Developmental Coordination Disorder (DCD): Relevance for Clinical Psychologists in Europe

Understanding the impact of developmental coordination disorder on Belgian children and families: A national survey study

BACKGROUND

Developmental Coordination Disorder (DCD) is an under-recognized and often trivialized neurodevelopmental condition impacting five to six percent of children. This study aimed to map the impact of DCD on children and their families in Belgium.

METHODS

The Australian 'Impact for DCD' questionnaire was translated and adapted to suit the Belgian context. Parents of 4-to-18-year-old children living in Belgium with movement difficulties consistent with DCD were invited to complete the online survey covering diagnosis, activities, school, therapy, and social and emotional impact.

RESULTS

A total of 491 children were included in the analyses. First concerns emerged primarily at home (61.4%) at age 3.3 ± 2.25y, with help sought at age 4.7 ± 2.57y. Formal diagnosis occurred at age 6.9 ± 2.36y, with DCD (76.5%) and/or dyspraxia (38.4%) the most frequently received terms. DCD was generally unknown, especially within school settings. Nearly one in four children (23.2%) repeated a year of school. Reduced sleep quality (50.6%), fatigue after school (76.0%), difficulties with toilet training (47.9%) and speech articulation (52.3%), as well as elevated emotional problems (52.7%) and peer-related issues (46.4%), were prevalent. Most children received therapy (89.2%) but 59.1% of parents did not feel adequately supported to assist their child. Moreover, 37.5% of parents regularly took time off work to facilitate their child's therapy attendance, while 49.1% had reduced their working hours or were contemplating doing so (16.7%). Parents expressed concerns about their child's future and well-being, with a prominent plea for guidance on supporting their child and increased awareness. Parents reported important strengths in their children, including empathy, creativity, cognitive abilities, perseverance, and good social and/or language skills.

CONCLUSIONS

These results highlight the significant impact of DCD from parents' perspectives. The next step is to explore ways to empower and support parents, raise awareness, and collaborate with policymakers to address these challenges.

Association Between Developmental Coordination Disorder Traits, Autistic Traits, and Emotional/Behavioral Problems in Japanese Preschool Children

Background/Objectives: Few studies have examined the association between developmental coordination disorder (DCD) traits and emotional/behavioral problems in preschool children, considering the influence of autistic traits. Furthermore, no consistent results have been obtained. The aim of this study was to investigate how DCD traits in preschool children are related to emotional/behavioral problems, controlling for the effects of autistic traits. Methods: A questionnaire survey was administered to 277 parents of children (154 boys, 73.0 ± 3.8 months) who underwent the school physical examination in Y city near Tokyo, Japan, from October to December 2021. The Developmental Coordination Disorder Questionnaire-Japanese version (DCDQ-J) was used to measure DCD traits, the Autism Spectrum Screening Questionnaire (ASSQ) was used to measure autistic traits, and the Strengths and Difficulties Questionnaire (SDQ) was used to measure emotional/behavioral problems. In the hierarchical multiple regression analysis, the SDQ was the dependent variable, with gender entered in Step 1, ASSQ in Step 2, and DCDQ in Step 3. Results: The results showed that autistic traits are associated with preschool children's emotional/behavioral problems, but even after controlling for autistic traits, higher DCD traits had a relationship with higher conduct problems, hyperactivity/inattention, and peer problems and lower prosocial behavior of preschool children. Conclusions: This result indicates the need for the support of children with motor skill difficulties. Additionally, a focus on mitigating DCD traits not only improves motor skills but also prevents emotional/behavioral problems in preschool children.

