Assessment of developmental coordination disorder in adulthood: a scoping review

Abstract

Purpose

Developmental coordination disorder (DCD) is a life-long condition, but the diagnostic process for adults has not been formally established. The purpose of this study was to ascertain which assessment tools are used to assign participants into the group with DCD in studies investigating this condition in adulthood.

Design/methodology/approach

A scoping review was conducted using PRISMA guidelines. Peer reviewed literature published between January 2008 and April 2024 was searched using five databases: AMED, CINAHL Ultimate, Google Scholar, PubMed and Scopus. Data was extracted using the “Joanna Briggs Institute” scoping review guidelines.

Findings

In total, 36 articles were identified as meeting the inclusion criteria for this review. The Adult Developmental Co-ordination Disorders/Dyspraxia Checklist was the most frequent tool used to measure current and past impact on occupational performance. Level of motor skill was only measured in 51% of the studies, and none of these studies used tests with norms for an adult population. The Movement Assessment Battery for Children 2 was the most commonly used tool to measure level of motor skill.

Originality/value

Findings from this scoping review could be used in the creation of a pilot pathway for the assessment of adults for DCD.

Citation

Armstrong, D. (2024), "Assessment of developmental coordination disorder in adulthood: a scoping review", Irish Journal of Occupational Therapy, Vol. 52 No. 2, pp. 81-90. https://doi.org/10.1108/IJOT-08-2024-0033

Introduction

In 2019, the European Academy of Childhood Disability (EACD) produced international clinical practice recommendations addressing developmental coordination disorder (DCD) in relation to definition, diagnosis, assessment and intervention (Blank et al., 2019). It was concluded that there is sufficient evidence that DCD is a life-long condition and thus continues to impact self-care, productivity and leisure throughout adulthood. The EACD produced criteria for a diagnosis of DCD in adults which are based on the DSM-5 (American Psychiatric Association, 2013) criteria with some amendments:

• “The acquisition and execution of coordinated motor skills is substantially below that expected given the individual’s chronological age and sufficient opportunities to acquire age-appropriate motor skills;

• The motor skills deficit described in criterion I significantly and persistently interferes with activities of daily living appropriate to chronological age (e.g. self-care, self-maintenance and mobility) and affects upon academic productivity, prevocational and vocational activities, leisure and work;

• The motor skills deficits are not better accounted for by any other medical, neurodevelopmental, psychological, social condition or cultural background; and

• Onset of symptoms is in childhood.” (Blank et al., 2019, p. 274).

Occupational therapists have a central role in the identification of children with DCD and can assess and provide findings in relation to the first, second and fourth criteria (Hunt et al., 2023). There is no existing assessment protocol for assessing adults for DCD (Mayes et al., 2024); thus, if a person has not been diagnosed in childhood, it can be very difficult to get a diagnosis in adulthood.

Having DCD in adulthood presents a myriad of challenges in addition to the obvious issues with motor coordination and resultant impact on occupational performance which are inherent in the diagnosis. Thomas and Christopher (2017) found increased levels of fatigue in adults with DCD. They conducted a cross-sectional group comparison between groups with DCD (n = 53) and Chronic Fatigue Syndrome (n = 84) and a matched control group (n = 52). They also found that the group with DCD had significantly lower self-esteem than either of the other groups and had significantly higher levels of fatigue with related cognitive issues than the control group. The DCD group had the highest rates of anxiety and depression, and it was postulated that these problems with emotional regulation may have been the contributing factor to the levels of fatigue. Scott-Roberts and Purcell (2018) conducted a phenomenological study exploring the lived experience of six adults with DCD, and based on these findings, they recommended that a measurement of anxiety and fatigue be standard as part of any assessment process in this population. Participants reported needing to be on high alert when managing everyday tasks, and it was noted that the ability to apply problem-solving skills to make adaptations to tasks and environments helped people to cope with their difficulties. Zaguri-Vittenberg et al. (2023) also used a phenomenological approach in a study involving 10 participants aged between 21 and 31 years of age. Findings indicated that the effort required for certain activities can result in feelings of stress and shame. Participants described the mental and emotional cost of engaging in daily activities such as making a bed or cooking a simple meal and their awareness that others would find these tasks easy. They discussed the importance of self-acceptance, understanding from their social network, and having strategies to help with occupational performance.

