Subtypes in developmental coordination disorder: what do we know so far? A systematic review.

Clinical Snapshot

Key Findings

• P Value: Not reported at the review level

• Effect Size: Not applicable — qualitative systematic review; no pooled effect size calculable

• Primary Outcome: No consistent, discrete subtypes of DCD were identified across studies. Identified cluster solutions primarily reflected gradients of severity (mild to severe) rather than qualitatively distinct domain-specific profiles.

• Nnt Or Sensitivity: Not applicable. Key quantitative finding: studies identified between 4 and 6 subtypes per study (most commonly 4); GRADE certainty of evidence rated low to very low across all included studies. Ten studies were included from 1,719 screened records.

• Confidence Interval: Not applicable — no meta-analytic pooling performed

Clinical Application

The review's conclusion — that DCD is better conceptualised as a spectrum of pervasiveness rather than discrete subtypes — has immediate implications for clinical practice. It suggests that individualised, severity-based assessment and intervention planning is more appropriate than subtype-specific treatment protocols. This is feasible within existing multidisciplinary assessment frameworks. However, the low certainty of evidence means clinicians should not abandon ongoing clinical subtyping efforts but should interpret them cautiously. In Australia, DCD is recognised by the RACGP and is assessed using tools such as the Movement Assessment Battery for Children, 2nd Edition (MABC-2) and the Developmental Coordination Disorder Questionnaire (DCDQ). The findings of this review are directly relevant to Australian paediatric occupational therapists, physiotherapists, and paediatricians who manage DCD. There is no PBS-listed pharmacological treatment for DCD; management is primarily via allied health intervention (occupational therapy, physiotherapy), which is supported under Medicare's Chronic Disease Management plans and NDIS funding for eligible children. The spectrum conceptualisation aligns with NDIS functional assessment frameworks, which focus on severity and participation impact rather than diagnostic subtypes. The TGA has not approved any DCD-specific pharmacotherapy. Australian clinicians should note that the absence of validated subtypes supports continued use of individualised, goal-directed intervention rather than subtype-specific protocols. Children and adolescents aged 0–18 years with a clinical diagnosis of DCD, including those with common comorbidities such as ADHD, autism spectrum disorder, and specific learning disorders. Findings are most relevant to clinicians involved in DCD assessment, diagnosis, and intervention planning.

Abstract

UNLABELLED: Developmental coordination disorder (DCD) is a highly heterogeneous disorder. This systematic review examined whether statistically derived clusters can effectively distinguish subgroups of children with DCD. Web of Science, Scopus, PubMed, Embase, and PsycInfo were systematically searched (CRD420251237685) using controlled terminology and free-text terms. Studies were eligible if they included children (aged 0-18 years) with DCD with(out) comorbidities and employed statistical clustering to identify subtypes. Methodological quality was assessed using an adapted version of the Critical Appraisal Skills Programme and certainty of the evidence with the Grading of Recommendations Assessment, Development and Evaluation. Ten of the 1719 search results were included, three of which included both children with DCD and typical development. Two studies explored clusters unidimensionally (motor-only and mental health-only). Eight studies included multiple domains of functioning: motor (n = 8), sensory functions (n = 5), fitness (n = 3), cognitive functions (n = 3), executive functions (n = 2), mental health (n = 1), and participation (n = 1). Studies identified between four (n = 4) and six (n = 1) subtypes, which primarily reflected gradients of severity rather than distinct domain-specific profiles. The overall certainty of evidence for distinct subtypes in DCD was rated low to very low. CONCLUSION: Evidence suggests that DCD is better conceptualized as a spectrum of pervasiveness rather than discrete subtypes. Existing findings lack consistency across studies due to methodological shortcomings and variable measurement domains. Although evidence-based clinical subtypes cannot yet be recommended, future research should prioritize subtyping studies focused on primary symptoms to better identify potential phenotypes within the DCD population. WHAT IS KNOWN: • DCD is a heterogeneous condition, and identifying discrete subtypes is a long-standing research goal to improve clinical support. • Researchers have proposed various motor and non-motor profiles, but no consensus exists on a definitive subtyping model. WHAT IS NEW: • This review found no consistent discrete subtypes, suggesting DCD is better viewed as a spectrum of pervasiveness rather than categories. • Future research should focus on subtyping primary motor symptoms to determine whether distinct, stable subgroups exist within the broader DCD population.

References

1. 1.Verbecque, E., Lust, J. M., & Smits-Engelsman, B. (2026). Subtypes in developmental coordination disorder: what do we know so far? A systematic review. European Journal of Pediatrics. https://doi.org/10.1097/DBP.0b013e3182a39890