The purpose of this study was to examine sensory processing, motor proficiency, and functional performance in children and adolescents with Developmental Coordination Disorder (DCD) compared with typically developing children (TDC), and to explore the correlations among these domains across a broad developmental age range.
Method
This cross-sectional study included children and adolescents aged 4–17 years classified as DCD and TDC. Sensory processing, motor proficiency, and functional performance were assessed using SPM, PEDI-CAT and BOT-2. Group differences and developmental trends were analyzed using analysis of variance. Pearson correlations were used to evaluate the association between sensory, motor, and functional performance.
Results
Children with DCD demonstrated significantly greater sensory-processing difficulties, lower motor proficiency, and reduced functional performance compared with TDC (all p < 0.001). Sensory processing, BOT-2 and PEDI-CAT scores for the DCD group consistently fell within the moderate difficulty range and below average across age groups, whereas TDC scores were within typical limits. A significant Group × Age interaction was identified for functional mobility (p = 0.02), reflecting an increasing functional gap with age. Sensory-processing difficulties were significantly associated with functional performance, whereas correlations between sensory processing and motor proficiency were not significant after correction.
Conclusion
Sensory, motor, and functional performance difficulties in DCD persist throughout childhood and adolescence. Sensory-processing difficulties appear to be more closely related to functional performance than to structured motor proficiency. These findings support the importance of early comprehensive, developmental assessment and intervention approaches addressing both sensory and functional challenges in children and adolescents with DCD.
Developmental Coordination Disorder (DCD) is a neurodevelopmental condition characterized by difficulties in acquiring and executing coordinated motor actions that results in slow, uncordinated and less motor proficiency affecting daily functioning, academic performance, and participation in social or recreational activities (Tamplain et al., 2024). The prevalence range is 1.8 to 8% with the incidence of DCD in children aged 5–11 years is 6% (Deshmukh et al., 2024). DCD is among the most common developmental disorders and frequently persists into adolescence and adulthood, influencing independence, participation, and psychosocial well-being (Dionne et al., 2023).
Although the exact cause of DCD remains unclear, evidence suggests that a combination of genetic, perinatal, and environmental factors contributes to its development (Allen et al., 2017). Children who are born preterm (before 37 weeks of gestation) or with low birth weight are at higher risk for DCD, reflecting the vulnerability of motor and sensory systems during early brain development (“Developmental Coordination Disorder,” 2020). Performing coordinated movements and motor skills is a complex neurodevelopmental process that relies on the integration of sensory input, motor planning, and motor execution through multiple brain regions, including the cerebellum, basal ganglia, and parietal cortex (Ryckman et al., 2017). Any disruption in this system can lead to difficulties with coordination and movement. Increasing evidence also suggests that DCD is not purely a motor disorder; rather, many children with DCD experience sensory-processing difficulties, including problems with proprioception, touch discrimination, and vestibular processing (Tran et al., 2022). These sensory issues may interfere with the ability to process and integrate sensory feedback, which is essential for accurate movement planning and adaptive motor responses (Tal-Saban et al., 2025).
Despite growing evidence of sensory involvement in DCD, research on sensory-processing difficulties in this population remains limited. Few studies have systematically explored how sensory modulation interacts with motor and functional performance, and findings to date are mixed (Weber et al., 2025, Allen et al., 2017). Some studies have reported significant associations between sensory and motor domains, while others find weak or inconsistent results (Denysschen et al., 2021). Furthermore, most prior work has focused on motor control and coordination in younger children (typically 4–10 years), leaving gaps in understanding the functional implications of the sensory and motor deficits, and how these challenges persist or evolve through adolescence (13 years and above) when functional expectations and environmental demands increase (Zwicker et al., 2013).
Previous studies have extensively examined the relationship between motor proficiency and functional performance, showing that motor coordination skills are closely linked to participation in daily activities and independence (Rinat et al., 2020, Denysschen et al., 2021). However, to date, no study has comprehensively explored the correlation of sensory processing with both motor proficiency and functional performance within the same cohort. Understanding how sensory difficulties interact with motor and functional outcomes across development is critical for designing holistic, evidence-based rehabilitation strategies (Allen & Casey, 2017).
The significance of our study lies in addressing these gaps by adopting a developmental framework including sensory processing, motor, and functional performance in children and adolescents aged 4 to 17 years. Examining these domains together allows for a comprehensive understanding of how sensory-motor systems contribute to participation and daily functioning and whether sensory-processing differences are stable or progressive with age.
