e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 1 6 ( 2 0 1 2 ) 5 7 3 e5 8 1

Official Journal of the European Paediatric Neurology Society

Review article

Developmental coordination disorder: A review and update

Jill G. Zwicker a,*, Cheryl Missiuna b, Susan R. Harris c, Lara A. Boyd c

a
Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
b
School of Rehabilitation Science and CanChild, McMaster University, Hamilton, Ontario, Canada
c
Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada

article info abstract

Article history: Present in approximately 5e6% of school-aged children, developmental coordination

Received 13 December 2011 disorder (DCD) is a neuromotor disability in which a child’s motor coordination difficulties
Received in revised form significantly interfere with activities of daily living or academic achievement. These chil-
7 May 2012 dren typically have difficulty with fine and/or gross motor skills, with motor performance
Accepted 18 May 2012 that is usually slower, less accurate, and more variable than that of their peers. In this
paper, we review the history of various definitions leading up to the current definition of
Keywords: DCD, prevalence estimates for the disorder, etiology, common co-morbidities, the impact
Developmental of DCD on the child’s life, and prognosis. As well, we briefly describe current interventions
coordination disorder for children with the disorder and results of recent neuroimaging studies of the brains of
DCD children with DCD, including research by the authors of this paper.
Children ª 2012 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights
Prognosis reserved.
Intervention
fMRI

Contents

1. Description, definition and history of DCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574

2. Prevalence of DCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575
3. Etiology and neurobiology of DCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575
4. Common co-morbidities associated with DCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 576
5. Impact of DCD on daily life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 576
6. Prognosis for children with DCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 576
7. Current intervention approaches for DCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577
8. Imaging studies of children with DCD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577
9. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577

* Corresponding author. Child & Family Research Institute, Developmental Neurosciences and Child Health, L408-4480 Oak Street,
Vancouver, B.C. V6H 3V4, Canada. Tel.: þ1 604 875 2000x6805; fax: þ1 604 875 3569.
E-mail address: jzwicker@cw.bc.ca (J.G. Zwicker).
1090-3798/$ e see front matter ª 2012 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.ejpn.2012.05.005
574 e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 1 6 ( 2 0 1 2 ) 5 7 3 e5 8 1
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 578
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 578
1. Description, definition and history of DCD
Matthew is a 9-year-old boy who has difficulty tying his shoes, a skill
his peers learned to do three years earlier. His mother helps him cut
his food and wash his hair, as he struggles to complete these tasks
independently. He has not mastered how to ride his bicycle, so he is
unable to ride to the park with his friends. Matthew has tried several
team sports, but no one passes the ball or puck to him; because he
feels excluded and inferior to his teammates, he does not want to
participate in sports anymore. Matthew’s parents are worried that
he is becoming socially isolated and withdrawn. At a recent parent
interview, Matthew’s teacher commented that, while he is a bright
and capable student, his printing is slow and often illegible. Matthew
does not complete many of his school assignments and homework
activities, and, as a result, his grades are suffering. Matthew’s
parents are increasingly concerned, but do not know what is wrong
with their son.
Matthew is like many children who have a neuro-
developmental disorder known as developmental coordina-
tion disorder (DCD). DCD is heterogeneous, with some
children having difficulty only with fine motor skills, only
gross motor skills, or both.1,2 Regardless of which skills are
affected, motor performance of children with DCD is usually
slower, less accurate, and more variable than in their
peers.3e10 Motor learning is also impacted, with children with
DCD having difficulty acquiring typical childhood skills, such
as tying shoes or riding a bicycle.3,11 As Polatajko highlighted,
DCD is more than just the lower end of normal variance in
motor abilities12; the motor impairment significantly impacts
daily life, and is not due to a neurological disorder or delayed
cognitive development.
Using the International Classification of Functioning,
Disability and Health (ICF) as a framework,13 the Fig. 1 depicts
how Matthew’s gross motor impairments (body function) limit
his ability to ride a bicycle (activity) and consequently restrict
his opportunities to ride to the park with his friends (partici-
pation). These limitations in his interaction with his peers
(environmental factors) further confound his frustration with
his motor in coordination and contribute to his low self-esteem
(personal factors). The ICF framework will be cited throughout
this review, as it relates to DCD.
Per the Diagnostic and Statistical Manual, fourth edition e
Text revision (DSM-IV-TR), four diagnostic criteria comprise
DCD,14 e:
A. Performance in daily activities that require motor coordi-
nation is substantially below that expected given the
person’s chronological age and measured intelligence.
This may be manifested by marked delays in achieving
motor milestones (e.g., walking, crawling, sitting),
e
With the release of DSM-V in 2013, these criteria may undergo
some revision.
dropping things, “clumsiness,” poor performance in
sports, or poor handwriting.
B. The disturbance in Criterion A significantly interferes with
academic achievement or activities of daily living.
C. The disturbance is not due to a general medical condition
(e.g., cerebral palsy, hemiplegia, or muscular dystrophy)
and does not meet the criteria for a Pervasive Develop-
mental Disorder.
D. If mental retardation is present, the motor difficulties are
in excess of those usually associated with it.
In 2012, the European Academy of Childhood Disability
(EACD) published interdisciplinary clinical practice guidelines
for definition, diagnosis, assessment, and intervention for
children with DCD.15 Recommendations within these guide-
lines resulted from extensive consultation with an interna-
tional group of researchers and clinicians and were previously
approved at two consensus conferences in Germany, with
input from German and Swiss medical and therapeutic
societies.15
We will review the history of various definitions leading up
to the current definition of DCD, prevalence estimates for the
disorder, possible etiology and neurobiology underlying DCD,
common co-morbidities, the impact of DCD on the child’s
daily life, and prognosis for the disorder. As well, we will
briefly describe current interventions for children with the
disorder, results of recent neuroimaging studies of the brains
of children with DCD, and future research aims.