There is evidence that adults with DCD can have difficulties in the area of executive function (Blank et al., 2019), specifically in the areas of planning and prospective memory (Mayes et al., 2023). There is also evidence of atypical sensory processing. Mayes et al. (2024) conducted a study involving 56 participants and found haptic perception and audio-visual integration to be reduced in the DCD group (n = 28) as compared to the neurotypical group (n = 28). Gentle and colleagues (2024) conducted a study involving 226 adults, 138 assigned to the DCD group and 88 to the typically developing group. They found that the adults with DCD had greater difficulty navigating and orientating themselves in a new environment and more problems estimating distance than the typically developing peers and proposed that this was in part due to visuo-spatial deficits and visual sensitivities.

Scoping reviews are useful in answering broad questions in relation to what is known about a concept to examine the extent and nature of evidence on a topic (Tricco et al., 2018). The aim of this review was to chart which assessments are being used in studies to determine whether an adult presents with DCD in relation to the three criteria that an occupational therapist can assess.

Method

Review question and objectives

The following review questions and objectives were set for a scoping review in relation to adult assessment of DCD.

Review Question: Which assessments are used in studies involving adults with DCD to determine whether those adults have DCD or probable DCD?

Objectives

To determine which assessments are being used to determine if an adult meets the following EACD criteria (Blank et al., 2019) for DCD:

• Acquisition and execution of coordinated motor skills is substantially below that expected given the individual’s chronological age and sufficient opportunities to acquire age-appropriate motor skills;

• Motor skills deficits significantly and persistently interfere with activities of daily living appropriate to chronological age and affects upon academic productivity, prevocational and vocational activities, leisure and work; and

• Onset of symptoms is in childhood.

The protocol used to address the review question and objectives was the PRISMA extension for scoping review (Tricco et al., 2018).

Study selection

The literature search was conducted using the terms “Developmental coordination disorder” OR “dyspraxia” OR “DCD” AND “Assessment” OR “evaluation” OR “screening” OR “test”, which were combined using Boolean logic to search the following data bases: Scopus, PubMed, CINAHL Ultimate, AMED and Google Scholar. The search parameters included articles published between January 2008 and April 2024. Inclusion and exclusion criteria were set for the selection of articles.

Inclusion criteria:

• Articles needed to be in peer reviewed journals;

• In the English language;

• Pertain to people aged 18 and over (adults); and

• Involve the use of an assessment method with adults to determine whether the person had DCD or probable DCD.

The following exclusion criteria were set for this review:

• The sole assessment for DCD for the adults in the study had taken place in childhood (before the age of 18); and

• The articles addressed motor assessment(s) but not specifically to assessments used in the diagnosis of DCD.

The initial search resulted in 6,433 articles. The titles and abstracts were screened, and 6,274 were omitted as they did not meet the inclusion criteria, and a further 37 were omitted as they were duplicates of other articles. The remaining 122 articles were accessed in full, and on review, a further 85 were excluded, leaving 36 articles which met the inclusion criteria.

Figure 1 below provides an outline of the search strategy.

Data charting process

Data was extracted from the studies reviewed using the principles recommended in an expansion of the “Joanna Briggs Institute” scoping review guidelines (Pollock et al., 2023). They recommend using a data extraction table to extract data relevant to the scoping review questions using population, concept and context, along with items relevant to the purpose of the review being conducted. The population of interest for this review was adults with DCD or probable DCD. The concept being investigated was the method used in studies to determine if an adult was assigned to the DCD group for a study pertaining to DCD in adulthood. The context of interest was the principal location of the study. The following headings were devised for the extraction table:

• Author(s), year and country of study;

• Population – number of participants and age range;

• Assessments used for level of motor skill;

• Assessments used re: Impact on occupational performance; and

• Assessments used re: onset of symptoms being in childhood.

