Developmental coordination disorder (DCD) is diagnosed in children who despite a normal neurological exam have impairment in the performance of functional motor skills lower than would be expected for their chronological age and intellectual level. The onset of symptoms should have occurred during the developmental period. The entity of DCD is not well understood and involves fine motor, perceptual visual, and executive function problems. [Farmer: 2017] Although not originally included in the definition of DCD [Kirby: 2014] [Cairney: 2010], in the DSM-5, DCD may co-exist with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, and specific learning disorders. [Harris: 2015] The prevalence of DCD is estimated at 5-6% of children and is more common in boys. [Cairney: 2010] Approximately ¾ of children with DCD continue to face coordination difficulties in adulthood. [Kirby: 2014] DCD can have serious consequences for a child's social, emotional, and educational functioning. Despite treatment, DCD may have lingering effects in adolescence. [Kirby: 2007] Children with DCD are more likely to be overweight or obese. [Hendrix: 2014]

Suspect DCD when:

• There are delayed developmental milestones in motor skills.
• A child is described as "clumsy" despite appropriate milestones.
• A child is unable to keep up with peers athletically or avoids physical activity.

Essential features of DCD include a marked impairment in the development of coordination. The impairment significantly interferes with academic achievement or activities of daily living, and these difficulties are not due to a general medical condition, such as cerebral palsy or stroke. The child may present with mild motor delays, mild hypotonia, difficulties with cross-body coordination, or problems with balance. The child should not have severe delay, evidence of motor plateau or regression, or significant abnormalities upon neurologic exam; these are flags for different disorders. If DCD is suspected, the medical home should ideally consult with a multidisciplinary team that includes neurology or developmental pediatrics and physical therapy/occupational therapy trained in standardized motor tools to assess children.

DSM-5 DCD diagnostic criteria: [American: 2013]

1. The acquisition and execution of coordinated motor skills are substantially below that expected given the individual's chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness (e.g., dropping or bumping into objects), as well as slowness and inaccuracy of performance of motor skills (e.g., catching an object, using scissors or cutlery, handwriting, riding a bike, or participating in sports).
2. The motor skills deficit(s) in criterion A significantly and persistently interferes with activities of daily living appropriate to chronological age (e.g., self-care and self-maintenance) and impacts academic/school productivity, prevocational and vocational activities, leisure, and play.
3. Onset of symptoms is in the early developmental period.
4. The motor skills deficits are not better explained by intellectual disability (intellectual developmental disorder) or visual impairment and are not attributable to a neurological condition affecting movement (e.g., cerebral palsy, muscular dystrophy, degenerative disorder).

Children with DCD should be referred to therapies (occupational therapy or physical therapy) to improve their motor performance. Task-oriented therapies for specific motor deficits were more successful than therapies aimed at more global functions such as sensory integration, although not much is known about prognosis with or without therapies.. [Harris: 2015] In addition, the DCD of children who also have ADHD or autism may benefit from medication aimed at those disorders, for instance, stimulants for ADHD. See Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder for further information about medications.

Children with DCD may have associated problems, such as joint hypermobility and obesity, which should be addressed as needed. Psychosocial problems, such as bullying, anxiety, and other mental health problems, should be sought and addressed if present. [Harris: 2015] Diagnosis and management information can be found at Missing link with id: 99e6f817.xml and Anxiety Disorders.

• Identify concern and consider a physical therapy assessment of motor skills for confirmation.
• Explain to child/family the nature of the condition.
• Consider neurologic or developmental pediatrics consultation.
• Ensure parents know how to access services needed via school system (e.g., physical and/or occupational therapy consultative input if needed, social skills support).
• Provide guidance regarding the appropriate types of community-based athletic programs (e.g., fun-focused vs. competitive).
• Refer to outpatient PT/OT for treatment as necessary.
• Seek associated problems, such as obesity and anxiety, and address as needed.