Identified by Orton in 1937, the significance of “clumsiness”
was not apparent in the literature until the early 1960s.16 Since
then, many terms have been used to describe children whose
motor difficulties interfere with daily living,17e19 e.g., clumsy
child syndrome,20 sensory integrative dysfunction,21 devel-
opmental dyspraxia,22 physical awkwardness,23 and percep-
tual motor dysfunction.24 In Scandinavian countries, the
acronym DAMP has been used to identify children with defi-
cits in attention, motor control, and perception.25
To improve communication and knowledge among clini-
cians and researchers working with “clumsy” children, an
international consensus meeting was held in London, Ontario
in 1994 to determine which terminology should be used to
describe these children. At this “London Consensus”, the term
DCD was accepted.17 The term “developmental coordination
disorder” and the diagnostic criteria for DCD had been added
to the third edition of the DSM26 and remain in the most
current edition.14 Ten years after the London Consensus
meeting, over 50% of all published articles used the term
DCD,27 showing that this term is gaining acceptance as the
preferred terminology. The London Consensus was re-
confirmed with the 2006 publication of the Leeds Consensus
Statement28 highlighting the agreement of international
researchers and clinicians to retain the term DCD as a distinct
and unique disorder. More recently, the EACD reaffirmed the
use of the term DCD in reference to children with
 e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 1 6 ( 2 0 1 2 ) 5 7 3 e5 8 1
Fig. 1 e Illustration of ICF framework of disability for Matthew, a 9-year-old boy with DCD.
developmental motor problems,15 as well as the DSM-IV
criteria14 for defining the disorder.
2. Prevalence of DCD
Depending upon the selection criteria used, prevalence esti-
mates for DCD vary from 1.4 to 19.0% of school-aged child-
ren.29e31 Using the most commonly reported prevalence of
5e6%,14 approximately 190,000 Canadian children aged 5e11
years may meet the diagnostic criteria for DCD,32 as well as
over a million children in the U.S.33 Data from other countries
have ranged from a lower reported prevalence of severe DCD
in the United Kingdom (1.8%),29 to an unusually high preva-
lence estimate in Greece (19.0%).31
A major reason for these varying prevalence rates is how
cases of DCD are identified.29 Higher prevalence rates may be
reported if not all diagnostic criteria for DCD are applied. Some
studies include children with motor coordination challenges
without quantifying intelligence or impact on activities of
daily living.34 In contrast, the prevalence of DCD may be
underreported due to lack of awareness of the disorder.35 For
example, a survey of physicians in a large city in Canada
showed that 174 of 191 (91%) had never heard of DCD.36
Variations in reported prevalence may also be due to selec-
tion of different cutoff scores used to indicate motor impair-
ment,28 lifestyle differences in various cultures,31 or
terminology used to describe these children.17
Clinical studies of children with DCD have reported higher
prevalence in boys. The gender ratio for boys to girls has
varied from 3:125, 37 to as high as 7:1.38 However recent
population-based studies suggest a lower ratio (1.9:1.0 male to
female)29 or almost equal gender distribution.39
Although reasons for the greater prevalence of DCD in boys
have not been described explicitly in the literature, this
difference may relate in part to the fact that DCD is more
prevalent in children born at very low birth weight or very
575
preterm (as compared to full-term, appropriately grown
infants)40; several recent studies have shown that neurolog-
ical outcomes are more adverse for male infants born preterm
than for their female counterparts.41e43
3. Etiology and neurobiology of DCD
Although the etiology of DCD is largely unknown, it may be
related to central nervous system pathology.14 DCD was first
conceptualized as a form of “minimal brain dysfunction”
(MBD), a term used to describe a collection of symptoms
reflecting learning, attention, and motor coordination defi-
cits.44 MBD was later replaced by complex “minimal neuro-
logical dysfunction” (MND), which reflects “a distinct form of
perinatally acquired brain dysfunction, which is likely asso-
ciated with a structural deficit of the brain”,45,p568 e.g., body
functions and structure, as in the ICF framework (see Fig. 1).13
MND has been proposed to result from stress associated with
preterm birth46; 12.5% to over 50% of children born preterm
have motor impairments consistent with DCD37,46e48 and are
6e8 times more likely to develop the disorder.40 Debate
continues as to whether children born preterm should be
diagnosed with DCD, as they may have another neurological
condition that could explain their motor deficits (Criterion
C).49
Others have proposed a variant of atypical brain develop-
ment as the source of DCD.50 Due to the overlapping nature of
developmental disorders, Kaplan et al. suggested that diffuse,
rather than specific, areas of the brain may be involved,51 i.e.,
children may have one or more disorders (e.g., affecting
motor, attention, and/or language), depending on the extent
of disruption to brain development.
Although not a cause of DCD per se, two possible mecha-
nisms underlying the disorder have been hypothesized. One,
the automatization deficit hypothesis, suggests that children
with DCD, like those with dyslexia, may have difficulty
576 e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 1 6 ( 2 0 1 2 ) 5 7 3 e5 8 1
making motor skills automatic.52,53 This hypothesis leads to
speculation that the cerebellum may be involved in DCD.1,2 An
alternative explanation, but one also suggesting cerebellar
involvement,54,55 is the internal modeling deficit hypoth-
esis.56e60 Successful motor control is thought to result from an
internal model that accurately predicts the sensory conse-
quences of motor command.61 Theoretical models of motor
learning posit that the cerebellum receives an efference copy
of the motor command and compares the predicted move-
ment with the actual movement; if there is a mismatch, the
cerebellum sends an error signal as feedback to create a more
accurate movement on subsequent occasions.62 Whether the
mechanism underlying DCD is due to an automatization
deficit or a deficit in forming an internal model, the cere-
bellum has been implicated in DCD.63,64
4. Common co-morbidities associated with DCD
DCD often co-occurs with other developmental disorders,
most commonly attention deficit hyperactivity disorder
(ADHD).38,65e69 Up to 50% of children with DCD have been
shown also to meet criteria for ADHD,38,69 with recent
evidence suggesting a genetic link between these two disor-
ders.70,71 Learning disabilities72,73 and speech/language
impairment74e78 have also been associated with DCD. A clin-
ical study showed that more than 50% of children identified
with severe dyslexia (or those in the bottom 5% of school-aged
readers) showed definite motor coordination difficulties for
which motor intervention would be recommended.72 In
another small study involving 11 children with DCD, 11 with
specific language impairment (SLI) and a comparison group of
typically developing children, almost half of those with DCD
