Helping Your Child with Developmental Coordination Disorder: How Occupational Therapy Supports Real Growth
Jul 23, 2025
When your child struggles with things other children seem to do with ease—like riding a bike, holding a pencil, or even climbing stairs—it can feel frustrating, heartbreaking, and confusing. If your child has Developmental Coordination Disorder (DCD), you’re not alone—and more importantly, there are effective ways to help.
One of the most powerful forms of support is occupational therapy (OT). But what does OT really involve? How do therapists help a child improve movement, coordination, and independence? And why do some activities look like play when the goal is real-life function?
Let’s unpack how occupational therapy supports children with DCD—using both bottom-up and top-down approaches—and what that looks like in everyday life.
A Quick Refresher: What Is Developmental Coordination Disorder?
Developmental Coordination Disorder is a neurodevelopmental condition that affects how a child plans, sequences, and executes motor tasks. Kids with DCD might appear clumsy, avoid sports or handwriting, or get overwhelmed by tasks with lots of steps (like tying shoes or packing a backpack). Their muscles are usually fine—the issue lies in how the brain communicates with the body.
What Is Occupational Therapy (OT)?
Occupational therapy helps children gain independence in the “occupations” of childhood—things like self-care, play, school tasks, and participation with peers. OT doesn’t just focus on movement, but also how motor skills interact with sensory processing, emotional regulation, executive functioning, and confidence.
Two Approaches to OT: Bottom-Up and Top-Down
Effective therapy often weaves together two main approaches:
Bottom-Up: Strengthening the Foundations
This approach focuses on building the underlying skills the child needs—like balance, core strength, fine motor control, and sensory integration.
Top-Down: Practicing Real-Life Tasks
This approach starts with a real-world activity the child wants to improve, and works backward to build strategies and adaptations that help them succeed.
Both are important. Let’s explore them in detail.
Bottom-Up Approaches: Building the Foundations
Think of this as strengthening the roots of a tree so the branches can grow strong. These interventions build the core physical and neurological systems that support coordination.
1. Core Strength and Stability
Children with DCD often have weak core muscles, which affects posture, balance, and hand control.
Activities might include:
• Animal walks (crab walk, bear crawl)
• Wheelbarrow walking
• Climbing therapy ladders or gym equipment
• Sitting on a therapy ball while doing puzzles or reading
2. Fine Motor Skill Development
This supports tasks like buttoning, writing, cutting, and using utensils.
Therapy activities might include:
• Threading beads or lacing cards
• Pinching putty or squeezing therapy balls
• Using tweezers to pick up small objects
• Practice with adapted scissors or pencil grips
3. Sensory Processing Support
Many kids with DCD have sensory integration difficulties. They might overreact to sounds or movement or not register body sensations well (proprioception).
Sensory-focused activities might include:
• Heavy work (pushing/pulling weighted items)
• Brushing programs
• Deep pressure massages or joint compressions
• Swings or spinning platforms (for vestibular input)
Why it matters: Sensory input helps children feel where their bodies are in space, improving movement planning.
4. Motor Planning and Sequencing
DCD often involves dyspraxia, or difficulty planning and executing new or complex movements.
OT might use:
• Obstacle courses where the child must remember and perform a sequence
• Multi-step art or building projects
• Imitation games like “Simon Says” or freeze dance
Visual tools like picture cards or step-by-step checklists help build sequencing.
Top-Down Approaches: Targeting Functional Tasks
Here, the therapist starts with a real-life task your child wants to master—like tying shoes, biking, or zipping a coat—and breaks it down to teach it step by step. This method is often used in a powerful evidence-based approach called CO-OP (Cognitive Orientation to daily Occupational Performance).
What is CO-OP?
CO-OP teaches kids to use cognitive strategies to solve motor problems. It’s goal-oriented and child-led.
The 4-step strategy:
1. Goal: What do I want to do?
2. Plan: How will I do it?
3. Do: Carry out the plan.
4. Check: Did it work? What can I change?
Here's an example:
10-year-old Lila wanted to learn to ride a two-wheeler. She and her therapist talked through what made biking hard (balancing, starting, pedaling). They made a plan, practiced it in small chunks, and problem-solved together. Lila kept a journal to reflect after each session. After 4 weeks, she was riding confidently—and felt empowered by having learned how to learn.
Examples of Top-Down Goals in OT:
• Dressing independently
• Cutting food with a fork and knife
• Packing and organizing a school bag
• Writing a paragraph legibly
• Playing a sport without freezing or falling behind
Why This Matters for Parents
Sometimes, a parent watches an OT session and thinks, They’re just playing with putty or tossing bean bags—how is this helping?
But OT is highly intentional. Every movement, game, or step is chosen to strengthen brain-body pathways and support real-world skills.
The ultimate goal is confidence and independence—not just stronger muscles or better balance, but a child who feels proud of what they can do and equipped to try again when they struggle.
How to Help at Home
Occupational therapy works best when it’s reinforced at home. Here are ways to carry over strategies:
• Ask your OT for home programs: A few fun, 10-minute activities each day can make a big difference.
• Use visual checklists for routines like getting dressed or packing up.
• Break large tasks into steps and celebrate each success.
• Give your child time and space to struggle—support, don’t rescue.
• Encourage effort, not perfection: “You kept trying even when that zipper was tricky. I’m proud of how you stuck with it.”
Occupational therapy for DCD is not just about improving how a child moves—it’s about helping them live fully in their world. Whether through strengthening their muscles, reworking their sensory systems, or teaching them how to think through everyday tasks, OT meets children where they are and walks with them toward independence. If your child has DCD, they are not broken. They are developing in a different way—and with the right support, they can build the tools and confidence they need to thrive.
Parenting Alongside You,
Dr. Emma and The Aparently Parenting Team
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