Developmental Coordination Disorder (DCD), also known as dyspraxia, is a neurodevelopmental condition affecting approximately 5-6% of school-aged children. This translates to a significant number of children who experience challenges with motor skills, impacting their daily lives and academic performance. Despite its prevalence, DCD often remains underdiagnosed, highlighting a critical need for increased awareness and understanding among healthcare professionals. Studies reveal a significant gap in physician knowledge regarding DCD, with a considerable portion of pediatricians and general practitioners reporting limited familiarity with the condition and even fewer having diagnosed it. This article aims to provide a comprehensive overview of DCD diagnosis, encompassing definition, risk factors, screening methods, diagnostic procedures, and associated conditions, to equip healthcare professionals with the necessary knowledge for effective identification and management.
Understanding Developmental Coordination Disorder
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) defines DCD as a condition characterized by motor coordination skills that are substantially below what is expected for a child’s chronological age. Children with DCD may be described as “clumsy” and may have a history of delayed motor milestones, such as crawling and walking. These coordination difficulties, affecting fine or gross motor skills, or both, significantly interfere with academic achievement and activities of daily living. It is crucial to distinguish DCD from motor difficulties arising from other medical conditions like cerebral palsy, muscular dystrophy, visual impairment, or intellectual disability. If a child has an intellectual disability, the motor difficulties in DCD are more pronounced than typically expected for their cognitive abilities. A key diagnostic criterion in DSM-5 is that the onset of DCD symptoms occurs during the developmental period.
Identifying Risk Factors for DCD
Several factors have been identified as increasing the risk of DCD. Research indicates that children born with very low birth weights are at a higher risk. Boys are also more likely to be diagnosed with DCD compared to girls. A large-scale study of Danish children identified additional risk factors including very preterm birth, being small for gestational age, and delayed independent walking (15 months or later). Retrospective studies have corroborated the association with male sex and low birth weight, and have also indicated a potential link with postnatal steroid exposure. Furthermore, children with DCD are observed to have a higher predisposition to becoming overweight or obese.
Beyond perinatal factors, studies have also linked DCD to other developmental challenges. Difficulties with attention, social communication, and phonological skills (like repeating nonwords) have been identified as risk factors. Specifically, challenges in spelling and reading are also strongly associated with DCD. These findings suggest a complex interplay of factors contributing to the development of DCD.
Screening for Developmental Coordination Disorder: Recognizing Suspect Cases
DCD should be suspected when parents, caregivers, or teachers express concerns about a child’s clumsiness or persistent delays in motor milestones. Clinicians should be attentive to reports of difficulties with both gross motor skills (like running, jumping, ball skills) and fine motor skills (like handwriting, using utensils, manipulating small objects). Difficulties with oral motor coordination, such as blowing bubbles or candles, may also be indicative. When concerns arise, a structured approach to screening is essential.
A series of questions, as outlined in Box 2 of the original article, can guide initial screening during a consultation. These questions cover areas such as prematurity, birth weight, age of walking, perceived clumsiness, difficulties in daily living activities (dressing, eating), bicycle riding age, fine motor challenges (handwriting, cutting), gross motor difficulties (sports, physical education), and family history of DCD, ADHD, or learning disabilities. Affirmative answers to these questions, in the absence of other medical explanations for motor difficulties, should prompt further expert assessment for DCD.
Utilizing Screening Questionnaires for DCD
In addition to clinical questioning, standardized questionnaires can enhance the screening process. The Developmental Coordination Disorder Questionnaire (DCDQ) is a valuable tool for general practitioners. This 15-item questionnaire, designed for children aged 5–15 years, is considered the most effective screening questionnaire for DCD currently available. The DCDQ, along with scoring instructions, is freely accessible at www.dcdq.ca. By using the DCDQ in conjunction with age-based scoring, healthcare providers can determine the likelihood of DCD and guide decisions regarding referral for comprehensive diagnostic evaluation.