performed similarly to the children with SLI in several
measures of expressive language, leading the authors to
conclude that: “language impairment is a common co-
occurring condition in DCD.”79,p165 Children with DCD may
have more than one co-morbid disorder51,72,80,81; the high
degree of overlap among these developmental disorders has
led some researchers to speculate about shared etiology.51
One possible common neurological substrate proposed for
the co-occurrence of DCD and ADHD is the cerebellum, with
up to 50% of children with ADHD showing motor difficulties
that are consistent with DCD.64 Learning disabilities, espe-
cially dyslexia, and SLI may also be due to cerebellar
involvement.64
5. Impact of DCD on daily life
As outlined in Criterion B of the DSM-IV-TR diagnostic
criteria,14 a child’s motor coordination difficulties must
significantly interfere with activities of daily living or
academic achievement for a DCD diagnosis, e.g., activity
limitations as in the ICF framework (see Fig. 1).13 The types of
difficulties children with DCD experience have been well
documented.11,82e84 Self-care challenges include difficulty
with dressing, managing buttons and zippers, tying shoelaces,
using a knife and fork, and toileting. Difficulty with school-
related tasks can negatively impact academic achievement,
e.g., copying, drawing, painting, printing, handwriting, using
scissors, organizing, and finishing work on time. Physical
education can also be affected, as children with DCD have
trouble throwing, catching, or kicking a ball, running, skip-
ping, and playing sports. Despite average or above intelli-
gence, children with DCD have poorer school outcomes than
peers.85e88
Difficulty with motor skills also impacts leisure participa-
tion of children with DCD. Their motor impairment not only
affects sport-related skills, but other skills important in
childhood, such as riding a bicycle.82 Perhaps as a result of
their poorer athletic and social competence,85,89 children with
DCD engage in fewer physical and group activities than their
peers,85,90e93 e.g., participation restrictions per the ICF
framework,13 which can lead to social isolation94,95 (environ-
mental factors in the ICF framework).13
Beyond the motor domain, children with DCD can experi-
ence significant secondary emotional and mental health
concerns, e.g., low self-worth and self-esteem,84,89,96,97 high
rates of anxiety and depression,25,39,84,89,97 and emotional/
behavioural disorders,98e100 e.g., personal factors in the ICF
framework).13 Thus, DCD has far-reaching effects in multiple
domains101 “with considerable consequences in daily life”.15,
p. 59
In a recent systematic review of 41 studies that examined
various quality of life domains in children with DCD, Zwicker
and colleagues101 reported that children with DCD performed
significantly lower than typically developing peers in
a number of gross motor and fine motor skills, daily living
skills, and leisure/recreational activities.
6. Prognosis for children with DCD
Previously, the common belief was that children with DCD
would outgrow their motor difficulties.102,103 However, longi-
tudinal studies have shown that these motor problems can
persist into adolescence86,88,104 and adulthood.105 Long-term
outcomes often extend beyond the motor domain to include
secondary mental health, emotional, and behavioural
issues.39,92,99 Based upon a qualitative exploration of experi-
ences of parents of children with DCD, Missiuna et al.
proposed that there may be a developmental trajectory in
DCD, extending from motor and play concerns in the early
years, to self-care, academic, and peer problems in middle
childhood, and to issues with self-concept and emotional
health in later childhood and adolescence.92 Children with
DCD who have co-morbid conditions (e.g., ADHD) have poorer
psychosocial outcomes106 and higher levels of depressive
symptoms93,107 than those with DCD alone.
Interestingly, children with DCD have also been shown to
be at higher risk for obesity108,109 and coronary vascular
disease.110 Compared to typical peers, they have lower
cardiorespiratory and physical fitness111e114 with differences
in fitness levels increasing with age.113
Despite the challenges facing children with DCD, func-
tional outcomes can be improved with intervention,115e118
with the EACD guidelines recommending that all children
with DCD should receive intervention.15 In addition to child-
focused interventions delivered by occupational therapists
or physical therapists, parents and teachers can play positive
 e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 1 6 ( 2 0 1 2 ) 5 7 3 e5 8 1
roles in supporting the needs of children with DCD.119,120 As
children grow, they may learn to use compensatory strategies
and to adapt their occupations to ones with less demand on
motor coordination, strategies leading to positive outcomes in
adulthood.93
7. Current intervention approaches for DCD
A variety of different treatment approaches for DCD exist,
many of which have been compared with one another121e123
and systematically reviewed.11,124e126 Interventions can be
broadly categorized into two types: process or deficit-oriented
and task-specific.11,123 Deficit-oriented approaches include
sensory integration therapy,127,128 sensorimotor-oriented
treatment,129,130 and process-oriented treatment.24,131 The
premise of these approaches is that intervention is targeted at
the underlying process deficit, with remediation of the deficit
resulting in improved task performance.123 Deficit-oriented
approaches are based on outdated neuromaturational and
hierarchical theories,121,123 with inconclusive evidence for
their effectiveness.11,122,123
Grounded in current theories of motor control and motor
learning,132 task-oriented approaches include task-specific
intervention,133,134 neuromotor task training,117,118 Cognitive
Orientation to daily Occupational Performance (COeOP),115,116
and ecological intervention.123,135 Evidence for task-specific
interventions is promising,11,122,123 with some agreement
that this approach is preferred over deficit-oriented
approaches.11,123,136
Despite theory and evidence favouring task-specific inter-
ventions, no single approach has been fully substantiated by
research123 and none have been grounded in neurobiological
data or informed by neuroimaging studies. Wilson argued that
examining brainebehaviour interactions using a cognitive
neuroscientific approach might help us better understand motor
learning in children with DCD.122 Neuroimaging studies could
increase our understanding of the neurobiology of DCD and
inform our thinking about interventions for children with this
disorder.
Based on principles of motor learning and neuroplasticity,
it is conceivable that children with DCD can demonstrate
improved motor skill and relatively permanent change in
association with motor learning training.132,137 At this point in
time, it is not known what type and amount of training is
required to induce neuroplastic change, or what training, if
any, can facilitate updating of the internal model of move-
ment in children with DCD. Functional magnetic resonance
imaging ( fMRI) and diffusion tensor imaging (DTI) are tools
that can help elucidate answers to these questions.
