There is a scene parents almost always describe in the same words. The ball comes, he watches it come, puts his hands up a moment too late, and the ball bounces off his chest. The others laugh, not unkindly, they simply laugh. He laughs too. And next time, when the teams are picked, he stands at the back of the line.
Then there are the stairs taken one step at a time at eight years old, the laces that never get done, the glass knocked over at every dinner, the exercise book that looks like someone else wrote it. And the phrase you hear from everyone: “he's just a bit clumsy, he'll grow out of it”.
Sometimes that is true. Sometimes it is not, and it has a name.
When “clumsy” has a name
It is called developmental coordination disorder, also known as dyspraxia. It is a neurodevelopmental condition: the child has an intelligence within the normal range, has no neurological illness, and nevertheless learns movements more slowly and performs them worse than would be expected for his age.
It is not laziness. It is not a lack of practice. It is not that he “doesn't try”. It is the way the brain plans and adjusts a movement: the sequence has to be built almost from scratch each time, instead of becoming automatic. That is why children with this difficulty tire more quickly doing the same things: for them, movement costs attention, not just muscle.
How common is it? The most-used estimates put it at 2-7% of school-age children: that means on average at least one per class. The range is wide because it depends on how it is measured. A two-phase epidemiological study gave a questionnaire to 2,306 children aged 6 to 10 and then took the suspected cases to a proper clinical interview with the full DSM-5 criteria: of the 198 assessed, 49 received the diagnosis, a prevalence of 2.1%. In the same study, attention deficit hyperactivity disorder was significantly more frequent in these children: the two often go together.
How it differs from ordinary variation
This is the real question, and the honest answer is that clumsiness alone is not enough. Children differ: some catch a ball in mid-air at six and others only get there at nine, and that is all normal.
What shifts the discussion is one precise criterion: interference. Not “how awkward is he”, but how much it is taking away from him. The motor difficulties need to be below what is expected for the age, present since early on (not appearing suddenly), not explained by another condition, and above all they need to interfere with everyday life: dressing, eating, writing, keeping pace at school and in play.
In services a standardised test is used and results are read in percentiles. In one study that followed children aged 7 to 14, the classification was as follows:
| Score on the motor test | Band | What it means |
|---|---|---|
| 25th percentile and above | Typical development | Within normal variation |
| Between the 6th and 16th percentile | Moderate difficulties | Grey area, to be monitored |
| 5th percentile or below | Severe difficulties | Below 95% of peers |
That “5th percentile” is the numerical translation of a sentence you may already have thought: he is clumsier than every child his age I know.
And here is the most useful finding. In the same study the groups were followed up over two school years. The group with moderate difficulties gained on average more points a week than classmates with typical development and reached the normal range: they really did catch up as they grew. The group with severe difficulties improved at the same rate as their peers, so they were progressing, but they stayed exactly the same distance behind: they grew without ever closing the gap.
Put simply: “he'll grow out of it” is true for some and false for others, and the difference lies in severity. That is why it is worth looking into rather than waiting and seeing.
If your concern is instead about a younger child who has not yet built the basic milestones, the picture is different and you will find it in Not crawling and not walking: the real windows of motor milestones.
The signs, age by age
None of these on its own means anything. It is the number and the persistence that matter.
In early childhood and nursery school
- Learns new movements much more slowly than others and forgets them quickly.
- Falls often even on flat ground, bumps into things, seems not to know where his body ends.
- Refuses jigsaw puzzles, scissors, colouring: fine activities frustrate him straight away.
- Cannot stand on one foot, does not hop with both feet together when his peers can.
In primary school
- Buttons, laces and zips remain an ordeal well past the age of his classmates.
- Handwriting is slow, laborious, hard to read, and he tires from writing, not just writes badly.
- In PE he is always the last one picked; catching a ball and riding a bike come late or not at all.
- He starts to avoid: “I don't feel like it”, “it's boring”, a stomach ache on PE days.
That last point is the most important one.
The part almost everyone underestimates: participation
When people talk about a clumsy child, they almost always talk about movement. But the biggest harm is not the gesture: it is what he stops doing so as not to look foolish.
It starts with withdrawing. A systematic review of 12 studies that measured physical activity with objective tools (accelerometers, not questionnaires), ten of them pooled in a meta-analysis, found that children with this disorder spend less time in moderate-to-vigorous activity than their peers, with the clearest and most consistent effect precisely in the 6-14 year range. Less movement means, in the studies, more sedentary behaviour, more overweight and lower fitness: a circle that closes in on itself.
And it does not close at the end of childhood. A Finnish longitudinal study assessed the motor competence of 656 people at five years and re-measured them with an accelerometer at twenty-five: those at risk as children still took fewer total steps as adults and spent more time in light and sedentary activity. Twenty years later.
