DCD is a neurodevelopmental disorder with primary deficits in fine and gross motor coordination (American Psychiatric Association, 2013). The DSM-5 criteria for a DCD diagnosis include: (1) the acquisition and execution of motor skills and related coordination are below what is expected based on age, (2) the deficits of motor skill and coordination significantly interfere with daily life in the domains of self-care, scholastics, work, leisure, and play, (3) the symptoms began in childhood, and (4) the deficits cannot be better explained by any other condition (e.g., cerebral palsy or neurodegenerative disorder; American Psychiatric Association, 2013; see Table 1). DCD has a profound impact on the lives of individuals suffering from the disorder.

Accumulating research highlights the psychological effects of DCD symptoms still remain unclear (e.g., Kirby et al., 2013; Tal Saban & Kirby, 2018; Zwicker et al., 2018) and executive functioning differences may be present (e.g., Bernardi et al., 2018; Sartori et al., 2020). Furthermore, there is a lack of established gold standard diagnostic procedure for adults with DCD despite increasing evidence that motor symptoms and psychosocial consequences continue into adulthood in most cases (Purcell et al., 2015; Tal Saban & Kirby, 2018).

DCD is a common neurodevelopmental disorder, with a prevalence frequently cited as 5% (Blank et al., 2019). Despite this, DCD has received minimal attention in research, especially compared to other neurodevelopmental disorders (see Figure 1; Bishop, 2010). Even child and adolescent psychiatrists have been reported to profess poor general knowledge of DCD (Wilson et al., 2013). This alludes to a history of potentially overlooking individuals with DCD.

While the number of publications and citations for papers about DCD is still far behind comparable conditions (e.g., ADHD), there has been a promising increase in publications over the last decade (see Figure 1). In addition, international guidelines for most aspects of DCD were recently released for health care professionals of all fields (Blank et al., 2019). The guidelines solidify that DCD is a unique condition to be recognized by psychologists and offer important insights. Therefore, in this narrative review, we (1) extend upon these guidelines to include an overview on the current state of lesser understood features of DCD (e.g., executive functions, co-occuring ADHD, adult DCD), and (2) highlight available resources specifically for European psychologists (e.g., tools available in various European languages). We include recent insights with research primarily published in the last decade to provide an up-to-date overview of DCD.

DCD has a lifetime prognosis with major symptoms including difficulties with planning and execution of fine motor (e.g., sketching) and gross motor coordination (e.g., riding a bicycle). As described in the DSM 5, individuals with DCD can appear to be generally clumsy, and often have delays in reaching motor milestones compared to their peers (American Psychiatric Association, 2013). Examples of this can be very evident, such as having to spend longer than other children in learning how to hold a pencil, or subtler, such as having more trouble learning to play a musical instrument in school than other children. Notably, research in the last decade has provided increasing evidence that symptoms of DCD extend beyond motor coordination. More specifically, impaired executive functions (i.e., inhibition, cognitive control, working memory, and related processes such as attention) can be recognized as a prominent feature of DCD (Bernardi et al., 2018; Leonard & Hill, 2015; Sartori et al., 2020). However, neither the DSM-5 nor the ICD-11 consider these as potential symptoms of DCD (Purcell et al., 2015; see Table 1). Furthermore, the specific symptom profiles and the extent to which executive function impairments in DCD can be attributed to co-occurring conditions (e.g., attention and inhibition difficulties typical to ADHD) remains unclear (Blank et al., 2019).

A combination of executive functioning and motor coordination difficulties may result in a plethora of consequences and challenges for individuals with DCD in all stages of life. Recent research has suggested core symptoms of DCD likely entail secondary psychological problems, such as decreased quality of life, lower self-esteem, impaired social relationships compared to typically developing peers (e.g., Tal Saban & Kirby, 2018; Zwicker et al., 2018). Internalizing symptoms in the form of secondary anxiety and depression may often occur as a consequence of DCD (Draghi et al., 2020; Kirby et al., 2013; Mancini et al., 2019; Omer et al., 2019; Rigoli & Piek, 2016), which should be of concern in psychotherapy. More research is needed to understand the specificity of these features as they are known in similar conditions (e.g., ADHD). Consequences of DCD also include a risk for obesity, cardiovascular problems, reduced fitness ability, and worse self-reported general health compared to typically developing peers (Cairney et al., 2017; Joshi et al., 2015; Kirby et al., 2013).

