Dyspraxia (DCD) in Children: Signs, Diagnosis and How Occupational Therapy Helps
What dyspraxia or developmental coordination disorder is, signs by age, how it's diagnosed, and the evidence-based OT approaches like CO-OP that help children.
Some children seem to trip over everything, take forever to get dressed, and find handwriting exhausting, even though they are bright and want to do well. For some of them, the reason is dyspraxia, known in medical terms as developmental coordination disorder (DCD).
This guide explains what dyspraxia is, the signs to look for at each age, how it’s diagnosed, and how occupational therapy helps.
What is dyspraxia (DCD)?
Developmental coordination disorder, also known as dyspraxia, is a condition affecting physical coordination (NHS). A child with DCD finds it hard to plan, learn and carry out movements, so their motor skills are well below what’s expected for their age, even though their intelligence is typical.
- It affects about 5–6% of school-aged children (DSM-5), roughly one or two children in every classroom.
- It is diagnosed more often in boys than girls.
- It often occurs alongside ADHD, dyslexia, speech and language difficulties or autism.
- It is lifelong, but children can learn to do the skills that matter to them, especially with the right support.
Signs of dyspraxia by age
| Age | Signs you may notice |
|---|---|
| Babies and toddlers | Late to sit, crawl or walk; difficulty feeding themselves; avoids puzzles and building toys; seems more clumsy than other children |
| Preschool (3–5 years) | Bumps into things and falls often; struggles to jump, hop or pedal a tricycle; difficulty with crayons, scissors and buttons; messy eater; dislikes drawing |
| School age (5–11 years) | Slow, untidy or tiring handwriting; trouble with shoelaces, zips and cutlery; poor at catching, kicking and ball games; difficulty learning to ride a bike; disorganised bag and desk; slow to get changed for PE |
| Teenagers and adults | Difficulty with handwriting speed, organisation and time management; learning to drive or cook can take longer; may avoid sport and feel self-conscious |
How it affects everyday life
Coordination problems spill into many areas of a child’s day:
- Self-care: dressing, fastenings, brushing teeth, using a knife and fork
- School: handwriting, using a ruler and scissors, copying from the board, organising work
- Play and sport: ball skills, bikes, playground equipment, team games
- Confidence: many children with DCD feel frustrated, avoid physical activity and can develop anxiety or low self-esteem
Hard to move
Tasks take more effort
Avoids activity
Skips sport and play
Less practice
Fewer chances to improve
Lower confidence
Feels "I'm no good at this"
Without support, children with DCD can get caught in this cycle. Therapy and adapted activities help break it.
How dyspraxia is diagnosed
DCD is usually diagnosed after age 5, because young children vary so much in how quickly they develop (NHS). A doctor, usually a pediatrician, makes the diagnosis together with an occupational therapist or physiotherapist.
International guidelines (Blank et al., 2019) use four criteria, based on the DSM-5:
-
Motor skills well below age level
Shown on a standardised test, such as the Movement Assessment Battery for Children (Movement ABC-2).
-
Affects daily life
The difficulties interfere with self-care, school, play or leisure.
-
Started early
Symptoms began in the early developmental period.
-
Not explained by another condition
Not due to cerebral palsy, muscular dystrophy, a visual problem or intellectual disability.
If you’re worried, start with your child’s doctor or school. In the UK you can also speak to your health visitor or the school’s special educational needs coordinator (SENCO). They may refer your child to an occupational therapist, pediatrician or another professional for assessment.
How occupational therapy helps dyspraxia
There is no cure for DCD, but therapy helps children learn the skills that matter most to them and makes daily life easier. The occupational therapist assesses how your child manages self-care, school work and play, then works on the actual tasks your child wants or needs to do.