8. Imaging studies of children with DCD
Recently, researchers have used fMRI to examine brain func-
tion in children with DCD. Querne et al. reported that children
with DCD seem to have dysfunction in the attentional brain
network as evidenced by lower activation in the dorsolateral
prefrontal cortex compared to control children during a “go/
no-go” task.138 Kashiwagi and colleagues showed that
577
children with DCD had significantly less activation of the left
superior and inferior parietal lobules than control children
during a continuous, visuomotor tracking task,139 thus
implicating the parietal lobe in coordination dysfunction. In
contrast, subsequent fMRI work by our group, involving 7
children with DCD and 7 age-matched controls performing
a fine-motor trail-tracing task, demonstrated that those with
DCD had greater brain activation than controls in the frontal,
parietal and temporal brain regions; typically-developing
children showed greater activation in the precuneus and
areas associated with motor control, motor learning, and error
processing.140 In addition to differences in brain activation,
children with DCD activated almost twice as many brain
regions as control children. This finding suggests that children
with DCD had to direct more effort to complete the task,141
consistent with clinical observations of these children when
engaged in motor-based activities.
In contrast to greater brain activation in children with DCD
during motor performance,140 we found that these children
demonstrated under-activation of brain areas relative to
same-age peers during a motor learning paradigm.142 Children
with and without DCD were scanned for a second time while
completing the fine motor, trail-tracing task after practicing
the task for three days (four 2-min blocks per day) outside the
scanner. Significant differences between groups were noted in
a broad network of regions associated with motor learning,
including bilateral inferior parietal lobules, right dorsolateral
prefrontal cortex, and in the cerebellum (right crus I, left
lobule VI, and left lobule IX). The relative under-activation of
these regions in children with DCD may be associated with
their poorer motor learning compared to control children, but
future work with a larger sample is needed to confirm this
hypothesis.
In a pilot study of children with and without DCD, Zwicker
et al.143 used DTI to explore the integrity of motor, sensory and
cerebellar pathways in the brain. The authors reported
significantly lower mean diffusivity of the posterior cortico-
spinal tract and posterior thalamic radiation in children with
DCD as compared to controls. Lower axial diffusivity was
significantly correlated with lower scores on a clinical test of
motor abilities, suggesting that altered microstructural
development of sensory and motor pathways may be impli-
cated in DCD.
As others have suggested,144,145 we believe neuroimaging
techniques, such as fMRI, can advance clinical practice by
informing clinician scientists how interventions shape
patterns of brain activity and lead to improved function. This
is our hope in our continued line of neuroimaging inquiry
involving children with DCD.
9. Conclusion
Although DCD is a relatively common disorder affecting about
5e6% of school-aged children, far less has been written about
it in the child neurology literature than less prevalent devel-
opmental disabilities, such as cerebral palsy and autism
spectrum disorder. This is likely due, in part, to the changing
name of the disorder and its common co-morbid association
578 e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 1 6 ( 2 0 1 2 ) 5 7 3 e5 8 1
with ADHD, which has garnered far more attention and
research.
This review article presents new knowledge gleaned from
neuroimaging studies, i.e., fMRI and DTI, that will help
paediatric neurologists and others begin to understand brain
differences between children with DCD and typically devel-
oping children. As well, it draws attention to the recently
published EACD clinical practice guidelines and recommen-
dations from which future research aims can be developed.
We hope that our article will assist in increasing awareness
about DCD and its impact on the lives of children. Greater
attention to identification and diagnosis of DCD is urgently
needed to initiate support, education, and intervention for
children and their families. Further research into the neuro-
biology of DCD will help to better understand the disorder and
inform development or refinement of interventions to
improve outcomes for these children. As a child interviewed
in one of our qualitative studies stated: DCD is “sort of frus-
trating sometimes, but if you can get over the stuff that you’re
bad at, then it’s, you can, it’s pretty good.” (“Tristan”, age 11;
unpublished data).
Acknowledgements
Dr. Zwicker was previously supported by a Quality of Life
Strategic Training Fellowship in Rehabilitation Research from
the Canadian Institutes of Health Research Musculoskeletal
and Arthritis Institute and a Senior Graduate Training Schol-
arship from the Michael Smith Foundation for Health
Research (MSFHR); she is currently funded by the Canadian
Child Health Clinician Scientist Program and an MSFHR/
NeuroDevNet Postdoctoral Award. At the time of writing, Dr.
Missiuna was supported by a Rehabilitation Scientist award
from the Ontario Ministry of Health and Long Term Care and
the Ontario Neurotrauma Foundation. Dr. Boyd is Canada
Research Chair in Neurobiology of Motor Learning and an
MSFHR Career Investigator.
references
1. Visser J. Developmental coordination disorder: a review of
research on subtypes and comorbidities. Hum Mov Sci
2003;22:479e93.
2. Rivard L, Missiuna C, Pollock N, David KS. Developmental
coordination disorder (DCD). In: Campbell SK, Palisano RJ,
Orlin MN, editors. Physical therapy for children. 4th ed. St.
Louis, MO: Elsevier; 2011. p. 498e538.
3. Geuze RH. Postural control in children with developmental
coordination disorder. Neural Plast 2005;12:183e96.
4. Johnston LM, Burns YR, Brauer SG, Richardson CA.
Differences in postural control and movement performance
during goal directed reaching in children with
developmental coordination disorder. Hum Mov Sci
2002;21:583e601.
5. Lundy-Ekman L, Ivry R, Keele S, Woollacott M. Timing and
force control deficits in clumsy children. J Cogn Neurosci
1991;3:367e76.
6. Estil LB, Ingvaldsen RP, Whiting HT. Spatial and temporal
constraints on performance in children with movement co-
ordination problems. Exp Brain Res 2002;147:153e61.
7. Piek JP, Skinner RA. Timing and force control during
a sequential tapping task in children with and without
motor coordination problems. J Int Neuropsychol Soc
1999;5:320e9.
8. Henderson L, Rose P, Henderson S. Reaction time and
movement time in children with a developmental coordination
disorder. J Child Psychol Psychiatry 1992;33:895e905.
9. Raynor AJ. Fractioned reflex and reaction time in children
with developmental coordination disorder. Motor Control
1998;2:114e24.
10. Volman M, Geuze RH. Relative phase stability of bimanual
and visuomanual rhythmic coordination patterns in
children with a developmental coordination disorder. Hum
Mov Sci 1998;17:541e72.
11. Polatajko HJ, Cantin N. Developmental coordination disorder
(dyspraxia): an overview of the state of the art. Semin Pediatr
Neurol 2006;12:250e8.
12. Polatajko HJ. Developmental coordination disorder (DCD):
alias the clumsy child syndrome. In: Whitmore K, Hart H,
Willems G, editors. A Neurodevelopmental approach to specific
learning disorders. Clinics in Developmental Medicine, no. 145.