Despite the often stated DCD prevalence rate of 5% (Blank et al., 2012; Blank et al., 2019), prevalence in some in many countries is not clear. Among existing estimates is that 1-19% of school-aged children in the UK suffer from DCD (Zwicker et al., 2012), but more recent estimates are around 10% in samples from the US and 24% from Brazil based on a study children in these regions (Valentini et al., 2017). While the prevalence rate in adults is not known, DCD is estimated to persist into adulthood in 30-70% of cases (Tal Saban & Kirby, 2018). In addition, a recent cross-sectional analysis of children in Spain estimates the prevalence of high risk for DCD is about 12% (Delgado-Lobete et al., 2019). Differences in prevalence estimates still vary greatly between existing studies, possibly due to a variance in identification of DCD.

Previous research has estimated that DCD occurs three to seven times more often in males than females (Zwicker et al., 2012), with recent evidence of a more equal gender ratio in a Brazilian sample (Valentini et al., 2017). However, these gender differences are not necessarily universal, as some recent research has found a more equal ratio between gender in Brazil (Valentini et al., 2017). These gender differences may also be a consequence of bias in detection of symptoms or referral bias, as has occurred for similar neurodevelopmental disorders such as ADHD (Young et al., 2020). Beyond gender differences, recent research found that left-handedness is nearly twice as prevalent among those with DCD as it is for typically developing controls (Darvik et al., 2018). Further research has yet to explore the underlying mechanisms in this phenomenon.

Relatively little is known about the causes of DCD. Compelling evidence for a 70% heritability estimate for DCD was calculated with a population of Swedish twin pairs (Lichtenstein et al., 2010). Low birth weight and premature birth are also predictors of DCD, particularly among males (Spittle et al., 2021; Zwicker et al., 2012). While little is known about risk factors for DCD aside from being male and preterm (van Hoorn et al., 2021), some research on neurodevelopmental disorders in general suggests there may be additional links to family income in addition to low birthweight and premature birth (e.g., Carlsson et al., 2021).

Among the various challenges in the diagnosis and detection of DCD are its co-occurring conditions (Cleaton & Kirby, 2018). For instance, DCD and Attention-Deficit/Hyperactivity Disorder (ADHD) have a particularly high co-occurrence of about 50% (Blank et al., 2019). Given the symptomatic overlaps, including motor impairments in ADHD (Kaiser et al., 2015), and attention, inhibition, and hyperactivity sometimes observed in DCD (Harrowell et al., 2018; Wilson et al., 2020), some have speculated whether DCD might be a subtype of ADHD. While concrete evidence for this assumption remains limited to date, more research speaks for a unique pathology in DCD (e.g., in the genetic profile, Pearsall-Jones et al., 2009; physiological responding, Goulardins et al., 2015; neural mechanisms, Meachon et al., 2021). This has also been supported by findings for unique functional pathways in co-occurring DCD and ADHD as opposed to just one disorder (McLeod et al., 2014). It is important that this co-occurrence receives more scientific attention in the future to identify not only the extent to which the clinical symptoms but also their endophenotypes overlap (e.g., Conzelmann et al., 2009). This may help to prevent misdiagnosis, given the many similarities between DCD and ADHD. One simple step researchers and clinicians can take to work toward this goal is to screen for DCD when working with patients who have ADHD (Lange, 2018), and vice versa.

Another common co-occurrence is Autism Spectrum Disorder (ASD; Caçola et al., 2017). ASD can be diagnosed as a co-occurring disorder of DCD since the DSM-5, and researchers are just beginning to explore the co-occurring diagnosis. Unlike ADHD, existing literature clearly supports that the difficulties sourcing from DCD or ASD are unique (Paquet et al., 2019). For example, a systematic review of DCD and ASD behavioral outcomes primarily found clear differences between DCD and ASD (Caçola et al., 2017). Thus, it can be assumed that co-occurring cases of DCD and ASD present a much more complex symptom profile than DCD or ASD alone

In the screening and diagnostic process for DCD, the current best practice is to ensure all four major DSM-5 criteria for diagnosis are met. There are various tests and screening tools which European clinicians can use to identify if a diagnosis of DCD should be considered. The most common tools relevant to European psychologists will be highlighted in this section.

Motor skill assessment is crucial to establish meeting the first criterion for a DCD diagnosis in the DSM-5: that motor skills are below the expected development compared to same-age peers. While there are many tools which can be used to assess motor skills (see Cancer et al., 2020 for an overview of other motor screening tools for children), two of the most common screening tools used to assess risk for DCD are the Movement Assessment Battery for Children (MABC-2; Henderson et al., 2007) and the Bruininks-Oseretsky Test of motor proficiency (BOT-2; Bruininks & Bruininks, 2005). The MABC-2 was developed in English to identify probable DCD in children aged 3 to 16, and is available in Dutch (Schoemaker et al., 2012), German (Petermann, 2008), Italian (Zoia et al., 2019), Greek (Ellinoudis et al., 2011), Norwegian (Holm et al., 2013), and Spanish (age band 1 validated by Niño-Cruz et al., 2019; see Table 2). In addition, some researchers have reported using the MABC-2 but do not reference a validated translation or test of the psychometric properties of the reported language used (e.g., Danish, Slovenian, Swedish; Blank et al., 2019).