Results

Research relating to DCD in adults is being carried out internationally, with the studies in this review emanating from Israel, Australia, Korea, India, Japan and across Europe. The lack of a pathway for the assessment of DCD in adults impacts this research as, in the majority of studies, participants did not have a formal diagnosis and thus can only be legitimately placed in a “probable DCD” group. The ages of the adults involved in the studies ranged from 18 to 66 years old, there were younger participants in some of the studies, but only the data relating to the assessment of participants over 18 was extracted. The following Table 1 provides a summary of the data extracted for this scoping review.

Assessments used to measure level of motor skill

Only 52% (n = 19) of the studies measured the participants level of motor skill. The most frequently used measure was the MABC-2 (Henderson et al., 2007). This assessment tool provides standardised scores for people up to the age of 16 years and 11 months, and thus the percentile scores being used for the adults in the studies were those of children aged 16. In total, 10 of the studies used the MABC-2 alone to measure motor skill. Six of these studies included participants in the DCD group if they scored at or below the 16^th percentile (De Oliveira and Wann, 2010, 2012; Mayes et al., 2023, 2024; Suzuki et al., 2020; Warlop et al., 2020); one used at or below 15^th percentile (Gentle et al., 2021); and a further two used at or below the 5^th percentile (Purcell et al., 2015; Zaguri-Vittenberg et al., 2023). The MABC-2 was used in another of the studies (Job et al., 2019) to compare the control group with the DCD group, and thus a percentile score for inclusion was not established, but the average score for their participants was reported at the 12^th percentile.

Six of the studies used both the MABC-2 and the BOT-2 Brief (Bruininks and Bruininks, 2005) to assign participants to the DCD group. The BOT-2 and BOT-2 Brief use norms up to the age of 21 years and 11 months. Inclusion criteria in relation to the BOT-2 Brief were at or below the 18^th in five of the studies (Du et al., 2015; Gentle et al., 2016; Wilmut et al., 2015; Wilmut et al., 2017) and at or below the 15^th percentile in one study (Gentle et al., 2016). The inclusion criteria using the MABC-2 were taken as being at or below the 15^th percentile in two of these studies (Gentle et al., 2016; Wilmut and Byrne, 2014), at or below the 16^th in one of the studies (Wilmut and Barnett, 2017) and at or below the 9^th percentile in another of the studies (Wilmut et al., 2017). Two of the studies used the cut off percentile as at or below the 5^th percentile (Du et al., 2015; Wilmut et al., 2015).

Only one of the studies used the BOT-2 Brief alone (Hyde et al., 2018), and an inclusion criteria of at or below the 15^th percentile was used in this study. One study (He et al., 2018) used the full BOT-2 assessment (Bruininks and Bruininks, 2005) and also set an inclusion criteria of at or below the 15th percentile. Tal-Saban and Kirby (2021) conducted a study using participants with a prior diagnosis of DCD and thus did not measure level of motor skill. In total, 14 of the studies did not address the measurement of motor skill at all in assigning participant to a DCD group (Baiano et al., 2023; Cleaton et al., 2021; Engel-Yeger, 2020, 2023; Forde and Smyth, 2022; Gentle et al., 2024; Kirby et al., 2010, 2013; Meachon and Alpers, 2023; Min Joo et al., 2023; Tal-Saban et al., 2012a, 2014a, 2014b, 2018). One of the studies stated that motor skill was measured by an occupational therapist observing the participants doing a task.

Assessments used to measure occupational performance

With the exception of one (Suzuki et al., 2020) all of the studies addressed the impact of the adult’s coordination difficulties on their occupational performance. The most commonly used assessment for this criteria was the ADC (Kirby et al., 2010). The questionnaire contains 40 items divided into three sections relating to occupational performance: difficulties experienced as a child, “the influence of DCD on the individual’s perception of their performance” and “current feelings about their performance as reflected upon by others” (Kirby et al., 2010, p. 133). The ADC can be used with any adult over 16 years of age and takes between 15 and 20 min to complete.