London: MacKeith Press; 1999. p. 119e33.
13. World Health Organization. The international Classification of
functioning, disability and health (ICF). Geneva: World Health
Organization; 2001.
14. American Psychiatric Association. Diagnostic and statistical
manual of mental disorders. text revision. 4th ed. Washington,
DC: Author; 2000.
15. Blank R, Smits-Engelman B, Polatajko H, Wilson P. European
Academy for Childhood Disability. European Academy for
Childhood Disability: recommendations on the definition,
diagnosis and intervention of developmental coordination
disorder (long version). Dev Med Child Neurol 2012;54:54e93.
16. Walton JN, Ellis E, Court SD. Clumsy children: developmental
apraxia and agnosia. Brain 1962;85:603e12.
17. Polatajko H, Fox M, Missiuna C. An international consensus
on children with developmental coordination disorder. Can J
Occup Ther 1995;62:3e6.
18. Missiuna C, Polatajko H. Developmental dyspraxia by any
other name: are they all just clumsy children? Am J Occup
Ther 1995;49:619e27.
19. Henderson SE, Henderson L. Toward an understanding of
developmental coordination disorder: terminological and
diagnostic issues. Neural Plast 2003;10:1e13.
20. Gubbay SS. The clumsy child: a study in developmental apraxia
and Agnostic Ataxia. London: WB Saunders; 1975.
21. Ayres AJ. Types of sensory integrative dysfunction among
disabled learners. Am J Occup Ther 1972;26:13e8.
22. Cermak S. Developmental dyspraxia. Adv Psychol
1985;23:225e48.
23. Miyahara M, Register C. Perceptions of three terms to
describe physical awkwardness in children. Res Dev Disabil
2000;21:367e76.
24. Laszlo JI, Sainsbury KM. Perceptual-motor development and
prevention of clumsiness. Psychol Res 1993;55:167e74.
25. Gillberg C. Deficits in attention, motor control, and
perception: a brief review. Arch Dis Child 2003;88:904e10.
26. American Psychiatric Association. Diagnostic and statistical
manual of mental disorders. revised. 3rd ed. Washington, DC:
Author; 1987.
27. Magalhaes LC, Missiuna C, Wong S. Terminology used in
research reports of developmental coordination disorder.
Dev Med Child Neurol 2006;48:937e41.
28. Sugden D. Developmental coordination disorder as a specific
learning disability. Leeds Consensus Statement. 2006:1e6.
 e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 1 6 ( 2 0 1 2 ) 5 7 3 e5 8 1
29. Lingam R, Hunt L, Golding J, Jongmans M, Emond A.
Prevalence of developmental coordination disorder using
the DSM-IV at 7 years of age: a UK population-based study.
Pediatrics 2009;123:e693e700.
30. Wright HC, Sugden DA. A two-step procedure for the
identification of children with developmental co-ordination
disorder in Singapore. Dev Med Child Neurol
1996;38:1099e105.
31. Tsiotra GD, Flouris AD, Koutedakis Y, et al. A comparison
of developmental coordination disorder prevalence rates in
Canadian and Greek children. J Adolesc Health
2006;39:125e7.
32. Canada Statistics. Table 051-0001 estimates of population, by
age group and sex. Canada: provinces and territories, annual
(persons). Statistics Canada. Available from: http://cansim2.
statcan.ca/cgi-win/cnsmcgi.pgm?&Lang¼E&ArrayId¼510001
&Array_Pick¼1&Detail¼1&ResultTemplate¼CII/CII___&Root
Dir¼CII/; 2006 [Accessed 23.8.2007].
33. U.S. Census Bureau. Age: Census 2000 Brief. Available at:
http://www.census.gov/prod/2001pubs/c2kbr01-12.pdf.
[accessed 11.4.2008].
34. Geuze RH, Jongmans MJ, Schoemaker MM, Smits-
Engelsman BC. Clinical and research diagnostic criteria for
developmental coordination disorder: a review and
discussion. Hum Mov Sci 2001;20:7e47.
35. Missiuna C, Gaines R, Soucie H. Why every office needs
a tennis ball: a new approach to assessing the clumsy child.
Can Med Assoc J 2006;175:471e3.
36. Gaines R, Missiuna C, Egan M, McLean J. Educational
outreach and collaborative care enhances physician’s
perceived knowledge about developmental coordination
disorder. BMC Health Serv Res 2008;8:21.
37. Missiuna C, Gaines R, McLean J, et al. Description of children
identified by physicians as having developmental
coordination disorder. Dev Med Child Neurol 2008;50:839e44.
38. Kadesjo B, Gillberg C. Developmental coordination disorder
in Swedish 7-year-old children. J Am Acad Child Adolesc
Psychiatry 1999;38:820e8.
39. Missiuna C, Cairney J, Pollock N, Cousins M, MacDonald K.
Exploring the psychological consequences of developmental
coordination disorder. Can Assoc Occup Ther Conf Proc.
Ottawa, CA: CAOT; 2009.
40. Edwards J, Berube M, Erlandson K, et al. Developmental
coordination disorder in school-aged children born very
preterm and/or at very low birth weight: a systematic
review. J Dev Behav Pediatr 2011;32:678e87.
41. Kent AL, Wright IM, Abdel-Latif MENew South Wales and
Australian Capital Territory Neonatal Intensive Care Units
Audit Group (37 collaborators). Mortality and neurologic
outcomes are greater in preterm male infants. Pediatrics
2012;129:124e31.
42. Lao TT, Sahota DS, Suen SS, Law LW. The impact of fetal
gender on preterm birth in a southern Chinese population.
J Matern Fetal Neonatal Med 2011;24:1440e3.
43. Marlow N, Hennessy EM, Bracewell MA, Wolke DEPICure
Study Group. Motor and executive function at 6 years of
age after extremely preterm birth. Pediatrics
2007;120:793e804.
44. Clements SD, Peters JE. Minimal brain dysfunctions in the
school-age child: diagnosis and treatment. Arch Gen
Psychiatry 1962;6:185e97.
45. Hadders-Algra M. Two distinct forms of minor neurological
dysfunction: perspectives emerging from a review of data of
the Groningen Perinatal Project. Dev Med Child Neurol
2002;44:561e71.