This study aimed to first compare sensory processing, motor proficiency, and functional performance between children with DCD and typical developing children (TDC). Secondly, to examine developmental trends across childhood and adolescence in sensory, motor, and functional domains. Final aim is to explore the association among sensory, motor, and functional abilities to better understand how these systems collectively influence functional performance. It was hypothesized that children with DCD would demonstrate greater sensory-processing difficulties, lower motor proficiency, and reduced functional performance compared with TDC, and that sensory and motor abilities would be significantly associated with functional outcomes.
Methods
Study Design and Setting
An observational study was conducted to compare sensory processing, motor proficiency and functional performance and participation between children with DCD and TDC, aged 4 to 17 years at Virginia Commonwealth University between March 2019 and August 2025. Participants were recruited through Children’s Hospital of Richmond (CHoR) and community advertisements. Assessment forms were filled by parents either online or in-person for Sensory Processing Measure (SPM) (Brown et al., 2024) and Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI-CAT) assessment (Haley et al., 2011). The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) assessment was completed based on standardized procedures in a research lab on campus (Radanović et al., 2021).
Participants
Children aged 4 to 17 years were eligible to participate in this study. Participants were divided into two groups: children with DCD and TDC. Children in the DCD group were included if they had a parent-reported history of difficulty with motor coordination and scoring below the cutoff on the Developmental Coordination Disorder Questionnaire (DCDQ’07, referred to in this paper as DCDQ) for an indication of possible DCD (Wilson et al., 2009). Children were excluded if they had a diagnosis of cerebral palsy, autism spectrum disorder, intellectual disability, or other genetic or neuromuscular conditions affecting sensory or motor function. TDC were included if they had no history of developmental, neurological, or sensory impairments. TDC children also had to score above the cutoff on the DCDQ. Written informed consent was obtained from parents or guardians, along with child assent prior to participation. The study protocol was approved by the Institutional Review Board at Virginia Commonwealth University.
Variables and Measures
The study evaluated three main domains—sensory processing, motor proficiency, and functional performance and participation—using standardized assessment tools. Sensory processing was measured using the Sensory Processing Measure–first edition (SPM) for participants at or under age 12 years (Parham et al., 2007).
SPM second edition (SPM-2) was added later when it was published in 2021 for the adolescents who participated after 2021 (Brown et al., 2024). SPM and SPM2 are parent-report questionnaires with domain-specific T-scores (vision, hearing, touch, body awareness, balance and motion, planning and ideas) and a sensory total T score with higher scores indicating greater sensory processing challenges. The SPM and SPM2 scores will be collectively referred to as the SPM scores for the remainder of the manuscript. Motor proficiency was assessed using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2), which was administered in-person by experienced pediatric occupational therapists at the research lab. The BOT-2 short form was used to evaluate overall motor performance to reduce testing burden on the research participants (Radanović et al., 2021). The BOT-2 evaluates fine and gross motor skills through items covering fine motor precision, integration, manual dexterity, bilateral coordination, balance, running speed and agility, upper-limb coordination, and strength, yielding standard scores and composite motor proficiency scores. Functional performance and participation were assessed using the Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI-CAT), which evaluates daily activities, mobility, social/cognitive function, and responsibility through direct observation and caregiver response (Haley et al., 2011). Higher PEDI-CAT scores reflect greater independence and participation in daily life. Additional demographic information, including age, sex, diagnosis, medical history, and parental education level, was collected via a parent questionnaire to characterize the sample and control for potential confounding variables.
The sample size was calculated for the primary outcome BOT-2 (Denysschen et al., 2021). Using means and standard deviation for children with DCD and TDC, we derived an anticipated standardized mean difference of 0.65. An independent-samples t-test (two-sided α = 0.05, power = 0.80, equal allocation) implemented in IBM SPSS Statistics version 31 (Power Analysis) (18) indicated 18 participants per group. Allowing 10% attrition, the recruitment target was 20 children per group and a total of 40 children.
Procedure
Parents completed the DCDQ, SPM, and PEDI-CAT questionnaires either online or during the in-person visit. A trained pediatric occupational therapist administered the BOT-2 through standardized procedures. These assessments were conducted in a child-friendly environment and typically required 30 min. These assessments were conducted as part of a larger study that included other assessments, the full study visit was 1–2 h long. The children were provided with breaks as needed to reduce the impact of fatigue on their performance.
