Is it "just" clumsiness?

The impact of Developmental Coordination Disorder on the health of young children – and what we can do about it

September 3, 2015

We all know (or remember) those kids who have trouble with their shoelaces, bump into desks, struggle with hand-eye coordination, and can't quite master handwriting. It can be a normal part of growing up, as some kids develop motor skills faster than others, but consistent problems with age-appropriate motor activities could be due to Development Coordination Disorder (DCD).

Children with DCD may appear to be "clumsy" or "awkward", and their difficulties with motor skills can get in the way of both school and play. Although the causes are unknown, the disorder affects 5-6% of school-aged children—which means, on average, that at least one child is affected in every classroom in Canada—and it shows up in boys more often than girls. Many uncoordinated kids have average or above-average intellectual abilities, and their difficulties with written work or in gym class can be major sources of frustration—so much so that they start to avoid certain tasks and activities altogether, including socializing with their peers.

When Dr. John Cairney from the Department of Family Medicine at McMaster University first learned about the disorder back in 2003, those social factors stood out to him the most. "I wondered about these children who had trouble playing with other children because they lacked the coordination to keep up," he explains. "That made me think about the developmental consequences. Play is so foundational to healthy development."

Shortly after Dr. Cairney developed an interest in DCD and began studying it, the impact of the disorder hit close to home. His nephew, who was very bright and engaged, was having trouble in school. "He struggled with printing and with physical tasks," recalls Dr. Cairney, who is now the Director of the Infant and Child Health Lab (INCH Lab) in Hamilton, Ontario. "It baffled people."

Common Characteristics of DCD:

  • Difficulty with gross motor skills (whole body) or fine motor skills (use of hands) or both
  • Delayed motor skill development and/or difficulty learning new motor skills
  • Difficulty with activities that require the coordinated use of both sides of the body (e.g., using a knife and fork) or adapting to a changing environment (e.g., playing baseball)
  • Low frustration tolerance, decreased self-esteem, and/or lack of motivation due to problems with everyday tasks

But Dr. Cairney recognized DCD—and getting a diagnosis is important, as it helps parents and educators identify what the problem really is and then find the right support. There is no medication or procedure that will correct DCD, but certain kinds of occupational therapy are essential. Occupational therapy can help people work through physical or health issues that interfere with everyday activities, and an occupational therapist with the proper training can provide strategies to help the child get better at performing troublesome tasks. Cognitive Orientation to Occupational Performance (or CO-OP), in particular, can lead to positive results. With the CO-OP approach, an occupational therapist focuses on teaching the child how to use cognitive strategies to improve task performance. The child chooses the goals, such as learning to jump rope or ride a bike, and then learns to analyze which part of the activity causes them to get stuck and how to adjust their body positions accordingly.


Sara and Yao, PhD students in the INCH Lab, watch a child on the stationary bike. Riding the bike is one of the activities that children perform in the lab as part of the Coordination and Activity Tracking in Children (CATCH) study, which tracks their motor coordination and physical fitness over time. (Photo credit: INCH Lab).

Contrary to popular belief, children with DCD will not "outgrow" their problems and catch up to their peers. Studies have shown that difficulties learning new motor skills will persist into adolescence and adulthood, so it's important to find the right interventions. In fact, research also shows that the problems aren't just physical: academic, social and emotional issues often develop if these children don't receive the help that they need.

One of Dr. Cairney's primary concerns with DCD is physical fitness. Children with motor coordination difficulties are more likely to be overweight and unfit by the time they become teenagers, so it's important to find physical activities that suit their abilities. "If they are not adequately supported, they may withdraw from physical activity," he explains, "and we know that there are serious health consequences to being less physically active."

In the INCH Lab, Dr. Cairney is currently conducting a CIHR-funded study, called the Coordination and Activity Tracking in Children (CATCH) study, to track the motor coordination and physical fitness of children over time. Participants visit the lab to go through a set of games and activities that allow Dr. Cairney's team to measure balance, manual dexterity, coordination, and physical fitness. "The kids are just playing, but we're learning through the play," he says. Through the study, which is one of the largest studies focusing on DCD in the world, Dr. Cairney hopes to uncover the best ways to help these children stay fit and healthy.

Our understanding and recognition of DCD has come a long way, but Dr. Cairney notes that lots of research questions remain—including ones about the right intervention for each child. "No two children with DCD are affected in exactly the same way," he explains, as each child can experience a different combination of difficulties. "We also want to understand the link with depression and anxiety, which often co-occur in children with DCD. Is the link neurological? Is it based on the experiences these kids face? Is it genetic? We want to know so that we can help."

A family doctor or pediatrician needs to rule out other potential causes of motor problems—such as other physical, neurological, or behavioural disorders—in order to make a diagnosis of DCD. The disorder is usually identified and diagnosed after the age of 5, when motor difficulties noticeably interfere with the child's participation in school and on the playground.

For more information about DCD, including resources for parents and educators [ PDF (291 KB) - external link ], visit the Centre for Childhood Disability Research (CanChild) website.

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