Recognizing and Referring Children with Developmental Coordination Disorder: Role of the Speech Language Pathologist
Speech-language pathologists often receive referrals for young children who are demonstrating early delays in speech and/or language development. Many of these children also have motor coordination difficulties that, although not immediately evident, can be detected, if one knows what to look for.
Recently, increased attention is being given to the motor difficulties of children who used to be labeled “clumsy” or “physically awkward” but who are now recognized as having Developmental Coordination Disorder (DCD). In the past, these children received little attention because many believed that they would overcome their difficulties with time. We now know that children’s motor coordination difficulties affect their ability to participate in everyday activities at home, at school and in the community and may impact significantly on their physical, social and emotional well-being.
Research has demonstrated that approximately half of the children who present with “specific” speech/language impairments may also have DCD. There are strong theoretical reasons to believe that the underlying mechanism of both disorders may be shared. It is important for speech-language pathologists to learn to recognize characteristic signs and behaviors of children with DCD in order to enable early identification and appropriate intervention.
You may observe that children look awkward, that they squirm around because they have trouble maintaining a stable position, or that their hands don’t seem to work together efficiently. More often, however, you may notice that you are “helping” children with coordination problems more than is necessary for their age. Do you find yourself pushing in the child’s chair, stabilizing paper or objects for them, cueing and assisting them to complete a very basic task? Becoming familiar with the expectations for typical children may help you to recognize when children are delayed in their ability to manage self-care activities such as dressing, feeding or to perform pre-academic skills such as cutting and printing.
If a child demonstrates uncoordinated movements and motor abilities below those expected for their age, they may have Developmental Coordination Disorder (DCD). This flyer will help you recognize children at risk for DCD and determine the need for referral to other service providers for further evaluation.
Recognizing Children with Developmental Coordination Disorder (DCD)
Described by those around them as being clumsy, children presenting with the characteristics of DCD are often referred to as “motor delayed.” You might hear or observe that these children have difficulty with skipping, hopping, jumping, and balancing. Handwriting, printing, copying, cutting and other fine motor tasks also present challenges. Children with DCD usually also have difficulty with zippers, snaps, buttons, tying shoelaces, throwing and catching balls, learning to ride a bicycle. Organizational skills might be less well developed than their peers. Motor skills require effort so children with DCD are often slow to complete tasks at school and may appear inattentive. Children with DCD usually begin to withdraw from and avoid motor and sports activities at an early age. They often seem verbally advanced but immature socially and might have behavioural or emotional problems.
Definition: Developmental Coordination Disorder is a an impairment in the development of motor coordination which significantly interferes with academic achievement and activities of daily living. Developmental Coordination Disorder may exist in isolation OR may co-occur with other conditions such as learning disabilities or attention deficit disorder.
A) Learning and execution of coordinated motor skills is below expected level for age, given opportunity for skill learning.
B) Motor skill difficulties significantly interfere with activities of daily living and impact academic/school productivity, prevocational and vocational activities, leisure and play.
(American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.)
C) Onset is in the early developmental period.
D) Motor skill difficulties are not better explained by intellectual delay, visual impairment or other neurological conditions that affect movement.
Note: Criterion D require the involvement of a family practitioner or developmental pediatrician to rule out other explanations for the clumsiness. In many states and provinces, only a medical doctor or a psychologist is permitted to make this diagnosis.
of the school-aged population, more common in boys, has Developmental Coordination Disorder.
Associated Disorders: Phonological Disorder, Expressive Language Disorder, Mixed Receptive-Expressive Language Disorder
For more information about identifying children with DCD, please see:
Missiuna, C., Gaines, R., & Pollock, N. (2002). Recognizing and referring children at risk for developmental coordination disorder: Role of the speech language pathologist. Journal of Speech Language Pathology and Audiology. 26, 172-179.
Characteristic Features of Children with Developmental Coordination Disorder:
- Clumsiness and/or incoordination
- Handwriting / printing / copying difficulties
- Difficulty finishing academic tasks on time
- Require extra effort and attention when tasks have a motor component
- Difficulty with activities of daily living (e.g., dressing, feeding, grooming)
- Difficulty with sports and on the playground (last to “get picked” for teams)
- Difficulty learning new motor skills
- Difficulty with, or reduced interest in, physical activities
If you suspect that a child is demonstrating the characteristics of DCD, you may want to ask parents about developmental concerns in other domains (fine motor, self-care). It will be important to inquire as to whether or not there are difficulties at home or at school. Is the child having trouble with buttons, using eating utensils or tying shoelaces? Are fine motor activities such as printing, cutting, or completing puzzles difficult for the child? Does the child have to exert a lot of effort to complete motor tasks? Do parents find themselves assisting the child with self-care activities, more than they believe that they should?
If your observations and parental report are consistent with the characteristics outlined above, you may consider making a referral to an occupational therapist. A child with DCD may also be referred to a physiotherapist with gross motor concerns. It is probable that a child with DCD will experience delays in fine motor and/or self-care skill acquisition that may not have been identified before this.
You should also consider encouraging the family to be seen by their family physician. It is important that a medical practitioner rule out other conditions that might explain the poor motor coordination.
Resource to Share with Parents
When Your Child is Having Motor or Self-Care Difficulties ...
Some children who have speech and/or language difficulties also have trouble performing some motor activities. They may have trouble coordinating their movements to run, skip or jump. They may experience frustration at learning to ride a tricycle or to catch a ball. Others may have difficulty managing to eat neatly with a spoon or fork, learning to print their name or use scissors, doing up buttons and zippers or learning to tie their shoelaces.
You may have some concerns about your child’s ability to perform some or all of these motor activities. Your child has now been seen by a speech-language pathologist and he or she thinks that there is a reason for your child to also be seen by an occupational therapist or a physical therapist. Both occupational and physical therapists work with children who have a variety of movement and coordination problems that impact on their ability to perform well at school, at home and on the playground. Some children who have the types of motor problems described above may have developmental coordination disorder. If your child is struggling with self-care or early academic tasks, he or she will likely benefit from a referral to an occupational therapist.
What can an occupational therapist do?
An occupational therapist will:
- Provide a thorough assessment of your child’s developmental skills
- Determine how different aspects of your child’s daily life are affected
- Teach your child ways of thinking his/her way through learning new tasks
- Provide adapted equipment and materials to improve task performance
- Help you and your child to set appropriate expectations
- Modify environmental factors to maximize participation
- Guide you in your selection of leisure activities for success
- Help you, your child and others to maximize his/her strengths
How do I find an occupational therapist or physical therapist in my area?
Your child’s speech-language pathologist can help you find and make a referral to an occupational or physical therapist. It may also be a good idea for your child to be seen by your family physician or pediatrician. Your doctor will be able to assist the occupational therapist and physical therapist in determining the possible reasons for your child’s motor difficulties.
Cheryl Missiuna, PhD, OTReg (Ont)
Professor and Investigator
School of Rehabilitation Science and CanChild
McMaster University, Hamilton, Ontario
B. Robin Gaines, PhD, CCC-SLP, CASLPO
Clinician and Researcher
Children's Hospital of Eastern Ontario
and University of Ottawa, Ottawa, Ontario