Comprehensive Assessment for DCD Diagnosis
A definitive diagnosis of DCD requires a thorough assessment process. This includes gathering detailed history, conducting clinical examinations, and utilizing standardized motor assessments.
History Taking
A detailed family history should encompass information on DCD, neurological disorders, mental health conditions, and social circumstances. The child’s developmental history should include specifics of pregnancy, birth, motor milestone attainment, academic progress, and any pre-existing or current medical conditions, particularly sensory or neurological concerns. It is crucial to document the child’s current difficulties with gross and fine motor skills, and their impact on daily living activities. Input from teachers regarding academic performance, motor skills in school, attention, and learning difficulties can provide valuable context for the assessment.
Clinical Examination
A comprehensive clinical examination is necessary to rule out other potential causes of motor difficulties. This examination should encompass neuromotor, medical, sensory, and behavioral status. Cognitive assessment is also important if learning difficulties are reported. Measuring Body Mass Index (BMI) should be a part of the general physical exam, given the increased risk of overweight and obesity in children with DCD.
The neuromotor examination should include elements relevant to identifying motor coordination difficulties in school-aged children. Box 3 from the original article provides a summary of key components adapted from the American Academy of Pediatrics guidelines. These components include cranial nerve assessment (eye movements, visual fields, pupillary responses, facial expressions, oral motor function), strength and flexibility evaluation (muscle bulk, joint flexibility, grasp strength), and motor planning observation (functional gross and fine motor skills, hand dominance).
Establishing a DCD Diagnosis: Multidisciplinary Team Approach
The European Academy of Childhood Disability recommends that DCD diagnosis be made by a multidisciplinary team. This team ideally includes a physician (such as a child psychiatrist, developmental pediatrician, or child neurologist) and an occupational therapist or physical therapist proficient in using standardized motor assessment tools. This collaborative approach ensures a comprehensive evaluation considering various aspects of the child’s development and motor skills.
Box 4 of the original article outlines the DSM-5 diagnostic criteria for DCD and provides examples of assessment methods for each criterion. Criterion A focuses on motor coordination significantly below expected levels given the child’s age and opportunity for skill learning. This is typically assessed using standardized motor tests like the Movement Assessment Battery for Children-2 (Movement ABC-2) or the Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2). Criterion B confirms that motor difficulties significantly interfere with daily living or academic achievement. Criterion C states that the onset of symptoms is during the early developmental period. Criterion D specifies that motor difficulties are not better explained by intellectual disability, visual impairment, or neurological conditions affecting movement.
Co-occurring Conditions and DCD
It is common for children with DCD to have other co-occurring conditions, such as Attention-Deficit/Hyperactivity Disorder (ADHD), autism spectrum disorder, or specific learning disabilities. Unlike previous diagnostic manuals, DSM-5 allows for concurrent diagnoses, acknowledging the complexity of neurodevelopmental conditions. Furthermore, children with DCD are at an increased risk of experiencing anxiety and depression. Psychosocial difficulties, overweight or obesity, joint hypermobility, reduced physical fitness, and decreased participation in physical and social activities are also frequently observed in children with DCD. Recognizing these co-occurring conditions is essential for holistic management and support.
Best Practices in DCD Diagnosis and Management
Best practice for DCD involves a multifaceted approach that emphasizes early identification, accurate diagnosis, and evidence-based interventions. Raising awareness about DCD among healthcare professionals, educators, and parents is paramount. Coordinated services and consumer involvement in setting treatment goals are crucial principles for effective management. Evidence-based interventions, such as task-oriented therapies and occupational or physical therapy focusing on functional tasks, have demonstrated effectiveness in improving motor skills in children with DCD.
By enhancing understanding of DCD diagnosis and promoting collaborative, evidence-based practices, healthcare professionals can significantly improve the lives of children affected by this prevalent yet often underrecognized condition.
