Dyspraxia And Developmental Coordination Disorder: Are The Symptoms The Same?

Some neurodevelopmental disorders are associated with difficulty coordinating movement. Conditions like cerebral palsy or tic disorders can cause significant developmental challenges that often respond well to professional support. Another condition, developmental coordination disorder, can cause similar challenges. Below is a review of developmental coordination disorder, its similarities to dyspraxia, its symptoms, and its management. 

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Dyspraxia vs. developmental coordination disorder

When dyspraxia symptoms significantly interfere with a person’s ability to complete activities of daily living, they might meet the criteria for developmental coordination disorder. DCD is typically diagnosed in childhood when developmental delays begin to interfere with a child’s ability to complete necessary tasks, such as tying shoes. In the past, DCD was termed “clumsy child syndrome” due to the number of children who were referred for evaluation based on a lack of coordination.

Neurodevelopmental disorders

DCD falls within a group of conditions known as neurodevelopmental disorders. These disorders occur when the development of the nervous system is disrupted. Brain or spinal cord features do not develop correctly, eventually producing noticeable symptoms. Most neurodevelopmental disorders are diagnosed in childhood due to the developmental delays commonly associated with them. 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) recognizes six categories of neurodevelopmental disorders: 

• Intellectual disabilities 
• Communication disorders
• Autism spectrum disorder
• Attention-deficit hyperactivity disorder (ADHD) 
• Motor disorders
• Specific learning disorders

DCD falls within the motor disorder category, but neurodevelopmental disorders can often impact brain function. While a person might meet the criteria for a specific disorder, having one type of neurodevelopmental disorder increases the likelihood that they will experience impacts from another. 

Physical symptoms of developmental coordination disorder

DCD is primarily concerned with motor difficulties and delayed acquisition of motor skills. Common symptoms include: 

• Poor balance and clumsiness
• Difficulty combining movements into a single sequence 
• Difficulty grasping objects like pencils and crayons 
• Clumsiness to the point of causing injury or breaking objects
• Difficulty learning basic movement patterns, such as those required for writing

Types of motor skills

Developmental coordination disorder affects two main groups of motor skills: gross and fine motor skills. Gross motor skills refer to whole-body movement and coordination, such as those required for walking, running, climbing, and jumping. Fine motor skills refer to the ability to use small movements effectively, such as when using cutlery, tying shoelaces, and cooking. 

DCD can affect fine and gross motor skills simultaneously, but not always in the same way. For example, a child may struggle to tie their shoes but demonstrate few challenges with whole-body movement. The physical difficulties associated with DCD are often challenging to quantify, and professional assessment is typically recommended to determine if movement problems amount to a clinical disorder. 

Cognitive symptoms of developmental coordination disorder

While DCD is primarily characterized by challenges associated with intentional movement, evidence suggests that the condition is also associated with cognitive dysfunctions. Those diagnosed with DCD are more likely to demonstrate deficits in executive function, behavioral control, and emotional regulation. The deficits are likely related to DCD and independent of a mental health condition or other disorder. 

Emerging research suggests that working memory is often impacted in those with DCD, frequently appearing as short-term memory deficits. Those with DCD often have problems remembering steps in a sequence, organizing their time, and keeping track of objects. Comorbid conditions are also common; evidence indicates that DCD is associated with a higher rate of specific learning difficulties and mental disorders like ADHD (in 75% of people with DCD). 

Diagnosing developmental coordination disorder

A medical or mental health professional must diagnose DCD. Diagnosis typically occurs in childhood, often when caregivers notice developmental delays or motor coordination issues. In the United States, diagnosis is primarily guided by four criteria: 

1. Motor coordination is significantly reduced, although the child’s intelligence is within the typical range for their age
2. The child’s motor coordination difficulties interfere with their daily life
3. Another medical condition cannot explain the motor coordination difficulties 
4. If comorbidities are present, such as intellectual disability, motor coordination is still disproportionately affected

A thorough assessment usually includes a review of the child’s medical, social, developmental, family, and academic histories. Several other potential diagnoses, such as multiple sclerosis and cerebral palsy, must be ruled out for DCD to be diagnosed. Professionals often use standardized instruments like the Movement Assessment Battery for Children (Movement-ABC) and the Developmental Coordination Disorder Questionnaire (DCD-Q) to help separate DCD symptoms from those that other conditions could potentially explain. 

