Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Developmental coordination disorder: Clinical features and diagnosis

S Sutton Hamilton, MD
Section Editors
Teresa K Duryea, MD
Carolyn Bridgemohan, MD
Deputy Editor
Mary M Torchia, MD


Motor skills are typically acquired in a continuous, progressive, orderly process [1]. Normal motor function requires the coordination of neurologic, physiologic, and biologic processes including proprioception, vestibular integration, strength, balance, coordination, dexterity, visual-motor ability, and visual ability. Individual and environmental factors, such as motivation, perseverance, opportunity for practice, and encouragement, also play a role. Problems in any of these areas can result in deficits in motor skills, or clumsiness.

Developmental coordination disorder (DCD) is characterized by problems with motor coordination that interfere with academic performance and social integration in otherwise healthy children [2-4]. These motor problems typically present in the early school years with difficulty performing simple motor tasks (eg, running, buttoning, or using scissors) and usually persist into adolescence and adulthood [5-7].

This topic review will discuss the etiology, clinical features, evaluation and diagnosis of DCD. The management and outcome of DCD are discussed separately. (See "Developmental coordination disorder: Management and outcome".)


In this topic, we will use the term "developmental coordination disorder" (DCD) to describe problems in motor coordination that interfere with academic performance and/or socialization. DCD is the preferred term in countries that use the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification [2]. Specific developmental disorder of motor functions (SDDMF) is preferred in countries in which the International Classification of Diseases, 10th revision (ICD-10) has legal status.

Other terms that have been used to describe this disorder include [2,8-10]:

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Sep 2017. | This topic last updated: Sep 08, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Lipkin PH. Motor development and dysfunction. In: Developmental-Behavioral Pediatrics, 4th, Carey WB, Crocker AC, Coleman WL et al (Eds), Saunders Elsevier, Philadelphia 2009. p.643.
  2. Blank R, Smits-Engelsman B, Polatajko H, et al. European Academy for Childhood Disability (EACD): recommendations on the definition, diagnosis and intervention of developmental coordination disorder (long version). Dev Med Child Neurol 2012; 54:54.
  3. American Psychiatric Association. Developmental coordination disorder. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA 2013. p.74.
  4. Leeds Consensus Statement (2006). Developmental Coordination Disorder as a Specific Learning Difficulty. Sugden, D. http://www.dcd-uk.org/index.html (Accessed on May 17, 2011).
  5. Losse A, Henderson SE, Elliman D, et al. Clumsiness in children--do they grow out of it? A 10-year follow-up study. Dev Med Child Neurol 1991; 33:55.
  6. Blondis TA, Snow JH, Roizen NJ, et al. Early maturation of motor-delayed children at school age. J Child Neurol 1993; 8:323.
  7. Cantell MH, Smyth MM, Ahonen TP. Clumsiness in adolescence: educational, motor, and social outcomes of motor delay detected at 5 years. Adapted Physical Activity Quarterly 1994; 11:115.
  8. Gubbay SS. The Clumsy Child: A Study of Developmental Aparaxia and Agnosic Ataxia, 1st ed, WB Saunders, Philadelphia 1975.
  9. Macnab JJ, Miller LT, Polatajko HJ. The search for subtypes of DCD: is cluster analysis the answer? Hum Mov Sci 2001; 20:49.
  10. Gibbs J, Appleton J, Appleton R. Dyspraxia or developmental coordination disorder? Unravelling the enigma. Arch Dis Child 2007; 92:534.
  11. Henderson SE, Hall D. Concomitants of clumsiness in young schoolchildren. Dev Med Child Neurol 1982; 24:448.
  12. Blondis TA. Motor disorders and attention-deficit/hyperactivity disorder. Pediatr Clin North Am 1999; 46:899.
  13. Willoughby C, Polatajko HJ. Motor problems in children with developmental coordination disorder: review of the literature. Am J Occup Ther 1995; 49:787.
  14. Kadesjö B, Gillberg C. Developmental coordination disorder in Swedish 7-year-old children. J Am Acad Child Adolesc Psychiatry 1999; 38:820.
  15. Smyth TR. Impaired motor skill (clumsiness) in otherwise normal children: a review. Child Care Health Dev 1992; 18:283.
  16. Harris SR, Mickelson EC, Zwicker JG. Diagnosis and management of developmental coordination disorder. CMAJ 2015; 187:659.
