Child and Adult Developmental Co-ordination Disorder (DCD), also known as Dyspraxia in Ireland  and the UK, is a common disorder affecting fine or gross motor co-ordination in children and adults. This condition is formally recognised by international organisations including the World Health Organisation. DCD is distinct from other motor disorders such as cerebral palsy and stroke. The range of intellectual ability is in line with the general population. Individuals may vary in how their difficulties present; these may change over time depending on environmental demands and life experience, and will persist into adulthood. An individual’s co-ordination difficulties may affect participation and functioning of everyday life skills in education, work and employment.

Children may present with difficulties with self-care, writing, typing, riding a bike and play as well as other educational and recreational activities. Many of these difficulties will continue on into adulthood while they also struggle with learning some independent living skills, driving a car and managing education and employment. There may be a range of co-occurring difficulties which can also have serious negative impacts on daily life, these include social emotional difficulties, challenges with planning and organisation, as well as problems with time management, all of which may impact an adult's education or employment experience.

The term ‘dyspraxia’ is used in many different ways by different people, which can cause confusion. Some use it interchangeably with ‘DCD’ to mean the same thing. Others use it to refer to something quite different. Unlike DCD, there is no internationally agreed formal definition or description of the term ‘dyspraxia’ and it is not included in DSM-5. Despite this, in Ireland and the UK the term ‘dyspraxia’ is sometimes used in a very broad way to refer to children who have motor difficulties plus difficulties with: speech,organisation, planning, sequencing, working memory and various other psychological, emotional and social problems. However, there is little research evidence to support such a broad diagnostic category.

Developmental Coordination Disorder (DCD) is the term used in DSM-5 to refer to a condition in which an individual has severe difficulties in learning everyday motor skills, which cannot be explained by physical,sensory or intellectual impairment. The main features of this condition are clearly described in DSM-5.  The term ‘dyspraxia’ is used in many different ways by different people, which can cause confusion. Some use it interchangeably with ‘DCD’ to mean the same thing. Others use it to refer to something quite different. Unlike DCD, there is no internationally agreed formal definition of the term ‘dyspraxia’, and it is not included in DSM-5.

• Motor coordination difficulties impact on daily functioning and / or academic ability
• Not due to a learning disability
• Not due to an underlying medical disorder
• Not associated with Autistic Spectrum Disorder or other syndromes

Movement clumsiness has gained increasing recognition as an important condition of childhood; however, its diagnosis is uncertain. Approaches to assessment and treatment vary depending on theoretical assumptions about etiology and its developmental course.

Over the past century, many terms have been used to describe children with clumsy motor behavior. The wide variation in labeling has depended to a large extent on cultural or professional backgrounds. For example, medical professionals use medical terms (eg, clumsy child syndrome or minimal brain dysfunction), whereas educational professionals use educational terms (eg, poorly coordinated children, movement-skill problems, or physical awkwardness).

In addition, the various labels used have embodied assumptions about the etiology. Examples include developmental dyspraxia (which suggests underlying difficulties in motor planning), perceptual motor difficulties (which suggests problems in perceptual motor integration), minor neurologic dysfunction (MND), and sensory integrative dysfunction.

In response to the confusing and counterproductive heterogeneity of the labels, participants at an international multidisciplinary consensus meeting in 1994 agreed to use the term developmental coordination disorder (DCD), as described in theDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).[1]In 2013, the diagnostic criteria were further refined with the publication of theDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).[2]

The currently available data are insufficient to permit clear definition of the parameters of motor coordination difficulties in children. Various grades of severity and comorbidity seem to exist. Some children have only a relatively minor form of motor dyscoordination, whereas others have associated learning disabilities, attention deficit, and other difficulties.

In 1996, Fox and Lent reported that in contrast to the common belief that children grow out of motor coordination difficulties, such difficulties in fact tend to linger if no intervention takes place.[3] Intervention can be beneficial if initiated during the first years of life, while the brain is changing dramatically and new connections and abilities are being acquired.

Children with multiple conditions are at greatest risk for developing behavioral difficulties over time. Some evidence supports dividing DCD into subtypes on the basis of main features, such as ability to manipulate objects, speed of movement, ability to catch objects (eg, balls thrown, struck, or kicked during sports activities), or writing ability.

A discussion about including DCD, as currently defined, into the cerebral palsy category was held.[4] This inclusion would put DCD on the low end of the continuum of neuromotor disabilities, also described as minimal cerebral palsy, and result in a 20-fold increased incidence.[5]

Diagnostic criteria (DSM-5)

DSM-5 classifies DCD as a discrete motor disorder under the broader heading of neurodevelopmental disorders.[2] The specific DSM-5 criteria for DCD are as follows:

• Acquisition and execution of coordinated motor skills are below what would be expected at a given chronologic age and opportunity for skill learning and use; difficulties are manifested as clumsiness (eg, dropping or bumping into objects) and as slowness and inaccuracy of performance of motor skills (eg, catching an object, using scissors, handwriting, riding a bike, or participating in sports)
• The motor skills deficit significantly or persistently interferes with activities of daily living appropriate to the chronologic age (eg, self-care and self-maintenance) and impacts academic/school productivity, prevocational and vocational activities, leisure, and play
• The onset of symptoms is in the early developmental period
• The motor skills deficits cannot be better explained by intellectual disability or visual impairment and are not attributable to a neurologic condition affecting movement (eg, cerebral palsy, muscular dystrophy, or a degenerative disorder)

The child with Dyspraxia/DCD may have a combination of several problems in varying degrees. These include:

• Poor balance
• Poor fine and gross motor co-ordination
• Poor posture
• Difficulty with throwing and catching a ball
• Poor awareness of body position in space
• Poor sense of direction
• Difficulty in hopping, skipping or riding a bike
• Sensitive to touch
• Confused about which hand to use
• Intolerance of having hair or teeth brushed, nails and hair cut
• Slow to learn to dress or feed themselves
• Find some clothes uncomfortable
• Difficulty with reading, writing
• Speech problems - slow to learn to speak and speech may be incoherent.
• Phobias or obsessive behavior and impatient

Children with Dyspraxia/DCD can be of average or above average intelligence but are often behaviorally immature. They try hard to fit in to socially accepted behavior when at school but often throw tantrums when at home. They may find it difficult to understand logic and reason.

Not all children with Dyspraxia/DCD have all these problems. Many parents will say that their children have some of these problems, but if your child has dyspraxia, either diagnosed or not, you may have observed a cluster of these difficulties.

There is no cure for Dyspraxia/DCD, but the earlier a child is treated, the greater the chance of improvement will be.  A lot of the skills that we take for granted will never become automatic for children with Dyspraxia/DCD, so they will have to be taught these skills. Occupational therapists, physiotherapists, and extra help at school can all assist these children with coping or overcoming many of the difficulties they face.

Dyspraxia/DCD is also known by other names including:

• Clumsy Child Syndrome
• Motor Learning Problems
• Sensory Processing Disorder

• Interest since mid 1960
• Prevalence 6% of 5 to 12 year olds
• 3:1 Boys:Girls
• High co-morbidity with other disorders e.g. ADD/ ADHD – 40%
• Children do not grow out of this disorder
• Currently no biological explanation for Dyspraxia/DCD.

Secondary difficulties:

• Self esteem
• Low self confidence
• Mental health issues
• Social difficulties
• Specific Learning Difficulties