Developmental co-ordination disorder (dyspraxia)

Developmental co-ordination disorder (DCD), also known as dyspraxia, is a condition affecting physical co-ordination. It causes a child to perform less well than expected in daily activities for their age. These difficulties significantly effect everyday skills that involve coordination such as in play, leisure, school and self care skills (such as dressing). This condition is not due any medical cause or by other conditions that effect coordination such as intellectual disability, visual impairment, neurological conditions (e.g., cerebral palsy) or other general medical conditions.

DCD is a lifelong condition. It is thought to affect 2-5% of children in the UK. DCD can make it difficult for people to carry out everyday activities that others manage easily such as using cutlery, handwriting, riding a bike and kicking a ball. DCD effects people in different ways during their lives. All children have unique strengths, interests and needs. No two children with DCD are the same.

This YouTube video by the DCD project helps to explain what it is.

Dyspraxia or DCD?

While many people in the UK use the term dyspraxia to refer to the difficulties with movement and co-ordination that first develop in young children, this term is used less often by healthcare professionals. Instead, most healthcare professionals use the term developmental co-ordination disorder (DCD) to describe the condition.

What causes DCD?

There is currently no known cause for DCD. It is not caused by any illness, injury or a medical cause. It is something you are born with and is lifelong condition. There is no test for DCD but there are agreed criteria that need to be met for a diagnosis to be given. Diagnosis is a done via a process involving the child or young person, the family, medical professionals, health professionals and education.

What can help?

It is important to focus on the tasks your child/young person wants to be able to do. This could be anything from tying their shoe laces, riding a bike, cutting up their food, knitting, kicking a ball. It is important that your child wants to do the task. There is little evidence that working generally on motor skills like strength, balance or grasp will help them to do the tasks.

When teaching children and young people with DCD new tasks there are some things to bear in mind that can really help.

  • It helps to break the activity down into manageable steps. Your child can then learn one step at a time. You can also look at each of the steps together to see what helps and which steps are more difficult.
  • Modify the task. For example, if your child is finding it difficult to dress standing up then let them dress sitting on the bed, in a chair or on the floor.
  • Manage your expectations. Do they need to learn how to tie their laces? Could they wear Velcro shoes or no-tie laces instead?  
  • Allow extra time for tasks. Children with DCD benefit from extra time to think about what they are trying to do. They also benefit from extra time to physically do the task. 
  • Allow your child/young person to do it their way (even if it is different from how you would do it).
  • Think about the environment. Find the right time and place to work together on the task. Remove distractions. 
  • Children or young people with DCD often benefit from visual instructions rather than listening to you telling them what to do. Use visual supports such as checklists, pictures of the steps of the activity, demonstrations or videos.
  • Learn what you can about DCD. Share that you understand how DCD can affect your child/young person and how much effort they are putting in to be more independent. 

M.A.T.C.H framework

M.A.T.C.H. is a framework you can use to help children and young people with DCD learn new tasks. M.A.T.C.H. stands for:

  • Modify the task
  • Alter your expectations
  • Teach strategies
  • Change the environment
  • Help by Understanding

You can find more about the MATCH approach on the CanChild website and watch this YouTube video about DCD in secondary school.

The evidence suggests that children and young people with DCD benefit from a problem-solving based approach like cognitive orientation to daily occupational performance (CO-OP). It uses a strategy called “goal, plan, do, check” to help you and your child/young person to come up with a plan. For example:

  • Goal – What do I want to do/achieve?
  • Plan – How am I going to do it? Talk to your child/young person about where the task is going wrong for them and ask them for their ideas to make it easier. Try breaking the task down into steps. Watch your child/young person doing each step so you can see what is going wrong. Talk about what you are seeing. Try to come up with solutions together. Make a plan together.
  • Do – Carry out the plan.
  • Check – How did that go? Talk with your child/young person about how it went, what would they do differently, what worked well, come up with a new plan and then keep going through the process of doing, checking and planning.

Check out this YouTube video by NHS Greater Glasgow and Clyde for more information.

Frequently asked questions

How do you get a diagnosis of DCD?

DCD is diagnosed in Worcestershire after a specialist assessment with a children’s occupational therapist and a paediatrician.