Then there is the emotional side, which parents sense but find hard to demonstrate. In a sample of 1,206 teenagers aged 12 to 14, those with a probable coordination disorder were less active, had a lower sense of personal worth and more internalising problems: anxiety, low mood, withdrawal. But the same study also found the good news: when physical activity and self-esteem rose together, internalising problems fell more in the teenagers with motor difficulties than in the others. They are the most fragile and, at the same time, the ones who gain the most.
How does the harm pass from the body to mood? Through peers. In an analysis of 70 children aged 5 to 11, the link between motor difficulties and behaviour problems was mediated at least in part by difficulties with peers: it is not the clumsiness that does the damage, it is being left out.
On quality of life, in a study of 50 children of about 10 years old, both the children and their parents rated it lower than normative values. With one detail worth keeping in mind: parents rated it worse than the children themselves did. If you are picturing a bleaker scene than he is living, that is documented, and he is doing better than you see.
Finally, school, where the cost shows up most clearly. In a British prospective study, 284 teenagers diagnosed at 7 were compared with 5,425 peers at the end of secondary school at 16: a median of 2 exams passed against 7. The gap shrank considerably after correcting for gender, socioeconomic status and IQ, but it remained. And the figure that says it all: nearly 40% of these teenagers received no formal support at school.
What works: training the task, not the ability
Here the research is unusually clear about direction, and unusually cautious about size.
The direction: task-oriented approaches work. That means choosing with the child a concrete goal that is his own, I want to ride a bike, I want to tie my shoes by myself, I want to catch the ball, and training that, breaking it down, simplifying it, and giving him strategies to think it through before doing it. The historical alternative was to train “underlying functions” (balance, perception, sensory integration) in the hope that the benefit would transfer by itself to real activities. The international guidelines on developmental coordination disorder, 35 recommendations built on literature reviews and formal consensus of a multidisciplinary panel, treat activity- and participation-oriented interventions as the reference framework, the one everything else is added to; and the 2025 systematic review that updates the physiotherapy guidelines points to task-oriented intervention as the recommended first choice.
The size, on the other hand, must be stated honestly. A 2025 meta-analysis of 32 randomised controlled trials found clear improvements in overall motor skills, balance and performance in daily activities, with task-oriented training as the most effective strategy. But in the same analysis participation did not improve and psychosocial factors did not reach significance. And a Cochrane review of 15 studies and 649 children concluded, on the quality of the available evidence, that it had “very little confidence” in the estimate of the effect, in contrast with earlier reviews, which were all enthusiastic.
This is not a detail to hide, it is information you need: movement can be trained, while self-esteem and participation have to be worked on separately and on purpose. Anyone who promises you that learning to catch a ball will also sort out the rest is telling you something the data do not support.
One last practical indication, and it is gold dust. In a systematic review of 66 studies (18 pooled in a meta-analysis), the total dose in minutes and the frequency of sessions were significant moderators of the effect: more minutes and more often, more robust effects. Not “more intense”: more often.
Why working remotely with these children works well
Put together the two things just seen, that you train the real task and that frequency matters, and the conclusion is almost obvious: the right place is not a rehabilitation gym once a week. It is your home, every day, inside play.
An hour in a clinic teaches a movement in a context that is not his. The child has to tie his shoes, on his floor, with you in a hurry because it is late. That is the real task.
Direct evidence on remote work is still scarce and small, and I give it to you for what it is. A randomised controlled trial from 2025 with 20 children aged 3 to 7 compared eight weeks of in-person therapy with the same eight weeks plus a weekly thirty-minute session at home by video: the group with the added remote session made greater gains in independence in daily activities and on the goals chosen by the family. It should be read for what it says: the remote part was added, it did not replace anything. And in a qualitative study of parents of children with this diagnosis receiving telerehabilitation, the request was clear: a mixed model, not everything online.
What video work does very well, however, is the thing that matters most: training you. Watching how the child handles the task in his own environment, understanding where the sequence gets stuck, choosing one thing at a time, simplifying it and giving you a way to repeat it every day for ten minutes. The frequency that makes the difference in the studies is only achieved this way.
If you also notice persistent walking on tiptoe or feet that look flat to you, these are different chapters and often less serious than they seem: Child who walks on tiptoe and Flat feet in children.
Five things to change this week
- One goal at a time, chosen by him. Not “improve coordination”, but skip the rope three times in a row. Letting him choose is half the work.
- Ten minutes a day, not an hour on Sunday. Frequency beats duration.
- Break the movement down. First the ball bouncing and catching it standing still, then from one step away, then in mid-air. If he misses three times in a row, you have moved up a step too quickly.