Prevalence and associated factors of developmental coordination disorder in primary school children

Developmental coordination disorder (DCD) is one of the most frequently observed movement disorders in childhood, yet data on its prevalence are still unclear. This two-stage epidemiological study aims to determine the prevalence of DCD in children between 6 and 10 years of age according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). In the first stage, the Developmental Coordination Disorder Questionnaire (DCDQ'07) were given to primary school students. In the second stage, clinicians conducted psychiatric interviews with children who had an indication of DCD or were suspected of having DCD according to the DCDQ'07 and their parents. The interviews utilized the DSM-5 diagnostic criteria for DCD and applied the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-Turkish Adaptation (K-SADS-PL) and Wechsler Intelligence Scale for Children (WISC-R) to identify co-occurring disorders. In the first stage, 2,306 children were evaluated, and 205 were invited for a clinical interview. Of the 198 children interviewed, 49 met the diagnostic criteria for DCD. The prevalence of DCD in Türkiye was found to be 2.1%. High parental education level, a previous psychiatric admission of the child, mother's postpartum depressive symptoms, co-occurring disorders, and co-occurring attention deficit hyperactivity disorder (ADHD) were significantly more common among children with DCD. Potentially associated factors were evaluated by logistic regression analysis. The mother's education level, the presence of postpartum depressive symptoms, and co-occurring disorders in the child were found to be associated factors.

Motor skills in children with ADHD: overlap with developmental coordination disorder

Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) often have overlooked motor difficulties which can be at least partially attributed to co-occurring conditions such as Developmental Coordination Disorder (DCD). Understanding the influence of DCD and motor difficulties is important to detect in children for early support. Accordingly, the present study examined the prevalence of DCD diagnoses, cases of probable DCD, and related impairments among German-speaking parents of children with ADHD. A total of N = 168 parents completed an online study about their child's potential for co-occurring DCD via the Developmental Coordination Disorder Questionnaire (DCD-Q). Even after children with DCD diagnoses were removed from the sample (n = 46), a majority still remained below threshold for probable DCD (55.9%) according to parent-reports. Via exploratory analyses, we also found that a majority of parents in the sample had not heard of DCD before (64.9%) and that many parents did not deem DCD as relevant to their children, even when their DCD-Q scores were in the range of probable DCD. The results align with a high prevalence of DCD in children with ADHD despite a simultaneous lack of awareness of DCD. Furthermore, findings in our sample align with frequently estimated global co-occurrence rates of 50% between ADHD and DCD. Broadly, the results support that motor difficulties should be considered in ADHD assessment and intervention.

A Qualitative Investigation into the Experiences of Students with Developmental Coordination Disorder (DCD/Dyspraxia) in Higher Education

Developmental coordination disorder (DCD/Dyspraxia) is a commonly misunderstood and under-recognized specific learning difficulty (SpLD) in educational settings. This lifelong condition affects fine and gross motor coordination and significantly interferes with many activities of daily living, academic achievement, and employment opportunities. However, most Higher Education Institutions (HEIs) are unaware of its prevalence within their context, even though 5% of the general population have DCD and the enrolment of students in UK Higher Education with a known disability has increased by 42.4% between 2018 and 2023. Thus, understanding the lived experiences of students with DCD within Higher Education in the UK remains a considerable gap in knowledge. Through the use of focus groups, the lived experiences of 10 students with DCD at two UK HEIs were investigated. The thematic analysis identified four main themes: 'Awareness of DCD', 'Participation in Higher Education for individuals with DCD', 'Wellbeing', and 'Everyday living'. Students shared that HEIs appeared to lack awareness of DCD and felt they had an inability to specify the correct support at university. Importantly, whilst the students in the study were not always confident in identifying the specific support they needed, they shared the strategies they used to aid their university experience. The students described the physical toll that many everyday living tasks can take, which subsequently negatively impact academic participation and wellbeing. On a positive note, many of the students discussed positive experiences at university, such as enjoying their own autonomy (and flexibility) to be independent and inform strategies for their own learning. Importantly, the findings from this work highlight the complexity and heterogeneity of DCD and the need for a tailored approach to supporting individuals with this condition. Given the importance of educational qualifications to enter the workplace, and the contribution of employment to quality of life, these findings help signpost areas where HEIs can improve the experiences of students with DCD that may also enhance academic success.