  17. Lingam R, Hunt L, Golding J, et al. Prevalence of developmental coordination disorder using the DSM-IV at 7 years of age: a UK population-based study. Pediatrics 2009; 123:e693.
  18. Faebo Larsen R, Hvas Mortensen L, Martinussen T, Nybo Andersen AM. Determinants of developmental coordination disorder in 7-year-old children: a study of children in the Danish National Birth Cohort. Dev Med Child Neurol 2013; 55:1016.
  19. Zwicker JG, Yoon SW, Mackay M, et al. Perinatal and neonatal predictors of developmental coordination disorder in very low birthweight children. Arch Dis Child 2013; 98:118.
  20. Zhu JL, Olsen J, Olesen AW. Risk for developmental coordination disorder correlates with gestational age at birth. Paediatr Perinat Epidemiol 2012; 26:572.
  21. Edwards J, Berube M, Erlandson K, et al. Developmental coordination disorder in school-aged children born very preterm and/or at very low birth weight: a systematic review. J Dev Behav Pediatr 2011; 32:678.
  22. Schmidt B, Roberts RS, Davis P, et al. Long-term effects of caffeine therapy for apnea of prematurity. N Engl J Med 2007; 357:1893.
  23. Doyle LW, Schmidt B, Anderson PJ, et al. Reduction in developmental coordination disorder with neonatal caffeine therapy. J Pediatr 2014; 165:356.
  24. Taft LT, Barowsky EI. Clumsy child. Pediatr Rev 1989; 10:247.
  25. Smyth MM, Mason UC. Planning and execution of action in children with and without developmental coordination disorder. J Child Psychol Psychiatry 1997; 38:1023.
  26. Smyth MM, Mason UC. Use of proprioception in normal and clumsy children. Dev Med Child Neurol 1998; 40:672.
  27. Sigmundsson H, Hansen PC, Talcott JB. Do 'clumsy' children have visual deficits. Behav Brain Res 2003; 139:123.
  28. Wilson PH, McKenzie BE. Information processing deficits associated with developmental coordination disorder: a meta-analysis of research findings. J Child Psychol Psychiatry 1998; 39:829.
  29. Goez H, Zelnik N. Handedness in patients with developmental coordination disorder. J Child Neurol 2008; 23:151.
  30. Cairney J, Schmidt LA, Veldhuizen S, et al. Left-handedness and developmental coordination disorder. Can J Psychiatry 2008; 53:696.
  31. Zwicker JG, Missiuna C, Harris SR, Boyd LA. Brain activation of children with developmental coordination disorder is different than peers. Pediatrics 2010; 126:e678.
  32. Brown-Lum M, Zwicker JG. Brain Imaging Increases Our Understanding of Developmental Coordination Disorder: a Review of Literature and Future Directions. Curr Dev Disord Rsp 2015; 3:131.
  33. Langevin LM, MacMaster FP, Dewey D. Distinct patterns of cortical thinning in concurrent motor and attention disorders. Dev Med Child Neurol 2015; 57:257.
  34. Williams J, Kashuk SR, Wilson PH, et al. White matter alterations in adults with probable developmental coordination disorder: an MRI diffusion tensor imaging study. Neuroreport 2017; 28:87.
  35. Reynolds JE, Licari MK, Reid SL, et al. Reduced relative volume in motor and attention regions in developmental coordination disorder: A voxel-based morphometry study. Int J Dev Neurosci 2017; 58:59.
  36. Langevin LM, Macmaster FP, Crawford S, et al. Common white matter microstructure alterations in pediatric motor and attention disorders. J Pediatr 2014; 164:1157.
  37. Biotteau M, Chaix Y, Blais M, et al. Neural Signature of DCD: A Critical Review of MRI Neuroimaging Studies. Front Neurol 2016; 7:227.
  38. Lichtenstein P, Carlström E, Råstam M, et al. The genetics of autism spectrum disorders and related neuropsychiatric disorders in childhood. Am J Psychiatry 2010; 167:1357.
  39. Mosca SJ, Langevin LM, Dewey D, et al. Copy-number variations are enriched for neurodevelopmental genes in children with developmental coordination disorder. J Med Genet 2016; 53:812.
  40. Summers J, Larkin D, Dewey D. Activities of daily living in children with developmental coordination disorder: dressing, personal hygiene, and eating skills. Hum Mov Sci 2008; 27:215.