In total, 17 of the studies used the ADC alone to measure occupational performance (Baiano et al., 2023; Cleaton et al., 2021; Engel-Yeger, 2020; Engel-Yeger and Engel, 2023; Gentle et al., 2016, 2021, 2024; He et al., 2018; Hodgson and Hudson, 2017; Hyde et al., 2018; Job et al., 2019; Kirby et al., 2013; Mayes et al., 2023, 2024; Meachon and Alpers, 2023; Min Joo et al., 2023; Wilmut and Byrne, 2014), and five combined the ADC with participant interviews (Du et al., 2015; Verlinden et al., 2023; Wilmut and Barnett, 2017; Wilmut et al., 2015, 2017). One study (Kirby et al., 2010) combined the ADC with the Handwriting Proficiency Screening Questionnaire (Rosenblum, 2008). One of the studies conducted the ADC, undertook participant interviews and used information from referral forms (Purcell et al., 2015).

Seven of the studies (Forde and Smyth, 2022; Sankar et al., 2020; Tal-Saban et al., 2012a, 2014a, 2014b, 2018, 2021) used AAC-Q (Tal-Saban et al., 2012a) alone, and one study combined the AAC-Q with participant interviews (Zaguri-Vittenberg et al., 2023). The AAC-Q is a 12-item, self-report questionnaire used to screen for difficulties in adolescents and adults aged 16–35. It was designed to act as a screening tool for DCD in this population and takes 10–15 min to complete. Cut off scores are given for each gender for suspected or clinical DCD (below the 5th percentile) and borderline DCD (5th–−15th percentile). Testing indicates that there is sufficient evidence of the reliability and validity of the instrument (Tal-Saban et al., 2012a, 2012b).

One study accepted a self-report of occupational performance problems (De Oliveira and Wann, 2010), and two of the studies did not look at current difficulties in this area on the basis that the participants had been diagnosed with DCD in childhood (De Oliveira and Wann, 2012; Warlop et al., 2020).

Assessments used to establish onset of symptoms were in childhood

The ADC contains a section on occupational performance difficulties experienced in childhood, and thus studies using this tool to measure current occupational performance problems also used it to ascertain if these problems were long-standing. Five of the studies did not elicit data about this area (Suzuki et al., 2020; Tal-Saban et al., 2012a, 2014a, 2014b, 2018). One used a demographic questionnaire alone (Forde and Smyth, 2022), and three took self/parent-report without any other measure (De Oliveira and Wann, 2010; Verlinden et al., 2023; Zaguri-Vittenberg et al., 2023). Four of the studies addressed this issue by indicating a prior diagnosis of DCD (De Oliveira and Wann, 2010; Sankar et al., 2020; Tal-Saban and Kirby, 2021; Warlop et al., 2020).

Discussion

DCD is a condition that can persist into adulthood, impacting not only occupational performance but also mental health, executive function, sensory processing and levels of fatigue (Blank et al., 2019; Scott-Roberts and Purcell, 2018; Thomas and Christopher, 2017; Zaguri-Vittenberg et al., 2023). The EACD has established four criteria for the assessment of DCD in adulthood (Blank et al., 2019). The aim of this scoping review was to discover which assessments are used in studies involving adults with DCD to determine whether those adults have DCD or probable DCD in relation to the three criteria that occupational therapists can assess. The ADC was the most commonly used assessment in research to assign participants to a DCD group and has potential to be used to gather data on two of these criteria, i.e. the impact of the motor performance problems on self-care, productivity and leisure, and whether these types of problems have been present since childhood. The questionnaire has been tested for construct and concurrent validity content and for reliability. The ADC also has a section for demographic information relating to family, socio-economic status, medications, past diagnosis and any relevant interventions. It has been translated and adapted to a German version (Meachon et al., 2022), Asian Uzbekistan version (Saidmamatov et al., 2023), Korean version (Min Joo et al., 2023) and Italian version (Zappullo et al., 2023). The AAC-Q is also being used as a screening tool but only gives information on a range of current occupational performance problems and has a cut-off point of age 35, both of which limit its use diagnostically.