EEG spectral power in developmental coordination disorder and attention-deficit/hyperactivity disorder: a pilot study

Developmental coordination disorder (DCD) and attention-deficit/hyperactivity disorder (ADHD) overlap in symptoms and often co-occur. Differentiation of DCD and ADHD is crucial for a better understanding of the conditions and targeted support. Measuring electrical brain activity with EEG may help to discern and better understand the conditions given that it can objectively capture changes and potential differences in brain activity related to externally measurable symptoms beneficial for targeted interventions. Therefore, a pilot study was conducted to exploratorily examine neurophysiological differences between adults with DCD and/or ADHD at rest. A total of N = 46 adults with DCD (n = 12), ADHD (n = 9), both DCD + ADHD (n = 8), or typical development (n = 17) completed 2 min of rest with eyes-closed and eyes-open while their EEG was recorded. Spectral power was calculated for frequency bands: delta (0.5-3 Hz), theta (3.5-7 Hz), alpha (7.5-12.5 Hz), beta (13-25 Hz), mu (8-13 Hz), gamma (low: 30-40 Hz; high: 40-50 Hz). Within-participants, spectral power in a majority of waveforms significantly increased from eyes-open to eyes-closed conditions. Groups differed significantly in occipital beta power during the eyes-open condition, driven by the DCD versus typically developing group comparison. However, other group comparisons reached only marginal significance, including whole brain alpha and mu power with eyes-open, and frontal beta and occipital high gamma power during eyes-closed. While no strong markers could be determined to differentiate DCD versus ADHD, we theorize that several patterns in beta activity were indicative of potential motor maintenance differences in DCD at rest. Therefore, larger studies comparing EEG spectral power may be useful to identify neurological mechanisms of DCD and continued differentiation of DCD and ADHD.

Anthropometric, physical activity, and psychological characteristics of Korean adults with and without developmental coordination disorder (DCD)

Developmental Coordination Disorder (DCD), also known as Dyspraxia, is characterized by movement difficulties in individuals without discernible neurological disorders or identifiable medical conditions. Previous studies from various countries have highlighted disparities in anthropometric, physical activity, and psychological characteristics between children diagnosed with DCD and their typically developing (TD) peers. These differences are influenced by sociocultural norms and geographical locations. However, little attention has been given to scrutinizing analogous differences in adult populations, particularly within Republic of Korea. This study aims to address this knowledge gap by employing a battery of questionnaires to assess anthropometric, physical activity, and psychological traits in a cohort of 377 Korean adults, encompassing those with DCD (n = 54) alongside TD counterparts (n = 323). It was hypothesized that Korean adults with DCD would exhibit higher body mass index and lower ratings in physical activity and psychological characteristics than TD, consistent with the previous studies performed in other countries on children. The results showed no statistically significant differences between the DCD and TD groups in anthropometric characteristics such as weight (kg), height (cm), and body mass index. The prevalence of walking and biking for daily commuting in daily routines within Korean society might have contributed to the mitigation of anthropometric among individuals with/without DCD. Statistically significant differences were found in physical activity levels at work and recreational settings, as shown in physical activity scores and duration. The DCD group also displayed lower scores across several psychological characteristics, including exercise adherence, intrinsic motivation, self-efficacy, physical self-concept, exercise expectations, and intrinsic regulation. These findings underscore the necessity of incorporating sociocultural dynamics when investigating anthropometric, physical activity, and psychological characteristics in adults with DCD. Their perceived difficulties in fine motor skills were also significantly poor than TD. Future research studies are warranted to elucidate the underlying mechanisms driving the observed patterns in this study, thus contributing to a more nuanced comprehension of how DCD manifests within specific sociocultural contexts.

