An occupational therapy perspective on recognising motor coordination difficulties during ADHD screening and developmental assessments.
Introduction
During an ADHD assessment, much of the discussion naturally focuses on attention, impulsivity, activity levels and emotional regulation. However, developmental history-taking often reveals additional information that can be equally important in understanding a child’s needs.
One observation parents frequently share relates to their child’s physical coordination.
Comments such as:
“They’ve never been particularly coordinated.”
“They’re always falling over something.”
“They seem to knock into everything!”
may initially appear to be relatively minor observations. Parents might describe frequent trips and falls, bumping into furniture, dropping objects, spilling drinks or struggling with everyday physical activities.
For some families, these behaviours have become such a familiar part of daily life that they are rarely questioned. Others may be increasingly concerned about their child’s frequent accidents or difficulties keeping up with their peers.
From a neurodevelopmental and occupational therapy perspective, these observations are worth exploring.
Although motor coordination difficulties are not a core diagnostic feature of Attention Deficit Hyperactivity Disorder (ADHD), they can form an important part of a child’s wider developmental presentation. They may be associated with differences in attention, executive functioning, motor development or sensory processing. They may also indicate a co-occurring condition, such as Developmental Coordination Disorder (DCD).
Understanding what parents mean when they describe a child as clumsy can therefore provide valuable clinical information.
1. Recognising motor difficulties during developmental history-taking
Parents do not always recognise coordination as something that needs to be discussed during an ADHD assessment.
They may initially seek support because of concerns about concentration, behaviour, emotional regulation or difficulties at school. However, when practitioners begin exploring early development and everyday functioning, other patterns can become apparent.
Parents may describe a child who:
Frequently trips, stumbles or falls.
Regularly bumps into furniture, walls or doorframes.
Drops objects or struggles to hold onto things.
Often spills food and drinks.
Finds catching and throwing a ball difficult.
Struggles with buttons, zips and shoelaces.
Avoids climbing, cycling or playground activities.
Appears less physically coordinated than children of a similar age.
Takes longer to master unfamiliar physical activities.
These experiences can provide useful insight into a child’s functional abilities.
What may initially sound like a general description of clumsiness could actually reflect an underlying difficulty with motor coordination that has never been formally investigated.
This is why it is important to explore these observations rather than simply recording them as another characteristic of the child’s behaviour.
2. Understanding the relationship between ADHD and coordination
There is evidence that some children with ADHD experience difficulties with motor performance. These may involve balance, coordination, manual dexterity, motor timing and the ability to carry out movements efficiently.
There are several possible reasons why motor difficulties may be observed alongside ADHD. For example, a child who is easily distracted may not fully register obstacles in their environment. A child who acts impulsively may move before considering what is in their way. Difficulties with planning, monitoring and regulating behaviour may also affect how successfully they complete physical activities.
Consider a child rushing through the classroom, turning quickly without looking or attempting several things simultaneously. Their apparent clumsiness may partly reflect difficulties with attention and impulse control.
However, it is important to distinguish between motor difficulties influenced by ADHD symptoms and more persistent problems with the development and execution of coordinated movements.
Not every child with ADHD who appears accident-prone has an underlying coordination disorder, and not every coordination difficulty can be explained by attention or impulsivity.
This distinction is particularly important when taking a detailed developmental history.
3. Could Developmental Coordination Disorder be present?
One condition worth considering when parents report longstanding coordination difficulties is Developmental Coordination Disorder (DCD), sometimes referred to as dyspraxia.
DCD is a neurodevelopmental condition characterised by difficulties acquiring and performing coordinated motor skills. These difficulties can affect a child’s independence, participation and ability to manage everyday activities.
Children with DCD may experience challenges with both gross motor skills (larger body movements) and fine motor skills (smaller, more precise movements).
During an assessment, relevant developmental information might include:
Gross motor difficulties
Difficulty learning to ride a bicycle.
Problems with balance and stability.