Statistical Analysis
All analyses were performed using SPSS version 31.0. (IBM SPSS Statistics for Windows, Version 31.0, 2024, n.d.) Descriptive statistics were calculated for demographic and outcome variables, with continuous data reported as mean, standard deviation (SD) and categorical data as frequencies.
First, primary analyses compared children on the primary outcome measures (SPM, PEDI-CAT, and BOT-2) with group (TDC vs. DCD) and age groups (4–6 years, 7–9 years, 10–12 years and 13–17 years) as independent factors, using general linear model univariate analysis. The SPM has 8 subdomains, and PEDI-CAT has 4 domains. Holm adjusted alpha was used as a correction for multiple comparisons, based on the number of subdomain comparisons of that assessment. To examine the relationship between sensory processing and functional abilities, a Pearson correlation coefficient was calculated between the SPM Sensory Total T-score, PEDI-CAT domains T-score, and the BOT-2 gender specific standard score. The gender specific standard score is selected over the combined gender standard score for the BOT-2 to account for an imbalance in the percentage of male and female participants in the DCD group.
Results
The study sample comprised 48 children, mean age 125.18 (SD = 42.17) months, including 24 TDC and 24 DCD. The distribution across age categories was 4–6 years (n = 10), 7–9 years (n = 12), 10–12 years (n = 12), and 13–17 years (n = 14). See Table 1 for more information about both sample groups.
Table 1
Participants demographics
Age in months
Full sample size (n = 48)
125.18 (SD = 42.17)
TDC (n = 24)
DCD (n = 24)
Age in months
129.0 (43.2)
121.29 (41.6)
Birth weight in lbs
7.0 (1.98)
7.2 (1.88)
Gender
Male (% of total sample)
12 (25.0%)
17 (35.4%)
Female
12 (25.0%)
7 (14.6%)
Hand dominance
Right
23 (47.9%)
23 (47.9%)
Left
1 (2.1%)
1 (2.1%)
Race
White
13 (27.1%)
22 (45.8%)
African
1 (2.1%)
0 (0%)
Asian
9 (18.8%)
0 (0%)
Black
0 (0%)
1 (2.1%)
Multi race
1 (2.1%)
1 (2.1%)
Age categories
4–<7 years
5 (10.4%)
5 (10.4%)
7–<10 years
6 (12.5%)
6 (12.5%)
10–<13 years
6 (12.5%)
6 (12.5%)
13–<18 years
7 (14.6%)
7 (14.6%)
TDC vs. DCD Group Differences
Significant group differences were observed for SPM total T score between TDC and DCD (p < 0.001) as shown in Fig. 1a. Further significant differences were observed for all SPM subdomains (p < 0.001) after Holm adjusted alpha. For PEDI-CAT, daily activities, mobility and social T score was significantly different (p < 0.01) between TDC and DCD except for responsibility. For motor proficiency (BOT-2), gender specific standard score was significantly different between TDC and DCD (p < 0.001) presented in Fig. 1b. See Table 2 for detailed statistics.
Fig. 1
a Clustered bar graph of mean SPM sensory total T score by age categories and group. b Clustered bar graph of mean BOT-2 gender specific standard score by age categories and group
Group differences between TDC and DCD for SPM, PEDI-CAT and BOT-2
Assessment scales
TDC mean (SD)
DCD mean (SD)
F statistics
P-value (* for sig.)
