Physical Therapy Management of Children with Developmental Coordination Disorder

A Summary of the Clinical Practice Guidelines:

In the most recent issue of the Pediatric Physical Therapy Journal, the developmental coordination disorder (DCD) clinical practice guidelines were published. These guidelines serve as a clear outline of information for an effective and coordinated approach to the care for a child diagnosed with DCD. This information not only helps physical therapists provide the highest quality care, but also provides information to families of children diagnosed with DCD.

What is Developmental Coordination Disorder?

DCD had previously been described as clumsy child syndrome, developmental dyspraxia, sensory integration disorder, perceptual-motor difficulties, or minor neurologic dysfunction. Now DCD has clearer guidelines on diagnosing that include 4 criteria:

• Coordination significantly below age expected levels

• Clumsiness, slowness, or inaccuracy that limit the ability to participate in age expected activities when playing with friends or taking part in school

• Presentation of symptoms early in development

• Symptoms can not be explained by another condition or diagnosis

How is a child diagnosed with DCD?

Physical therapists cannot diagnose a child with DCD or any other medical or psychiatric diagnosis. It requires a physician, psychologist, or psychiatrist to make that diagnosis. However, physical therapists can provide information on the child’s performance with age-appropriate gross motor skills. Children at higher risk for being diagnosed with DCD included children born weighing less than 3.3 lb or less than 32 weeks of gestation. Children with DCD may also have coexisting neurological conditions including attention deficit disorder, attention-deficit hyperactivity disorder, autism spectrum disorder, sensory differences, intellectual disability, or other learning disabilities.

What will physical therapy look like for my child with DCD?

The first step is evaluation. This starts with a discussion about the current team in place and ensuring there is a way for open communication with the child’s pediatrician. Additionally, medical history via a developmental summary is essential to get as full a picture of the child’s past as possible. Next is the assessment and observation of the current functional level of the child and then the possible use of standardized tests or measures to accurately track the progress made. Common areas for assessment are muscular strength, muscular endurance, cardiorespiratory fitness, power, and balance. All the information gathered in the evaluation then creates the treatment plan for a child that focuses on task-oriented activities specific to each child. This will depend on what activities a child finds most difficult. These task-oriented activities will be paired with activities and exercises to address the specific areas limiting their functional level (strength, balance, endurance, etc.). It is suggested that for DCD, treatment is provided either individually or in a small group of no more than 6 people. The carryover provided by a home exercise program is also essential to reaching a child’s PT goals.

What comes after PT?

Once a child approaches their PT goals, discharge can be discussed with the child’s family. The goal is a return to community-based activity. This can include a variety of sports with soccer and taekwondo having the most evidence for selection. For children with DCD, PT is often an ongoing part of a child’s development with annual PT check-ins recommended to continue to assess a child’s ability to perform age-appropriate skills. Most children do not outgrow DCD in adolescence or adulthood on their own. Any remaining areas of limitation can impact a child’s social participation.

If you have any questions about DCD or your child’s performance with age expected activities, please reach out to our front desk staff who will set up a time to talk with one of our physical therapists.