Struggling to catch, throw or kick a ball.
Avoidance of sports and physical activities.
Difficulty learning new movement sequences.
Fine motor difficulties
Problems managing buttons, zips and shoelaces.
Difficulties using scissors or cutlery.
Poor handwriting or reduced writing speed.
Struggling with small objects and everyday practical tasks.
Motor learning difficulties
Taking longer than expected to develop new physical skills.
Needing considerably more practice than peers.
Finding previously unfamiliar movements difficult to coordinate.
Struggling to transfer newly learned skills into everyday situations.
ADHD and DCD can occur together. Consequently, identifying ADHD symptoms should not mean that other developmental differences are overlooked.
Where a child demonstrates persistent motor difficulties, practitioners should consider whether additional assessment may be beneficial.
4. Exploring what parents mean by ‘clumsy’
Simply documenting that a child is clumsy provides limited clinical information.
The more useful approach is to understand what happens, how frequently it occurs and whether it affects the child’s everyday life.
When parents raise concerns about coordination, I would explore several areas.
Everyday movement and awareness
Does your child frequently bump into objects or people?
Do they seem to trip or fall more often than other children?
Have these difficulties been present from an early age?
Do they appear aware of their position in relation to their surroundings?
Gross motor development
How did they manage learning to walk, run and climb?
Did they find activities such as cycling or swimming difficult?
How do they manage balance and ball skills?
Do they avoid physical activities at school or during play?
Fine motor development
Can they manage buttons, zips and shoelaces independently?
Do they frequently drop objects?
How do they manage handwriting, drawing and using scissors?
Do they struggle with cutlery or other everyday equipment?
Sensory and body awareness
Do they sometimes use excessive force when handling objects?
Do they frequently lean against furniture or other people?
Do they seek activities involving jumping, pushing or crashing?
Do they appear to have difficulty judging their position in space?
Impact on daily functioning
Does coordination affect their independence?
Do they become frustrated when completing practical tasks?
Are they reluctant to participate in games or sports?
Have similar difficulties been reported by teachers?
These questions help establish whether the concerns relate to occasional accidents or a more consistent pattern of motor difficulties.
5. Considering the different factors behind coordination difficulties
Clumsiness is not a diagnosis, and similar behaviours can arise for different reasons.
It is therefore helpful to consider the wider developmental picture.
Attention and executive functioning
Distractibility, impulsivity and difficulties with self-monitoring can affect how a child navigates their environment and completes physical tasks.
Motor coordination
Difficulties with balance, postural control, manual dexterity and movement execution may contribute to frequent accidents and problems with everyday activities.
Motor planning
Some children find it difficult to organise and sequence the movements needed to complete unfamiliar tasks. This can affect learning new physical skills and carrying out multi-step activities.
Sensory processing and proprioception
Proprioception provides information about the position and movement of our bodies. Differences in how sensory information is processed may influence body awareness and movement. These possibilities should be explored on an individual basis rather than automatically attributed to ADHD.
Other developmental or physical factors
Visual difficulties, neurological conditions and musculoskeletal problems may also contribute to coordination concerns. These should be considered where the child’s history or presentation indicates a need for further investigation.
The aim is to avoid assuming that one explanation accounts for every difficulty a child experiences.
6. Why the distinction matters in an ADHD assessment
Developmental history-taking is an opportunity to identify patterns that might otherwise be missed.
To illustrate this, consider two children whose parents both describe them as particularly accident-prone.
Child A
Frequently bumps into objects when moving quickly, becomes distracted during activities and often acts without considering their surroundings.
Child B
Has longstanding difficulties with balance, catching a ball, learning to ride a bicycle, using cutlery and managing clothing fastenings.
Although both children might be described as clumsy, their developmental histories suggest different areas for further exploration.
For Child A, attention, impulsivity and executive functioning may be contributing to the difficulties.
For Child B, the persistent challenges across a range of motor activities may raise greater concern about an underlying coordination difficulty.
