Movement confidence or competence… impact of Developmental Coordination Disorder/Dyspraxia

Professor Amanda Kirby, CEO of Do-IT Solutions., Campaigner for Neurodiversity, Medic, Knowledge Translator, researcher.

Originally published as part of The Neurodiversity 101 LinkedIn Newsletter.

I was out walking yesterday where there was aware of some black ice on the path. While walking and staying upright it made me realise how I had changed my movements as I was concerned that I did not land on my backside! I took a wider stance and slower more cautious movements. ( Penguin walking has been recommended this week –https://www.youtube.com/watch?v=F6W9i3DAfoM)

It also made me think about people with DCD where co-ordination and balance maybe harder for some.DCD has been a passion and interest of mine for nearly 40 years as I have close family members with DCD now and in the past. It is not one condition but people may present variably often with fine motor, gross motor and balance challenges.

How do others judge someone with poor coordination now and in the past?

Poor coordination has been seen as being less capable and even the terms used are pretty derogatory! The word clumsy for example. “Clumse” is an older, dialectal word related to “clumsy,” meaning benumbed (numbed with cold), idle, lazy, loutish, or a stupid person (numbskull), stemming from Scandinavian roots for being speechless or motionless. While the adjective clumsy (awkward, lacking coordination) became standard, “clumse” refers to these archaic senses of stiffness, dullness, or lack of grace, often due to cold or fear.

What is DCD?

Developmental Coordination Disorder (DCD), is often called dyspraxia, and is still widely misunderstood.

Developmental Coordination Disorder (DCD) in the DSM-5 involves significantly below-expected motor skill acquisition, impacting daily activities (self-care, school, play), with symptom onset in early development, and isn’t better explained by intellectual disability or another neurological condition.

It’s classified as a neurodevelopmental disorder, characterised by ‘clumsiness’, poor fine/gross motor skills (handwriting, sports, riding bikes), and persistent functional limitations, requiring a multidisciplinary assessment for accurate diagnosis. It was often seen as a childhood condition till I and others did work in the late 90s/early 2000s. Like other neurodevelopmental conditions we now recognise that DCD is a lifelong condition and doesn’t ‘just’ disappear in adolescence. It often overlaps with Autism, ADHD, Dyslexia and Dyscalculia and DLD.

Too often, cautious movements are described as being due to anxiety or lack of confidence. People can often have a view that if only a person tried a bit harder and went for it with more effort they would be OK… but this is not true!Current evidence tells a more accurate and far more respectful story.

I have often written about DCD before (https://www.linkedin.com/pulse/neurodiversity-what-dyspraxiadcd-why-aware-prof-amanda-kirby/) and see more information at https://www.isra-dcd.com/.. and have written several books too.e.g. ..https://www.amazon.co.uk/Dyspraxia-Developmental-Co-ordination-Amanda-Kirby/dp/0285635123

A recent paper by Harris, Rathbone and Wilmut titled “Does how I feel change how I move? The influence of anxiety, self-efficacy and resilience on movement in adults with Developmental Coordination Disorder” made me think about the difference between confidence and competence and how this relates to our movements.

4-5% of people have DCD… Yes… that is a big number and far more than prevalence for Autism but it is still spoken about far less.

DCD is not about being careless or fearful

Some people have thought that if you are careless and then this makes you more ‘clumsy’ or less well coordinated. The reality is that adults with DCD usually know their bodies very well.

What we know is that often people with DCD can:

• misjudge space less reliably
• experience more variable, less predictable movement
• need to make adjustments while they are moving

This is not a mindset problem. It is a motor control difference.

Caution is an intelligent strategy

Research shows that adults with DCD often leave themselves more space when moving through gaps or navigating environments.

This is not over-caution. It is risk-aware adaptation. It sounds a sensible approach. How do you walk on a cold icy day?

People with DCD learn, through experience since young that their movements can vary from moment to moment. So they compensate – sensibly.

Anxiety is not the main driver

A common assumption is that people with DCD move cautiously because they are anxious. We know that anxiety in some children with DCD is at a higher rate(https://pubmed.ncbi.nlm.nih.gov/21377831/) and a more recent paper highlights his (https://link.springer.com/article/10.1007/s40474-022-00251-7). I wrote about this in the past with the studies I completed with colleagues:

We found that approximately 76% of their adults with DCD fell outside the ‘normal’ range according to a standardised anxiety questionnaire (Hospital Anxiety and Depression Scale) (Kirby A, et al. Self-reported mood, general health, wellbeing and employment status in adults with suspected DCD. Res Dev Disabil. 2013;34(4):1357–64.)

Adults with DCD have reported significantly more symptoms of both state and trait anxiety compared to their peers (using the state-trait anxiety inventory) (Hill EL, Brown D. Mood impairments in adults previously diagnosed with developmental coordination disorder. J Ment Health. 2013;22(4):334–40.)

Harris and colleagues demonstrated higher levels of both generalised anxiety and movement-specific anxiety (anxiety which is specifically focused on movement) in a group of adults with DCD in comparison to their non-DCD peers (Harris S, Wilmut K, Rathbone C. Anxiety, confidence and self-concept in adults with and without developmental coordination disorder. Res Dev Disabil. 2021;119:104119.)

However we have seen that the converse is that :

• general anxiety does not reliably predict how people move
• movement confidence is linked more closely to movement consistency, not fear

This matters, because it changes what support should look like.

Movement confidence is task-specific

Adults with DCD may feel confident in some situations and uncertain in others.

Movement confidence is:

• context-dependent
• shaped by past success and failure ( and how much practice you have had)
• closely linked to how predictable their movement feels

This is why “just be more confident” advice misses the point.

Perception and action don’t always line up smoothly

In people without DCD, judging a space and moving through it tend to match well.

In DCD, that link can be less smooth:

• judging what should work
• and what actually works may differ

So movement often relies on real-time adjustment rather than automatic flow.

What this means in practice

Supporting people with DCD works best when we:

• stop pathologising caution
• recognise adaptive strategies as strengths- this may also be a way of maintaining safety at work and school… we don’t all have to approach tasks in the same way… how many different ways to young children crawl/not crawl before walking?
• focus on improving consistency, not forcing speed – breaking tasks into parts and having sufficient time for practice can improve ability, confidence and competence
• allow personalised ways of moving
• design environments that reduce unnecessary risk

Confidence grows when people are allowed to move in ways that work for them.

The takeaways

DCD is not about someone ‘just’ needing.trying harder. It is about moving differently. If we look at children learning to write with their left hand rather than their right… not wrong… just different…

Or someone recording their work orally rather than ‘painstaking’ writing slowly and it being illegible for them and others….

When we understand this, we stop asking people to override their instincts and start supporting movement that is safe, effective, and ensuring people have their dignity maintained.

Blog Author

I am Amanda Kirby, CEO of Do-IT Solutions a tech-for-good company that delivers thought provoking consultancy and neuroinclusive guidance and training. We have developed cutting edge web-based screening tools that have helped 10s of 1000s of people. We strive to deliver person-centered solutions relating to neurodiversity and wellbeing.

I am a mixed bag of experiences and skills, an odd ball… and have 25+ years of working in the field of neurodiversity.

I am a medical doctor, Professor, and have a Ph.D. in the field of neurodiversity; parent and grandparent to neurodivergent wonderful kids and am neurodivergent myself.

Theo Smith and I wrote the UK award-winning book Neurodiversity at Work Drive Innovation, Performance, and Productivity with a Neurodiverse Workforce. My 10th book came out called Neurodiversity and Education in March this year. Excitingly, Theo and I have another book coming out next year!