- Change the sport, do not drop it. Swimming, climbing, martial arts, dance, cycling: without a ball in flight and without a team to beat, movement brings success instead of humiliation. International guidelines also recognise active video games as a useful complement, not a substitute.
- Tell him. “Your body learns movements more slowly, you are not stupid and you are not lazy.” Children who have no explanation build one for themselves, and it is always worse than the truth.
When a doctor is needed first
Some things are not a coordination disorder and call for a medical assessment before any work on movement:
- he gets worse or loses skills he had already acquired;
- the difficulty appeared suddenly, in a child who had been doing fine;
- there is a clear asymmetry: he always uses the same side, drags a foot, holds one arm differently from the other;
- he has marked stiffness, involuntary movements or tremors;
- he finds it increasingly hard to climb stairs or get up from the floor;
- falls with loss of consciousness, severe headaches or vision problems.
These pictures are not something we follow, and they cannot be assessed by video call: they need the paediatrician and, where indicated, child neuropsychiatry.
What we can do (and what we cannot)
First, honesty: we do not make the diagnosis. It is framed by a team, usually in child neuropsychiatry, with standardised tests and the exclusion of other conditions. If that is what you are looking for, that is the route, and it is worth taking: it opens the door to classroom support that nearly four in ten teenagers never get.
What we can do is the piece that is almost always missing: watch how he moves in his own environment and teach you how to train it every day, with goals chosen by him and one task at a time. There is no need to wait for a piece of paper to start: the diagnostic pathway and the work on movement can go on in parallel.
With Ri-Hub Junior you start with a free twenty-minute introductory consultation with a physiotherapist on the Italian professional register who works with children and teenagers: you show us the child doing something that is hard for him, such as shoes, stairs or the ball, and we tell you whether it makes sense to go further and where to start. Up to age 10, sessions last 50 minutes and cost 59,90 €; from 11 to 18 years old it is the standard session at 29,90 €.
And if behind it there is a complex neurological condition, the right place is not us: those pathways require in-person assessment and specialised centres, and we will tell you straight away rather than waste your time.
Psychomotor therapy is the most frequent suggestion in these cases: what it is and when it is really needed is in Psychomotor therapy.
If what strikes you most are the falls, those have their own threshold: Child who falls often.
Sometimes behind the clumsiness there is simply a very flexible child: Ligament laxity in children.
Somersaults, hopping on one foot, catching a ball: these skills do not arrive on their own, they are learned: Basic motor skills.
Sources
- International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder, Developmental Medicine & Child Neurology, 2019
- Physical and Mental Health of Children with Developmental Coordination Disorder, Frontiers in Public Health, 2016
- Prevalence and associated factors of developmental coordination disorder in primary school children, European Child & Adolescent Psychiatry, 2025
- A comparison of characteristics, developmental disorders and motor progression between children with and without developmental coordination disorder, Human Movement Science, 2021
- Objectively Measured Physical Activity in Children With Developmental Coordination Disorder: A Systematic Review and Meta-analysis, Archives of Physical Medicine and Rehabilitation, 2025
- Effect of childhood developmental coordination disorder on adulthood physical activity; Arvo Ylppö longitudinal study, Scandinavian Journal of Medicine & Science in Sports, 2022
- Moderating Effects of Physical Activity and Global Self-Worth on Internalizing Problems in School-Aged Children With Developmental Coordination Disorder, Frontiers in Psychology, 2018
- Peer problems mediate the relationship between developmental coordination disorder and behavioral problems in school-aged children, Research in Developmental Disabilities, 2012
- Health-related quality of life of children with Developmental Coordination Disorder, Research in Developmental Disabilities, 2019
- The impact of developmental coordination disorder on educational achievement in secondary school, Research in Developmental Disabilities, 2018
- Motor-Based Interventions in Children with Developmental Coordination Disorder: A Systematic Review and Meta-analysis of Randomised Controlled Trials, Sports Medicine Open, 2025
- Systematic Review to Inform the Developmental Coordination Disorder Clinical Practice Guideline Update: Physical Therapy Intervention, Pediatric Physical Therapy, 2025
- Task-oriented interventions for children with developmental co-ordination disorder, Cochrane Database of Systematic Reviews, 2017
- Motor Skill Interventions in Children With Developmental Coordination Disorder: A Systematic Review and Meta-Analysis, Archives of Physical Medicine and Rehabilitation, 2018
- The effect of telerehabilitation on activity performance and participation in daily life in children with developmental coordination disorder: A randomized controlled trial, PLoS One, 2025
- Bringing therapy home: Exploring parents' experiences of telehealth for children with developmental coordination disorder, British Journal of Occupational Therapy, 2023
Last source check: September 2026.