These presentations are not mutually exclusive. A child may experience both ADHD and DCD, and further assessment may be needed to understand the contribution of each.
The purpose of screening is not to reach conclusions based on isolated observations. It is to recognise patterns, understand their impact and identify when additional investigation is appropriate.
7. When should further assessment be considered?
A parent reporting that their child is clumsy does not automatically mean that they have DCD.
However, where coordination difficulties are longstanding, occur across different settings and interfere with everyday activities, further investigation may be appropriate.
Depending on the child’s presentation and the clinical pathway, this could involve:
An occupational therapy assessment exploring functional motor skills and participation.
A detailed review of developmental milestones and motor learning.
Assessment of fine and gross motor abilities.
Consideration of standardised motor assessment tools, such as the Movement Assessment Battery for Children (MABC-2) or Bruininks-Oseretsky Test of Motor Proficiency (BOT-2).
Consideration of vision, balance and other relevant developmental factors.
Gathering information from parents, teachers and other professionals involved in the child’s care.
It is important to recognise that ADHD screening questionnaires do not assess or diagnose DCD. A diagnosis requires a comprehensive assessment against recognised diagnostic criteria, including consideration of the impact on everyday functioning and exclusion of alternative explanations.
8. The wider impact on confidence and participation
Motor coordination difficulties can affect considerably more than a child’s ability to complete physical tasks.
Children who repeatedly struggle with activities that appear straightforward for their peers may become frustrated, anxious or reluctant to participate.
For example, a child may avoid playground games because they struggle to catch a ball. Another may dislike PE because they find running, balancing or coordinating movements challenging.
Everyday tasks such as getting dressed, using cutlery or completing written work can also become sources of frustration.
Over time, repeated difficulties may affect confidence, friendships, independence and willingness to attempt unfamiliar activities.
There is also a risk that these children are misunderstood.
They may be described as careless, inattentive or simply not trying hard enough, when the underlying difficulty may relate to motor coordination.
Listening carefully to parental observations can help practitioners recognise these challenges and ensure that the child’s difficulties are understood in context.
9. A broader perspective for neurodevelopmental practitioners
One of the most valuable aspects of developmental history-taking is the opportunity to look beyond the presenting concern.
When a parent mentions that their child has always struggled with coordination, it is worth exploring what this means in practice.
Are they frequently rushing and bumping into things? Do they struggle with balance and motor skills? Are everyday activities taking considerably longer than expected? Could there be an additional developmental condition contributing to their difficulties?
These questions can help build a more complete understanding of the child’s strengths, needs and developmental profile.
They also reinforce the importance of considering the child as a whole rather than focusing exclusively on the symptoms associated with the referral question.
Conclusion
An ADHD assessment should involve more than identifying difficulties with attention, hyperactivity and impulsivity. A thorough developmental history can reveal additional challenges that may have a significant impact on a child’s everyday functioning.
Persistent clumsiness is one such observation that deserves attention.
Although coordination difficulties are not part of the diagnostic criteria for ADHD, research has identified differences in motor competence among some children with ADHD. The potential overlap with Developmental Coordination Disorder further highlights the importance of exploring motor development as part of a wider neurodevelopmental assessment (Blanco-Martínez et al., 2025).
For occupational therapists and other neurodevelopmental practitioners, recognising these concerns is an important part of understanding the child’s overall presentation and identifying appropriate pathways for further assessment.
Sometimes, a seemingly ordinary comment from a parent can open up an important area of clinical enquiry.
The next time someone says their child has always been a little clumsy, it may be worth looking beyond the description and exploring what is really happening.
References and further reading
Blanco-Martínez, N., González-Devesa, D., Ayán-Pérez, C., & Diz-Gómez, J. C. (2025). Differences in motor competence between children and adolescents with and without ADHD: Findings from a systematic review and meta-analysis. Journal of Autism and Developmental Disorders.
