| Disorders usually first diagnosed in infancy, childhood, or adolescence. |
Motor Skills Disorders--
Dyspraxia entails the partial loss of the ability to coordinate and perform certain purposeful
movements and gestures in the absence of motor or sensory impairments.
Dyspraxia may be acquired (e.g. as a result of brain damage suffered from a stroke or other
trauma), or associated with failure / delay of normal neurological development - i.e. Developmental
Dyspraxia, or Developmental Coordination Disorder. The term apraxia is more often used to describe
this symptom in clinical practice, although strictly apraxia denotes a complete (as opposed to partial)
loss of the relevant function.
Developmental Dyspraxia is one or all of a heterogeneous range of psychological development
disorders affecting the initiation, organization and performance of action[1]. It entails the partial loss
of the ability to coordinate and perform certain purposeful movements and gestures in the absence
of motor or sensory impairments.
Developmental dyspraxia (referred to as developmental coordination disorder (DCD) in the US) is a
life-long condition that is more common in males than in females, and has been believed to affect 8%
to 10% of all children (Dyspraxia Trust, 1991). Ripley, Daines, and Barrett state that 'Developmental
dyspraxia is difficulty getting our bodies to do what we want when we want them to do it', and that
this difficulty can be considered significant when it interferes with the normal range of activities
expected for a child of their age. Madeline Portwood makes the distinction that dyspraxia is not due
to a general medical condition, but that it may be due to immature neuron development. The word
"dyspraxia" comes from the Greek words "dys" meaning bad and "praxis", meaning action or deed.
Dyspraxia is described as having two main elements:
Ideational dyspraxia - Difficulty with planning a sequence of coordinated movements.
Ideo-Motor dyspraxia - Difficulty with executing a plan, even though it is known.
Assessment and diagnosis
Assessments for dyspraxia typically require a developmental history, detailing ages at which
significant developmental milestones, such as crawling and walking, occurred. Motor skills screening
includes activities designed to indicate dyspraxia, including balancing, physical sequencing, touch
sensitivity, and variations on walking activities.
A baseline motor assessment establishes the starting point for developmental intervention
programs. Comparing children to normal rates of development may help to establish areas of
significant difficulty.
However, research in the BJSE has shown that knowledge is severely limited in many who should be
trained to recognise and respond to various difficulties, including Developmental Coordination
Disorder, Dyslexia and DAMP. The earlier that difficulties are noted and timely assessments occur,
the quicker intervention can begin. A teacher or GP could miss a diagnosis if they are only applying a
cursory knowledge.
"Teachers will not be able to recognise or accommodate the child with learning difficulties in class if
their knowledge is limited. Similarly GPs will find it difficult to detect and appropriately refer children
with learning difficulties."[1]
Developmental profiles
Various areas of development can be affected by developmental dyspraxia and many or all can
persist into adulthood. Often various coping strategies are developed, and these can be enhanced
through physiotherapy.
Speech and language
Developmental verbal dyspraxia is a type of ideational dyspraxia, causing linguistic or phonological
impairment. This is the favoured term in the UK; however it is also sometimes referred to as
articulatory dyspraxia and in the USA the usual term is apraxia of speech [2]. Key problems include:
* Difficulties controlling the speech organs.
* Difficulties making speech sounds
* Difficulty sequencing sounds
o Within a word
o Forming words into sentences
* Difficulty controlling breathing and phonation.
* Slow language development.
* Difficulty with feeding.
Fine motor control
Difficulties with fine motor co-ordination lead to problems with handwriting, which may be due to
either ideational or ideo-motor difficulties. Problems associated with this area may include:
* Learning basic movement patterns.
* Developing a desired writing speed.
* The acquisition of graphemes – e.g. the letters of the Latin alphabet, as well as numbers.
