Motor planning — or praxis — is the brain’s ability to conceive, organise, and carry out an unfamiliar physical task. It’s the invisible skill behind actions like learning to ride a bike, tying shoelaces, navigating a climbing frame for the first time, or following a dance sequence.

When motor planning works well, children pick up new physical skills relatively easily. They watch, they try, they adjust. When motor planning is impaired, every new physical challenge feels like an uphill battle.

As a paediatric occupational therapist in Malta, motor planning difficulties are one of the areas I assess most frequently — and one where early intervention makes a significant difference.

The Three Stages of Motor Planning

It helps to understand that motor planning happens in three stages, and a child can have difficulty at any of them:

Ideation

This is the ability to conceive an idea for how to interact with an object or environment. A child with ideation difficulties may struggle to think of what to do with new equipment. They may seem passive or unimaginative in play — not because they lack creativity, but because the first step of motor planning isn’t working effectively.

Planning

This is the ability to organise the sequence of movements needed to carry out the task. A child who has difficulty here knows what they want to do but can’t organise the steps to get there. They may give up quickly or become frustrated.

Execution

This is the ability to carry out the planned movement accurately and fluidly. Difficulties here often look like clumsiness, awkwardness, or significant effort in tasks that peers manage easily.

Signs of Motor Planning Difficulties

Children with motor planning difficulties may:

• Appear clumsy — frequently bumping into things, tripping, dropping objects
• Struggle to learn new physical skills, even with repeated practice
• Have difficulty following movement sequences in PE or dance
• Avoid physical challenges or new play equipment
• Take much longer than peers to master self-care tasks: dressing, fastening buttons, tying laces
• Have difficulty organising their body in space — sitting awkwardly, getting their arms and legs confused
• Show frustration, avoidance, or low confidence in physical tasks
• Have handwriting difficulties despite having adequate fine motor strength

How Motor Planning Affects Everyday Life

Motor planning underpins almost every physical activity a child does during the day. Consider what’s required to get dressed in the morning: understanding the sequence, knowing which limbs go where, adjusting when something doesn’t work. For a child with poor praxis, this can take significantly longer than expected and result in daily battles.

At school, PE, sport, handwriting, art, and science experiments all demand motor planning. Social life can also be affected — children who can’t keep up physically may avoid playground games, affecting friendships and self-esteem.

What Causes Motor Planning Difficulties?

Motor planning depends heavily on good sensory processing — particularly proprioception (the sense of where the body is in space) and tactile processing. Children with sensory integration difficulties often have impaired praxis as a result.

Motor planning difficulties also commonly co-occur with dyspraxia (Developmental Coordination Disorder), autism spectrum disorder, ADHD, and sensory processing disorder.

How Occupational Therapy Helps

Ayres Sensory Integration therapy — the approach I specialise in — directly addresses motor planning by providing rich sensory experiences that help the brain organise information more effectively. This isn’t about drilling specific skills: it’s about treating the underlying processing difficulties that affect all skill learning.

Activities That Target Motor Planning

• Obstacle courses: Require the child to plan how to navigate novel physical challenges. Changed regularly to keep providing new planning demands.
• Novel equipment: Swings, bolsters, scooter boards, and climbing apparatus provide rich proprioceptive and vestibular input while demanding motor planning.
• Imitation games: Following movement sequences in play targets the planning and execution stages of praxis.
• Construction activities: Building with complex materials demands spatial planning and sequential organisation.
• Craft and art projects: Multi-step activities develop planning, sequencing, and execution with hands.

What Parents Can Do at Home

• Provide plenty of varied physical play — climbing, crawling, rolling, jumping
• Introduce new activities regularly — even if your child resists initially, novelty is therapeutic
• Break new physical tasks into small steps and practise each step separately
• Use verbal cues and visual demonstrations to scaffold new learning
• Celebrate effort over achievement — the trying is the therapy

Children with motor planning difficulties are not lazy or uncoordinated by choice. They are working significantly harder than their peers to do things that seem simple. With the right support — at home and in therapy — they make real progress.

If you’re concerned about your child’s development, contact us at +356 99872936 or visit wonderkids.mt to book an assessment.

