Version July 2025
INTRODUCTION —
Developmental coordination disorder (DCD) is characterized by problems with motor coordination that interfere with academic performance and social integration in otherwise healthy children. It typically presents in the early school years and persists into adolescence or adulthood.
The management and outcome of DCD will be discussed here. Our approach to management is generally consistent with that described in professional guidelines. The clinical features and diagnosis of DCD are discussed separately. (See 'Society guideline links' below and "Developmental coordination disorder: Clinical features and diagnosis".)
TERMINOLOGY —
In this topic, we use the term "developmental coordination disorder" (DCD) to describe problems in motor coordination that interfere with academic performance and/or socialization and are not better explained by other medical or psychosocial conditions, such as brain tumors, metabolic conditions, and attention deficit hyperactivity disorder. DCD was first described in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and DCD is the preferred term in countries that use the DSM classification (eg, in the United States) [1,2]. "Developmental motor coordination disorder" is the preferred term in the International Classification of Diseases, 11th revision (ICD-11), which is used in many European countries [3].
The DSM Fifth Edition, Text Revision (DSM-5-TR) criteria for DCD include [2]:
●The achievement and performance of coordinated motor skills is substantially below that expected given the child's chronologic age and opportunity for skill learning and use
●The poor performance significantly and persistently interferes with activities of daily living appropriate to chronologic age and impacts academic/school productivity, prevocational and vocational activities, leisure, and play
●The symptoms began in the early developmental period
●The impairments in motor skills 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)
Although DCD is generally the preferred term in the United States, DCD is considered a mental health diagnosis for billing purposes and may not be covered by the child's medical insurance. Other terms for the diagnosis, such as "lack of coordination," "dyspraxia," and "dysgraphia," which are considered medical diagnoses, typically are covered by medical insurance.
GUIDING PRINCIPLES —
Guiding principles in the management of DCD include [1,4,5]:
●Individualizing the approach according to the child's strengths, weaknesses, self-concept, goals, and opportunities.
●Actively involving the child.
●Prioritizing functional skills that are relevant to everyday activities and are important to the child and child's caregivers.
●Teaching specific skills that can be generalized or transferred to other activities, settings, etc.
●Including accommodations for home and school.
●Involving multiple individuals in the treatment plan (eg, caregivers, teachers, health care professionals); this promotes development of adaptive skills and social integration in concert with development of motor skills [6].
●Addressing the child's physical fitness (eg, strength, endurance, flexibility).
●Planning for transitions that are associated with new difficulties (eg, from primary to secondary school, from education to employment).
SUPPORTIVE CARE
Education — Important aspects of education and counseling for children and caregivers of children with DCD include helping the child, caregivers, and teachers understand that the child's difficulty with motor tasks is not the child's fault (ie, the child is not lazy or sloppy) [7,8].
The clinician's recognition that the child has been teased or ostracized for incoordination can be of therapeutic benefit to the child [7], particularly if the child has been described as "lazy" or "sloppy" by teachers or caregivers.
The natural history of DCD should be explained, emphasizing that motor difficulties often persist into adulthood. (See 'Outcome' below.)
Caregivers can help educate teachers, coaches, and the caregivers of their child's friends about ways in which to foster the child's normal socialization by minimizing the impact of the child's DCD their ability to participate in age-appropriate activities (by choosing activities in which the child is likely to succeed). In qualitative studies, children with DCD benefit greatly when skill development allows them to participate in activities with their peers [9-11].
Children with DCD: At home, at school, and in the community is a booklet developed by the McMaster University CanChild Centre for Childhood Disability Research to help caregivers and educators identify and manage school-age children with movement problems [12].
School supports
●Handwriting – The school can implement a number of supports to circumvent difficulties with handwriting. These include [1,12]:
•Allowing the child to use a computer and providing direct instruction in keyboarding
•Shortening written assignments and providing extra time to complete assignments that require handwriting or other fine motor activities
•Allowing the child to use pencil grips or increased diameter writing implements as necessary
•Allowing the child to dictate assignments or to use voice-activated computer software to complete written assignments
•Allowing the child to give oral reports instead of written reports and to give oral answers to essay questions
•Providing the child typed copies (paper or electronic) of class notes and assignments to avoid the need for transcription from the board
•Avoiding other unnecessary copying
●School-based physical education – Children with DCD may benefit from accommodations to their physical education program to include activities that take advantage of the child's motor strengths. In some school systems, these accommodations may be made through the "other health impaired" classification of the Individuals with Disabilities Education Act. (See "Definitions of specific learning disorder and laws pertaining to learning disorders in the United States", section on 'Individuals with Disabilities Education Act'.)
