Physical Therapist's Guide to
Developmental Coordination Disorder
Developmental Coordination Disorder (DCD) affects approximately 5% to 6% of school-aged children. More than 1 million children in the United States are currently affected by the disorder. Children with DCD have difficulty performing everyday activities, such as riding a bicycle, playing sports, or skipping, running, or jumping. Their hand skills are frequently affected as well; children with DCD may have poor handwriting, have difficulty using hand-held objects like crayons or scissors, and take longer to accomplish school tasks. They often exert extra effort to perform tasks that are easy for other children to do, but they may think of themselves as lazy, clumsy, or awkward.
What is Developmental Coordination Disorder?
Developmental Coordination Disorder (DCD) is a movement (motor) skill (or neuro-developmental) disorder unrelated to physical disorders such as cerebral palsy, or to intelligence disorders. Coordination in children with DCD is markedly below expected levels for the child's age and intellect, and these movement problems significantly interfere with school performance and everyday living activities. These children do not have a general medical condition or a pervasive developmental disorder, such as those diagnosed with autism.
DCD affects areas of the brain that learn or "remember" movement. As a result, each motor task may seem new to the child, regardless of how many times it is repeated. Movements do not become automatic or feel normal or typical to the child. Children with DCD might have difficulty imitating movements or learning new motor skills.
Boys are diagnosed with DCD slightly more often than girls. Children with DCD also may have other separate conditions, such as attention deficit hyperactivity disorder (ADHD); speech/language impairments; or self-esteem, behavioral, and social/emotional difficulties. Children with DCD often develop poor health, poor fitness, obesity, and heart disease due to inactivity.
DCD continues throughout a person's lifespan. However, children and adolescents can improve their condition with the help of physical therapists and other health care professionals. Children with DCD can also learn to use new movement strategies and, with guidance, can identify leisure, recreational, and occupational activities that lead to a more positive and fulfilling lifestyle.
How Does it Feel?
A child with DCD feels that the body (arms and legs) will not move correctly. The child wants to throw a ball, ride a bike, or play a sport, but the body doesn't remember how to perform the necessary actions. Children with DCD may be called "clumsy" or "awkward." When they make a mistake in performing a task that includes several stages, they will start over again rather than repeat the most recent step. A child with DCD may develop low self-esteem and may demonstrate reluctance to participate in activities with other children.
Signs and Symptoms
Frequently, parents identify signs and symptoms of DCD before anyone else. They are concerned that their child is delayed in movement skills such as sitting alone or learning to walk and report these concerns to a health professional. However, signs and symptoms of DCD may not become apparent until school age when a child cannot play at recess in the same way as other children or takes too long to complete schoolwork. Children with DCD may be unable to skip, run, jump, or hop on one foot. They take a long time to get dressed, cannot use hand-held objects such as scissors or pencils, and are unable to throw or catch a ball accurately. Children with DCD can have difficulty following directions for movement that involve more than one step. In addition, they can have limited awareness of where their bodies are in space. They show a lack of interest in playing with other children, and they may express feelings of low self-esteem.
How Can a Physical Therapist Help?
The child's physical therapist will perform an evaluation that includes:
- Taking a history, asking questions about the mother's pregnancy and the child's birth and developmental stages (the age the child sat up, crawled, walked, etc), the general health of the child, and the parents' concerns
- Performing an examination that may include measuring height and weight; observing the child's movement patterns; making a hands-on assessment of muscle strength, tone, and flexibility; and testing the child's balance
- Performing specific tests to determine motor development such as skipping, walking on a straight line, or a balance beam
- Possible screening of hand use, vision, language skills, intellect, and other areas of development
- Referring the family and child to other health care professionals who can participate in a team effort to address the child's needs
Physical therapists work with children with DCD to improve muscle strength, coordination, and balance, and help them develop skills to improve their daily activities and quality of life.
- Improving strength. Your physical therapist will teach you and your child exercises to increase muscle strength. The therapist will identify games and fun tasks that improve strength, reduce obesity, and increase cardiac health.
- Improving balance. Your therapist may use equipment such as a balance beam to improve your child's one-foot standing, walking with one foot directly in front of the other foot, and jumping to the floor.
- Improving body awareness. Your physical therapist might have your child participate in obstacle courses to help your child with learning how to plan movement.
