The symptoms of DCD are overall coordination difficulties, gross motor clumsiness, balance problems, hypotonia and poor fine motor skills. Visual perception is also often negatively affected. The disorder is recognisable in the preschool years, but the diagnosis is usually not made until school age, if at all. The most conspicuous gross motor clumsiness is often evident in childhood and the affected individual often has problems learning to ride a bike, to ski, skate and play ball (there is usually a particular problem around group games, but good skills can sometimes be developed in "non-group" games or sports, such as tennis or badminton). PE is almost always a problem, and many children with DCD are actively or indirectly excluded from PE activities. The hypotonia contributes to an impression of "overflexible joints" and often also to poor posture and "awkward" body language. Managing pens, pencils, crayons and cutlery can be major problems affecting, in the end, academic output and table manners. The muscles of the speech apparatus are often also affected leading to articulation problems and slowing down of speech speed.