* Establishing the correct pencil grip
* Hand aching while writing
Whole body movement, coordination, and body image
Issues with gross motor coordination mean that major developmental targets including walking,
running, climbing and jumping are affected. One area of difficulty involves associative movement,
where a passive part of the body moves or twitches in response to a movement in an active part.
For example, the support arm and hand twitching as the dominant arm and hand move, or hands
turning inwards or outwards to correspond with movements of the feet. Problems associated with
this area may include:
* Poor timing
* Poor balance (sometimes even falling over in mid-step) Tripping over one's own feet is also not
uncommon. [2]
* Difficulty combining movements into a controlled sequence.
* Difficulty remembering the next movement in a sequence.
* Problems with spatial awareness, or proprioception
* Some people with dyspraxia have trouble picking up and holding onto simple objects [3] due to
poor muscle tone.
* This disorder can cause an individual to be clumsy to the point of knocking things over and
bumping into people accidentally.
* Some Dyspraxics have difficulty in determining left from right [citation needed].
* Cross-laterality, ambidexterity, and a shift in the preferred hand are also common in people with
dyspraxia[citation needed].
* Dyspraxics may also have trouble determining the distance between them and other objects.
General difficulties
Dyspraxic people may have Sensory Integration Dysfunction, a condition that creates abnormal
oversensitivity or undersensitivity to physical stimuli, such as touch, light, and sound [citation
needed]. This may manifest itself as an inability to tolerate certain textures such as sandpaper or
certain fabrics, or even being touched by another individual (in the case of touch oversensitivity) or
may require the consistent use of sunglasses outdoors since sunlight may be intense enough to
cause discomfort to a dyspraxic (in the case of light oversensitivity). An aversion to loud music and
naturally loud environments (such as clubs and bars) is typical behavior of a dyspraxic individual who
suffers from auditory oversensitivity, while only being comfortable in unusually warm or cold
environments is typical of a dyspraxic with temperature oversensitivity. This typically occurs if the
dyspraxia is comorbid to an autistic spectrum disorder (PDD) such as autistic disorder or Asperger
syndrome.
Dyspraxic people sometimes have difficulty moderating the amount of sensory information that their
body is constantly sending them, so as a result these people are prone to panic attacks[citation
needed]. Having other autistic traits (which is common with dyspraxia and related conditions[citation
needed]) may also contribute to sensory-induced panic attacks.
Dyspraxics (along with people who have similar conditions) may have difficulty sleeping since there is
an inability to force the brain to stop thinking and "shut down"[citation needed]. A dyspraxic is
nearly always thinking about several unrelated things at once, (the inverse is also possible, with only
one dominant thought occupying the dyspraxic's entire attention span at any given time) so this
may cause easy distractibility and daydreaming[citation needed]. It is quite easy for someone with
dyspraxia to concentrate entirely on a particular thought instead of on the situation at hand. For this
reason, dyspraxia may be misdiagnosed as ADHD since on the surface both conditions have similar
symptoms in some areas[citation needed]. Many people with dyspraxia have short-term memory
issues and may forget instructions they received only seconds before, tend to forget important
deadlines, and are constantly misplacing items.
Moderate to extreme difficulty doing physical tasks is experienced by dyspraxics, and fatigue is
common because so much extra energy is expended while trying to execute physical movements
correctly [2]. Some (but not all) dyspraxics suffer from hypotonia, which in this case is chronically
low muscle tone caused by dyspraxia[citation needed]. People with this condition have very low
muscle strength and endurance (even in comparison with other dyspraxics) and even the simplest
physical activities may quickly cause soreness and fatigue, depending on the severity of the
hypotonia. Hypotonia may worsen a dyspraxic's already poor balance to the point where it is
necessary to constantly lean on sturdy objects for support.
Dyspraxics may wish to live alongside others, although they often find it difficult. They can be messy
and cluttered with a tendency to outburst including aggression, 'good and bad days' (mood swings)
and difficulty in understanding the meaning of everyday interactions within a household [3] Because
of this, they sometimes end up arguing with people they care deeply about and regretting it when
the mood swing is over.