Journeying with developmental coordination disorder: The family experience

Background

Developmental coordination disorder (DCD) is a neurodevelopmental disorder impacting 5% - 6% of children and continues into adulthood for 50% - 70% of cases. Despite the multidomain and lifelong influence of this disorder, little consideration has been given to the experiences of the family. Post-diagnostic support has been recommended however, the specific areas requiring support remain vague.

Objectives

This study described the familial experiences of living with a member diagnosed with DCD.

Method

A qualitative descriptive study using a phenomenological approach allowed insight into the lived experiences of families journeying with DCD. Forty-four participants representing 8 countries participated in an online questionnaire with 12 participating in an online semi-structured interview.

Results

Themes generated reveal that obtaining a diagnosis and navigating the healthcare and education systems can be troublesome. Upon diagnosis, families tend to experience positive emotions such as relief. However, the daily challenges soon result in dominant negative emotional responses. DCD places significant financial burdens on families and impacts marital, parental and sibling relationships. Families often feel isolated from their communities as DCD is poorly understood.

Conclusion

DCD places families at risk as daily struggles require support which targets identified motor, cognitive, academic and emotional challenges. Creating awareness in society, education and healthcare would alleviate continual frustrations.

Contribution

This study provides insight into the wide-ranging impact that DCD has on families so that individualised support can be tailored, and general awareness raised.

[Recent research on the long-term neurodevelopmental outcomes of very preterm infants]

With the increase in the survival rate of very preterm infants, the long-term neurodevelopmental outcomes of such infants have attracted more and more attention. Very preterm infants tend to develop movement disorders and psychological and behavioral problems, including cerebral palsy, developmental coordination disorders, autism spectrum disorders, attention deficit hyperactivity disorders, specific learning disorders, and intellectual developmental disorders. It is of vital importance to improve the long-term prognosis of very preterm infants, and early comprehensive intervention measures can minimize disability and achieve optimal parenting outcomes. This article provides a review of the research progress on the long-term neurodevelopmental outcomes in extremely preterm infants.

Gait in children with and without ADHD: A systematic literature review

BACKGROUND

There is increasing speculation whether Attention-Deficit/Hyperactivity Disorder (ADHD) has phenotypic or secondary motor symptoms. Some evidence suggests even fundamental motor skills such as walking can differ in ADHD, however, the evidence is limited and has not been reviewed. Therefore, we conducted a systematic review to summarize the findings regarding gait in ADHD compared to typically developing children in (1) normal (i.e., self-paced), (2) paced or complex (i.e., walking backwards), and (3) dual-task contexts.

METHOD

Following a thorough literature search and application of stringent exclusion criteria, a total of 12 studies were included in this review. All studies examined normal walking with a variety of gait parameters in children (age range: 5-18), however, selected parameters and group differences were often inconsistent.

RESULTS

In self-paced walking, studies reporting gait with coefficients of variance (CVs) indicated several between-group differences, whereas averages of gait variables were the same for those with ADHD and typically developing children. Paced or complex walking contexts often differed between ADHD and typically developing groups, favoring the ADHD group in some cases, but primarily the typically developing participants. Finally, walking contexts with dual-tasks showed more frequent performance losses in the ADHD group.

DISCUSSION

Children with ADHD seem to have specific patterns of gait variability compared to typically developing children, particularly in complex walking contexts and at faster paces. The influence of age, medication, and method of gait normalization may have influenced the results of studies. Overall, this review highlights the potential for a unique gait profile in children with ADHD.