Task-oriented approaches have the best evidence
The international recommendations for DCD (Blank et al., 2019) recommend activity- and participation-oriented therapy, where children practise real skills in real contexts, over approaches that try to train underlying body functions in isolation.
| Approach | What it involves | Evidence |
|---|---|---|
| CO-OP (Cognitive Orientation to daily Occupational Performance) | The child chooses goals and learns a problem-solving strategy: Goal–Plan–Do–Check | Recommended; strong support for helping children reach their own goals |
| Neuromotor Task Training (NTT) | Practising specific motor tasks, with the therapist adjusting difficulty and feedback | Recommended |
| Task-specific practice in daily routines | Practising dressing, cutlery, cycling or handwriting at home and school | Recommended |
| Process-oriented approaches (e.g. sensory integration, kinaesthetic training alone) | Training underlying sensory or body functions without the real task | Not recommended as the main approach for DCD |
Based on Blank R, et al. International clinical practice recommendations on DCD. Dev Med Child Neurol. 2019.
The CO-OP approach in action
CO-OP, developed by occupational therapist Helene Polatajko and colleagues, teaches children a simple strategy they can use for any new skill.
-
Goal
"I want to tie my shoelaces."
-
Plan
"Make bunny ears, cross them, tuck one under, pull tight."
-
Do
Try the plan.
-
Check
"Did it work? The loop slipped, so I need to hold it tighter."
The child, not the therapist, works out what to change, guided by questions. This builds independence and helps skills transfer to new situations.
Adapting tasks and the environment
The OT also suggests changes that reduce the load on coordination:
- Dressing: elastic laces or Velcro shoes, loose-fitting clothes, practising in stages
- Eating: non-slip mats, cutlery with thicker handles
- School: pencil grips, sloped writing surfaces, extra time, keyboarding or speech-to-text, handouts instead of copying from the board
- Organisation: visual checklists, colour-coded folders, a set place for everything
Dyspraxia activities to try at home
Practise the specific skills your child needs, in short, fun sessions:
- Motor planning games: obstacle courses, Simon Says and animal walks. See motor planning activities.
- Two-handed tasks: threading, lacing, cutting and opening containers. See bilateral coordination activities.
- Hand strength: playdough, tongs and spray bottles. See hand strengthening activities.
- Body awareness: heavy work like carrying, pushing and wall push-ups.
- Real-life practice: dressing in steps, using cutlery, riding a balance bike, swimming.
Dyspraxia vs other conditions
| Dyspraxia (DCD) | Verbal dyspraxia (childhood apraxia of speech) | Cerebral palsy | |
|---|---|---|---|
| What's affected | Planning and coordination of body movements | Planning the movements needed for speech | Movement and posture, caused by brain injury or differences in brain development |
| Main professional | Occupational therapist, physiotherapist | Speech-language therapist | Multidisciplinary team |
| Muscle tone | Usually typical, sometimes low | Usually typical | Often high or low |
Summary
Dyspraxia, or DCD, is a common, lifelong condition that makes coordinated movement harder to learn. It affects self-care, school work, play and confidence. Early recognition helps, and occupational therapy, using task-oriented approaches like CO-OP plus practical adaptations, helps children master the skills that matter to them. Read more about fine motor skills, gross motor skills and occupational therapy for children.
Related guides: Pediatric OT goals.
Theory behind this: the OT approaches in this guide draw on the motor learning frame and CO-OP and the acquisitional frame.
References
- NHS. Developmental co-ordination disorder (dyspraxia) in children.
- Blank R, Barnett AL, Cairney J, et al. International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. Developmental Medicine & Child Neurology. 2019;61(3):242–285.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text revision (DSM-5-TR). 2022.
- Polatajko HJ, Mandich A. Enabling Occupation in Children: The Cognitive Orientation to daily Occupational Performance (CO-OP) Approach. CAOT Publications ACE.
- CanChild Centre for Childhood Disability Research. Developmental coordination disorder resources.
Frequently asked questions
What is dyspraxia?
Is dyspraxia the same as DCD?
What are the early signs of dyspraxia?
How is dyspraxia diagnosed?
Can a child grow out of dyspraxia?
How does occupational therapy help dyspraxia?
Written by
Payal Mehta, OT
Payal Mehta is a practising occupational therapist and co-founder of Occupational Therapy OT. She writes on pediatrics, sensory integration, and mental-health practice.
All articles by Payal →This article is for general education and is not a substitute for individualized assessment or treatment by a licensed occupational therapist. Always seek the guidance of a qualified professional for specific concerns.