The post Motor Planning: What It Is and Why Your Child Might Struggle appeared first on Occupational Therapy Malta.

Developmental Coordination Disorder — DCD — is a condition affecting motor coordination that significantly impacts a child’s ability to perform everyday tasks. It is sometimes called dyspraxia, though these terms have slightly different origins and emphases. DCD is recognised in diagnostic manuals as a neurodevelopmental condition — it is not caused by laziness, lack of trying, or poor parenting.

DCD affects approximately 5 to 6 percent of school-age children, making it one of the most common neurodevelopmental conditions. Despite this, it is frequently misunderstood and under-identified. Children with DCD are often labelled as clumsy, careless, or immature — labels that are both inaccurate and damaging.

What Causes DCD?

DCD is believed to involve differences in how the brain plans, sequences, and executes motor movements. Motor planning — the ability to imagine, organise, and carry out a new or complex movement — is a central challenge. This is why children with DCD often struggle most with novel motor tasks: they can learn a specific skill with enough practice, but applying it in a new context or learning a new movement is consistently difficult.

DCD frequently co-occurs with other neurodevelopmental conditions including ADHD, autism, dyslexia, and language disorder. It is important to consider the whole child rather than viewing DCD in isolation.

How DCD Affects Daily Life

The impact of DCD extends well beyond being clumsy on the sports field. It touches every aspect of daily life.

Self-Care

Dressing, managing fastenings (buttons, zips, shoelaces), using cutlery, brushing teeth, and managing personal hygiene can all be challenging for children with DCD. These tasks require precisely the kind of coordinated, sequenced movements that are difficult for them. Morning routines become stressful for children and families alike.

Handwriting

Handwriting is one of the most common referral reasons for children with DCD. Writing requires the coordination of posture, shoulder stability, wrist control, finger manipulation, and visual-motor integration — all simultaneously. Children with DCD often write slowly, with great effort, and produce output that does not reflect their intelligence or understanding.

Physical Education and Sport

PE and sports present significant challenges. Ball skills, team games, swimming, and gymnastics all require the kind of motor coordination and motor planning that are affected by DCD. Children with DCD are often the last picked for teams and may begin to avoid physical activity altogether — with significant implications for physical health and emotional wellbeing.

Social and Emotional Impact

The social and emotional impact of DCD should not be underestimated. Children with DCD often know they are struggling. They see their peers manage tasks they find impossibly difficult. Many develop anxiety, low self-esteem, and school refusal. Peer relationships can suffer when children cannot participate fully in sports and physical play.

The OT Approach to DCD

Occupational therapy is the primary professional support for children with DCD. The OT assessment identifies the specific motor planning, coordination, and sensory processing difficulties underlying the child’s challenges. From this, an individualised intervention plan is developed.

Task-Oriented Approaches

Modern evidence-based practice for DCD focuses on teaching specific functional skills the child needs — rather than generalised motor exercises. We practise the actual task (e.g., shoe tying, handwriting, catching a ball) using motor learning principles: breaking tasks into steps, providing clear demonstration, giving the right amount of practice, and offering feedback that helps the child feel what the correct movement is like.

Cognitive Strategies

Approaches like the Cognitive Orientation to daily Occupational Performance (CO-OP) teach children to solve their own motor problems using a “Goal, Plan, Do, Check” framework. This empowers children to analyse what is going wrong in their movement and generate their own solutions — a profoundly effective approach that generalises across settings.

Sensory Integration

Where sensory processing difficulties are contributing to the motor planning challenges, sensory integration therapy addresses the underlying neurological processing that supports coordinated movement.

What Families Can Do at Home

• Allow extra time for tasks that are difficult — rushing increases anxiety and reduces performance
• Break new skills into small steps and teach one step at a time
• Celebrate effort and persistence, not just achievement
• Find activities your child enjoys and is good at — swimming, art, music — to build confidence
• Communicate with school so teachers understand the condition and can make appropriate accommodations
• Avoid comparing your child to siblings or peers

Getting Support in Malta

DCD is not always well understood in general healthcare settings in Malta, and families sometimes wait a long time before accessing appropriate support. An occupational therapy assessment can identify DCD and begin intervention without waiting for a formal medical diagnosis. Early support matters — both for skill development and for protecting the child’s self-esteem and wellbeing.

