ISAF-DCD: A Stress Adaptation Framework for Developmental Coordination Disorder

Theoretical Foundations

The ISAF-DCD framework synthesizes empirical DCD findings with established stress theories. It incorporates the environmental stress hypothesis, the transactional stress model, and the conservation of resources model. The framework is bidirectional and developmentally sensitive. It allows stress and adaptation processes to recur across the lifespan.

Core Mechanisms

ISAF-DCD proposes that motor coordination difficulties impact mental, cognitive, and physical health. This occurs through interactions between environmental demands, primary and secondary stressors, and coping responses. Personal and social factors also play a role. The framework clarifies the roles of resilience and social support. It refines the classification of environmental demands.

Comorbid Conditions

While presented for general neurodevelopmental conditions, the evidence base focuses on ADHD and Autism Spectrum Disorder (ASD). Generalization to other conditions is plausible but unevaluated here. The framework treats neurodevelopmental comorbidity as a cross-cutting factor. It also represents the reciprocal relationship between stress and motor functioning.

Empirical Support and Limitations

Direct empirical support for some components remains limited. This is especially true for proposed corticolimbic mechanisms. Therefore, ISAF-DCD should be treated as a hypothesis-generating framework. It requires rigorous longitudinal and intervention-based evaluation. The framework aims to organize fragmented literature. It remains provisional in its current form.

Clinical Presentation of DCD

DCD is characterized by significant deficits in acquiring and executing coordinated motor skills. These deficits interfere with daily activities and academic performance (Li et al., 2024). DSM-5-TR criteria state motor difficulties must manifest early in development. They cannot be better explained by intellectual disability or neurological conditions. Despite clear nosology, DCD remains under-recognized in clinical practice. This contributes to unnecessary stress for affected individuals and families (Meachon et al., 2024; Murray et al., 2025).

Heterogeneity and Subtypes

Common DCD features include slow, inefficient, and poorly coordinated fine and gross motor movements (Schott, 2019). However, clinical presentation is heterogeneous. Group analysis studies have identified motor, cognitive, and visuomotor performance patterns. These patterns may distinguish DCD subgroups (Lust et al., 2022). Some children show generalized difficulties in fine motor, gross motor, and balance. Others show more circumscribed issues in manual dexterity, balance, motor planning, or visuospatial processing. A recent systematic review found no coherent evidence for stable, discrete DCD subtypes. It suggested DCD is better conceptualized as a severity and extent spectrum (Verbecque et al., 2026).

Cognitive Profiles

Cognitive profiles are also heterogeneous. Executive function difficulties involve planning, working memory, and inhibition. These cognitive challenges often co-occur with the motor deficits, further complicating the clinical picture. The interplay between these cognitive and motor domains is a key focus of the ISAF-DCD framework.