Developmental coordination disorder — formative SAQs

SAQ 1 — Criteria, exclusions and tools (10 marks)

A registrar says “messy handwriting equals DCD.” An 8-year-old boy has lifelong difficulty with PE, cutlery and written work. Parents call him lazy. Examination is neurologically normal. A DCDQ screen is positive. [1] [7]

Questions

1. State the core diagnostic elements of DCD and why handwriting alone is insufficient. (3 marks) [1]
2. List four red-flag findings that should divert you from a simple DCD label. (2 marks) [4]
3. Distinguish the roles of DCDQ and a standardised motor battery (e.g. MABC-2). (2 marks) [1] [7]
4. Outline first-line management principles including task-oriented therapy and school supports. (3 marks) [1] [5]

Model answers

1. Motor skill substantially below age/opportunity; interference with ADL/school/play; developmental onset; not better explained by intellectual disability alone, visual impairment, or neurological condition. Handwriting is one possible impact, not a full criterion set. [1]
2. Any four of: regression; progressive weakness/Gowers; spasticity/asymmetric UMN signs; seizures/encephalopathy; new focal neurology. [4]
3. DCDQ = parent-report screen. MABC-2/BOT = standardised quantification of motor skill. Neither alone is the whole diagnosis; clinical synthesis is required. [1] [7]
4. Name DCD without shame; set functional goals; refer for task-oriented OT/PT (CO-OP/NTT principles); school adaptations (time, keyboard, PE inclusion); protect successful activity; treat comorbidity; close loops. Avoid inventing a core DCD drug. [1] [5]

SAQ 2 — Comorbidity, activity deficit and evidence (10 marks)

A 10-year-old with probable DCD avoids PE, is gaining weight, and has untreated ADHD symptoms. The family asks for “a tablet to fix coordination.” [4] [9]

Questions

1. Explain the activity-deficit pathway linking DCD to fitness and weight risk. (3 marks) [9]
2. How should coexisting ADHD change the plan? (2 marks) [4] [1]
3. What does intervention evidence say about task-oriented versus process-only therapy? (3 marks) [5] [6]
4. What will you tell the family about medication for core DCD? (2 marks) [1]

Model answers

1. Motor difficulty → task failure → avoidance of practice/sport → less activity → lower fitness and higher overweight/obesity risk → further exclusion and avoidance. Interrupt with successful, graded activity and skill teaching. [9]
2. Assess and treat ADHD on its merits so the child can sustain practice and classroom work; do not assume attention treatment replaces motor teaching. Dual plans are required. [4] [1]
3. Meta-analyses show task-/activity-oriented interventions have stronger motor effects than process-oriented approaches used as the main plan. Use real-skill practice with strategies (e.g. Goal–Plan–Do–Check). [5] [6]
4. There is no first-line disease-modifying drug for core DCD motor deficit. Medication may be appropriate for comorbid ADHD when indicated, but it is not a coordination cure. [1]