- Improving skills through task-oriented and task-specific learning. Your physical therapist may work individually with you or recommend a community program to help your child learn a specific task such as bike riding. The therapist may suggest adaptations, such as a 3-wheeled bike or training wheels, to keep your child safe while accomplishing a new skill.
Can this Injury or Condition be Prevented?
The exact cause of DCD is not known, but the disorder is associated with children who are born prematurely or have low birth weight. Sometimes changes in the brain can be seen on brain scans ordered by a physician. One area of the brain, the cerebellum, may be affected. However, the exact cause of DCD is often never known.
Excellent prenatal care is important for all pregnant women. Once a child is diagnosed with DCD, the physical therapist and other health care professionals can prevent some of the additional complications that might occur, such as poor posture, walking with the feet turned in or out, a delay in learning additional motor skills, low self-esteem caused by an inability to keep up with peers, and obesity or cardiac impairments caused by inactivity.
Real Life Experiences
Peter is a 9-year-old boy who has always been considered clumsy and awkward. He was born prematurely and was slow to learn to sit up, crawl, and walk. Peter is a messy eater, and he still needs guidance to take a bath, get dressed, and complete his homework in a timely fashion. He has asked to stop going to physical education classes at school because he cannot keep up with the other children, and his family is concerned about his recent weight gain. His parents have not sought physical therapy or other services at school, but they have decided to seek services over the summer break. They find a pediatric physical therapist who discusses Peter's movement problems with him and his family. The therapist examines Peter and confirms that he is experiencing developmental coordination problems. Over the summer, the therapist works with Peter and his family to add strengthening and balance activities to the games that the family participates in at home. The physical therapist also reminds Peter’s family that he might need to practice new skills many times in order to master them. Peter learns safe ways to use playground equipment. The family is encouraged to reduce "screen time" (sedentary time in front of a television, computer screen, or hand-held game device) and to increase family time with Peter playing interactive games that encourage active walking, running, and jumping movements.
Collaborating with the family, the therapist consults with community groups to support Peter's summer plans for an appropriate bike-riding training course and for a youth camp for children with developmental disorders, which includes activities like beginning dance and trampoline. The physical therapist offers to refer the family to other professionals to help Peter master tasks like dressing and eating. By the end of the summer, Peter is participating with children with similar challenges in a bike-riding program with an adapted bike. He can perform several specific movements on a trampoline under supervision, and he performs in a recital for beginner tap dancers. With the family's permission, the therapist plans to work with the school personnel when school begins in the fall to continue Peter's participation in selected school physical activities. As Peter ages, his health care team will help him learn to drive a car, make job choices, and transition to productive adulthood.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:
- A physical therapist who is experienced in pediatrics and developmental disorders. Some physical therapists have a pediatric practice and will work with you and your child in the home or in the school or community environment.
- A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in pediatric physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to developmental conditions.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping children with developmental disorders.
- During your first visit with the physical therapist, be prepared to describe your child's symptoms in as much detail as possible, and say what makes your child's coordination worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
APTA has determined that the following articles provide some of the best scientific evidence on Developmental Coordination Disorder. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free access of the full article, so that you can read it or print out a copy to bring with you to your health care provider.
Zwicker JG, Missiuna C, Harris SR, Boyd LA. Developmental coordination disorder: a review and update. Eur J Paediatr Neurol. 2012 June 14 [Epub ahead of print] Article Summary on PubMed.
Zwicker JG, Harris SR, Klassen AF. Quality of life domains affected in children with developmental coordination disorder: a systematic review. Child Care Health Dev. 2012 April 20 [Epub ahead of print]. Article Summary on PubMed.
Tal-Saban M, Zarka S, Grotto I, et al. The functional profile of young adults with suspected Developmental Coordination Disorder (DCD). Res Dev Disabil. 2012;33:2193–2202. Article Summary on PubMed.
Asonitou K, Koutsouki D, Kourtessis T, Charitou S. Motor and cognitive performance differences between children with and without developmental coordination disorder (DCD). Res Dev Disabil. 2012;33:996–1005. Article Summary on PubMed
US National Library of Medicine, PubMed Health. Developmental coordination disorder. Available here. Revised November 2, 2010. Accessed July 18, 2012.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.
Authored by Venita Lovelace-Chandler, PT, PhD, board-certified clinical specialist in pediatric physical therapy. Reviewed by the editorial board.