  41. Prunty MM, Barnett AL, Wilmut K, Plumb MS. Handwriting speed in children with Developmental Coordination Disorder: are they really slower? Res Dev Disabil 2013; 34:2927.
  42. Skinner RA, Piek JP. Psychosocial implications of poor motor coordination in children and adolescents. Hum Mov Sci 2001; 20:73.
  43. Wegner LM. Gross Motor Dysfunction: Its Evaluation and Management. In: Developmental-Behavioral Pediatrics, 3rd, Levine MD, Carey WB (Eds), WB Saunders, Philadelphia 1999. p.452.
  44. Wilson BN, Kaplan BJ, Crawford SG, et al. Reliability and validity of a parent questionnaire on childhood motor skills. Am J Occup Ther 2000; 54:484.
  45. Cairney J, Hay JA, Faught BE, et al. Developmental coordination disorder, generalized self-efficacy toward physical activity, and participation in organized and free play activities. J Pediatr 2005; 147:515.
  46. Cairney J, Hay JA, Faught BE, Hawes R. Developmental coordination disorder and overweight and obesity in children aged 9-14 y. Int J Obes (Lond) 2005; 29:369.
  47. Dewey D, Kaplan BJ, Crawford SG, Wilson BN. Developmental coordination disorder: associated problems in attention, learning, and psychosocial adjustment. Hum Mov Sci 2002; 21:905.
  48. Lingam R, Golding J, Jongmans MJ, et al. The association between developmental coordination disorder and other developmental traits. Pediatrics 2010; 126:e1109.
  49. Pratt ML, Hill EL. Anxiety profiles in children with and without developmental coordination disorder. Res Dev Disabil 2011; 32:1253.
  50. Kirby A, Sugden D, Purcell C. Diagnosing developmental coordination disorders. Arch Dis Child 2014; 99:292.
  51. Schoemaker MM, Lingam R, Jongmans MJ, et al. Is severity of motor coordination difficulties related to co-morbidity in children at risk for developmental coordination disorder? Res Dev Disabil 2013; 34:3084.
  52. Kadesjö B, Gillberg C. Attention deficits and clumsiness in Swedish 7-year-old children. Dev Med Child Neurol 1998; 40:796.
  53. Goulardins JB, Rigoli D, Licari M, et al. Attention deficit hyperactivity disorder and developmental coordination disorder: Two separate disorders or do they share a common etiology. Behav Brain Res 2015; 292:484.
  54. Martin NC, Piek JP, Hay D. DCD and ADHD: a genetic study of their shared aetiology. Hum Mov Sci 2006; 25:110.
  55. Fliers E, Rommelse N, Vermeulen SH, et al. Motor coordination problems in children and adolescents with ADHD rated by parents and teachers: effects of age and gender. J Neural Transm (Vienna) 2008; 115:211.
  56. Leeds Consensus Statement (2006). Seminar 3 -- Characteristics and comorbidity. http://www.dcd-uk.org/seminar3.html.
  57. Green D, Charman T, Pickles A, et al. Impairment in movement skills of children with autistic spectrum disorders. Dev Med Child Neurol 2009; 51:311.
  58. American Psychiatric Association. Autism spectrum disorder. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA 2013. p.50.
  59. Gillberg C, Kadesjö B. Why bother about clumsiness? The implications of having developmental coordination disorder (DCD). Neural Plast 2003; 10:59.
  60. Emck C, Bosscher R, Beek P, Doreleijers T. Gross motor performance and self-perceived motor competence in children with emotional, behavioural, and pervasive developmental disorders: a review. Dev Med Child Neurol 2009; 51:501.
  61. Biancotto M, Skabar A, Bulgheroni M, et al. Neuromotor deficits in developmental coordination disorder: evidence from a reach-to-grasp task. Res Dev Disabil 2011; 32:1293.
  62. Mon-Williams MA, Wann JP, Pascal E. Visual-proprioceptive mapping in children with developmental coordination disorder. Dev Med Child Neurol 1999; 41:247.
  63. Rigoli D, Piek JP, Kane R, Oosterlaan J. An examination of the relationship between motor coordination and executive functions in adolescents. Dev Med Child Neurol 2012; 54:1025.
  64. Rahimi-Golkhandan S, Steenbergen B, Piek JP, Wilson PH. Deficits of hot executive function in developmental coordination disorder: sensitivity to positive social cues. Hum Mov Sci 2014; 38:209.