Often, their moods do not last too long, but they are very intense. When angered, a dyspraxic may
feel beyond furious but soon the mood will be over and he\she may regret things they did when they
were angry.
Overlap with other conditions
Dyspraxics may have other difficulties that are not due to dyspraxia itself but often co-exist with it.
They may have characteristics of dyslexia (difficulty with reading and spelling), dyscalculia (difficulty
with mathematics), expressive language disorder (difficulty with verbal expression), ADHD (poor
attention span) or Aspergers Syndrome (poor social cognition, and a literal understanding of
language, making it hard to understand idioms or sarcasm). However, they are unlikely to have
problems in all of these areas. The pattern of difficulty varies widely from person to person, and it is
important to understand that a major weakness for one dyspraxic can be a strength or gift for
another. For example, while some dyspraxics have difficulty with reading and spelling due to an
overlap with dyslexia, or numeracy due to an overlap with dyscalculia, others may have brilliant
reading and spelling or mathematical abilities. Similarly, some have autistic traits such as lacking an
appreciation of irony or social cues, while others thrive on an ironic sense of humour as a bonding
tool and a means of coping. [4]
Frustration and low self-esteem are common to many dyspraxics, whatever their profile of
difficulties. [5]
Other names
Collier first described developmental dyspraxia as 'congenital maladroitness'. A. Jean Ayers referred
to it as a disorder of sensory integration in 1972 while in 1975 Dr Sasson Gubbay called it the
'clumsy child syndrome' [6]. It has also been called minimal brain dysfunction although the two latter
names are no longer in use. Other names include:
* Dyspraxia - This is the term primar
* Developmental Co-ordination Disorder - a subtly different condition by definition, in practice, very
similar.
* Sensorimotor dysfunction
* Perceptuo-motor dysfunction
* Motor Learning Difficulties
The World Health Organisation currently lists Developmental Dyspraxia as Specific Developmental
Disorder of Motor Function [7].
* References provided by request.
Dyspraxia entails the partial loss of the ability to coordinate and perform certain purposeful
movements and gestures in the absence of motor or sensory impairments.
Dyspraxia may be acquired (e.g. as a result of brain damage suffered from a stroke or other
trauma), or associated with failure / delay of normal neurological development - i.e. Developmental
Dyspraxia, or Developmental Coordination Disorder. The term apraxia is more often used to describe
this symptom in clinical practice, although strictly apraxia denotes a complete (as opposed to partial)
loss of the relevant function.
Developmental Dyspraxia is one or all of a heterogeneous range of psychological development
disorders affecting the initiation, organization and performance of action[1]. It entails the partial loss
of the ability to coordinate and perform certain purposeful movements and gestures in the absence
of motor or sensory impairments.
Developmental dyspraxia (referred to as developmental coordination disorder (DCD) in the US) is a
life-long condition that is more common in males than in females, and has been believed to affect 8%
to 10% of all children (Dyspraxia Trust, 1991). Ripley, Daines, and Barrett state that 'Developmental
dyspraxia is difficulty getting our bodies to do what we want when we want them to do it', and that
this difficulty can be considered significant when it interferes with the normal range of activities
expected for a child of their age. Madeline Portwood makes the distinction that dyspraxia is not due
to a general medical condition, but that it may be due to immature neuron development. The word
"dyspraxia" comes from the Greek words "dys" meaning bad and "praxis", meaning action or deed.
Dyspraxia is described as having two main elements:
Ideational dyspraxia - Difficulty with planning a sequence of coordinated movements.
Ideo-Motor dyspraxia - Difficulty with executing a plan, even though it is known.
Assessment and diagnosis
Assessments for dyspraxia typically require a developmental history, detailing ages at which
significant developmental milestones, such as crawling and walking, occurred. Motor skills screening
includes activities designed to indicate dyspraxia, including balancing, physical sequencing, touch
sensitivity, and variations on walking activities.