  • The children’s occupational therapist gathers information about and assesses a child’s everyday skills including play, self-care and school skills. They also assess a child’s coordination skills such as their balance and ability to use their hands for tasks such as handwriting, dressing or using cutlery. The occupational therapist may also complete an assessment which shows whether the child’s coordination and skills are at a less than average level for their age. They will complete an assessment and feedback to you about the outcome of this.
  • Sometimes a child may have particular difficulties with a specific skill such as handwriting that may improve with some advice from the occupational therapist. If they find that the child has significant difficulties with their motor skills, that are less than average for a child of their age, and are not due to other causes (e.g. medical causes or intellectual disability) they will ask a paediatrician to see the child.
  • The paediatrician will complete a medical examination to ensure that the child’s difficulties are not due to any other cause. If they do not find any other medical reason they may then give a diagnosis of DCD.

Who can request an assessment for a DCD assessment?

For children in school, requests for assessments of motor co-ordination difficulties, or DCD, are only accepted from schools after following the Worcestershire dyspraxia pathway. This allows schools to implement universal and targeted strategies first, before seeking a specialist assessment. Information on the pathway is available for school on the Worcestershire County Council website.

  • A referral to the Learning Support Team is not needed for this, although can be requested by school if they feel this would be helpful.
  • Where health professionals are concerned about a child’s motor coordination, they should direct parents and carers to discuss with their school SENCO about starting the Worcestershire Dyspraxia Pathway. 
  • Referrals are only considered for children aged over 5 years, as it is not usually possible to diagnose before this age. 

What if my child’s school is not in Worcestershire?

We only accept referrals for children who’s GP is in Worcestershire. However, if their GP is in Worcestershire and their school is in another county, we still request that they follow the Worcestershire dyspraxia pathway. This ensures that the school has implemented universal and targeted strategies before requesting a specialist assessment. We do not request that schools arrange a learning support team assessment prior to referring to children's occupational therapy.

What if my child is home schooled?

Parents or carers of home schooled children who are concerned about their child’s coordination skills should contact us to discuss this on the occupational therapy advice line on 0300 247 0017. This is available on Wednesdays (9am - 12pm) and Thursday’s (1pm - 4pm).

Is a referral needed for paediatricians or physiotherapist as well?

No, if the referral is purely around seeking an assessment of a child to see whether they have DCD, a referral should be made just to children's occupational therapy. They will then refer onto a paediatrician if this is needed. If you think that a child may need physiotherapy as well, please contact us to check whether this is needed via the occupational therapy advice line on 0300 247 0017. This is available on Wednesdays (9am - 12pm) and Thursday’s (1pm - 4pm).

What if a child has a known condition, other than DCD, that effects their everyday skills or conditions?

If a child or young person has known medical or physical condition that effects their movement, they are not usually assessed for DCD, and would not usually be on the Worcestershire dyspraxia pathway as a cause is already known that may explain their difficulties. However, you can get advice around managing how this effects daily life on our occupational therapy advice line on 0300 247 0017. This is available on Wednesdays (9am - 12pm) and Thursday’s (1pm - 4pm). The occupational therapist on the advice line can talk to you about whether a referral is required, or can advise you on things you can try.

Where can I get further support and information?

The following websites are really helpful for getting up to date tips, information and support.

  1. Moving and and doing interactive webinar: The Worcestershire Paediatric OT Team regularly run an interactive webinar for parents of children called Moving and doing. This is for parents/carers (or school staff) of school aged children with difficulties with everyday skills (such as using cutlery, or dressing) or coordination skills. Parents/carers are able to book onto this directly themselves without needing any referral.
  2. The Dyspraxia Foundation: A support group for individuals and families effected by Dyspraxia
  3. NHS Greater Glasgow and Clyde webpage: This has lots of information and practical tips for children with DCD.
  4. Sheffield Children’s NHS Foundation Trust motor skills page : This has some great “top tips” sheets for different everyday skills
  5. CanChild by McMaster University, Canada: This site contains a lot of information around DCD and approaches that can be used at home and in school.
  6. Watch Me Do it by Manchester Metropolitan University : This organisation has done research which showed that watching video demonstrations recorded from a first-person viewpoint can help children with DCD (or coordination difficulties) learn everyday movement skills. Their website has a large video library of different everyday skills.
  7. School-based fundamental movement skill screening (FUNMOVES): An approach that we are currently encouraging schools to adopt in Worcestershire, developed originally by the Centre for Applied Education Research in Bradford.
  8. General NHS information on DCD