Diagnosis and management of developmental coordination disorder

Developmental coordination disorder is a common neuromotor condition, affecting about 5%-6% of school-aged children;1 this equates to more than 400 000 Canadian children.2 Despite its prevalence, developmental coordination disorder may be underrecognized by health care professionals.1,3 In a recent online survey of 1297 parents, teachers and physicians, only 41% of pediatricians and 23% of general practitioners had knowledge of the condition; the physician respondents were from Canada, the United States and the United Kingdom.3 Furthermore, only 23% of the pediatricians and 9% of the general practitioners surveyed had ever diagnosed developmental coordination disorder. The vast majority of the physicians reported the need for more education about the condition.3 In this article, we define developmental coordination disorder and describe how it is diagnosed, discuss associated risk factors and the consequences of the condition on physical, social and emotional well-being, and present the evidence that supports promising interventions. This review is supported by the findings of recent systematic reviews as well as evidence-based recommendations from the European Academy of Childhood Disability1 (Box 1). In this same systematic review,29 the effects of methylphenidate on fine motor performance were reported from three studies involving children who had developmental coordination disorder and ADHD; the effect size was medium (dw = 0.79). In a blinded study published after the systematic review, motor performance measured on the Movement Assessment Battery for Children, second edition, was substantially improved when children with developmental coordination disorder and concurrent ADHD were taking methyl-phenidate.30 Unfortunately, we found no studies that evaluated the effects of chemical supplements in children who had developmental coordination disorder without ADHD. Like children with other types of developmental disabilities, children with developmental coordination disorder do not "outgrow" their disorder. There is far less research on issues in adulthood, however. Several studies have assessed psychosocial, motor and executive functions in adults with developmental coordination disorder. Small observational studies noted that adults with the disorder had significantly high levels of depressive symptoms and anxiety,35,36 as well as decreased levels of participation in everyday life, and lower quality of life and life satisfaction.37 In addition, small st