  65. Rahimi-Golkhandan S, Piek J, Steenbergen PH, Wilson PH. Hot executive function in children with developmental coordination disorder: Evidence for heightened sensitivity to immediate reward. Cogn Dev 2014; 32:23.
  66. Leonard HC, Bernardi M, Hill EL, Henry LA. Executive Functioning, Motor Difficulties, and Developmental Coordination Disorder. Dev Neuropsychol 2015; 40:201.
  67. Chen HF, Cohn ES. Social participation for children with developmental coordination disorder: conceptual, evaluation and intervention considerations. Phys Occup Ther Pediatr 2003; 23:61.
  68. Zwicker JG, Harris SR, Klassen AF. Quality of life domains affected in children with developmental coordination disorder: a systematic review. Child Care Health Dev 2013; 39:562.
  69. Bejerot S, Humble MB. Childhood clumsiness and peer victimization: a case-control study of psychiatric patients. BMC Psychiatry 2013; 13:68.
  70. Bejerot S, Edgar J, Humble MB. Poor performance in physical education - a risk factor for bully victimization. A case-control study. Acta Paediatr 2011; 100:413.
  71. Wagner MO, Bös K, Jascenoka J, et al. Peer problems mediate the relationship between developmental coordination disorder and behavioral problems in school-aged children. Res Dev Disabil 2012; 33:2072.
  72. Rigoli D, Piek JP, Kane R. Motor coordination and psychosocial correlates in a normative adolescent sample. Pediatrics 2012; 129:e892.
  73. Hill LJ, Mushtaq F, O'Neill L, et al. The relationship between manual coordination and mental health. Eur Child Adolesc Psychiatry 2016; 25:283.
  74. Harrowell I, Hollén L, Lingam R, Emond A. Mental health outcomes of developmental coordination disorder in late adolescence. Dev Med Child Neurol 2017; 59:973.
  75. Moruzzi S, Pesenti-Gritti P, Brescianini S, et al. Clumsiness and psychopathology: causation or shared etiology? A twin study with the CBCL 6-18 questionnaire in a general school-age population sample. Hum Mov Sci 2010; 29:326.
  76. Waszczuk MA, Leonard HC, Hill EL, et al. Coordination difficulty and internalizing symptoms in adults: A twin/sibling study. Psychiatry Res 2016; 239:1.
  77. Mancini VO, Rigoli D, Heritage B, et al. The Relationship between Motor Skills, Perceived Social Support, and Internalizing Problems in a Community Adolescent Sample. Front Psychol 2016; 7:543.
  78. Rigoli D, Kane RT, Mancini V, et al. The relationship between motor proficiency and mental health outcomes in young adults: A test of the Environmental Stress Hypothesis. Hum Mov Sci 2017; 53:16.
  79. Sigurdsson E, Van Os J, Fombonne E. Are impaired childhood motor skills a risk factor for adolescent anxiety? Results from the 1958 U.K. birth cohort and the National Child Development Study. Am J Psychiatry 2002; 159:1044.
  80. Lingam R, Jongmans MJ, Ellis M, et al. Mental health difficulties in children with developmental coordination disorder. Pediatrics 2012; 129:e882.
  81. Missiuna C, Cairney J, Pollock N, et al. Psychological distress in children with developmental coordination disorder and attention-deficit hyperactivity disorder. Res Dev Disabil 2014; 35:1198.
  82. Campbell WN, Missiuna C, Vaillancourt T. Peer victimization and depression in children with and without motor coordination difficulties. Psychol Sch 2012; 49:328.
  83. Bogart LM, Elliott MN, Klein DJ, et al. Peer victimization in fifth grade and health in tenth grade. Pediatrics 2014; 133:440.
  84. Copeland WE, Wolke D, Angold A, Costello EJ. Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry 2013; 70:419.
  85. Piek JP, Baynam GB, Barrett NC. The relationship between fine and gross motor ability, self-perceptions and self-worth in children and adolescents. Hum Mov Sci 2006; 25:65.
  86. Vedul-Kjelsås V, Sigmundsson H, Stensdotter AK, Haga M. The relationship between motor competence, physical fitness and self-perception in children. Child Care Health Dev 2012; 38:394.
