Unlocking Movement: Why Gross Motor Skills & Bilateral Integration Matter for Neurodivergent Children

Why Gross Motor Coordination and Bilateral Integration Matter in Neurodivergent Children

Introduction
When we think of school readiness, we often focus on literacy, numeracy, and social skills. But beneath these academic milestones lies a foundational set of physical skills—particularly gross motor coordination and bilateral integration—that are often overlooked. For neurodivergent children, especially those with conditions such as Dyspraxia, ADHD, Autism, and Developmental Coordination Disorder (DCD), these motor skills play a pivotal role in daily success and well-being.

Occupational therapy (OT) can offer early, life-changing interventions. But to act early, parents, teachers, and caregivers must first understand what these difficulties look like—and what happens when they’re ignored.

Understanding Gross Motor Coordination

Gross motor coordination refers to the ability to use large muscle groups to perform movements such as running, jumping, climbing, balancing, and maintaining posture. These are the foundational movements that support everything from playground activities to classroom sitting.

Common signs of poor gross motor coordination in school-going children:

• Clumsiness or frequent tripping and falling

• Difficulty learning to ride a bike or catch a ball

• Poor balance during activities like hopping, skipping, or climbing

• Fatigue during physical activities

• Awkward or stiff body movements

• Preference for sedentary play over active games

These children may also struggle with sports and physical education, which can affect peer relationships, self-esteem, and even classroom behavior.

What Is Bilateral Integration?

Bilateral integration is the ability to use both sides of the body together in a coordinated way. It underpins tasks like tying shoelaces, using scissors, cutting food, climbing stairs, and writing with one hand while stabilizing paper with the other.

For children with neurodivergent conditions, bilateral integration can be disrupted due to challenges with sensory processing, body awareness (proprioception), or neurological development.

Signs of bilateral integration difficulties:

• Trouble crossing the midline (e.g., reaching across the body with the opposite hand)

• Avoidance of tasks requiring two hands working together

• Difficulty with symmetrical movements like jumping jacks

• Trouble following multi-step motor instructions

• Poor pencil grip or writing mechanics due to one hand not stabilizing properly

How These Challenges Impact Learning and Life

When gross motor and bilateral integration skills are underdeveloped, the effects ripple across a child’s life—physically, emotionally, socially, and academically.

1. Classroom performance suffers:
Poor postural control can make it hard to sit still or maintain focus. Difficulty using both hands can make writing and cutting frustrating and slow. These struggles can lead to avoidance behaviors and meltdowns during structured tasks.

2. Social participation declines:
Playground games and sports often require fluid gross motor and bilateral coordination. When children can’t keep up physically, they may be left out or teased—damaging their self-esteem and increasing social withdrawal.

3. Emotional regulation is harder:
Movement is linked to emotional regulation. Children with poor gross motor skills may also have difficulties calming themselves, leading to higher frustration and behavioural outbursts.

4. Risk of secondary diagnoses increases:
Without support, motor coordination issues can contribute to or worsen symptoms of anxiety, depression, and school refusal in later years.

Why Early Intervention Matters

Children don’t “grow out of” motor coordination challenges—they grow into greater difficulties if left unsupported. The earlier occupational therapy begins, the easier it is to shape motor pathways, develop new strategies, and prevent long-term impacts.

Benefits of early OT intervention:

• Improved muscle tone, balance, and coordination

• Better handwriting and fine motor control

• Enhanced attention and classroom participation

• Greater confidence in physical and social activities

• Reduced frustration and behavioral outbursts

• Empowered parents and teachers who can support development at home and in school

How Occupational Therapy Helps

Occupational therapists assess each child’s specific needs using standardized tools and clinical observations. They then tailor intervention programs that build gross motor and bilateral integration through play-based, engaging activities.

Typical OT strategies include:

• Core strength and postural control exercises (e.g., animal walks, stability ball games)

• Bilateral coordination games (e.g., clapping rhythms, using scooter boards, parachute play)

• Obstacle courses that require planning, sequencing, and balance

• Activities that cross the midline (e.g., figure-8 movements, yoga poses)

• Sensory integration techniques to improve body awareness and movement confidence

Importantly, therapists also train parents and educators to reinforce these skills in everyday settings—maximizing carryover and long-term success.

Real-Life Example

Take the case of “Eli,” a 7-year-old with undiagnosed dyspraxia. At school, he avoided physical games and struggled with writing, often complaining that his hand hurt or that he was “bad at everything.” Teachers saw him as unmotivated; peers teased him for being clumsy.

After an OT assessment, it became clear that Eli had significant bilateral coordination challenges. With weekly therapy, home activities, and school accommodations, Eli slowly built strength, endurance, and confidence. Within six months, his teacher reported improved posture, more willingness to participate, and even a smile during P.E.

What You Can Do as a Parent or Educator

If you suspect a child is struggling with gross motor or bilateral integration skills, don’t wait for a diagnosis. Early support leads to better outcomes.

Here’s how to get started:

• Observe: Take note of patterns in movement difficulties.

• Speak up: Share concerns with your child’s teacher or GP.

• Request a referral: Ask for an occupational therapy assessment through your school or local health service.

• Create movement opportunities: Encourage activities like climbing, crawling, yoga, swimming, and balance games at home.

• Stay informed: Read credible resources like Newbee Publication’s therapy guides or consult apps like Locus Therapy that screen and support early motor development.

Conclusion

Gross motor coordination and bilateral integration are not just “physical” skills—they are deeply tied to a child’s overall development. For neurodivergent children, these areas deserve focused attention and support. Early occupational therapy can change the trajectory of a child’s school experience, confidence, and long-term well-being.

Let’s move beyond waiting and watching. Let’s act early, so every child can move, learn, and thrive.