Toward preventive interventions in developmental coordination disorder: in need of early behavioral markers?

Developmental Coordination Disorder (DCD) affects around 5% of children in the general population and up to 31% of those in at-risk groups. Despite its prevalence and life-long impact, DCD remains largely underdiagnosed, with most interventions occurring post-diagnosis. This delay risks missing sensitive windows for neurodevelopmental support and postpones necessary adaptations in the learning environment. The objective of this narrative review is to examine how early behavioral indicators can be integrated into developmentally informed intervention pathways for DCD. Scope: This narrative review synthesizes current intervention strategies and neurodevelopmental behavioral markers in DCD to inform a model that integrates early behavioral indicators into targeted educational and health interventions. We propose a two-stage approach, aligned with a Response to Intervention (RTI) framework, combining early transdiagnostic screening with later diagnostic confirmation. Early identification and Tier-2 intervention: In early infancy, available behavioral markers are typically sensitive but not specific, identifying motor-atypical development without distinguishing among disorders. This justifies a transdiagnostic Tier-2 entry: children receive monitoring and support based on early motor atypia or delay, not yet tied to a specific condition. Such interventions can yield developmental benefits even for children who ultimately do not meet DCD diagnostic criteria. Between 2 and 4 months, the Standardized Infant NeuroDevelopmental Assessment (SINDA; cut-off < 21) offers 94% sensitivity and 99% negative predictive value for predicting later motor delay or cerebral palsy. Broader awareness among clinicians, educators, and families is essential, with the sensitive LDCD-Q (Little Developmental Coordination Disorder Questionnaire) enabling broader community engagement in early screening. We advocate systematic follow-up of high-risk children, even in the absence of overt symptoms, and their inclusion in Tier-2 interventions to support optimal development and promote timely environment-based accessibility strategies. Later diagnosis and Tier-3 intervention: From age 4, the Movement Assessment Battery for Children–2 (MABC-2; cut-off <5th percentile) allows categorical diagnosis of DCD with 93% specificity and 79% positive predictive value, guiding Tier-3 interventions. Conclusion: Embedding early behavioral markers within an RTI framework enables preventive and universal motor-based programs (e.g., ENCOR) to be implemented earlier, while simultaneously supporting the deployment of educational compensation strategies. This approach shifts effective interventions upstream without prematurely medicalizing support.