Holm adjusted ⍺
SPM sensory total T score
53.1 (2.94)
67.2 (1.95)
F(1,42) = 17.7
< 0.001*
0.006
SPM social participation
47.06 (1.96)
56.97 (1.73)
F(1,44) = 14.32
< 0.001*
0.007
SPM vision
52.6 (2.11)
64.6 (1.86)
F(1,44) = 18.42
< 0.001*
0.008
SPM hearing
51.5 (1.95)
62.8 (1.72)
F(1,44) = 18.79
< 0.001*
0.01
SPM touch
51.1 (1.70)
62.9 (1.59)
F(1,44) = 26.61
< 0.001*
0.0125
SPM body awareness
49.4 (1.77)
62.9 (1.57)
F(1,44) = 32.79
< 0.001*
0.016
SPM balance & motion
49.8 (2.31)
64.7 (2.04)
F(1,44) = 23.26
< 0.001*
0.025
SPM planning
46.1 (2.26)
64.4 (2.00)
F(1,44) = 36.97
< 0.001*
0.05
PEDI-CAT daily activities T score
49.60 (2.19)
33.262 (2.13)
F(1,39) = 28.47
< 0.001*
0.0125
PEDI-CAT mobility T score
50.55 (1.89)
34.9 (1.84)
F(1,39) = 34.71
< 0.001*
0.016
PEDI-CAT social T score
46.11 (2.15)
35.93 (2.09)
F(1,39) = 11.47
0.002*
0.025
PEDI-CAT responsibility T score
48.53 (2.01)
44.31 (1.96)
F(1,39) = 2.251
0.144
0.05
BOT-2 gender specific standard score
48.89 (1.75)
38.36 (1.750)
F(1,48) = 18.103
< 0.001*
0.05
Developmental Group Trends
For all the domains of SPM, the Group × Age interaction was non-significant (all p > 0.05), indicating that although TDC consistently outperformed DCD, the magnitude of the group difference remained stable across developmental stages. For the PEDI-CAT, A significant Age × Group interaction was found for the Mobility domain (p = 0.02), indicating that the magnitude of group differences in mobility performance varied across age groups. Estimated marginal means of TDC showed stable or slightly improved Mobility scores with increasing age (≈ 49–55 T), whereas children with DCD demonstrated a marked age-related decline (≈ 46 T at the youngest to ≈ 22 T at the oldest age group) presented in Fig. 2. Consequently, the functional gap between groups widened substantially in the older age category. No significant Age × Group interactions were found for daily activities, social, and responsibility (all p > 0.05). Age × Group interaction was observed to be non-significant for the BOT-2 gender specific standard score (p = 0.370). Details are presented in Table 3.
Fig. 2
Interaction plot of PEDI-CAT mobility domain T score by group
A significant negative correlation was observed between sensory processing difficulties and functional performance, as the SPM sensory total T score was negatively correlated with the PEDI-CAT daily activities (−0.443, p = 0.004), mobility (−0.411, p = 0.005) and social T score (−0.446, p = 0.003) except for responsibility (−0.085, p = 0.596) after Holm adjustment, indicating that children with the higher sensory processing difficulties tended to have lower functional and participation performance scores as presented in Table 4. Furthermore, BOT-2 gender specific standard score was positively correlated with PEDI-CAT daily activities (0.529, p = < 0.001), mobility (0.391, p = 0.010), and responsibility (0.457, p = 0.002) except for social domain (0.188, p = 0.214) after Holm adjustment.
Table 4
Correlations between SPM, BOT-2 gender specific standard score and PEDI-CAT domains
SPM
Correlation coefficient
P value
Holm adjusted alpha
BOT-2 gender specific standard score
SPM sensory total T score
−0.179
0.239
0.05
SPM social participation
−0.331
0.023
0.008
SPM vision
−0.289
0.054
0.0125
SPM hearing
−0.293
0.051
0.01
SPM touch
−0.274
0.069
0.016
SPM body awareness
−0.234
0.122
0.025
SPM balance & motion
−0.383
0.009
0.007
SPM planing
−0.384
0.009
0.006
PEDI-CAT daily activities T score
0.529
< 0.001*
0.0125
PEDI-CAT mobility T score
0.391
0.010*
0.025
PEDI-CAT social T score
0.188
0.214
0.05
PEDI-CAT responsibility T score
0.457
0.002*
0.016
SPM sensory total T score
PEDI-CAT daily activities T score
−0.443
0.004*
0.025
PEDI-CAT mobility T score
−0.441
0.005*
0.016
PEDI-CAT social T score
−0.446
0.003*
0.0125
PEDI-CAT responsibility T score
−0.085
0.596
0.05
The correlations between SPM sensory total T score and BOT-2 gender specific score were not significant (−0.176, p = 0.239) after Holm adjustment as shown in Fig. 3. The SPM subdomain correlations with BOT-2 were also not significant after Holm adjustment; details are presented in Table 4.
Fig. 3
Scatter plot of BOT-2 gender specific score by SPM sensory total T score by group
The current study demonstrated significant differences in sensory processing, motor proficiency, and functional and participation performance in children with DCD compared to TDC, and also examined the group differences across developmental stages. Children with DCD consistently scored within the “Moderate difficulties” range (60–70), whereas TDC scores fell within the “Typical” range (< 60) for SPM sensory total and sub domains T score. Functional performance, measured by PEDI-CAT showed significant group differences across domains with DCD participants scoring below average indicating lower function and performance on the domains of daily activities, mobility, and social function. Consistent with diagnostic expectations, DCD participants displayed below-average BOT-2 gender specific standard scores, signifying persistent motor coordination difficulties, worse functional performance and less motor proficiency compared to TDC which is consistent with previous research studies (Pranjić et al., 2023; Weber et al., 2025).
