Physical Therapy and Developmental Coordination Disorder (DCD)/Dyspraxia

Developmental Coordination Disorder (DCD) and Dyspraxia

Children with DCD or Dyspraxia are often called clumsy or even lazy.  They often have difficulty keeping up with their peers during gross motor play, have frequent falls, and have a hard time doing daily skills, such as zippering and tying shoe laces.  Many children with these diagnoses have difficulty when learning a new movement-based skill.  Research has shown that children with coordination problems do not simply outgrow them.  In fact, these children are at greater risk for being sedentary and less healthy as adults than their peers.

Physical Therapy and DCD/Dyspraxia

During a physical therapy evaluation a child’s gross motor skills and movement patterns are observed.  The child’s flexibility, tone, strength, and sensory organization will be assessed.

Based on the evaluation findings, physical therapy can include:

  • Strengthening/stretching exercises
  • Balance activities
  • Motor planning activities
  • Sensory organization activities
  • Orthotic recommendations

The SMILE Approach for Children with DCD/Dyspraxia

Kid PT uses the Sensory Motor Integration for Life and Education (SMILE) approach to help children with DCD or Dyspraxia to achieve their goals.  The focus of SMILE for children with this diagnosis is the “teach the child how to fish.”  Building the foundations of movement rather than teaching gross or fine motor splinter skills is the focus of intervention, rather than the traditional breaking down and teaching of each skill.  This approach improves the child’s learning abilities and decreases their reliance on others.   

The three levels of SMILE work together to ALIGN the body, ACTIVATE the neuromuscular system, and INTEGRATE the sensory-motor systems.  These three pillars work as a sequence of increasing sensory-motor complexity to build a solid foundation for movement. More advanced developmental skills for learning and daily life can then develop with more spontaneity and less intervention.    

Learn More About the SMILE Levels of Intervention


  • Children with DCD and dyspraxia often have low tone as well.  With the flexibility of a child with low tone, they are often assumed to be flexible everywhere.  When you look closely at their core, the opposite is discovered.  Children with low tone typically don’t develop sufficient three-dimensional control in their core.  Without the development of core control, asymmetries, often from in utero positioning, remain.
  • Children with any developmental delay, without neurological dysfunction, are often responding ONLY to postural imbalances. This means that if we eliminate the imbalances, the child takes off spontaneously and without further intervention. In these children, change happens FAST.


  • Once a child has the available mobility to achieve a balanced core, many children need additional guidance to learn how to turns those muscles on.  Once a child learns how to combine deep breaths with good posture, they are ready to gain strength, endurance, and motor control in order to use that control all day.
  • Many children with hypotonia have used compensatory patterns since infancy, such as breath holding to keep their balance.  This solution doesn’t work well when the child has to breathe or talk.  A lack of deep breathing skills can affect a child’s balance, can cause constipation, limits turning on the calming system that opposes the fight-or-flight response and can affect visual skill development.
  • The SMILE approach is not your typical core strengthening program!  Typical core strengthening does not focus on the activation of the inner core as preparation for movement.  We focus on quality, not quantity.  The breath and control of posture are integral to this level.  


  • The Integration Level is a key for a child to move their movement skills to the next stage.  We move through daily life without consciously thinking about how we are moving our bodies.  We can walk while daydreaming without bumping into a street sign and we can sit in a chair without falling off while reading and writing.  This may sound natural for many of us, but children with postural deficits use excessive energy, attention and focus to fulfill all of the expectations they face each day.  The goal of Level 3 is to make movement as automatic as possible so that children can focus on higher level skills, whether it is moving through the classroom without bumping into things or learning algebra.    
  • This level uses principles and strategies of Sensory Organization and Vestibular Rehabilitation to build these higher level foundation components.  This level will train the child’s sensory-motor system to develop automaticity in order to multi-task and to free the child up for higher cognitive skills.

By focusing on the building blocks of movement through the S.M.I.L.E. approach, children can build the foundations they need for success in daily life and in school.

If you have concerns both in your child’s movement patterns as well as their engagement with you, contact Kid PT here or Call us at 908-543-4390 to arrange a screening.