Handwriting Evaluation in School-Aged Children With Developmental Coordination Disorder: A Literature Review

Despite widespread computer use, legible handwriting remains an important common life skill that requires more attention from schools and health professionals. Importantly, instructors and parents typically attribute the difficulties to laziness or a lack of effort, causing the youngster anger and disappointment. Handwriting issues are a public health concern in terms of both prevalence and consequences. Writing is a tough and diverse activity that requires cognitive, perceptual-motor, mental, and emotional talents. It is largely a motor process involving an effective level of motor organization that results in exact movement synchronization. Handwriting problems have been connected to developmental disorders such as developmental coordination disorder. For the affected youngsters, forming letters takes more work, and the kid may forget what he or she planned to write. School children's primary handwriting issues include illegible writing, slow handwriting, and strained writing. Handwriting problems may lead to scholastic underachievement and low self-esteem. Because of this complication, some school-aged children develop handwriting difficulties, which cause psychological distress and learning impairments. In the treatment of children with bad handwriting, the therapeutic intervention has been demonstrated to be successful. We aimed to determine how efficient tools and scales are which assess handwriting in school-aged children having developmental coordination disorder. Keyword searches were conducted on Google Scholar and PubMed, yielding 45 results, eight of which met the inclusion requirements. We concluded that there are a lot of scales and tools to date but no scale focuses on the temporal and spatial parameters for handwriting evaluation.

The Relationships between Self-Reported Motor Functioning and Autistic Traits: The Italian Version of the Adult Developmental Coordination Disorders/Dyspraxia Checklist (ADC)

BACKGROUND

We developed the Italian version of the adult developmental co-ordination disorders/dyspraxia checklist (ADC), providing reliability and concurrent validity data for the scale (Aim 1). In addition, we investigated the relationships between motor coordination difficulties and different autistic traits (Aim 2).

METHODS

498 participants (341 females; age range = 18-34) underwent the Italian version of the ADC, as well as a handwriting speed test, the autism spectrum quotient, the empathy quotient, and the systemizing quotient.

RESULTS

The distinction between three main factors (A, B, and C) identified in the original version of the ADC was confirmed here. Internal consistency of the ADC subscales was adequate, as well as the correlation with the handwriting speed test used to assess concurrent validity. No substantial sex differences on the ADC scores were found. Furthermore, data revealed that poor autistic-related communication skills and lower levels of systemizing tendencies were, among all the investigated autistic traits, those more strongly associated with higher motor coordination difficulties.

CONCLUSIONS

The Italian ADC seems a valuable tool for assessing motor coordination difficulties in adults and can reveal the nuanced impact exerted by different autistic traits on self-reported motor functioning.

How are you getting by? Coping in developmental coordination disorder versus attention-deficit/hyperactivity disorder

Objective

Developmental Coordination Disorder (DCD) and Attention-Deficit/Hyperactivity Disorder (ADHD) persist into adulthood; however, little research exists to describe how adults with DCD and/or ADHD cope with their symptoms. Therefore, the purpose of this study was to investigate coping mechanisms reported by adults with DCD, ADHD, or both conditions. We expected there would be strategies specific to each condition and a broader scope of mechanisms reported by those with co-occurring DCD+ADHD.

Method

N = 161 participants completed the online survey, including n = 31 with DCD only, n = 116 with ADHD only, and n = 14 with DCD+ADHD.

Results

Most participants reported adaptive strategies. Of these, behavioral adaptations were most relevant to ADHD, while environmental modifications were common in DCD. Cognitive reframing and social support were similarly relevant to those with DCD and DCD+ADHD. Coping strategy categories were most uniform for the DCD+ADHD group.

Conclusions

Coping profiles highlight several noteworthy differences between DCD and ADHD which may be relevant for treatment.

Distinct mental health profiles in children with Developmental Coordination Disorder: A latent class analysis and associations

BACKGROUND

Children with Developmental Coordination Disorder (DCD) show indications for mental health problems. However, these problems are poorly understood.

AIMS

To identify patterns (profiles) of mental health in this population and to analyze the associations between profiles and child characteristics.

METHODS AND PROCEDURES

Parents of 119 children with DCD completed the Strengths and Difficulties Questionnaire.