46. Holsti L, Grunau RV, Whitfield MF. Developmental
coordination disorder in extremely low birth weight children
at nine years. J Dev Behav Pediatr 2002;23:9e15.
579
47. Davis NM, Ford GW, Anderson PJ, Doyle LWVictorian Infant
Collaborative Study Group. Developmental coordination
disorder at 8 years of age in a regional cohort of extremely-
low-birthweight or very preterm infants. Dev Med Child
Neurol 2007;49:325e30.
48. Goyen TA, Lui K. Developmental coordination disorder in
"apparently normal" schoolchildren born extremely
preterm. Arch Dis Child 2009;94:298e302.
49. Majnemer A. Motor incoordination in children born preterm:
coordinated efforts needed. Dev Med Child Neurol
2007;49:325e30.
50. Gilger JW, Kaplan BJ. Atypical brain development:
a conceptual framework for understanding developmental
learning disabilities. Dev Neuropsychol 2001;20:465e81.
51. Kaplan BJ, Wilson NB, Dewey D, Crawford SG. DCD may not
be a discrete disorder. Hum Mov Sci 1998;17:471e90.
52. Fawcett AJ, Nicolson RI. Automatisation deficits in balance
for dyslexic children. Percept Mot Skills 1992;75:507e29.
53. Nicolson RI, Fawcett AJ, Dean P. Time estimation deficits in
developmental dyslexia: evidence of cerebellar involvement.
Proc Biol Sci 1995;259:43e7.
54. Ito M. Neurobiology: internal model visualized. Nature
2000;403:153e4.
55. Ito M. Mechanisms of motor learning in the cerebellum.
Brain Res 2000;886:237e45.
56. Kagerer FA, Bo J, Contreras-Vidal JL, Clark JE. Visuomotor
adaptation in children with developmental coordination
disorder. Motor Control 2004;8:450e60.
57. Kagerer FA, Contreras-Vidal JL, Bo J, Clark JE. Abrupt, but not
gradual visuomotor distortion facilitates adaptation in
children with developmental coordination disorder. Hum
Mov Sci 2006;25:622e33.
58. Williams J, Thomas PR, Maruff P, Butson M, Wilson PH.
Motor, visual and egocentric transformations in children
with developmental coordination disorder. Child Care Health
Dev 2006;32:633e47.
59. Wilson PH, Maruff P, Butson M, et al. Internal representation
of movement in children with developmental coordination
disorder: a mental rotation task. Dev Med Child Neurol
2004;46:754e9.
60. Wilson PH, Maruff P, Ives S, Currie J. Abnormalities of motor
and praxis imagery in children with DCD. Hum Mov Sci
2001;20:135e59.
61. Krakauer JW, Shadmehr R. Towards a computational
neuropsychology of action. Prog Brain Res 2007;165:383e94.
62. Kawato M. Internal models for motor control and trajectory
planning. Curr Opin Neurobiol 1999;9:718e27.
63. Cantin N, Polatajko HJ, Thach WT, Jaglal S. Developmental
coordination disorder: exploration of a cerebellar
hypothesis. Hum Mov Sci 2007;26:491e509.
64. Zwicker JG, Missiuna C, Boyd LA. Neural correlates of
developmental coordination disorder: a review of
hypotheses. J Child Neurol 2009;24:1273e81.
65. Dewey D, Kaplan BJ, Crawford SG, Wilson BN.
Developmental coordination disorder: associated problems
in attention, learning, and psychosocial adjustment. Hum
Mov Sci 2002;21:905e18.
66. Kadesjo B, Gillberg C. Attention deficits and clumsiness in
Swedish 7-year-old children. Dev Med Child Neurol
1998;40:796e804.
67. Piek JP, Dyck MJ. Sensory-motor deficits in children with
developmental coordination disorder, attention deficit
hyperactivity disorder and autistic disorder. Hum Mov Sci
2004;23:475e88.
68. Piek JP, Dyck MJ, Nieman A, et al. The relationship between
motor coordination, executive functioning and attention in
school aged children. Arch Clin Neuropsychol
2004;19:1063e76.
580 e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 1 6 ( 2 0 1 2 ) 5 7 3 e5 8 1
69. Watemberg N, Waiserberg N, Zuk L, Lerman-Sagie T.
Developmental coordination disorder in children with
attention-deficit-hyperactivity disorder and physical
therapy intervention. Dev Med Child Neurol 2007;49:920e5.
70. Martin NC, Piek JP, Hay D. DCD and ADHD: a genetic study of
their shared aetiology. Hum Mov Sci 2006;25:110e24.
71. Fliers E, Vermeulen S, Rijsdijk F, et al. ADHD and poor motor
performance from a family genetic perspective. J Am Acad
Child Adolesc Psychiatry 2009;48:25e34.
72. Iversen S, Berg K, Ellertsen B, Tonnessen FE. Motor
coordination difficulties in a municipality group and in
a clinical sample of poor readers. Dyslexia 2005;11:217e31.
73. Jongmans MJ, Smits-Engelsman BC, Schoemaker MM.
Consequences of comorbidity of developmental
coordination disorders and learning disabilities for severity
and pattern of perceptual-motor dysfunction. J Learn Disabil
2003;36:528e37.
74. Alloway TP, Archibald L. Working memory and learning in
children with developmental coordination disorder and
specific language impairment. J Learn Disabil 2008;41:251e62.
75. Cheng HC, Chen HY, Tsai CL, Chen YJ, Cherng RJ.
Comorbidity of motor and language impairments in
preschool children of Taiwan. Res Dev Disabil
2009;30:1054e61.
76. Gaines R, Missiuna C. Early identification: are speech/
language-impaired toddlers at increased risk for
developmental coordination disorder? Child Care Health Dev
2007;33:325e32.
77. Hill EL. Non-specific nature of specific language impairment:
a review of the literature with regard to concomitant motor
impairments. Int J Lang Commun Disord 2001;36:149e71.
78. Webster RI, Majnemer A, Platt RW, Shevell MI. Motor
function at school age in children with a preschool diagnosis
of developmental language impairment. J Pediatr
2005;146:80e5.
79. Archibald LMD. Alloway TP.Comparing language profiles:
children with specific language impairment and
developmental coordination disorder. Int J Lang Commun
Disord 2008;43:165e80.