The BOT-2 was designed in English as a motor competency test for broader populations among children from 4 to young adults of 21 years old, and available in German (Blank et al., 2014), and Spanish (validated for 4-7 years old children by Serrano-Gómez and Correa-Bautista, 2015). The BOT-2 can reportedly be used to diagnose individuals of any language group, because it uses motor-skill games independent of language (Baharudin et al., 2020), however, its norms should be extended beyond what is now exclusively based on US norms. For example, recent research on the ecological validity of the German BOT-2 showed it strongly relates to other relevant fine motor skills and some gross motor skills, however subtests for bilateral coordination and balance do not have clear ecological validity (e.g., to sports and bike riding) among German children (Vinçon et al., 2017). Notably, the concerns of translation (i.e., for the MABC-2 checklist) and norms is also prevalent with MABC-2, which was developed with UK samples. Some slight differences were observed between British norms and those of other nationalities tested on the MABC-2, suggesting the consideration norms for motor tests be adapted to specific countries, even within Europe (Barnett, 2014; Zoia et al., 2019). Given the age cutoffs, caution should be taken in the interpretation of scores for adolescents and adults, and should not outweigh assessment of the other diagnostic criteria for DCD.

There are several questionnaires which can be used to assess the second and third DSM-5 criterion regarding persistent interruptions of symptoms and presence of symptoms in childhood. For children, the Developmental Coordination Disorder Questionnaire is a popular parent-report measure of DCD symptoms developed in English (Wilson et al., 2009). The DCD-Q has been translated and validated into many languages spoken in Europe (see Table 2, including German, (DCDQ-G; Kennedy-Behr et al., 2013), Dutch (DCDQ-NL; Schoemaker et al., 2006), Italian (Caravale et al., 2015), Spanish (Salamanca et al., 2012), Danish (Milidou et al., 2015), and French-European (DCDQ-FE: Ray-Kaeser et al., 2019). In addition, a version to indicate DCD in young children (ages 3-4) exists, known as the Little Developmental Coordination Disorder Questionnaire developed in Hebrew (LDCD-Q; Rihtman et al., 2011) and translated into English (LDCDQ-CA; Wilson et al., 2015) and Dutch (LDCDQ-NL; Cantell et al., 2019). The LDCDQ was also translated into many European languages (Rihtman et al., 2015; see Table 1), however validation studies to confirm these translations have not yet been published. Notably, in adolescent populations, parents were less accurate in identifying motor competencies than their adolescent children’s self-reports (Timler et al., 2018), but to our knowledge, there is no evidence if this is the same in children versus parent-reports. Therefore, parent-reports should be used with caution in older children, and should be accompanied by in-depth assessment of the adolescents themselves.

To gain better insight into the daily life interruptions in adulthood, the self-report Adult Developmental Co-ordination Disorders/Dyspraxia Checklist (ADC) was developed and validated in English and Hebrew to detect probable cases of DCD in individuals 16 years and older (Kirby et al., 2010). The ADC was also recently translated into German (Meachon et al., 2022) and reevaluated for potential to screen for motor and executive functioning parameters of DCD (Meachon et al., 2022). In addition to the ADC, Tal Saban et al. (2012) developed the Adolescents and Adults Coordination Questionnaire (AAC-Q) as a shorter-form self-report tool to screen for DCD compared to the ADC. The AAC-Q was developed in English (Tal Saban et al., 2012) and recently translated into Spanish (Delgado-Lobete et al., 2021). While retrospective diagnosis of DCD in adulthood is certainly possible, it must be on the premise that symptom experiences began in childhood. There is currently no gold standard motor assessment tool for screening in adults.

In accordance with the final criterion of the DSM-5 for DCD, causes of clumsiness or differences in gait from other medical conditions or brain injury must be ruled out. Contrary to the exclusion criteria of intellectual disorders listed in the DSM-5 and ICD-10 (DSM-5; American Psychiatric Association, 2013; ICD-10; World Health Organization, 2016), children with DCD may score lower than average on some or all domains of IQ tests due to interruptions in motor processing and perception (Jaščenoka & Petermann, 2018). Recent consensus established that IQ score cutoffs should not prevent the diagnosis of DCD (Blank et al., 2019). More research is needed to conclude if this is consistent across the development and into adulthood.