OUTCOMES AND RESULTS

Results indicated that a four latent class was the best model. Profile 1 was defined as "no" mental health problems (n = 28; 24 %), Profile 2 was defined as "hyperactivity" problems (n = 53; 43.3 %), for clinical indications for hyperactivity, Profile 3 was defined as "internalizing" problems (n = 8; 7.3 %), for clinical indications for emotional symptoms and peer problems, and Profile 4 was defined as "internalizing and externalizing problems" (n = 30; 25.4 %), for clinical indications for problems in both areas. In addition, having a co-occurring disorder, accommodation plans, and using medications were associated with the profiles.

CONCLUSIONS AND IMPLICATIONS

There are distinct and unique profiles that children with DCD exhibit. Clinicians can use these profiles to better understand the presentation of mental health symptoms in this population and provide adequate services or support if mental health difficulties are present.

Handwriting and Motor-Related Daily Performance among Adolescents with Dysgraphia and Their Impact on Physical Health-Related Quality of Life

Knowledge is limited about dysgraphia in adolescence and its association with daily motor-related daily performance and health-related quality of life (HRQOL). This study aimed to (1) compare and (2) examine correlations between handwriting measures, motor-related daily performance, and HRQOL of adolescents with and without dysgraphia and (3) examine the contribution of motor-related daily performance and handwriting measures to predict their physical HRQOL. There were eighty adolescents (13-18 yr): half with dysgraphia and half matched controls without dysgraphia per the Handwriting Proficiency Screening Questionnaire and Handwriting Legibility Scale participated. They copied a paragraph script onto a paper attached to the Computerized Penmanship Evaluation Tool digitizer and completed the World Health Organization Quality of Life Questionnaire-brief version and the Adult Developmental Coordination Disorder Checklist (ADC). We found significant between-group differences in motor-related daily performance, handwriting measures, and HRQOL and significant correlations between HRQOL and handwriting process measures and motor-coordination ability. Handwriting measures predicted 25%, and the ADC A and C subscales 45.6%, of the research group's physical QOL domain score variability. Notably, the control group's current perceptions of their motor-coordination performance (ADC-C) predicted 36.5% of the variance in physical QOL. Dysgraphia's negative effects during childhood and adolescence may reduce adolescents' HRQOL now and into adulthood.

The adult developmental coordination disorders/dyspraxia checklist - German: adapted factor structure for the differentiation of DCD and ADHD

BACKGROUND

The Adult Dyspraxia/DCD Checklist (ADC) is the only existing self-report questionnaire to screen adults for potential Developmental Coordination Disorder (DCD). It was developed in English and Hebrew, however, its factor structure has not yet been assessed.

AIMS

The goals of the current study were to (1) develop and refine a German translation, (2) explore the emerging factors in a new and restructured ADC in German and apply this structure to an English ADC, and (3) explore its potential for distinguishing DCD versus ADHD.

METHOD

In a series of three studies, we assessed comprehensibility of the translation and revisions to the questionnaire. We further examined subscale structure in a sample of N = 148 individuals with DCD or ADHD and retested it in an English-speaking sample (N = 134).

RESULTS

Overall, we found decent reliability and construct validity for the German ADC. Three components emerged with themes of fine motor coordination, gross motor coordination, and executive functions which had strong psychometric properties in German and English.

CONCLUSIONS

The studies collectively highlight the German translation is effective and has strong potential to differentiate DCD and ADHD. Most notably, there are unique symptom profiles in motor and executive functioning difficulties in adults with DCD or ADHD. WHAT THIS PAPER ADDS?: The translation and preliminary validation of the German ADC in this study has the potential to screen for probable DCD in German-speaking adults for the first time. In addition, the new subscale structure can be generalized to the English version as well and allows for the potential assessment of several key symptomatic patterns in the realms of gross motor, fine motor, and executive functioning skills that differ between adults with DCD and ADHD. These differences were fairly consistent between English- and German-speaking samples, indicating potential for more widespread assessment and differentiation of DCD and ADHD.