Canadian Association of Occupational Therapists

Poor handwriting is only a symptom: Children with Developmental Coordination Disorder

By Cheryl Missiuna

Occupational therapists are often asked to consult with educators about a child’s handwriting. However, when they arrive at the school, they also hear that the child is the last to go out at recess, never seems able to get his homework organized, is disruptive during arts and crafts, won’t participate in physical education class, is teased a lot and has no friends.

Many of the children referred to occupational therapy with the types of problems described above have Developmental Coordination Disorder (DCD). Most will not, however, have received that diagnosis. One of the first things that occupational therapists can do is help educators understand that the child’s issues are not just behavioural and that, in fact, there may be an underlying motor problem. Exploring whether or not a child has had an adequate opportunity to learn to print or write is an important next step. Finally, occupational therapists can determine whether the problem is solely in the area of handwriting or, as many suspect, may also be impacting on other self-care, academic and leisure activities. In most situations, referral to a family physician or paediatrician will be appropriate at this stage because physicians need to rule out other possible explanations for the motor incoordination. Although the situation in Canada is improving, many physicians are still not familiar with the term DCD. Occupational therapists may be able to assist in the diagnostic process by summarizing their observations and concerns for the physician.

Why do we need to label it DCD?

The fact that DCD is a recognized medical diagnosis gives credibility to it as a health issue, not just an educational issue. More importantly to occupational therapists, the criteria for diagnosing DCD include the fact that the child’s motor coordination problems and motor delays must impact on self-care and academic activities. This means that identifying the presence of occupational performance issues is a critical part of the diagnostic process and provides strong support for occupational therapy intervention.

How does occupational therapy help children with DCD?

Optimal service provision can take many forms. Some organizations, for example,have moved toward innovative approaches to identification and intervention with children with DCD. Occupational therapists may work with speech-language pathologists and physical therapists within interdisciplinary service delivery models to facilitate earlier identification and assessment of preschool and young school-aged children with DCD. Therapists may work with small groups of young children using strategy-based teaching of specific motor skills or may consult with parents and educators about ways to make the child’s daily experiences more successful. In particular, guidance regarding ways to enhance participation in physical activities is also an important component of intervention with children with DCD. If there is an opportunity for intervention over a few sessions, then an individualized, cognitive approach is recommended for children with DCD as it uses a problem-solving framework for teaching skills that is more likely to generalize beyond the treatment sessions. This one-on-one intervention requires an occupational therapist trained in a cognitive approach known as Cognitive Orientation to Daily Occupational Performance (CO-OP) (Polatajko & Mandich, 2004).

Children with DCD are often the first to miss out on services when resources are limited. Instead of viewing their problems as “less severe,” we need to realize that they are children who have the potential for a great deal of improvement with the assistance of occupational therapists and other health service providers. We have strong evidence that, without this help, secondary academic, physical, social and emotional problems develop. The occupational performance issues of these children can be remediated with cognitive intervention and appropriate management of their environments at home, school and in the community. Early identification is critical if we are to make a difference in the everyday lives of these children.     


Polatajko, H. J., & Mandich, A. (2004) Enabling occupation in children:  The Cognitive Orientation to daily Occupational Performance (CO-OP) approach. Ottawa, ON: CAOT Publications ACE

About the author

Cheryl Missiuna, Ph.D., OT Reg. (Ont.) is a Professor in the School of Rehabilitation Science and Director of CanChild Centre for Childhood Disability Research at McMaster University in Hamilton, Ontario. Her research focuses on early identification of children with DCD and delivery of occupational therapy services in school settings.

This article first appeared in the September/ October 2002 issue of Occupational Therapy Now magazine published by the Canadian Association of Occupational Therapists. It was updated in August 2010 and additional resources have been provided.

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