80. Kooistra L, Crawford S, Dewey D, Cantell M, Kaplan BJ.
Motor correlates of ADHD: contribution of reading disability
and oppositional defiant disorder. J Learn Disabil
2005;38:195e206.
81. Tseng MH, Howe TH, Chuang IC, Hsieh CL. Cooccurrence of
problems in activity level, attention, psychosocial
adjustment, reading and writing in children with
developmental coordination disorder. Int J Rehabil Res
2007;30:327e32.
82. Dunford C, Missiuna C, Street E, Sibert J. Children’s
perceptions of the impact of developmental coordination
disorder on activities of daily living. Br J Occup Ther
2005;68:207e14.
83. Miller LT, Missiuna CA, Macnab JJ, Malloy-Miller T,
Polatajko HJ. Clinical description of children with
developmental coordination disorder. Can J Occup Ther
2001;68:5e15.
84. Missiuna C, Gaines R, Soucie H, McLean J. Parental questions
about developmental coordination disorder: a synopsis of
current evidence. Paediatr Child Health 2006;11:507e12.
85. Cantell MH, Smyth MM, Ahonen TP. Clumsiness in
adolescence: educational, motor, and social outcomes of
motor delay detected at 5 years. Adapt Phys Activ Q
1994;11:115e29.
86. Cantell MH, Smyth MM, Ahonen TP. Two distinct pathways
for developmental coordination disorder: persistence and
resolution. Hum Mov Sci 2003;22:413e31.
87. Geuze RH, Borger H. Children who are clumsy: five years
later. Adapt Phys Activ Q 1993;10:10e21.
88. Losse A, Henderson SE, Elliman D, et al. Clumsiness in
children-do they grow out of it? A 10-year follow-up study.
Dev Med Child Neurol 1991;33:55e68.
89. Skinner RA, Piek JP. Psychosocial implications of poor motor
coordination in children and adolescents. Hum Mov Sci
2001;20:73e94.
90. Bouffard M, Watkinson EJ, Thompson LP, Causgrove
Dunn JL, Romanow SKE. A test of the activity deficit
hypothesis with children with movement difficulties. Adapt
Phys Activ Q 1996;13:61e73.
91. Chen HF, Cohn ES. Social participation for children with
developmental coordination disorder: conceptual,
evaluation and intervention considerations. Phys Occup Ther
Pediatr 2003;23:61e78.
92. Missiuna C, Moll S, King S, King G, Law M. A trajectory of
troubles: parents’ impressions of the impact of
developmental coordination disorder. Phys Occup Ther Pediatr
2007;27:81e101.
93. Missiuna C, Moll S, King G, Stewart D, MacDonald K. Life
experiences of young adults who have coordination
difficulties. Can J Occup Ther 2008;75:157e66.
94. Mandich AD, Polatajko HJ, Rodger S. Rites of passage:
understanding participation of children with developmental
coordination disorder. Hum Mov Sci 2003;22:583e95.
95. Poulsen AA, Ziviani JM, Cuskelly M, Smith R. Boys with
developmental coordination disorder: loneliness and team
sports participation. Am J Occup Ther 2007;61:451e62.
96. Piek JP, Barrett NC, Allen LS, Jones A, Louise M. The
relationship between bullying and self-worth in children
with movement coordination problems. Br J Educ Psychol
2005;75:453e63.
97. Piek JP, Baynam GB, Barrett NC. The relationship between
fine and gross motor ability, self-perceptions and self-worth
in children and adolescents. Hum Mov Sci 2006;25:65e75.
98. Heath NL, Toste JR, Missiuna C. An exploration of the
relationship between motor impairment and emotional/
behavioural difficulties amongst children suspected of
having DCD. Israeli J Occup Ther 2005;14:E153e71.
99. Green D, Baird G, Sugden D. A pilot study of
psychopathology in developmental coordination disorder.
Child Care Health Dev 2006;32:741e50.
100. Cairney J, Veldhuizen S, Szatmari P. Motor coordination and
emotional-behavioral problems in children. Curr Opin
Psychiatry 2010;23:324e9.
101. Zwicker JG, Harris SR, Klassen AF. Quality of life domains
affected in children with developmental coordination
disorder: a systematic review. Child Care Health Dev 2012 Apr
20. doi:10.1111/j.1365-2214.2012.01379.x [Epub ahead of
print].
102. Fox AM, Lent B. Clumsy children: primer on developmental
coordination disorder. Can Fam Physician 1996;42:1965e71.
103. Sellers JS. Clumsiness: review of causes, treatments, and
outlook. Phys Occup Ther Pediatr 1995;15:39e55.
104. Hellgren L, Gillberg C, Gillberg IC, Enerskog I. Children with
deficits in attention, motor control and perception (DAMP)
almost grown up: general health at 16 years. Dev Med Child
Neurol 1993;35:881e92.
105. Cousins M, Smyth MM. Developmental coordination
impairments in adulthood. Hum Mov Sci 2003;22:433e59.
106. Rasmussen P, Gillberg C. Natural outcome of ADHD with
developmental coordination disorder at age 22 years:
a controlled, longitudinal, community-based study. J Am
Acad Child Adolesc Psychiatry 2000;39:1424e31.
107. Piek JP, Rigoli D, Pearsall-Jones JG, et al. Depressive
symptomatology in child and adolescent twins with
attention-deficit hyperactivity disorder and/or
developmental coordination disorder. Twin Res Hum Genet
2007;10:587e96.
 e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 1 6 ( 2 0 1 2 ) 5 7 3 e5 8 1
108. Cairney J, Hay JA, Faught BE, Hawes R. Developmental
coordination disorder and overweight and obesity in
children aged 9-14 y. Int J Obes 2005;29:369e72.
109. Cairney J, Hay JA, Veldhuizen S, et al. Trajectories or relative
weight and waist circumference among children with and
without developmental coordination disorder. CMAJ
2010;182:1167e72.
110. Faught BE, Hay JA, Cairney J, Flouris A. Increased risk for
coronary vascular disease in children with developmental
coordination disorder. J Adolesc Health 2005;37:376e80.
111. Cairney J, Hay JA, Faught BE, Flouris A, Klentrou P.
Developmental coordination disorder and cardiorespiratory
fitness in children. Pediatr Exerc Sci 2007;19:20e8.
112. Chia LC, Guelfi KJ, Licari MK. A comparison of the oxygen cost
of locomotion in children with and without developmental
coordination disorder. Dev Med Child Neurol 2010;52:251e5.