●Other school supports – Additional, grade-specific information about school supports is available through the McMaster University CanChild Centre for Childhood Disability Research, including:
•DCD educational materials for home, school, and health professionals
•Grade-specific flyers for teachers of children with DCD
Sports participation — Sports participation and exercise may be beneficial for children with DCD, decreasing loneliness and improving self-esteem [13,14]. However, the sport, level of competition, and characteristics of the child and coach(es) must be factored into decisions about sports participation. Participation in team sports may be a practical means of decreasing isolation when the child-team-caregiver fit is right. It is important for the coach to have an understanding of children with diverse skills. Sports in which the child participates as an individual on a team (eg, swimming, track and field, tennis, martial arts, bowling) may be better than those that require coordination of the child’s actions with those of teammates (eg, soccer). Noncompetitive or intramural teams may be better than more competitive travel teams. Limited research suggests Taekwondo and Tia Chi muscle-power training as a means of improving strength and balance [15-17].
Self-esteem — Addressing self-esteem is key component of the management of DCD. The child's self-esteem and/or resilience may be increased through cognitive and behavioral strategies, including [7,8,18]:
●Encouraging the child to participate in activities in which they can achieve success (eg, swimming, horseback riding, weight training)
●Modifications of expectations (eg, less emphasis on competitive sports)
●Modifications of the environment (eg, self-gripping fasteners rather than buttons or ties)
TREATMENT OF ASSOCIATED CONDITIONS —
Children with DCD and associated conditions should receive supportive care and treatment of the associated condition. Treatment of the associated condition may facilitate treatment of DCD. The treatment priorities should be individualized according to the type and severity of the associated condition and the preferences of the child and caregivers [1].
Associated conditions should be treated as they are in children without DCD. Treatment of associated conditions is discussed separately:
●Attention deficit hyperactivity disorder (ADHD) (see "Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis")
Children with coexisting ADHD and DCD appear to benefit from stimulant therapy, which reduces symptoms of ADHD and DCD and is associated with improved quality of life [19-22]. (See "Attention deficit hyperactivity disorder in children and adolescents: Treatment with medications".)
●Autism spectrum disorder (see "Autism spectrum disorder in children and adolescents: Overview of management and prognosis")
●Learning disabilities (see "Specific learning disorders in children: Educational management")
●Social/emotional disorders (eg, depression, anxiety) (see "Overview of prevention and treatment for pediatric depression" and "Psychotherapy for anxiety disorders in children and adolescents" and "Pharmacotherapy for anxiety disorders in children and adolescents")
INTERVENTIONS TO IMPROVE MOTOR PERFORMANCE —
In addition to supportive care and treatment of associated conditions, children with DCD should receive interventions to improve motor skills and function.
Occupational and physical therapy
Goals — The goals of occupational and physical therapy are to [1,23]:
●Improve motor function
●Increase activity and participation, particularly in tasks that the child needs for everyday living
●Transfer the skill from the therapy setting to real world situations (requires active involvement of the child, caregivers, and/or teachers)
Types of therapy — The types of occupational and physical therapy for DCD can be classified according to the primary target of the intervention as follows:
●Activity-oriented and participation-oriented interventions – Activity- and participation-oriented interventions target performance or participation in the activity in real world situations; they are sometimes called "task-oriented" interventions) [23].
Task-oriented interventions focus on teaching essential activities of daily living and stimulating participation at home, school, and in recreational activities [1]. They target specific tasks in specific settings (handwriting, ball skills) that are chosen in consultation with the child and caregivers [24-27]. Active involvement of the caregivers may facilitate transfer to real world situations.
Examples of activity- or participation-oriented approaches that have been used for children with DCD include Neuromotor Task Training [24,28], Cognitive Orientation to daily Occupational Performance [26,29-31], general skill training [32], and play or sport-related skill training [15,16,23].
●Body function-oriented interventions – Body function-oriented interventions target body functions needed to perform activities (eg, hand eye coordination); they are sometimes called "process-oriented" interventions [23]. Examples of body function-oriented approaches include strength training [33] and aerobic fitness training.
