Background: Developmental Coordination Disorder (DCD) affects 5-6% of children. There is growing evidence that DCD is associated with greater levels of internalising symptoms (i.e. depression and anxiety). This is the first systematic review and meta-analysis to explore the magnitude of this effect, the quality of the evidence, and potential moderators.

Methods: A systematic search was conducted to identify studies reporting a comparison between individuals with DCD/probable DCD and typically developing (TD) individuals on measures of internalising symptoms. A pooled effect size (Hedges g) was calculated using random effects meta-analysis. Study quality, publication bias and potential moderators of the effect were explored.

Results: Twenty studies, including a total of 23 subsamples, met the inclusion criteria, of which 22 subsamples were included in the meta-analysis (DCD: n=1123; TD: n=7346). A significant, moderate effect of DCD on internalising symptoms was found (g=0.61). This effect remained robust after accounting for publication bias and excluding lower quality studies. The effect was significantly larger in studies utilizing a cross-sectional design (vs. longitudinal), convenience sampling (vs. population screening) and a majority male sample.

Conclusions: The findings demonstrate that individuals with DCD experience greater levels of internalising symptoms than their peers. This highlights the importance of routine screening for emotional difficulties in DCD, raising awareness of the condition in mental health services, and developing psychosocial interventions that extend beyond a focus on motor impairments. However, there is a need for higher quality, longitudinal studies to better understand the causal relationship between DCD and internalising symptoms.