  87. Rivilis I, Hay J, Cairney J, et al. Physical activity and fitness in children with developmental coordination disorder: a systematic review. Res Dev Disabil 2011; 32:894.
  88. Wrotniak BH, Epstein LH, Dorn JM, et al. The relationship between motor proficiency and physical activity in children. Pediatrics 2006; 118:e1758.
  89. Faught BE, Hay JA, Cairney J, Flouris A. Increased risk for coronary vascular disease in children with developmental coordination disorder. J Adolesc Health 2005; 37:376.
  90. Gueze RH, Jongmans MJ, Schoemaker MM, Smits-Engelsman BC. Clinical and research diagnostic criteria for developmental coordination disorder: a review and discussion. Hum Mov Sci 2001; 20:7.
  91. Noritz GH, Murphy NA, Neuromotor Screening Expert Panel. Motor delays: early identification and evaluation. Pediatrics 2013; 131:e2016.
  92. Levine MD. Developmental Variation and Learning Disorders, Educators Publishing Service, Inc, Cambridge, MA 1987.
  93. Casselbrant ML, Furman JM, Rubenstein E, Mandel EM. Effect of otitis media on the vestibular system in children. Ann Otol Rhinol Laryngol 1995; 104:620.
  94. Casselbrant ML, Redfern MS, Furman JM, et al. Visual-induced postural sway in children with and without otitis media. Ann Otol Rhinol Laryngol 1998; 107:401.
  95. Golz A, Angel-Yeger B, Parush S. Evaluation of balance disturbances in children with middle ear effusion. Int J Pediatr Otorhinolaryngol 1998; 43:21.
  96. Orlin MN, Effgen SK, Handler SD. Effect of otitis media with effusion on gross motor ability in preschool-aged children: preliminary findings. Pediatrics 1997; 99:334.
  97. Blondis TA. Developmental Coordination Disorder. In: Deficits and Hyperactivity in Children and Adults, Accardo PJ, Blondis TA, Whitman BY, Stein M (Eds), Marcel Dekker, New York 1999. p.265.
  98. Weintraub S, Mesulam MM. Developmental learning disabilities of the right hemisphere. Emotional, interpersonal, and cognitive components. Arch Neurol 1983; 40:463.
  99. Voeller KK. Clinical neurologic aspects of the right-hemisphere deficit syndrome. J Child Neurol 1995; 10 Suppl 1:S16.
  100. Johnston O, Crawford J, Short H, et al. Poor co-ordination in 5 year olds: a screening test for use in schools. Aust Paediatr J 1987; 23:157.
  101. Bax M, Whitmore K. Neurodevelopmental screening in the school-entrant medical examination. Lancet 1973; 2:368.
  102. Wilson B, Pollock N, Kaplan BJ, et al. Reliability and construct validity of the Clinical Observations of Motor and Postural Skills. Am J Occup Ther 1992; 46:775.
  103. The assessment of Developmental Coordination Disorder. In: Leeds Consensus Statement (2006). Developmental Coordination Disorder as a specific learning disability. http://www.dcd-uk.org/assessment.html (Accessed on September 23, 2010).
  104. Hendersen SE, Sugden DA. Movement assessment battery for children. The Psychological Corporation, 1992.
  105. Hay JA, Hawes R, Faught BE. Evaluation of a screening instrument for developmental coordination disorder. J Adolesc Health 2004; 34:308.
  106. Cairney J, Veldhuizen S, Kurdyak P, et al. Evaluating the CSAPPA subscales as potential screening instruments for developmental coordination disorder. Arch Dis Child 2007; 92:987.
  107. Jacobson RD. Approach to the child with weakness or clumsiness. Pediatr Clin North Am 1998; 45:145.
  108. Deuel RK. Developmental dysgraphia and motor skills disorders. J Child Neurol 1995; 10 Suppl 1:S6.
  109. Coster WJ, Haley S, Baryza MJ. Functional performance of young children after traumatic brain injury: a 6-month follow-up study. Am J Occup Ther 1994; 48:211.
  110. Consensus conference. Rehabilitation of persons with traumatic brain injury. NIH Consensus Development Panel on Rehabilitation of Persons With Traumatic Brain Injury. JAMA 1999; 282:974.
  111. Tsao CY. Guanine triphosphate-cyclohydrolase 1-deficient dopa-responsive dystonia presenting as frequent falling in 2 children. J Child Neurol 2012; 27:389.