Therapy recommendations — For children diagnosed with DCD, we prefer occupational and physical therapy rather than no intervention. In some studies, occupational and physical therapy have been associated with short-term improvement in skills in children with DCD and few, if any, adverse effects [22,23,34-36]. Occupational and physical therapy also may improve the child's physical fitness and self-esteem.
On the other hand, systematic reviews and meta-analyses of the effects of occupational and physical therapy in children with DCD have inconsistent conclusions regarding benefits [22,23,34-37]. A 2020 review of eight meta-analyses and systematic reviews (ie, a meta-review) concluded that many of the studies included in both types of reviews were not of high quality, and many meta-analyses did not adhere to many of the steps described in the Cochrane Handbook [38]. Consequently, it is not possible to draw conclusions about the effectiveness of intervention versus no intervention.
●Therapy type – For children with DCD who receive occupational or physical therapy, we prefer activity- and/or participation-oriented interventions with or without body function-oriented approaches rather than body function-oriented interventions alone. This preference is based upon expert opinion [1]. The results of the 2020 meta-review described above demonstrate that it is not possible to draw conclusions about the superiority of one approach over the other [38].
Additional studies are necessary to determine the optimal approach for particular groups of children, the duration of effect, and how well skills learned in the therapy setting transfer to real world activities of daily living and participation in recreational activities [23].
●Therapy regimen – There is little information to guide recommendations for frequency or duration of therapy. These decisions are best made on a case-by-case basis, tailored to individual goals and response to treatment (based on levels of activities and participation).
In a systematic review of randomized and observational studies, the mean duration of protocols was 10 weeks (range 2 to 18) [1]. Training protocols of 10 to 15 hours and 20 to 30 hours appeared to be similarly effective on standardized measures of body function/activity. However, these measures do not assess the transfer of skills to complex real world situations.
●Group versus individual therapy – For children with DCD in whom the cost of individual occupational and physical therapy is a concern, small group (eg, four to six children) therapy may be an option. In a systematic review of randomized and observational studies, improvements in motor performance were achieved in individual therapy and group therapy in small groups (eg, four to six children) [23]. Small group therapy also may help children with DCD improve their ability to address peer problems.
●Caregiver or teacher-directed therapy – Caregiver- and/or teacher-directed therapy has been effective in improving motor skills in some observational studies [39]. However, additional studies are necessary before caregiver- or teacher-administered therapy can be considered an alternative to therapy directed by an occupational or physical therapist.
Specific skills
Handwriting — Among children with DCD, handwriting is a particular problem and frequent reason for referral to occupational therapy [1]. Activity-oriented interventions to address handwriting may be beneficial in improving handwriting skills [40-42]. They may be used in addition to supports provided at school to circumvent handwriting difficulties. (See 'School supports' above.)
Activity-oriented training in keyboard and tablet skills and/or assistive technology consultation may be beneficial [1].
Bicycle riding — One of the most disabling things for a child with DCD can be the inability to ride a bike. Although inability to ride a bike does not impact school performance specifically, it may significantly limit socialization in some communities. Caregivers can be encouraged to seek specific therapy to acquire bike skills in middle childhood to avoid social isolation. Such therapy may be provided through school-based or community-based physical therapy.
Other interventions
●Organized programs for motor and social skills training – Children with DCD may benefit from organized programs to improve motor and social skills [43]. As an example, the "Animal Fun" program, which is delivered by teachers, is designed to promote motor and social skills through the imitation of animal movements and behaviors [44]. In randomized trials, children age 4 to 6 years with DCD who attended schools randomly assigned to the Animal Fun intervention improved motor skills and prosocial behavior compared with controls [45-48]. Additional studies are necessary before this program can be routinely recommended for children with DCD.
●Active video games – Training through active video games may improve balance and some functional tasks (eg, using stairs, getting up from chair) [23,24,49-55], but whether such training transfers to real world performance is uncertain. Small studies demonstrate that active video games improve general motor skills and fitness [1,23,55,56].
UNPROVEN INTERVENTIONS
Fatty acid supplementation — We do not suggest dietary supplementation with omega-3 and omega-6 fatty acids for DCD. Evidence is insufficient that it improves motor function [1].