Most of the existing research on DCD examines populations of affected children rather than adolescents and adults, even though a majority of adults with DCD continue to experience symptom-related difficulties in their daily lives (Tal Saban & Kirby, 2018). This mirrors a pattern observed in ADHD research, which primarily focuses on child and adolescent populations (Targum & Adler, 2014). The history of overlooking adult populations could be for strictly following diagnostic criteria for DCD (i.e., it must begin in childhood; American Psychiatric Association, 2013). Other possibilities might include (1) the lack of assessment tools for adults, (2) the complex phenotype in adulthood (e.g., co-occurring conditions, symptom progression), and (3) the heterogeneous compensatory strategies adults develop to deal with their motor constraints. Concerning the latter, compensatory strategies may mask symptoms for simple motor tasks (e.g., hand rotation task; Wilmut, 2017). This should be carefully considered in the diagnostic process for DCD, especially for adults with DCD who were not diagnosed in childhood.

Adults with DCD often struggle with difficulties in psychosocial domains, executive functioning, physical fitness, time management, and organization (e.g., Kirby et al., 2013; Kirby et al., 2011; Tal Saban & Kirby, 2018). In general, underlying mechanisms of DCD are not likely change across the lifespan, however the context, experience of the individual, and compensation may change. For example, motor challenges and difficulty with distance estimation may manifest in adulthood as problems in learning to drive or even crossing the road compared to typical adults (Kirby et al., 2010; Wilmut & Purcell, 2020). While the most relevant DCD symptoms for adults may vary interindividually, symptoms that are less easily detected or treated could become more problematic in adulthood. For example, executive functioning challenges were among the most commonly reported daily concerns for adults with suspected DCD (Purcell et al., 2015), a concern that might not be addressed in traditional physical training to treat symptoms of DCD.

There are also relationships between DCD and increased cognitive difficulties, fatigue, and somatic symptoms compared to a control group, albeit findings are based on cross-sectional data (Thomas & Christopher, 2018). Because of the considerable overlaps between DCD and ADHD that can also be present in adulthood, future research should work toward identifying the specific symptom profiles of DCD and ADHD.

Despite considerable research gaps on adult populations with DCD, some recent research has investigated DCD in emerging adults between the ages of 16 to 25 (e.g., Kirby et al., 2011). This group may still be dependent on their parents but are working toward independence and identity exploration (Tal Saban & Kirby, 2018). Due to the major life changes this age group commonly faces, it may be at risk for experiencing heightened difficulty in coping with DCD symptoms, and should be examined more in future research.

There are several training programs frequently utilized for treating specific motor features of DCD used by occupational and physical therapists such as Cognitive Orientation to Daily Occupational Performance (CO-OP) and Neuromotor Task Training (Smits-Engelsman, 2013; Smits-Engelsman et al., 2018). CO-OP and NTT are activity or task-oriented approaches which specifically target physical fitness and motor task-performance (Montgomery et al., 2018) and are historically effective for treating children with DCD (Polatajko & Mandich, 2004). These trainings, along with any other existing treatment, are not intended to cure DCD, and can substantially help the patient improve specific motor skills. However, the increasing evidence that DCD is more than just a disorder of motor functions qualifies that more psychological interventions should be comprehensively investigated (Tamplain & Miller, 2021). It is possible that psychological support may be equally important as physical treatment for some patients with DCD. This is especially relevant to reduce any risk for potential secondary psychosocial consequences such as depression or anxiety (Kirby et al., 2013).

Presently, an interdisciplinary approach along with occupational therapists and physiotherapists (e.g., typical treatment: CO-OP; NTT for training specific motor skills) is recommended for effective intervention with DCD (Blank et al., 2019; Montgomery et al., 2018). It is also important that specific difficulties to the individual and the goals of the patient are considered in treatment, as this has led to reduced anxiety compared to preset large-group interventions in children (Caçola et al., 2016). For example, one individual might find it most pertinent to practice typing on a keyboard for work or school, while another might want to reduce their anxiety participating in group sports. The role of motor concerns may be direct or indirect in treatment, but regardless, the patient’s preferences should determine the approach and prioritization of goals in their treatment plan. A recent review and meta-analysis of motor-based interventions for DCD also suggests that effective interventions are personalized for the patient and their specific goals, contexts, active involvement, functionality and support from peers (Smits-Engelsman et al., 2018). In sum, tailor-made treatments have potential to improve both motor and psychological outcomes, and psychological interventions for secondary problems and psychological consequences of DCD should be examined in great detail future research.

Overall, there are existing research gaps in the understanding of DCD, however, a recent increase in international attention to the condition is promising. We deem it relevant that more European psychological researchers and practitioners take note of this upsurge and integrate motor skill screenings into their work where possible. Such inclusion is pertinent for more accurate symptom profiles, prevalence estimates, improved differential diagnosis, and effective treatment of the symptoms of DCD across all age groups.