Our ability to coordinate movements so that we can button our shirts or tie our shoelaces is often taken for granted. But performing these seemingly simple tasks may be daunting for a child or adolescent with motor coordination problems.

Mild to moderate motor coordination prob-lems may accompany a range of disorders, including learning disorders (particularly nonverbal learning disorder), attention-deficit/hyperactivity disorder, and various congenital problems (e.g., premature birth, low birthweight, mental retardation).

Motor coordination problems may also occur in children and adolescents who have no obvious physical or mental impairments. These children and adolescents have been classified as having developmental dyspraxia, minimal cerebral dysfunction, or sensory integration problems. The American Psychiatric Association classifies these children and adolescents as having developmental coordination disorder (DCD), defined as "marked impairment in the development of motor coordination."1 It is estimated that 6 percent of children ages 5 to 11 in the United States have DCD.1

There is no consensus whether DCD is a physiological or developmental disorder or, if the disorder is physiological, whether it is multisensory or unisensory. Children and adolescents with DCD may have problems with gross motor skills, fine motor skills, or both. Some have difficulty planning movements (dyspraxia) and executing them, others have difficulty planning movements but not executing them, and others have difficulty executing movements but not planning them.

Children and adolescents with DCD should not be confused with those who do not perform motor skills as well as their peers. Rather, children and adolescents with DCD have extreme difficulty acquiring new motor skills. Practice can help them, but it must be structured in specific ways to be effective. Motor skill development is slow for children and adolescents with DCD, and perceptual motor skills that are complex and/or require precise perception, such as writing between the lines on a sheet of paper, can be very difficult.

Significance

Children and adolescents with motor coordination problems are at risk for low academic performance, poor self-esteem, and inadequate physical activity participation. Unless there is intervention, their problems are likely to continue through adolescence. These children and adolescents are likely to avoid physical activity and experience frustration if they are forced to participate. Motor coordination problems do not resolve themselves, and children and adolescents do not outgrow them.2

Children and adolescents with motor coordination problems are usually underactive throughout their school years and may not attain even moderate levels of proficiency in most types of physical activities. DCD, particularly when combined with other problems, is rarely identified until a child is at least 8 years old. The disorder often goes undiagnosed. One reason for this is that motor coordination problems manifest themselves in many ways, some of which are considered normal. For example, tripping and falling are not uncommon in young children and often go unremarked. Not catching a ball in a baseball game or striking out repeatedly may be attributed to lack of practice rather than to difficulty learning motor skills. Therefore, unless children and adolescents are severely affected (particularly in fine motor skills such as those needed for handwriting), usually neither parents nor school personnel perceive the child's or adolescent's poor coordination as a problem that needs special attention.