Pharmacotherapy — Pharmacotherapy is not indicated for children with DCD unless they have a coexisting condition that requires pharmacotherapy. The effectiveness of pharmacotherapy for the treatment of DCD has not been systematically evaluated [1].
Other unproven interventions — Neither sensory integration therapy nor kinesthetic (ie, proprioception) sensitivity training have been conclusively proven to be beneficial for children with DCD [1].
OUTCOME —
The motor deficits of DCD usually persist into adulthood and can be associated with significant difficulties in adjustment [1,57-63]. In prospective studies, motor deficits that persist into adolescence or adulthood are associated with increased academic, emotional, and behavioral problems [57,64-68].
Children with DCD are less physically active than their typically developing peers [1,69], largely because of their decreased sense of self-efficacy [70,71]. The decrease in physical activity has been associated with increased risk factors for atherosclerotic disease, including increased body fat and decreased cardiorespiratory fitness [69,72-75]. However, studies evaluating the association between DCD and atherosclerosis are lacking.
These children have higher rates of mental health difficulties in young adulthood compared with their neurotypical peers [76-79]. Adults with DCD are at increased risk for unemployment, which is an additional risk factor for poor physical and mental health outcomes [76,80]. In an observational study, adults with a diagnosis of DCD or suspected DCD who were unemployed reported lower life satisfaction and higher levels of anxiety and depression than those who were employed [80].
Upon entry into adolescence and early adulthood, children who have comorbid ADHD are more severely affected by mental health disorders compared with same-aged peers with only a diagnosis of DCD [61]. When followed to the age of 22 years, individuals with DCD and ADHD were more likely than same-aged peers without either diagnosis to have alcohol use disorder (24 versus 4 percent), meet criteria for a personality disorder (33 versus 7 percent), or have a record of criminal offense (19 versus 0 percent) [81,82]. Individuals with DCD and ADHD attained lower levels of academic achievement, with only 2 percent attending a four-year college compared with 15 percent of controls. Groups with ADHD alone and DCD alone were too small for reliable comparison with those with ADHD and DCD. Similar differences in outcomes were found in a study that followed individuals to age 31 years [82].
SOCIETY GUIDELINE LINKS —
Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Developmental coordination disorder".)
SUMMARY AND RECOMMENDATIONS
●Terminology – Developmental coordination disorder (DCD) is characterized by problems with motor coordination that interfere with function in academics, social integration, or recreation and are not related to other medical or psychosocial conditions. (See 'Terminology' above.)
●Management principles – DCD is a heterogeneous disorder and requires an individualized approach to management. Additional guiding principles include (see 'Guiding principles' above):
•Actively involving the child
•Prioritizing functional skills that are relevant to everyday activities and important to the child and child's caregivers
•Teaching specific skills that can be generalized or transferred to other activities, including accommodations for home and school
•Involving multiple individuals in the treatment plan (eg, caregivers, teachers)
•Addressing physical fitness
•Planning for transitions that are associated with new difficulties (eg, from primary to secondary school)
●Supportive care and associated conditions – Children with DCD and associated conditions should receive supportive care and treatment of the associated condition. Treatment of the associated condition may facilitate treatment of DCD. (See 'Treatment of associated conditions' above.)
Supportive care includes (see 'Supportive care' above):
•Education of the child and caregivers about DCD
•Implementation of support at school to circumvent difficulties in handwriting, physical education, and other school-related activities
•Considering characteristics of the child, coach(es), sport, and level of competition when making decisions about organized sports participation
•Interventions to foster the child's self-esteem
●Interventions to improve function – For children diagnosed with DCD, we prefer occupational and physical therapy rather than no intervention. However, there is insufficient evidence to conclude that intervention with occupational or physical therapy is more beneficial than no intervention. (See 'Therapy recommendations' above.)
For children with DCD who receive occupational or physical therapy, we prefer activity- and/or participation-oriented interventions with or without body function-oriented approaches rather than body function-oriented interventions alone. However, there is insufficient evidence to conclude that one modality is superior to the other. (See 'Occupational and physical therapy' above.)
●Outcome – The motor deficits of DCD usually persist into adulthood. Children with DCD are more likely than their peers to have internalizing symptoms, obesity, and poor physical fitness because of reluctance to engage in physical activity. (See 'Outcome' above.)