Although DCD is chiefly considered a physical disorder, professionals may also conduct cognitive assessments to determine the extent of neurodevelopmental impacts. DCD is often associated with learning difficulties and adverse mental health impacts, requiring a broad approach to diagnosing it. Typically, several sessions are required before a diagnosis can be reached. 

The challenges of identifying symptoms of a coordination disorder

One of the most significant challenges of diagnosing DCD and other neurodevelopmental disorders is the substantial overlap that can exist between conditions. For example, DCD is associated with difficulty staying organized and managing time, which are also common symptoms of ADHD. Similarly, those with ADHD are often clumsier than average and may have trouble with coordinated movement. 

Determining the most appropriate diagnosis can involve assessing each symptom's magnitude and impact on a person’s life. Because neurodevelopmental disorders are most often diagnosed in childhood, evaluating adverse effects can frequently be challenging, especially with young children. 

Disorder screening tests

There is no “gold standard” for diagnosing DCD. Professionals reach a conclusion using a combination of structured clinical interviews, rating scales, cognitive assessments, and practical skills assessments. Following diagnosis, screening instruments might help refine occupational or physical therapy goals. A professional like an occupational therapist can interpret assessment data to develop a management plan to help people with DCD learn skills and strategies for navigating their motor control problems. 

Commonly-associated disorders

DCD is associated with several comorbid disorders. Comorbid disorders are diagnosed when a person meets the criteria for a separate disorder and demonstrates symptoms that are not attributable to DCD. The most common comorbid condition associated with DCD is ADHD, with some studies suggesting that as many as 50% or more of people with ADHD meet the criteria for DCD and vice versa. Other common comorbid conditions include:

• Fetal alcohol spectrum disorder
• Specific learning disorder
• Nonverbal learning disorder
• Sensory processing disorder
• Visual processing disorders

A person with DCD is unlikely to have all the conditions listed above, but a diagnosis of DCD makes each of the above conditions more likely. 

How occupational therapy as a child helps motor skills

Most children diagnosed with DCD are referred for physical or occupational therapy. Therapy typically focuses on improving motor skills, coordination, and motor efficiency. Common interventions include neuromotor training and task-oriented activities. Behavioral reinforcement to help children stay motivated is also commonly included. Individual therapy programs are evidence-based, and most children demonstrate fundamental improvements in motor skills and daily functioning. 

Occupational therapy treats more than developmental coordination disorder

Another facet of occupational therapy focuses on learning new strategies and alternative ways to carry out tasks. Many interventions, such as using diaries to stay organized, become more relevant as children age. Those interventions can also be used to treat comorbid conditions associated with DCD, such as ADHD or communication disorders. 

Other treatments for the disorder

Physical and occupational therapy are often considered the most effective treatments for DCD, as medication cannot effectively treat DCD. While some promising neurological interventions using state-of-the-art technology are in development for some conditions, such as Parkinson’s disease, there are currently no solutions available for those with DCD. Currently, the most effective approaches are early assessment and diagnosis, occupational and physical therapy for a diagnosed child, and training to help caregivers support optimal development. 

Mental health support

Mental health support may be helpful for children diagnosed with DCD and their caregivers. Most people are diagnosed in childhood, and much of the treatment load falls upon parents and guardians. Children may benefit from behavioral therapy that helps them stay focused on improving their motor skills and building habits that support daily functioning. Caregivers might benefit from support from a professional to help them manage the mental load associated with raising a child with DCD. In addition, both caregivers and children may benefit from family therapy in addition to working with an occupational or physical therapist. 

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Online therapy options 

While therapy is often helpful for children and their families, not everyone can easily access support. Common barriers to therapy include high costs and substantial travel commitments. Insurance coverage for mental health care can vary considerably between carriers and locations, and not everyone can afford some of the costs of therapy, even with insurance. In many cases, online therapy through a platform like BetterHelp for adults or TeenCounseling for teens aged 13 to 19 can offer a cheaper alternative than in-person therapy. Online therapy also allows a person to attend sessions from home or another comfortable location, removing the commitment to travel to a physical office. 

While managing DCD often requires in-office visits with occupational or physical therapists, online therapy may help caregivers manage stressors associated with raising a child with the condition. Older children might also benefit from encouragement and mental health support from a mental health professional. Online therapists use the same evidence-based techniques as traditional therapists, having received the same training and education. In the early days of teletherapy, some professionals were concerned that it was less effective than in-person therapy. However, contemporary evidence suggests that, in most cases, online therapy is as effective as its in-person counterpart.