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Coordination Disorders and ADHD

While some children with ADHD can seem clumsy because they are not paying attention to the task they are performing, other children with ADHD who seem clumsy may have Developmental Coordination Disorder (DCD). DCD is a neurodevelopmental disorder that often occurs in children with ADHD. [Kirby: 2014] [Cairney: 2010] DCD may be diagnosed in children who have impairment in the performance of functional motor skills lower than would be expected for their chronological age and intellectual level and despite a normal neurological exam.

Delayed development of the prefrontal cortex and executive function [Sun: 2012], underlying deficits in perceptual factors, speed of decision making and feedback, and motor programming differences have been hypothesized as some of the causes for DCD. The prevalence of DCD is estimated at 5-6% of children [Cairney: 2010] and is more common in boys. Approximately ¾ of children with DCD continue to face coordination difficulties in adulthood. [Kirby: 2014] DCD can have serious consequences for a child's social, emotional, and educational functioning.
When asked, parents can usually distinguish between children who are clumsy due to inattention from those who have difficulty learning and coordinating motor tasks. Suspect DCD when:
  • There are delayed developmental milestones in motor skills
  • A child is described as "clumsy" despite appropriate milestones
  • A child unable to keep up with peers athletically or avoids physical activity
Consider DCD when:
  • A child is diagnosed with ADHD, autism, speech or language impairment, or dyslexia [Kirby: 2014]
  • Other family members have DCD

Diagnosis

Essential features of DCD include a marked impairment in the development of coordination. The impairment significantly interferes with academic achievement or activities of daily living, and these difficulties are not due to a general medical condition such as cerebral palsy or stroke. The child may present with mild motor delays, mild hypotonia, difficulties with cross body coordination, or problems with balance. The child should not have severe delay, show evidence of motor plateau or regression, or show significant abnormalities on neurologic exam; these are flags for different disorders. The medical home may want to consult with neurology or developmental pediatrics if DCD is suspected. A physical therapy assessment of motor skills may also helpful.

DSM-V Developmental Coordination Disorder Diagnostic Criteria
A. The acquisition and execution of coordinated motor skills is substantially below that expected given the individual's chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness (e.g., dropping or bumping into objects) as well as slowness and inaccuracy of performance of motor skills (e.g., catching an object, using scissors or cutlery, handwriting, riding a bike, or participating in sports).
B. The motor skills deficit in criterion A significantly and persistently interferes with activities of daily living appropriate to chronological age (e.g., self-care and self-maintenance) and impacts academic/school productivity, prevocational and vocational activities, leisure, and play.
C. Onset of symptoms is in the early developmental period.
D. The motor skills deficits are not better explained by intellectual disability (intellectual developmental disorder) or visual impairment and are not attributable to a neurological condition affecting movement (e.g., cerebral palsy, muscular dystrophy, degenerative disorder).
[American: 2015]

Treatment

Treatment primarily focuses on practice of specific functional tasks through play, school programming, and/or specific physical/occupational therapy programming. Programming motivates the child to improve the skill and practice helps improve specific skills such as writing neatness or catching a baseball. Practice of motor skills should be separated from performance (e.g., grading of schoolwork should focus on content not neatness, accommodations such as using a computer or scribe, and specific tasks that work on neatness of writing as a separate goal). Improvement of skill will likely not be generalized to an overall reduction in clumsiness.

The child's social environment should be structured to minimize social impacts. The role of enhancing processing of perceptual inputs (e.g., sensory integration therapy) is controversial, but may be helpful. [Zimmer: 2012] The use of omega fatty acids has not been demonstrated to improve motor coordination skills in DCD, but may improve some of the behavioral characteristics associated with DCD and ADHD. [Richardson: 2005]

Role of the medical home provider

  • Identify concern and consider a physical therapy assessment of motor skills for confirmation
  • Explain to child/family the nature of the condition
  • Obtain neurologic or developmental pediatrics consultation if concerns regarding other potential motor disorders
  • Ensure parents know how to access services needed via school system (e.g., PT and/or OT consultative input if needed, social skills support)
  • Provide guidance regarding the appropriate types of community based athletic programs (e.g., fun focused vs. competitive)
  • Refer to outpatient PT/OT for consultation if severity of impairment warrants

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Helpful Articles

PubMed Search on Developmental Coordination Disorder in Children

Kirby A, Sugden D, Purcell C.
Diagnosing developmental coordination disorders.
Arch Dis Child. 2014;99(3):292-6. PubMed abstract

Zimmer M, Desch L.
Sensory integration therapies for children with developmental and behavioral disorders.
Pediatrics. 2012;129(6):1186-9. PubMed abstract / Full Text
Occupational therapy with the use of sensory-based therapies may be acceptable as one of the components of a comprehensive treatment plan for children with developmental and behavioral disorders. Pediatricians and other clinicians should discuss the limitations of these therapies with parents.

Richardson AJ, Montgomery P.
The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder.
Pediatrics. 2005;115(5):1360-6. PubMed abstract

Cairney J, Veldhuizen S, Szatmari P.
Motor coordination and emotional-behavioral problems in children.
Curr Opin Psychiatry. 2010;23(4):324-9. PubMed abstract

Zwicker JG, Missiuna C, Harris SR, Boyd LA.
Developmental coordination disorder: a review and update.
Eur J Paediatr Neurol. 2012;16(6):573-81. PubMed abstract

Missiuna C, Gaines R, Soucie H, McLean J.
Parental questions about developmental coordination disorder: A synopsis of current evidence.
Paediatr Child Health. 2006;11(8):507-12. PubMed abstract / Full Text

Authors

Reviewing Author: Robyn Nolan, MD - 4/2015
Compiled and edited by: Lynne M Kerr, MD, PhD - 7/2009
Content Last Updated: 4/2015

Page Bibliography

American Psychiatric Association: DSM-5 Task Force.
Diagnostic and Statistical Manual of Mental Disorders.
Fifth ed. The American Psychiatric Publishing; 2015. http://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425...

Cairney J, Veldhuizen S, Szatmari P.
Motor coordination and emotional-behavioral problems in children.
Curr Opin Psychiatry. 2010;23(4):324-9. PubMed abstract

Kirby A, Sugden D, Purcell C.
Diagnosing developmental coordination disorders.
Arch Dis Child. 2014;99(3):292-6. PubMed abstract

Richardson AJ, Montgomery P.
The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder.
Pediatrics. 2005;115(5):1360-6. PubMed abstract

Sun J, Buys N.
Early executive function deficit in preterm children and its association with neurodevelopmental disorders in childhood: a literature review.
Int J Adolesc Med Health. 2012;24(4):291-9. PubMed abstract

Zimmer M, Desch L.
Sensory integration therapies for children with developmental and behavioral disorders.
Pediatrics. 2012;129(6):1186-9. PubMed abstract / Full Text
Occupational therapy with the use of sensory-based therapies may be acceptable as one of the components of a comprehensive treatment plan for children with developmental and behavioral disorders. Pediatricians and other clinicians should discuss the limitations of these therapies with parents.