Developmental Medicine & Child Neurology 2007, 49: 405–405 405 The incidence of developmental coordination disorder (DCD) is sufficient to rank it as one of the most common disorders amongst school-aged children and it has featured within the pages of DMCN for more than 35 years. One might expect that appropriate interventions could yield success for this group because, by definition, the problems exhibited are not due to ‘a general medical condition…and does not fit the criteria for a per- vasive developmental disorder’ (Criterion C, DSM-IV-TR, p 58). In his review, Sugden addresses the current status of the field and the difficulties of establishing a framework to guide interven- tion. As a result, he leans towards more functional approaches that address the tasks a child wants to achieve (e.g. scoring goals, riding a bike) in the contexts they wish to achieve them. From a standpoint of having worked in remedial settings with children with DCD, it is difficult to argue against the logic of this approach. From the standpoint of cognitive-neuroscience, however, I feel that we will be able to refine these approaches. Part of the problem in establishing common principles is that DCD may co-occur with other developmental disorders. A recent series of meetings sponsored by the UK Economic and Social Research Council brought together some of the leading interna- tional researchers in the field of DCD and resulted in a consensus statement 1 that included a reinterpretation of Criterion C. This suggests that, so long as a disorder of movement is a primary con- dition (and other DSM-IV criteria are met), the presence of a co- occuring disorder should not always lead to exclusion from a DCD study group. The implications of this require consideration. Given that DCD may be identified alongside autistic spectrum disorder (ASD) or attention-deficit–hyperactivity disorder (ADHD), one approach would be to fractionate into multiple groups (e.g. those with DCD and ASD; or DCD, dyslexia, and ADHD). But this is unlikely to produce results that will provide a coherent perspective as to why a specific child may be unable to perform coordinated actions in everyday contexts. Clearly prob- lems with a child’s general attention or conformity might blur any results in a movement task. However, any responsible researcher excludes data from participants who were simply ‘not on task’. It is possible to create interesting, challenging games where children with ADHD or ASD can be ‘on-task’ for some periods and in many cases they do display fundamental prob- lems with the coordination of movements. These problems can- not be understood within the framework of ADHD or ASD, they are features of a movement disorder. Attention does play a role in movement organization, but the nature of attention in the con- text of ongoing movements is very different from the way it is assessed in general clinical screening. In movement, it is the rapid switching of gaze to each task in turn. This is a capability that is examined in motor-control research, 2, 3 rather than in the Commentary Current approaches to intervention in children with developmental coordination disorder other discipline areas. Although the motor system is highly com- plex, we are reaching a point where neurophysiological work is converging with imaging and behavioural work in humans and the fine detail of motor mechanisms is becoming ever more apparent. Not all children with DCD will exhibit similar problems. We would anticipate that children whose predominant problem lies in postural balance, manual control, or interceptive timing may have disruption to different subsystems. But establishing whether some children have problems with dorsal-stream pro- cessing, or cerebellar interactions (as an example of two of the more common hypotheses) is now a realistic challenge. Although there may be differences in the problems manifest with DCD, there are no reasons to suppose that disruption to sub- systems won’t overlap directly with movement problems exhibit- ed in children classified as ADHD or ASD. Reflecting back on the issue of a coherent framework to understand coordination disor- ders, we are some way from an accepted framework at present, but it is certainly on the horizon if we can identify common fea- tures. The problem with being over keen to establish a framework is highlighted by Sugden’s discussion of process-oriented approaches and sensory integrative therapy. It is highly likely that some children with movement problems do indeed have prob- lems with integrating emergent sensory information in on-going tasks. There are, however, considerable problems in refining mea- sures to assess this in a dynamic context and, to date, there is insuf- ficient evidence to accept this as a general framework. In the past the move to a process-oriented approach has sometimes been too hasty, with insufficient empirical support. But where children exhibit specific deficits in coordination, whatever the broad diag- nosis, there must be common perceptuomotor subsystems that are poorly developed or refined. The task of identifying these is challenging, but converging methods do hold promise, and in the next few years I would hope to see increasing moves towards merging functional approaches with themes emerging from neuromotor research. John Wann References 1. Sugden DA, editor. (2006) Leeds consensus statement: Developmental Coordination Disorder as a specific learning difficulty. Leeds: DCD- UK/Dyscovery Centre. 2. Mon-Williams MA, Tresilian JR, Bell VE, Coppard VL, Nixdorf M, Carson RG. (2005) The preparation of reach-to-grasp movements in adults, children, and children with movement problems. Q J Exp Psychol A, 58: 1249–1263. 3. Wilmut K, Wann JP, Brown JH. (2006) Problems in the coupling of eye and hand in the sequential movements of children with Developmental Coordination Disorder. Child Care Health Dev 32: 665–678. See related article on page 467