What is DCD? 

DCD is a complex developmental motor disorder affecting at least 1.8 % of children aged 7–8 years in the general population and up to 6 % of children aged 5–11 years depending on case definition. 

DCD is defined by delays and deficits in the acquisition and execution of motor skills and is often associated with other developmental and psychiatric disorders such as specific learning disorder, specific language impairments and problems of inattention adding to the complexity of the disorder. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders: DSM 5.

Children with DCD are reported to have more difficulty than their peers in planning and executing activities of daily living, academic tasks and leisure activities. The impact of impaired motor functioning also has profound consequences for their social, psychological and cognitive development and these secondary problems are known to persist into adolescence and adulthood. 

Co-occurring conditions 

Children with DCD often have one or more co-occuring conditions which affect motor development, coordination and learning. ADHD has been found to be the most frequent co-occurring disorder with DCD. Several studies - mostly examining clinical samples - suggest a rate of 50% or higher.  A recent study also shows that DCD is present in about one third of children with Specific language impairment. 

Accumulating research and evidence from clinical practice shows children with DCD to be at increased risk of psycho-social problems that impact negatively on participation and longer term outcomes.  

Generalized joint hypermobility is a musculoskeletal condition in which the connective tissue is more pliable than usual. This affects joint and muscle function, and impacts blood vessel, bladder and bowel function. Children with joint hypermobility also tend to have a cautious nature which in turn affects motor learning and performance. Read more

Autism spectrum disorder (ASD): it is now recognized that difficulties with motor coordination and learning are a core feature of ASD. Read more

Intervention approaches

Children with DCD  usually need treatment. Indications for intervention are essentially dependent on the influence of the diagnosis on activities of everyday living (self-care, academic/school productivity, leisure, play and other daily physical activity).  The severity of motor impairment impacts not only the presentation of DCD but also participation, which has important implications for treatment. In school children, specific fine motor problems may be more relevant for school achievement than gross motor problems. Gross motor problems on the other hand seem to be important for participation in play, sport and leisure and development of social contact with peers.

Efficacy of interventions to improve motor performance in children with developmental coordination disorder: a combined systematic review and meta-analysis. "In general, intervention is shown to produce benefit for the motor performance of children with DCD, over and above no intervention. However, approaches from a task-oriented perspective yield stronger effects. Process-oriented approaches are not recommended for improving motor performance in DCD, whereas the evidence for chemical supplements for children with DCD is currently insufficient for a recommendation." PDF

Since the publication of the first version of the DCD guideline new reviews and meta-analysis were published. Lucas et al., 2016 found that some interventions with a task oriented framework improved gross motor outcomes in DCD and CP. Offor et al. 2016, concluded that task oriented approaches (Neuromotor Task Training) and motor training programs from traditional and contemporary Physical Therapy frameworks are beneficial for children with DCD. Interventions based on Physical Therapy motor skills training and NTT are effective for gross motor problems. NTT is also effective for fine motor problems. Together this gives enough evidence for a level A recommendation for  task specific training, like Neuromotor Task Training (NTT). 

Mandatory characteristics of up to date task oriented approaches interventions are:

1.    Client oriented (meaningful for the client)

2.    Goal oriented: Aiming at activities and participation as described ICF-CY

3.    Task and context specific (what is to be learned, and for which circumstances)

4.    Active role of the client

5.    Aiming at functionality not at normality

6.    Active involvement of parent(s)/caretakers to enable transfer.

Neuromotor Task Training:  Neuromotor Task Training (NTT) is a context and task based and constraints-led approach to intervention for children with developmental movement conditions.  NTT is based on the understanding that a child's ability to successfully achieve a desired  movement goal resides in the interaction between the child, the task and the social and physical environment (C-T-E).  

CO-OP:  Cognitive Orientation to daily Occupational Performance (CO-OP) is a therapeutic treatment approach for people (children and adults) who have difficulties performing everyday skills. CO-OP is an active iterative client-centered meta-cognitive approach that employs collaborative goal setting, dynamic performance analysis, cognitive strategy use, enabling principles and guided discovery to promote skill acquisition, generalization and transfer. Read more