113. Schott N, Alof V, Hultsch D, Meermann D. Physical fitness in
children with developmental coordination disorder. Res Q
Exerc Sport 2007;78:438e50.
114. Tsiotra GD, Nevill AM, Lane AM, Koutedakis Y. Physical
fitness and developmental coordination disorder in Greek
children. Pediatr Exerc Sci 2009;21:186e95.
115. Miller LT, Polatajko HJ, Missiuna C, Mandich AD, Macnab JJ.
A pilot trial of a cognitive treatment for children with
developmental coordination disorder. Hum Mov Sci
2001;20:183e210.
116. Polatajko HJ, Mandich AD, Miller LT, Macnab JJ. Cognitive
orientation to daily occupational performance (CO-OP): part
II - the evidence. Phys Occup Ther Pediatr 2001;20:83e106.
117. Schoemaker MM, Niemeijer AS, Reynders K, Smits-
Engelsman BC. Effectiveness of neuromotor task training for
children with developmental coordination disorder: a pilot
study. Neural Plast 2003;10:155e63.
118. Niemeijer AS, Smits-Engelsman BC, Schoemaker MM.
Neuromotor task training for children with developmental
coordination disorder: a controlled trial. Dev Med Child Neurol
2007;49:406e11.
119. Missiuna C, Rivard L, Pollock N. They’re bright but can’t
write: developmental coordination disorder in school aged
children. Teach Except Child [serial online](1). Article 3: August
15, 2009. Available from: http://escholarship.bc.edu/
education/tecplus/vol1/iss1/3, 2004;1.
120. Sugden DA, Chambers ME. Intervention in children with
developmental coordination disorder: the role of parents
and teachers. Br J Educ Psychol 2003;73:545e61.
121. Mandich AD, Polatajko HJ, Macnab JJ, Miller LT. Treatment of
children with developmental coordination disorder: what is
the evidence? Phys Occup Ther Pediatr 2001;20:51e68.
122. Wilson PH. Practitioner review: approaches to assessment
and treatment of children with DCD: an evaluative review.
J Child Psychol Psychiatry 2005;46:806e23.
123. Sugden D. Current approaches to intervention in children
with developmental coordination disorder. Dev Med Child
Neurol 2007;49:467e71.
124. Hillier S. Intervention for children with developmental
coordination disorder: a systematic review. Internet J Allied
Health Sci Pract 2007;5:1e11.
125. Morgan R. Systematised review: the effectiveness of occupational
therapy interventions for children with developmental coordination
disorder [MSc]. Salford, UK: University of Salford; 2006.
126. Pless M, Carlsson M. Effects of motor skill intervention on
developmental coordination disorder: a meta-analysis.
Adapt Phys Activity Q 2000;17:381e401.
581
127. Davidson T, Williams B. Occupational therapy for children
with developmental coordination disorder: a study of the
effectiveness of a combined sensory integration and
perceptual-motor intervention. Br J Occup Ther
2000;63:495e9.
128. Polatajko HJ, Kaplan BJ, Wilson BN. Sensory integration
treatment for children with learning disabilities: its status 20
years later. Occup Ther J Res 1992;12:323e41.
129. DeGangi GA, Wietlisbach S, Goodin M, Scheiner N. A
comparison of structured sensorimotor therapy and child-
centered activity in the treatment of preschool children with
sensorimotor problems. Am J Occup Ther 1993;47:777e86.
130. Leemrijse C, Meijer OG, Vermeer A. The efficacy of le bon
départ and sensory integration of children with
developmental coordination disorder: a randomised study of
six cases. Ned Tijdschr Fysiother 2001;111:43e51.
131. Polatajko HJ, Macnab JJ, Anstett B, et al. A clinical trial of the
process-oriented treatment approach for children with
developmental co-ordination disorder. Dev Med Child Neurol
1995;37:310e9.
132. Schmidt RA, Lee TD. Motor control and learning: a behavioral
Emphasis. Champaign, IL: Human Kinetics; 2005.
133. Revie G, Larkin D. Task-specific intervention with children
reduces movement problems. Adapt Phys Activ Q
1993;10:29e41.
134. Larkin D, Parker H. Task-specific intervention for children
with DCD: a systems view. In: Cermak S, Larkin D, editors.
Developmental coordination disorder. Albany, NY: Delmar; 2002.
p. 234e47.
135. Sugden D, Henderson S. Ecological intervention for children with
movement difficulties. Oxford, UK: Pearson; 2007.
136. Missiuna C, Rivard L, Bartlett D. Exploring assessment tools
and the target of intervention for children with
developmental coordination disorder. Phys Occup Ther Pediatr
2006;26:71e89.
137. Kleim JA, Jones TA. Principles of experience-dependent
neural plasticity: implications for rehabilitation after brain
damage. J Speech Lang Hear Res 2008;51:S225e39.
138. Querne L, Berquin P, Vernier-Hauvette M-P, et al.
Dysfunction of the attentional brain network in children
with developmental coordination disorder: a fMRI study.
Brain Res 2008;1244:89e102.
139. Kashiwagi M, Iwaki S, Narumi Y, Tamai H, Suzuki S.
Parietal dysfunction in developmental coordination
disorder: a functional MRI study. Neuroreport
2009;20:1319e24.
140. Zwicker JG, Missiuna C, Harris SR, Boyd LA. Brain activation
of children with developmental coordination disorder is
different than peers. Pediatrics 2010;126:e678e86.
141. Saling LL, Phillips JG. Automatic behavior: efficient, not
mindless. Brain Res Bull 2007;73:1e20.
142. Zwicker JG, Missiuna C, Harris SR, Boyd LA. Brain activation
associated with motor skill practice in children with
developmental coordination disorder: an fMRI study. Int
J Dev Neurosci 2011;29:145e52.
143. Zwicker JG, Missiuna C, Harris SR, Boyd LA. Developmental
coordination disorder: a pilot diffusion tensor imaging
study. Pediatr Neurol 2012;46:162e7.
144. Boyd LA, Vidoni ED, Daly JJ. Answering the call: the influence
of neuroimaging and electrophysiological evidence on
rehabilitation. Phys Ther 2007;87:684e703.
145. Gordon N. The cerebellum and cognition. Eur J Paed Neurol
2007;11:232e4.