A baseline motor assessment establishes the starting point for developmental intervention
programs. Comparing children to normal rates of development may help to establish areas of
significant difficulty.
However, research in the BJSE has shown that knowledge is severely limited in many who should be
trained to recognise and respond to various difficulties, including Developmental Coordination
Disorder, Dyslexia and DAMP. The earlier that difficulties are noted and timely assessments occur,
the quicker intervention can begin. A teacher or GP could miss a diagnosis if they are only applying a
cursory knowledge.
"Teachers will not be able to recognise or accommodate the child with learning difficulties in class if
their knowledge is limited. Similarly GPs will find it difficult to detect and appropriately refer children
with learning difficulties."[1]
Developmental profiles
Various areas of development can be affected by developmental dyspraxia and many or all can
persist into adulthood. Often various coping strategies are developed, and these can be enhanced
through physiotherapy.
Speech and language
Developmental verbal dyspraxia is a type of ideational dyspraxia, causing linguistic or phonological
impairment. This is the favoured term in the UK; however it is also sometimes referred to as
articulatory dyspraxia and in the USA the usual term is apraxia of speech [2]. Key problems include:
* Difficulties controlling the speech organs.
* Difficulties making speech sounds
* Difficulty sequencing sounds
o Within a word
o Forming words into sentences
* Difficulty controlling breathing and phonation.
* Slow language development.
* Difficulty with feeding.
Fine motor control
Difficulties with fine motor co-ordination lead to problems with handwriting, which may be due to
either ideational or ideo-motor difficulties. Problems associated with this area may include:
* Learning basic movement patterns.
* Developing a desired writing speed.
* The acquisition of graphemes – e.g. the letters of the Latin alphabet, as well as numbers.
* Establishing the correct pencil grip
* Hand aching while writing
Whole body movement, coordination, and body image
Issues with gross motor coordination mean that major developmental targets including walking,
running, climbing and jumping are affected. One area of difficulty involves associative movement,
where a passive part of the body moves or twitches in response to a movement in an active part.
For example, the support arm and hand twitching as the dominant arm and hand move, or hands
turning inwards or outwards to correspond with movements of the feet. Problems associated with
this area may include:
* Poor timing
* Poor balance (sometimes even falling over in mid-step) Tripping over one's own feet is also not
uncommon. [2]
* Difficulty combining movements into a controlled sequence.
* Difficulty remembering the next movement in a sequence.
* Problems with spatial awareness, or proprioception
* Some people with dyspraxia have trouble picking up and holding onto simple objects [3] due to
poor muscle tone.
* This disorder can cause an individual to be clumsy to the point of knocking things over and
bumping into people accidentally.
* Some Dyspraxics have difficulty in determining left from right [citation needed].
* Cross-laterality, ambidexterity, and a shift in the preferred hand are also common in people with
dyspraxia[citation needed].
* Dyspraxics may also have trouble determining the distance between them and other objects.
General difficulties
Dyspraxic people may have Sensory Integration Dysfunction, a condition that creates abnormal
oversensitivity or undersensitivity to physical stimuli, such as touch, light, and sound [citation
needed]. This may manifest itself as an inability to tolerate certain textures such as sandpaper or
certain fabrics, or even being touched by another individual (in the case of touch oversensitivity) or
may require the consistent use of sunglasses outdoors since sunlight may be intense enough to
cause discomfort to a dyspraxic (in the case of light oversensitivity). An aversion to loud music and
naturally loud environments (such as clubs and bars) is typical behavior of a dyspraxic individual who
suffers from auditory oversensitivity, while only being comfortable in unusually warm or cold
environments is typical of a dyspraxic with temperature oversensitivity. This typically occurs if the
dyspraxia is comorbid to an autistic spectrum disorder (PDD) such as autistic disorder or Asperger
syndrome.
