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Information for General Practitioners

This leaflet was produced through a consensus process led by Movement Matters, which involved relevant stakeholders and organisations from across the UK.

What is DCD?

  • Developmental Coordination Disorder (DCD), also known as Dyspraxia in the UK, is a common disorder affecting fine or gross motor coordination in children and adults.
  • This lifelong condition is formally recognised by international organisations including the World Health Organisation.
  • DCD is distinct from other motor disorders such as cerebral palsy and stroke and occurs across the range of intellectual abilities.
  • Individuals may vary in how their difficulties present; these may change over time depending on environmental demands and life experience.
  • An individual's coordination difficulties may affect participation and functioning of everyday life skills in education, work and employment.
  • Children may present with difficulties with self-care, writing, typing, riding a bike and play as well as other educational and recreational activities. In adulthood many of these difficulties will continue, as well as learning new skills at home, in education and work, such as driving a car and DIY.
  • There may be a range of co-occurring difficulties which can also have serious negative impacts on daily life. These include social and emotional difficulties as well as problems with time management, planning and personal organisation. These difficulties may also affect an adult's education or employment experiences.

At what age can I identify DCD?

Due to large variation in the environment and experiences of different children and their rates of development in the early years, formal identification of DCD rarely occurs prior to the age of 5 years.

How can I identify DCD?

The presence of motor difficulties can be determined through taking a developmental and educational history with the parent or carer. Parents may have noticed that a very young child has coordination difficulties or delays in motor development when compared with peers. There may also be some family history.
 
Parents may report that the child generally appears awkward or clumsy and that he/she has difficulties with some or all of the following:
  • Self-care e.g. washing, toileting, dressing (doing up buttons, tying shoelaces, putting clothes on the right way around).
  • Physical play and sports especially in playing team games, including ball skills.
  • Handwriting and drawing.
  • Using tools and equipment (e.g. a toothbrush, cutlery, scissors, rulers).
  • Doing crafts and playing with construction toys.
  • Learning new motor tasks.
Parents may also report:
  • General organisation and planning difficulties relating to their child and his/her belongings (e.g. losing clothing and books).
  • Social difficulties (e.g. difficulty in groups, especially maintaining friendships).
  • Emotional difficulties (e.g. low self-esteem).
DCD may exist with other conditions (such as ADHD, Autism, Dyslexia and Specific Language Impairment). In these cases, the child or adult may have a complex profile and a range of difficulties.

What can I do?

The following provides a potential graduated response in terms of order of action, and time available to you and could be completed over more than one consultation.
 
Stage 1: Take a full history
  • Ante and postnatal history checked for a history of maternal alcohol and drug use, maternal health, prematurity and birth trauma - look at mother’s notes.
  • Developmental history - late speech production, late walking, lack of crawling or feeding difficulties.
  • Cover the present problems:
  • Dressing – buttons, zips, laces.
  • Using tools – cutlery, writing, toothbrush.
  • Sports skills - difficulties in PE, ball games, bike riding.
  • General health – sleep, eating, bowels, bladder, energy.
  • Recent severe head injury – if problems have all followed, a paediatric assessment is needed.
  • Interests to assess his/her overall development – attitude to friends, reading, TV programmes, hobbies etc.
  • Are symptoms getting worse? (A history of deteriorating motor function should prompt you to refer to a paediatrician to check for Muscular Dystrophy). 
Gather information where possible also from teachers, especially the school SENCO.
 
Stage 2: Examination
 
If you do not feel confident in this, refer now sending your full histories.
 
If you do, check:
  • Height and weight.
  • Abnormal face – low set ears, slanting eyes, small head etc.
  • Unusual skin abnormalities – café au lait spots.
  • Hearing and vision (e.g. squint). You may wish to refer to orthoptic or audiology services.
  • Check power and tone, asymmetry of movements (consider cerebral palsy).
  • Assess development – use a scale or chart to compare if uncertain.
  • Ask the child to draw a picture of him/herself and write name - look for spacing, grip, control. 
 
Stage 3: Support Family
 
If you still doubt the diagnosis – refer.
 
If you are confident there is no: global developmental delay; Cerebral Palsy; sensory disturbance or other abnormalities described above then you could discuss DCD. You could also discuss local or national support groups.
 
Stage 4: Intervention
 
Referral at stages 1, 2, or 3 could be to:
 
Local community or general paediatrician or paediatric neurologist.
 
Referral at Stage 4 depends very much on local circumstances – ideally to a multidisciplinary paediatric disability team, but possibly direct referrals to physiotherapist or occupational therapist with experience and interest in the problems. They usually provide guidance for home and school. Route will be dependent on referral pathway in your area.
 
Ensure follow-up to make sure child and family are still supported.
 
The GP is a useful focal point for ensuring continuing care.

What support can be offered for a child with DCD?

Identification of DCD is important as there is much that can be done to support the child to develop their skills and to participate in activities at home, at school and in the community. The type and level of support and intervention offered by professionals will vary from region to region but there is also much that parents and teachers can do to support a child.
 
Appropriate goals for intervention should be identified by working together with the child, parent(s), teacher(s) and relevant professionals.
 
Some children will benefit from simple adaptations (e.g. elasticated clothing, pen grips), while others will need specialist intervention from health and/or educational professionals.
 
Be aware that times of transition from school to school, or to college or the workplace may see increased challenges for the child or adult and their family.
 
Educational training and coaching for parents is also important to create a supportive attitude.

Where can I go for further information?

www.movementmattersuk.org 
Click here to download leaflet.
 
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