The measurement of motor skill is limited by the lack of a norm-referenced tool for the adult population (Mayes et al., 2024). The MABC-2 and the BOT-2 Brief were the most commonly used measurements of motor competence in research, with the MABC-2 being most used. The MABC-3 was produced in 2023 (Henderson and Barnett, 2023) and the age-band now provides norms to the age of 25 years and 11 months of age, which offers more scope to assess adults for DCD than its predecessor. Normative data was co-collected between UK, Australia and New Zealand.

The BOT-2 and BOT-2 Brief have also been updated, and the third Edition – BOT-3 (Bruininks and Bruininks, 2024), is in press and due for publication in 2024. This assessment tool now also has norms up to age 25 years and 11 months. This tool is norm referenced to a US population, and thus the choice of whether to use the MABC-3 or the BOT-3 will in part be guided by context.

Limitations of this review

It is acknowledged that only articles written in the English language were sourced for this review, and thus further data on types of assessment tools used may have been missed. The research was conducted to address an issue arising from clinical practice rather than coming from a university setting and thus was limited by bias due to single author screening titles and extracting all data for this review.

Conclusion

DCD persists into adulthood, and thus there is a need to have an assessment process for the adult population. Having a diagnosis would allow the adult to have access to interventions, supports and accommodations that could facilitate optimal occupational performance. The ADC and the MABC-3 are potential assessments that could form part of an assessment pathway for adults for DCD in the European context.

Implications for practice and future research

The Royal College of Occupational Therapists UK (Royal College of Occupational Therapists, 2021) recommends that occupational therapists should contribute to the design and promotion of local pathways for the diagnosis of DCD in both children and adults. Information from this scoping review could be used in the formation of a pilot assessment pathway for assessing adults for DCD with the MABC-3 and the ADC forming part of the assessment process. It has been established that DCD persists into adulthood (Blank et al., 2019), and thus the pathway could be piloted with people diagnosed in childhood to ascertain its effectiveness.