Dyspraxic people sometimes have difficulty moderating the amount of sensory information that their
body is constantly sending them, so as a result these people are prone to panic attacks[citation
needed]. Having other autistic traits (which is common with dyspraxia and related conditions[citation
needed]) may also contribute to sensory-induced panic attacks.
Dyspraxics (along with people who have similar conditions) may have difficulty sleeping since there is
an inability to force the brain to stop thinking and "shut down"[citation needed]. A dyspraxic is
nearly always thinking about several unrelated things at once, (the inverse is also possible, with only
one dominant thought occupying the dyspraxic's entire attention span at any given time) so this
may cause easy distractibility and daydreaming[citation needed]. It is quite easy for someone with
dyspraxia to concentrate entirely on a particular thought instead of on the situation at hand. For this
reason, dyspraxia may be misdiagnosed as ADHD since on the surface both conditions have similar
symptoms in some areas[citation needed]. Many people with dyspraxia have short-term memory
issues and may forget instructions they received only seconds before, tend to forget important
deadlines, and are constantly misplacing items.
Moderate to extreme difficulty doing physical tasks is experienced by dyspraxics, and fatigue is
common because so much extra energy is expended while trying to execute physical movements
correctly [2]. Some (but not all) dyspraxics suffer from hypotonia, which in this case is chronically
low muscle tone caused by dyspraxia[citation needed]. People with this condition have very low
muscle strength and endurance (even in comparison with other dyspraxics) and even the simplest
physical activities may quickly cause soreness and fatigue, depending on the severity of the
hypotonia. Hypotonia may worsen a dyspraxic's already poor balance to the point where it is
necessary to constantly lean on sturdy objects for support.
Dyspraxics may wish to live alongside others, although they often find it difficult. They can be messy
and cluttered with a tendency to outburst including aggression, 'good and bad days' (mood swings)
and difficulty in understanding the meaning of everyday interactions within a household [3] Because
of this, they sometimes end up arguing with people they care deeply about and regretting it when
the mood swing is over.
Often, their moods do not last too long, but they are very intense. When angered, a dyspraxic may
feel beyond furious but soon the mood will be over and he\she may regret things they did when they
were angry.
Overlap with other conditions
Dyspraxics may have other difficulties that are not due to dyspraxia itself but often co-exist with it.
They may have characteristics of dyslexia (difficulty with reading and spelling), dyscalculia (difficulty
with mathematics), expressive language disorder (difficulty with verbal expression), ADHD (poor
attention span) or Aspergers Syndrome (poor social cognition, and a literal understanding of
language, making it hard to understand idioms or sarcasm). However, they are unlikely to have
problems in all of these areas. The pattern of difficulty varies widely from person to person, and it is
important to understand that a major weakness for one dyspraxic can be a strength or gift for
another. For example, while some dyspraxics have difficulty with reading and spelling due to an
overlap with dyslexia, or numeracy due to an overlap with dyscalculia, others may have brilliant
reading and spelling or mathematical abilities. Similarly, some have autistic traits such as lacking an
appreciation of irony or social cues, while others thrive on an ironic sense of humour as a bonding
tool and a means of coping. [4]
Frustration and low self-esteem are common to many dyspraxics, whatever their profile of
difficulties. [5]
Other names
Collier first described developmental dyspraxia as 'congenital maladroitness'. A. Jean Ayers referred
to it as a disorder of sensory integration in 1972 while in 1975 Dr Sasson Gubbay called it the
'clumsy child syndrome' [6]. It has also been called minimal brain dysfunction although the two latter
names are no longer in use. Other names include:
* Dyspraxia - This is the term primar
* Developmental Co-ordination Disorder - a subtly different condition by definition, in practice, very
similar.
* Sensorimotor dysfunction
* Perceptuo-motor dysfunction
* Motor Learning Difficulties
The World Health Organisation currently lists Developmental Dyspraxia as Specific Developmental
Disorder of Motor Function [7].
* References provided by request.
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