If you’re concerned about your child’s development, contact us at +356 99872936 or visit wonderkids.mt to book an assessment.

The post Helping Children with Coordination Difficulties (DCD): An OT Perspective appeared first on Occupational Therapy Malta.

Dyspraxia, now more commonly referred to as Developmental Coordination Disorder (DCD), is a condition that affects a child’s ability to plan and carry out coordinated movements. It is not a problem with muscles or intelligence. The difficulty lies in how the brain organises and sequences movement.

DCD is more common than many people realise. It affects around 5–6% of school-aged children and is more frequently identified in boys than girls. In my practice in Malta, it is one of the conditions I see most regularly.

Recognising the Signs of Dyspraxia

The signs of DCD vary by age and can be subtle in younger children. It is important to know what to look for at each stage of development.

Toddlers and Preschool Age (2–4 years)

• Delayed milestones such as crawling, walking or self-feeding
• Difficulty with simple puzzles or stacking blocks
• Avoids physical play or appears unusually clumsy
• Struggles to use cutlery or dress independently

Primary School Age (5–11 years)

• Messy or effortful handwriting
• Difficulty with physical education — catching, throwing, skipping
• Slow to learn new motor tasks like riding a bike
• Appears disorganised and forgetful
• Fatigue after physical tasks that peers manage easily

Older Children and Teenagers

• Avoids sport or social activities involving physical skill
• Difficulty with time management and organisation
• Low self-esteem related to academic or physical performance

How Is Dyspraxia Diagnosed?

There is no single test for DCD. Diagnosis typically involves a standardised assessment of motor skills, a detailed developmental history and observation of the child. In Malta, assessments are carried out by occupational therapists or paediatric physiotherapists, often alongside a paediatrician or psychologist.

The most commonly used tool is the Movement Assessment Battery for Children (MABC-2), which assesses manual dexterity, balance and ball skills. Diagnosis requires that the difficulties are significant, persistent and not explained by another condition.

How Occupational Therapy Helps

OT is the primary evidence-based intervention for DCD. Therapy does not try to “fix” the brain’s motor planning system directly. Instead, it builds functional skills through practice, problem-solving and environmental adaptations.

Task-Oriented Approaches

Modern OT for DCD focuses on the specific tasks a child finds difficult — tying shoelaces, using scissors, riding a bike. We break these tasks into manageable steps, practise them in a supportive environment and help the child develop their own problem-solving strategies.

This approach, sometimes called the Cognitive Orientation to daily Occupational Performance (CO-OP), teaches children to think through how they approach tasks, not just repeat movements.

Gross Motor Development

For children who struggle with balance, coordination and physical confidence, OT sessions include activities that develop these skills in a safe, encouraging environment. Obstacle courses, balance challenges and ball games are all therapeutic tools in disguise.

Fine Motor and Self-Care Skills

Handwriting, cutting, fastening buttons and using cutlery are all areas where children with DCD often need targeted support. OT addresses these through graded practice and, where needed, adaptive equipment or technique modifications.

Supporting Your Child at Home

• Allow extra time for tasks that require coordination — rushing increases anxiety and reduces performance.
• Break new skills into steps and practise one step at a time.
• Use verbal cues. Narrating movements helps — “first we push our arm through the sleeve, then we pull it down.”
• Celebrate effort. Children with DCD work harder than their peers for the same outcomes. Acknowledge that.
• Find physical activities they enjoy. Swimming and martial arts are often good fits for children with DCD.

Early Support Makes a Difference

Children with unidentified DCD often develop secondary difficulties — anxiety, low self-esteem and avoidance of challenges. Early identification and targeted OT support can prevent these from taking hold. In Malta, accessing an assessment at the first sign of concern is always the right move.

With the right support, children with DCD go on to develop the skills and confidence they need to participate fully in school and life.

If you’re concerned about your child’s development, contact us at +356 99872936 or visit wonderkids.mt to book an assessment.

The post Dyspraxia in Children: Signs, Diagnosis and How OT Helps appeared first on Occupational Therapy Malta.