Figures

Figure 1

Search strategy

Table 1

Data extraction of included studies

Author(s) year and country of study	Population –– no. of participants and age range	Assessments used for level of motor skill	Assessments used re: impact on occupational performance	Assessments used re: onset of symptoms was in childhood
Baiano et al. (2023) Italy	334 university students aged from 18 to 34.	None	Adult developmental co-ordination disorders/dyspraxia checklist (ADC) Kirby et al. (2010)	ADC
Cleaton et al. (2021). UK	1,476 participants aged from 16 to 60.	None	ADC	ADC
De Oliveira and Wann (2010) UK	40 participants aged from 15 to 27.	Movement assessment battery for children second Edition (MABC-2) (Henderson et al., 2007) –below or at the 16th percentile	Self-report	Self-report
De Oliveira and Wann (2012). UK	26 aged from 15.3 to 21.3	MABC- 2 – at or below the 16th percentile	Assessed in childhood	Assessed in childhood
Du et al. (2015) UK	30 Participants (mean age 25.4 years)	MABC-2 below the 5th percentile. Bruininks–Oseretsky Test of Motor Proficiency, Second Edition, Brief Form (BOT-2 Brief) (Bruininks and Bruininks, 2005) −18th percentile	ADC and a telephone interview	ADC Telephone interview
Engel-Yeger (2020) Israel	200 participants aged from 20 to 64	None	ADC	ADC
Engel-Yeger and Engel (2023) Israel	317 participants aged from 18 to 66 years	None	ADC	ADC
Forde and Smyth (2022) Ireland	85 participants aged from 18 to 63	None	AAC–Q	Demographic questions at initial intake
Gentle et al. (2016) UK	22 Participants aged from 18 to 32 years.	M-ABC-2 (below the 15th percentile) BOT-2 Brief (below the 18th percentile)	ADC	ADC and a telephone interview
Gentle et al. (2021) UK	55 participants aged from 18 to 57	MABC-2 – below the 15th percentile	ADC	ADC
Gentle et al. (2024) UK	226 participants aged from 18 to 55 years	None	ADC	ADC
He et al. (2018) UK	18 Participants aged from 18 to 30	BOT-2 scores at or below the 15th percentile	ADC	ADC
Hodgson and Hudson (2017) UK	24 participants aged from 18 to 43	None participants had been diagnosed previously.	ADC	ADC
Hyde et al. (2018) Australia	29 participants aged from 18 to 36	BOT-2 – Brief; at or below the 15th percentile	ADC	ADC
Job et al. (2019) UK	24 participants Mean age 26.33	MABC-2 – cut off score not given	ADC	Prior diagnosis and ADC
Kirby et al. (2010) UK and Israel	107 participants aged from 17 to 42	None	ADC The Handwriting Proficiency Screening Questionnaire (HPSQ) (Rosenblum, 2008)	ADC Demographic questionnaire
Kirby et al. (2013) UK	57 participants aged from 21 to 30	None	ADC	ADC
Mayes et al. (2023) UK	52 participants aged from 18 to 39	MABC-2 scores at or below the 16th percentile	ADC	ADC
Mayes et al. (2024) UK	56 participants mean age = 25.31 SD = 5.95	MABC-2 below the 16th Percentiles	ADC	ADC
Meachon and Alpers (2023). Germany	161 participants aged from 18 to 62	None	ADC	ADC
Min Joo et al. (2023) Korea	377 participants aged from 18 to 24	None	ADC translated into Korean	ADC translated into Korean
Purcell et al. (2015) UK	16 participants aged from 18 to 53	MABC – 2 at or below the 5th percentile.	Referral and history taking questionnaire ADC	Self-report ADC
Sankar et al. (2020) India	15 participants aged from 20 to 40	None - Prior diagnosis	Confirmed the diagnosis using AAC-Q.	Prior diagnosis
Suzuki et al. (2020) Japan	81 participants mean age 24.48 SD 5.33	MABC-2 at or below the 16th percentile.	None	None
Tal-Saban et al. (2012a, 2012b) Israel	429 participants aged from 19 to 25;	None	AAC-Q	None
Tal-Saban et al. (2014a, 2014b) Israel	96 Participants mean age 24 SD [SD = 1.91]	None	AAC-Q	None
Tal-Saban et al. (2014a, 2014b) Israel	96 participants aged from 22 to 29.	None	AAC–Q	None
Tal-Saban et al. (2018). Israel	2,309 participants mean age 20.68 year (standard deviation 3.42)	None	AAC–Q	None
Tal-Saban and Kirby (2021). Israel	110 participants aged from 18 to 40	Previous diagnosis	AAC-Q	Previous diagnosis
Verlinden et al. (2023) Belgium	Three Participants aged 51, 19, 27	None	ADC and interview	Self-report, Parent report, case notes.
Warlop et al. (2020). Belgium	20 participants aged from 22 to 23	MABC-2 16th percentile or below	Diagnosed in childhood	Diagnosed in childhood
Wilmut and Barnett (2017). UK	30 participants aged from 19 to 34	BOT-2 Brief at or below 18th percentile and MABC-2 at or below the 16th percentile	ADC and a telephone interview	ADC and a telephone interview
Wilmut et al. (2015). UK	30 participants (mean age 25.3 years, range 19.2–34.2 years)	MABC-2 scored at or below the 5th percentile BOT-2 Brief at or below the 18th percentile	ADC and a telephone interview	ADC and a telephone interview
Wilmut et al. (2017) UK	124 participants aged from 7 to 34	MABC-2 at or below the 9th BOT-2 Brief. at or below 18th	ADC and telephone interviews	ADC and telephone interviews
Wilmut and Byrne (2014) UK	34 participants (mean age 24:09, SD = 52 months)	MABC-2, BOT-2 Brief. at or below 15th	ADC	ADC
Zaguri-Vittenberg et al. (2023) Israel	10 participants aged from 21 to 31	M-ABC-2 at or below 5th percentile	AAC-Q Participant interview	Participant interview

Source: Author’s compilation