The developmental group trend analyses further revealed that group differences in SPM sensory domains, BOT-2 gender specific standard score, and PEDI-CAT functional and performance measures domains remained stable across age, except for PEDI-CAT mobility, where an Age × Group interaction emerged. While TDC showed stable or slightly improved mobility with age, children with DCD exhibited a progressive decline, leading to an increasingly wide functional gap in older age groups. This pattern suggests that as motor and environmental demands increase with age, children with DCD may struggle to maintain functional performance, possibly due to limited compensatory strategies or effects of motor coordination issues (Rinat et al., 2020; Subara-Zukic et al., 2022).
Significant positive correlations between BOT-2 gender specific standard scores with PEDI-CAT domains indicate that children with good motor proficiency demonstrate better performance in daily activities, mobility and responsibility. These results are consistent with prior research studies that motor competence facilitates participation in everyday activities by supporting in executing tasks, movement efficiency, and confidence in functional routines (Allen & Casey, 2017; Bart et al., 2011; Bo & Lee, 2013). In contrast, the SPM sensory total T-score showed significant negative correlations with PEDI-CAT domains, suggesting that greater sensory-processing difficulties were associated with reduced functional abilities, particularly in daily activities, mobility and social participation (Bart et al., 2011; Cleaton et al., 2019).
The SPM Total T-score was not significantly associated with the BOT-2 gender-specific standard score; after applying the Holm correction for multiple comparisons (Chen et al., 2017), none of the correlations between the BOT-2 gender-specific standard score and the SPM subdomain T-scores remained statistically significant. Although significant weak to moderate negative correlations were observed at the unadjusted level, particularly for balance and motion, vision, hearing, touch, and planning and ideas, after adjustment these correlations were not significant, suggesting that the observed associations were not robust after accounting for multiple testing. The discrepancy may reflect differences in assessment methodology: the BOT-2 evaluates motor output under controlled, structured conditions (Radanović et al., 2021), whereas the SPM and PEDICAT captures caregiver perceptions of sensory regulation and participation in natural environments (Brown et al., 2024). While sensory modulation difficulties may contribute to challenges in daily functioning, how children plan, initiate, and sustain movements in real-world situations, they do not appear to directly influence structured motor task performance as captured by the BOT-2 (Denysschen et al., 2021; Grohs et al., 2021). Differences in measurement context and method may therefore have affected direct associations. A small amount of missing data was present, with three cases having incomplete data for SPM and two for the PEDI-CAT. Although pairwise exclusion minimized data loss, the reduced sample size in some correlations may have slightly limited statistical power of the observed correlations.
The results underscore the importance of incorporating regular sensory and motor assessments into routine care and highlight the need for continued developmental monitoring of children with DCD. Because these differences become more evident as environmental demands increase in school years, follow-up into adolescence is important to identify overall sensory, motor and functional performance difficulties that may impact academic readiness, social participation, and long-term functional outcomes.
Limitations
Several limitations of this study should be acknowledged. First, the sensory outcomes were assessed from parent-report questionnaires (SPM), which may introduce bias related to parental perceptions or expectations regarding children with DCD compared to TDC. Second, there was an imbalance in gender distribution in the DCD group which may have reduced statistical power to detect weaker associations. Finally, there was no blinding of therapists or researchers who supported data collection, nor of parents completing questionnaires, raising the potential for expectation bias. These limitations may have influenced the results, but the consistency of findings across sensory, motor, and function performance and participation domains strengthens confidence in the overall conclusions.
Future Research Direction
Future research should prioritize the development and use of objective measures of sensory processing to complement parent-reported questionnaires and reduce the risk of reporting bias. Larger studies with more balanced representation of male and female children with DCD are needed to identify whether subtle differences exist between male and female. In addition, longitudinal designs with extended follow-up into adolescence would help determine whether the developmental and sensory differences identified in childhood persist or diminish over time. Such work is essential to better understand the long-term trajectories of children with DCD and to inform targeted interventions aimed at improving sensory, motor and functional outcomes.
Conclusion
This study demonstrates that children with DCD exhibit persistent sensory processing, motor and functional performance differences compared to TDC through early childhood into adolescence. The findings underscore the need for continuous sensory, motor and functional performance monitoring of children with DCD across developmental stages. Early identification of these difficulties and timely intervention is critical for improving overall development and functional performance of children with DCD.
Declarations
Competing Interests
The authors declare that they have no financial or non-financial competing interests relevant to the content of this article.
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