Developmental coordination disorder (DCD), also known as developmental motor coordination disorder, developmental dyspraxia or simply dyspraxia (from Ancient Greek praxis 'activity'), is a neurodevelopmental disorder characterized by impaired coordination of physical movements as a result of brain messages not being accurately transmitted to the body. Deficits in fine or gross motor skills movements interfere with activities of daily living. It is often described as disorder in skill acquisition, where the learning and execution of coordinated motor skills is substantially below that expected given the individual's chronological age. Difficulties may present as clumsiness, slowness and inaccuracy of performance of motor skills (e.g., catching objects, using cutlery, handwriting, riding a bike, use of tools or participating in team sports or swimming). It is often accompanied by difficulty with organisation and/or problems with attention, working memory and time management.

A diagnosis of DCD is reached only in the absence of other neurological impairments such as cerebral palsy, multiple sclerosis, or Parkinson's disease. The condition is lifelong and its onset is in early childhood. It is thought to affect about 5% of the population.

The World Health Organization (WHO) recognise DCD as a condition, and have published their definition in the International Classification of Diseases. This describes DCD as:

6A04 Developmental motor coordination disorder

Developmental motor coordination disorder is characterised by a significant delay in the acquisition of gross and fine motor skills and impairment in the execution of coordinated motor skills that manifest in clumsiness, slowness, or inaccuracy of motor performance. Coordinated motor skills are substantially below that expected given the individual's chronological age and level of intellectual functioning. Onset of coordinated motor skills difficulties occurs during the developmental period and is typically apparent from early childhood. Coordinated motor skills difficulties cause significant and persistent limitations in functioning (e.g., in activities of daily living, school work, and vocational and leisure activities). Difficulties with coordinated motor skills are not solely attributable to a Disease of the Nervous System, Disease of the Musculoskeletal System or Connective Tissue, sensory impairment, and not better explained by a Disorder of Intellectual Development.

— The ICD-11 International Classification of Diseases 11th Revision (2018)^[1]

The American Psychiatric Association (APA)'s Diagnostic and Statistical Manual, DSM-5 classifies Developmental Coordination Disorder (DCD) as a discrete motor disorder under the broader heading of neurodevelopmental disorders.^[2] It is often described as a disorder in skill acquisition or motor learning, where the learning and execution of coordinated motor skills is substantially below that expected given the individual's chronological age.^[3] Various areas of development can be affected by DCD and these may persist into adulthood.^[4][5][6]

In children, DCD may exhibit as delays in early development of sitting, crawling, walking; poor ability or difficulties with childhood activities such as running, jumping, hopping, catching, sports and swimming; slowness; frequent tripping and bruising; poor handwriting skills; difficulties with self care; difficulties with skills such as using cutlery or tying shoelaces; poor spatial understanding; difficulty following instructions; poor time management; and often losing objects.^[7]

In adulthood, in addition to a childhood history as above, the condition may manifest as a difficulty learning new motor skills or applying skills in a different or busy environment, poor organisation and time management skills, missed deadlines and lateness for appointments (or earliness as a coping strategy), and awkward pauses before answering in conversation. There is often a history of underachievement in education or the workplace. Although skills can be acquired, such as neat handwriting, handwriting speed will then be much lower than expected.^[7]

Evidence from research and clinical practice indicates that DCD is not just a physical disorder, and there may be deficits in executive functions, behavioural organisation and emotional regulation that extend beyond the motor impairments and which are independent of diagnoses of co-morbidities.^[8] In addition to the physical or motor impairments, developmental coordination disorder is associated with problems with memory, especially working memory.^[9] This typically results in difficulty remembering instructions, difficulty organizing one's time and remembering deadlines, increased propensity to lose things or problems carrying out tasks which require remembering several steps in sequence (such as cooking). Whilst most of the general population experience these problems to some extent, they have a much more significant impact on the lives of dyspraxic people.^[10] However, many dyspraxics have excellent long-term memories, despite poor short-term memory.^[10] Many dyspraxic people benefit from working in a structured environment, as repeating the same routine minimises difficulty with time-management and allows them to commit procedures to long-term memory.

People with developmental coordination disorder sometimes have difficulty moderating the amount of sensory information that their body is constantly sending them, so as a result these dyspraxic people may be prone to sensory overload and panic attacks.^[10]

Moderate to extreme difficulty doing physical tasks is experienced by some people with dyspraxia, and fatigue is common because so much energy is expended trying to execute physical movements correctly. Some dyspraxic people have hypotonia, low muscle tone, which can also detrimentally affect balance.^[11]

Assessments for developmental coordination disorder typically require a developmental history,^[42] detailing ages at which significant developmental milestones, such as crawling and walking,^[43][44][45] occurred. Motor skills screening includes activities designed to indicate developmental coordination disorder, including balancing, physical sequencing, touch sensitivity, and variations on walking activities.^{[citation needed]}

The American Psychiatric Association has four primary inclusive diagnostic criteria^[45] for determining if a child has developmental coordination disorder.

The criteria are as follows:

1. Motor coordination will be greatly reduced, although the intelligence of the child is normal for the age.
2. The difficulties the child experiences with motor coordination or planning interfere with the child's daily life.
3. The difficulties with coordination are not due to any other medical condition
4. If the child does also experience comorbidities such as intellectual or other developmental disability; motor coordination is still disproportionally affected.^[42]

The exact proportion of people with the disorder is unknown since the disorder can be difficult to detect due to a lack of specific laboratory tests, thus making diagnosis of the condition one of elimination of all other possible causes/diseases. Approximately 5–6% of children and adults are affected by this condition.^{[2][63][43][64][65]} and approximately 2% are severely affected.^[7]

DCD is a lifelong neurological condition that is expected to be as common in males as it is in females.^[4][5][6] Currently however, the diagnosis criteria favour males which results in over 80% of males being diagnosed before the age of 16 compared to only 22% for females. ^{[citation needed]}

There is no cure for the condition. Instead, it is managed through therapy. Physical therapy or occupational therapy can help those living with the condition.

Some people with the condition find it helpful to find alternative ways of carrying out tasks or organizing themselves, such as typing on a laptop instead of writing by hand, or using diaries and calendars to keep organized.^[66] A review completed in 2017 by Cochrane of task-oriented interventions for DCD resulted in inconsistent findings and a call for further research and randomized controlled trials.^[67]

Collier first described developmental coordination disorder as "congenital maladroitness". A. Jean Ayres referred to developmental coordination disorder as a disorder of sensory integration in 1972,^[68][69] while in 1975 Sasson Gubbay, MD, called it the "clumsy child syndrome".^[42][70][71] Developmental coordination disorder has also been called "minimal brain dysfunction", although the two latter names are no longer in use.

Other names include developmental apraxia,^[42] disorder of attention and motor perception (DAMP)^[42][70] dyspraxia,^[44] developmental dyspraxia,^[42][72][73] "motor learning difficulties",^[42][70] perceptuo-motor dysfunction,^[42][70][69] and sensorimotor dysfunction.^[42]

The World Health Organization currently lists developmental coordination disorder as "Specific Developmental Disorder of Motor Function".^[44]