Developmental coordination disorder subtypes in children: An unsupervised clustering

Abstract

AimTo identify subtypes of developmental coordination disorder (DCD) in children.MethodChildren with DCD diagnosed through comprehensive evaluation at Robert‐Debré Children's University Hospital (Paris, France) were consecutively enrolled from February 2017 to March 2020. We performed an unsupervised hierarchical clustering based on principal component analysis using a large set of variables encompassing cognitive, motor, and visuospatial scores (Wechsler Intelligence Scale for Children, Fifth Edition; Developmental Neuropsychological Assessment, Second Edition; Movement Assessment Battery for Children, Second Edition).ResultsOne hundred and sixty‐four children with DCD were enrolled (median age 10 years 3 months; male:female ratio 5.56:1). We identified distinct subgroups with mixed visuospatial and gestural disorders, or with pure gestural disorders that predominantly impaired either speed or precision. Associated neurodevelopmental disorders, such as attention‐deficit/hyperactivity disorder, did not influence the results of the clustering. Importantly, we identified a subgroup of children with marked visuospatial impairment with the lowest scores in almost all of the evaluated domains, and the poorest school performance.InterpretationThe classification of DCD into distinct subgroups could be indicative of prognosis and provide critical information to guide patient management, taking into account the child's neuropsychological profile. Beyond this clinical interest, our findings also provide a relevant framework with homogeneous subgroups of patients for research on the pathogenesis of DCD.

“Picture this from there”: spatial perspective-taking in developmental visuospatial disorder and developmental coordination disorder

“…In line with previous data on visuospatial abilities in the DVSD profile, we expect this group to obtain the lowest scores, as compared to the ND group, in all the measures assessing visuospatial processing, including VSPT (Fisher et al, 2022;Mammarella et al, 2023). On the other hand, we expect to find more heterogeneous performances for the DCD group in tasks assessing visuospatial processing (Gras et al, 2023). As regards the comparison between the two clinical groups (i.e., DVSD and DCD), although considering the lack of studies that have directly compared these populations, based on recent findings (Cardillo et al, 2024), we expect to find a more severe impairment in the visuo-spatial domain for the DVSD group as compared to the DCD peers.…”

“…Along with DVSD, Developmental Coordination Disorder (DCD) may present with difficulties in visuospatial processing, although huge heterogeneity is reported (Cardillo et al, 2024). More in depth, some studies concluded for the presence of visuospatial impairments in this population (e.g., Van Waelvelde et al, 2004;Tsai et al, 2008;Gras et al, 2023), while others did not find any impairment (i.e., Bonifacci, 2004). Such heterogeneity in performances, albeit being reconducible to intra-group variability, well documented in neurodevelopmental disorders (e.g., Van Waelvelde et al, 2004;Tsai et al, 2008), may be attributed to methodological differences in the studies.…”

“…In fact, from the analysis of the extant literature often emerged small sample sizes (e.g., Ameratunga et al, 2004;King et al, 2011), heterogeneous age ranges (e.g., Ameratunga et al, 2004;Crawford and Dewey, 2008;King et al, 2011;Tsai et al, 2012;Pisella et al, 2020), as well as variability in the method of identification of children with or without DCD (i.e., use of different cut-off scores or lack of confirmation of the diagnosis using shared criteria) (e.g., Van Waelvelde et al, 2004;Williams et al, 2006;Crawford and Dewey, 2008;Tsai et al, 2008Tsai et al, , 2012Wang et al, 2017). Nonetheless, Gras et al (2023) pointed out that the presence of visuospatial difficulties in the DCD profile seems to constitute a marker for a more severe condition than the presence of motor difficulties alone. In any case, DCD is primarily defined by the presence of an "impairment in the execution of coordinated motor skills, " as suggested by the ICD-11 nomenclature (World Health Organization, 2018).…”