Developmental coordination disorder — branching viva

Stem

A 9-year-old is “always last in PE” and “writes too slowly.” Parents say he is lazy. The examiner will add red flags, tools and comorbidity. [1]

Branch 1 — Definition and criteria

Examiner: What is DCD? [1]

Strong answer: A neurodevelopmental disorder of coordinated motor skill acquisition and execution, with skills substantially below age and opportunity, interference in daily life or school, developmental onset, and not better explained by intellectual disability alone, visual impairment or a neurological condition. [1]

Examiner: How common is it? [4]

Strong answer: About 5–6% of school-age children in international reviews — common and under-recognised. [4]

Branch 2 — Red flags

Examiner: He uses his hands on his thighs to stand from the floor. What now? [4]

Strong answer: Treat as possible Gowers / neuromuscular pathway, not routine DCD. Check CK, examine carefully for progressive proximal weakness, and refer urgently. Do not label DCD. [4]

Examiner: What other signs end the simple DCD pathway? [1]

Strong answer: Regression, spasticity, asymmetric UMN signs, seizures/encephalopathy, progressive course. [1] [4]

Branch 3 — Tools

Examiner: Is a positive DCDQ enough? [7]

Strong answer: No. DCDQ'07 is a validated parent screen. I still need functional impact, examination exclusions and usually standardised motor testing (MABC-2/BOT) as part of synthesis. [7] [1]

Branch 4 — Management evidence

Examiner: What therapy philosophy will you defend? [5]

Strong answer: Task-oriented / activity-oriented practice (e.g. CO-OP Goal–Plan–Do–Check; neuromotor task training). Meta-analyses show stronger motor effects than process-only approaches as the main plan. Set functional goals; adapt school; prescribe successful activity; treat ADHD if present; no core DCD drug. [5] [1]

Branch 5 — Activity and health

Examiner: Why mention weight and fitness? [9]

Strong answer: Activity-deficit pathway — avoidance reduces practice and fitness and raises overweight/obesity risk. Participation is a health outcome, not optional. [9]

Branch 6 — Communication

Examiner: Parents say he is lazy. What do you say? [1]

Strong answer: “He is working harder than peers for the same motor result. This is a motor learning difficulty, not a character flaw. We will teach specific skills and change the load at school while he practises.” [1]

Examiner score cues

Clear pass: criteria accurate; red flags converted; tools used correctly; task-oriented plan; comorbidity considered; no invented drug.
Borderline: kind tone but process-only therapy forever or no school plan.
Fail: misses Gowers/neurology; diagnoses from handwriting alone; blames child; invents DCD medication. [1] [4] [5]