Aim: These international clinical practice recommendations (CPR) for developmental coordination disorder (DCD), initiated by the European Academy of Childhood Disability (EACD), aim to address key questions on the definition, diagnosis, assessment, intervention, and psychosocial aspects of DCD relevant for clinical practice. Method: Key questions in five areas were considered through literature reviews and formal expert consensus. For recommendations based on evidence, literature searches on ‘mechanisms’, ‘assessment’, and ‘intervention’ were updated since the last recommendations in 2012. New searches were conducted for ‘psychosocial issues’ and ‘adolescents/adults’. Evidence was rated according to the Oxford Centre for Evidence-Based Medicine (level of evidence [LOE] 1–4) and transferred into recommendations. For recommendations based on formal consensus, two meetings of an international, multidisciplinary expert panel were conducted with a further five Delphi rounds to develop good clinical practice (GCP) recommendations. Results: Thirty-five recommendations were made. Eight were based on the evidence from literature reviews (three on ‘assessment’, five on ‘intervention’). Twenty-two were updated from the 2012 recommendations. New recommendations relate to diagnosis and assessment (two GCPs) and psychosocial issues (three GCPs). Additionally, one new recommendation (LOE) reflects active video games as adjuncts to more traditional activity-oriented and participation-oriented interventions, and two new recommendations (one GCP, one LOE) were made for adolescents and adults with DCD. Interpretation: The CPR–DCD is a comprehensive overview of DCD and current understanding based on research evidence and expert consensus. It reflects the state of the art for clinicians and scientists of varied disciplines. The international CPR–DCD may serve as a basis for national guidelines. What this paper adds: Updated international clinical practice guidelines on developmental coordination disorder (DCD). Refined and extended recommendations on clinical assessment and intervention for DCD. A critical synopsis of current research on mechanisms of DCD. A critical synopsis of psychosocial issues in DCD, with implications for clinical practice. The first international recommendations to consider adolescents and adults with DCD.

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

Children born early (<37 weeks of gestation) are at high risk of a range of motor impairments due to a variety of biological and environmental risk factors. Cerebral palsy occurs more frequently in those children born preterm, with the risk increasing with decreasing gestational age. Mild and moderate motor impairments, consistent with developmental coordination disorder, occur in almost half of those children born preterm and include difficulties with balance, manual dexterity and ball skills. All forms of motor impairment are associated with comorbidities, which may have a greater effect on quality of life, academic achievement and participation in extracurricular activities than the motor impairment itself. Infants at risk of motor impairment can be identified in early infancy with a combination of clinical assessment tools and perinatal risk factors. However, the reliable diagnosis of motor impairment requires follow-up into early childhood and it is important to ensure that the appropriate intervention is implemented.

Cerebral palsy and developmental coordination disorder in children born preterm.

Developmental coordination disorder: core sensori-motor deficits, neurobiology and etiology.

Diagnostic criteria for DCD: Past and future.

Developmental coordination disorder is a common neuromotor condition, affecting about 5%–6% of school-aged children;[1][1] this equates to more than 400 000 Canadian children.[2][2] Despite its prevalence, developmental coordination disorder may be underrecognized by health care professionals.[1][

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Diagnosis and management of developmental coordination disorder

Objective To identify perinatal and neonatal risk factors associated with developmental coordination disorder (DCD) in very low birthweight children (VLBW: Design Retrospective design with prospectively collected cohort. Setting Neonatal Follow-Up Program, Vancouver, Canada. Patients 157 VLBW children assessed at 4–5 years who were free of cerebral palsy or major neurological impairment and had full-scale IQ >70. Main outcome measure Movement Assessment Battery for Children (MABC). Results Using ≤15th percentile on the MABC as the cut-off, 42% of our cohort developed DCD. Perinatal variables significantly associated with DCD were male sex, lower gestational age and lower birth weight, but only male sex and low birth weight independently predicted DCD, accounting for 20% of the variance in MABC scores. Compared with children without motor impairment, children with DCD had greater postnatal steroid exposure, longer duration of ventilation, more days on oxygen and significant retinopathy of prematurity, but only postnatal steroid exposure was significant, accounting for an additional 3% of the variance in MABC scores. Boys performed more poorly than girls on all subtests of the MABC. Conclusions Male sex and low birth weight were significant predictors of DCD, suggesting that these infants should be followed for detection of this common, but under-recognised disorder. Future research aimed at identifying neural underpinnings of DCD and possible antecedents to the disorder is warranted.

https://adc.bmj.com/content/archdischild/98/2/118.full.pdf

Julie Petrie-Thomas

Papers

Perinatal and neonatal predictors of developmental coordination disorder in very low birthweight children