper BC, Schoemaker MM. Developmental coordination disorder in children with specific language impairment: co-morbidity and impact on quality of life. Research in developmental disabilities. 2013 Feb:34(2):756-63. doi: 10.1016/j.ridd.2012.10.014. Epub 2012 Dec 5     [PubMed PMID: 23220052]

Level 2 (mid-level) evidence


Lino F, Chieffo DPR. Developmental Coordination Disorder and Most Prevalent Comorbidities: A Narrative Review. Children (Basel, Switzerland). 2022 Jul 21:9(7):. doi: 10.3390/children9071095. Epub 2022 Jul 21     [PubMed PMID: 35884081]

Level 3 (low-level) evidence


Zwicker JG, Harris SR, Klassen AF. Quality of life domains affected in children with developmental coordination disorder: a systematic review. Child: care, health and development. 2013 Jul:39(4):562-80. doi: 10.1111/j.1365-2214.2012.01379.x. Epub 2012 Apr 20     [PubMed PMID: 22515477]

Level 1 (high-level) evidence


Bernardi M, Leonard HC, Hill EL, Botting N, Henry LA. Executive functions in children with developmental coordination disorder: a 2-year follow-up study. Developmental medicine and child neurology. 2018 Mar:60(3):306-313. doi: 10.1111/dmcn.13640. Epub 2017 Dec 14     [PubMed PMID: 29238952]


Caçola P, Getchell N, Srinivasan D, Alexandrakis G, Liu H. Cortical activity in fine-motor tasks in children with Developmental Coordination Disorder: A preliminary fNIRS study. International journal of developmental neuroscience : the official journal of the International Society for Developmental Neuroscience. 2018 Apr:65():83-90. doi: 10.1016/j.ijdevneu.2017.11.001. Epub 2017 Nov 7     [PubMed PMID: 29126862]


Smits-Engelsman BC, Blank R, van der Kaay AC, Mosterd-van der Meijs R, Vlugt-van den Brand E, Polatajko HJ, Wilson PH. Efficacy of interventions to improve motor performance in children with developmental coordination disorder: a combined systematic review and meta-analysis. Developmental medicine and child neurology. 2013 Mar:55(3):229-37. doi: 10.1111/dmcn.12008. Epub 2012 Oct 29     [PubMed PMID: 23106530]

Level 1 (high-level) evidence


Izadi-Najafabadi S, Gunton C, Dureno Z, Zwicker JG. Effectiveness of Cognitive Orientation to Occupational Performance intervention in improving motor skills of children with developmental coordination disorder: A randomized waitlist-control trial. Clinical rehabilitation. 2022 Jun:36(6):776-788. doi: 10.1177/02692155221086188. Epub 2022 Apr 24     [PubMed PMID: 35466705]

Level 1 (high-level) evidence


Niemeijer AS, Smits-Engelsman BC, Schoemaker MM. Neuromotor task training for children with developmental coordination disorder: a controlled trial. Developmental medicine and child neurology. 2007 Jun:49(6):406-11     [PubMed PMID: 17518923]


Zwicker JG, Rehal H, Sodhi S, Karkling M, Paul A, Hilliard M, Jarus T. Effectiveness of a summer camp intervention for children with developmental coordination disorder. Physical & occupational therapy in pediatrics. 2015 May:35(2):163-77. doi: 10.3109/01942638.2014.957431. Epub 2014 Sep 17     [PubMed PMID: 25229503]


Gibbs J, Appleton J, Appleton R. Dyspraxia or developmental coordination disorder? Unravelling the enigma. Archives of disease in childhood. 2007 Jun:92(6):534-9     [PubMed PMID: 17515623]


Blank R, Smits-Engelsman B, Polatajko H, Wilson P, European Academy for Childhood Disability. European Academy for Childhood Disability (EACD): recommendations on the definition, diagnosis and intervention of developmental coordination disorder (long version). Developmental medicine and child neurology. 2012 Jan:54(1):54-93. doi: 10.1111/j.1469-8749.2011.04171.x. Epub     [PubMed PMID: 22171930]


Hendrix CG, Prins MR, Dekkers H. Developmental coordination disorder and overweight and obesity in children: a systematic review. Obesity reviews : an official journal of the International Association for the Study of Obesity. 2014 May:15(5):408-23. doi: 10.1111/obr.12137. Epub 2014 Jan 6     [PubMed PMID: 24387283]

Level 1 (high-level) evidence


Zwicker JG, Missiuna C, Boyd LA. Neural correlates of developmental coordination disorder: a review of hypotheses. Journal of child neurology. 2009 Oct:24(10):1273-81. doi: 10.1177/0883073809333537. Epub 2009 Aug 17     [PubMed PMID: 19687388]


Khairati F, Stewart N, Zwicker JG. How developmental coordination disorder affects daily life: The adolescent perspective. Research in developmental disabilities. 2024 Jan:144():104640. doi: 10.1016/j.ridd.2023.104640. Epub 2023 Dec 5     [PubMed PMID: 38056031]

Level 3 (low-level) evidence


Meachon EJ, Zemp M, Alpers GW. Developmental Coordination Disorder (DCD): Relevance for Clinical Psychologists in Europe. Clinical psychology in Europe. 2022 Jun:4(2):e4165. doi: 10.32872/cpe.4165. Epub 2022 Jun 30     [PubMed PMID: 36397944]


Prunty M, Barnett AL. Accuracy and Consistency of Letter Formation in Children With Developmental Coordination Disorder. Journal of learning disabilities. 2020 Mar/Apr:53(2):120-130. doi: 10.1177/0022219419892851. Epub 2019 Dec 13     [PubMed PMID: 31833795]

Level 3 (low-level) evidence


Missiuna CA, Pollock NA, Levac DE, Campbell WN, Whalen SD, Bennett SM, Hecimovich CA, Gaines BR, Cairney J, Russell DJ. Partnering for change: an innovative school-based occupational therapy service delivery model for children with developmental coordination disorder. Canadian journal of occupational therapy. Revue canadienne d'ergotherapie. 2012 Feb:79(1):41-50     [PubMed PMID: 22439291]


Camden C, Wilson B, Kirby A, Sugden D, Missiuna C. Best practice principles for management of children with developmental coordination disorder (DCD): results of a scoping review. Child: care, health and development. 2015 Jan:41(1):147-59. doi: 10.1111/cch.12128. Epub 2014 Jan 6     [PubMed PMID: 24387638]

Level 2 (mid-level) evidence