posed. However, consistent co-occurrence in twins appears only in severe cases.
Course modifiers. Individuals with ADHD and with developmental coordination dis-
order demonstrate more impair ment than individuals with  ADHD without developmen-
tal coordination disorder.
Culture-Related Diagnostic Issues
Developmental coordination disorder occurs  across cultures, races, and socioeconomic
conditions. By definition, “acti vities of daily living” implie s cultural differences necessi-
tating consideration of the context in whic h the individual child is living as well as
whether he or she has had appropriate opportun ities to learn and practice such activities. 
Functional Consequences of 
Developmental Coordination Disorder 
Developmental coordination disorder leads to  impaired functional performance in activ-
ities of daily living (Criterion B), and the impairment is increased with co-occurring con-
ditions. Consequences of developmental coordination disorder include reduced
participation in team play and sports; poor self-esteem and sense of self-worth ; emotional
or behavior problems; impair ed academic achievement; p oor physical fitness; and re-
duced physical activity and obesity.
Differential Diagnosis
Motor impairments due to another medical condition. Problems in coordination may
be associated with visual function impairme nt and specific neurological disorders (e.g.,
cerebral palsy, progressive lesions of the cerebellum, neuromuscula r disorders). In such
cases, there are additional findin gs on neurological examination. 
Intellectual disability (intell ectual developmental disorder). If intellectual disability is
present, motor competences may be impaired in accordance with the intellectual disabil-