International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder

. 2019 Jan 22;61(3):242–285. doi: 10.1111/dmcn.14132

Recommendation 3	GCP
We recommend the following criteria for the diagnosis of DCD. These criteria follow closely those proposed in DSM‐5 with some minor changes, including the order of criteria III and IV: IThe acquisition and execution of coordinated motor skills is substantially below that expected given the individual's chronological age and sufficient opportunities to acquire age‐appropriate motor skills. IIThe motor skills deficit described in criterion I significantly and persistently interferes with the activities of everyday living appropriate to chronological age (e.g. self‐care and self‐maintenance and mobility) and impacts upon academic/school productivity, prevocational and vocational activities, leisure, and play. IIIThe motor skills deficits are not better accounted for by any other medical, neurodevelopmental, psychological, social condition, or cultural background. IVOnset of symptoms in childhood (although not always identified until adolescence or adulthood). Comment: Criterion I: The symptoms of DCD may include slowness and/or inaccuracy of motor skills performed in isolation or in combination. Criterion III: This addresses issues of aetiology with regard to DCD and is designed to facilitate differential diagnosis. Examples of conditions which may rule out or influence the diagnosis of DCD are: (1) Medical conditions: movement disorders with known aetiologies (e.g. cerebral palsy, muscular dystrophy, childhood arthritis), side effects of drugs (e.g. neuroleptics, chemotherapy, sedatives), sensory problems (e.g. substantial visual impairments or impairments of the vestibular organ) (2) Other neurodevelopmental disorders (e.g. severe intellectual disabilities) or other psychological disorders (e.g. anxiety, depression), or other psychological conditions (e.g. attentional problems) as primary causes of motor problems (3) Social conditions (e.g. deprivation, cultural diversity) Note: It may be difficult to differentiate between conditions that may be causal and those that may co‐occur.³ For example, a child from a culture, which limits physical activity or which provides little opportunity for motor learning may present like a child with DCD (at least initially). A child with ADHD might appear to have movement problems, which are in fact caused by impulsivity and/or inattention. Especially in unclear cases, multiprofessional or repeated assessments can be helpful to differentiate. Criterion IV: The onset of symptoms is usually evidenced in infancy and childhood. The following recommendations are designed to offer guidance as to how to arrive at an accurate diagnosis of DCD. Instead of being listed according to the criteria I to IV they are given in the opposite order which is in line with how a medical professional would usually proceed with his/her examination. Thus, the process starts with: (1) considering the age and context of the child (criterion IV), (2) ruling out other medical conditions causing motor problems (criterion III), (3) taking into account the impact on activities and participation (criterion II), (4) quantifying the motor impairment (criterion I). It should be noted, however, that there are other pathways to diagnosis. For example, a child might be identified as having difficulties within a school system and be first assessed by a therapist or educational psychologist. Their assessments may show the child meets criteria I, II, and IV and only then might the child be referred to a medical doctor to exclude other conditions.	⇑⇑

Recommendation 3

GCP

We recommend the following criteria for the diagnosis of DCD. These criteria follow closely those proposed in DSM‐5 with some minor changes, including the order of criteria III and IV:

IThe acquisition and execution of coordinated motor skills is substantially below that expected given the individual's chronological age and sufficient opportunities to acquire age‐appropriate motor skills.

IIThe motor skills deficit described in criterion I significantly and persistently interferes with the activities of everyday living appropriate to chronological age (e.g. self‐care and self‐maintenance and mobility) and impacts upon academic/school productivity, prevocational and vocational activities, leisure, and play.

IIIThe motor skills deficits are not better accounted for by any other medical, neurodevelopmental, psychological, social condition, or cultural background.

IVOnset of symptoms in childhood (although not always identified until adolescence or adulthood).

Comment:

Criterion I: The symptoms of DCD may include slowness and/or inaccuracy of motor skills performed in isolation or in combination.

Criterion III: This addresses issues of aetiology with regard to DCD and is designed to facilitate differential diagnosis.

Examples of conditions which may rule out or influence the diagnosis of DCD are:

(1) Medical conditions: movement disorders with known aetiologies (e.g. cerebral palsy, muscular dystrophy, childhood arthritis), side effects of drugs (e.g. neuroleptics, chemotherapy, sedatives), sensory problems (e.g. substantial visual impairments or impairments of the vestibular organ)

(2) Other neurodevelopmental disorders (e.g. severe intellectual disabilities) or other psychological disorders (e.g. anxiety, depression), or other psychological conditions (e.g. attentional problems) as primary causes of motor problems

(3) Social conditions (e.g. deprivation, cultural diversity)

Note:

It may be difficult to differentiate between conditions that may be causal and those that may co‐occur.³ For example, a child from a culture, which limits physical activity or which provides little opportunity for motor learning may present like a child with DCD (at least initially). A child with ADHD might appear to have movement problems, which are in fact caused by impulsivity and/or inattention. Especially in unclear cases, multiprofessional or repeated assessments can be helpful to differentiate.

Criterion IV: The onset of symptoms is usually evidenced in infancy and childhood.

The following recommendations are designed to offer guidance as to how to arrive at an accurate diagnosis of DCD. Instead of being listed according to the criteria I to IV they are given in the opposite order which is in line with how a medical professional would usually proceed with his/her examination. Thus, the process starts with: (1) considering the age and context of the child (criterion IV), (2) ruling out other medical conditions causing motor problems (criterion III), (3) taking into account the impact on activities and participation (criterion II), (4) quantifying the motor impairment (criterion I).

It should be noted, however, that there are other pathways to diagnosis. For example, a child might be identified as having difficulties within a school system and be first assessed by a therapist or educational psychologist. Their assessments may show the child meets criteria I, II, and IV and only then might the child be referred to a medical doctor to exclude other conditions.

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