What is it?
A child with dyspraxia can present with a wide spectrum of difficulties. The term is, however, used to describe co-ordination difficulties with evidence of significant perceptual problems in the majority of cases. Caution should be taken when using the term as it may eventually be loosely applied to every child who shows a little forgetfulness, disorganisation and clumsiness in their daily routines. Children develop at different rates and this should always be taken into consideration when looking at individual cases.
The term dyspraxia is taken from the Greek word duspraxia. Duspraxia is formed of dus (or dys) and praxia(or praxis which is taken from an older Greek word prassein).Praxis is to practice an act or a function, pass through, experience; therefore "to act". Dys means impaired, ill or abnormal, so the literal meaning of dyspraxia is ill-doing or abnormal act.
Developmental dyspraxia is an immaturity of the organisation of movement. The brain does not process information in the way that allows the full transmission of neural messages. A child with dyspraxia will find it hard to plan what to do and how to do it. Dyspraxia is also known as Developmental Co-ordination Disorder (DCD), Perceptual-Motor Dysfunction, and Motor Learning Difficulties. The terms Clumsy Child Syndrome or Minimal Brain Damage are no longer used.
Children and adults with dyspraxia find it difficult to learn how to plan and co-ordinate their movements. the condition is therefore also known as a "motor learning disability". Someone with dyspraxia will find it hard to carry out smooth and co-ordinated movements because the simultaneous perceptual and motor processes of carrying out an act successfully is a complex task that requires conscious imaging, planning, positioning, balance, muscle activation and co-ordination.
Dyspraxia often comes with language problems and sometimes a degree of difficulty with perception and thought. Dyspraxia does not affect a person's intelligence, but it can cause difficulties with learning, especially for children.
What Causes Dyspraxia?
For the majority of people with dyspraxia there is no known cause. Current research suggests that it is due to an immaturity of neuron development in the brain. It is not a result of brain damage and people with dyspraxia have no clinical neurological abnormality that would explain the condition.
When considering the brain, the cerebral cortex (the upper most part of the brain) receives impulses from sensory organs through a network of nerve fibres passing from the brain stem. As a child grows and learns, the connections between the nerve cells (neural pathways) become established and reinforced with successful learning. When a child learns a series of movement patterns the repetition of movement reinforces the pattern so that its planning is almost reflex. The use of external sensory input such as sight and sound together with the learned movement patterns will enable the cerebral cortex to judge the best course of action and send out appropriate motor impulses.
The cerebral cortex is divided into a right hemisphere and a left hemisphere. Each side has different functions and operates quite separately. Some functions are shared, but the sides generally work independently to provide its information that is brought together to complete the whole picture e.g. the left hemisphere receives the information in a jumbled, disjointed way and
needs to work well together with the right hemisphere so that the information, images and actions are interpreted correctly for the right results.
In children with dyspraxia, the two hemispheres of the cerebral cortex are not working in harmony to produce the desired results. The basic development of the hemispheres appear reduced, and as they determine whether a person is right or left handed, you will often find that children with dyspraxia will use both hands without developing a dominant hand for some time. This affects fine motor activities even further e.g. handwriting skills.
The cerebral cortex also surrounds the "thalamus", "hypothalamus" and "pituitary gland of the limbic system. The limbic system is responsible for the instinctive and automatic responses with the body and it is closely linked to emotional behaviour. A mature cerebreal cortex would be able to dampen down the limbic system's emotional response to external stimuli. If the cerebral cortex does not mature as expected, the individual would be excitable, over emotional and extremely sensitive to external sensory input.
Symptoms of Dyspraxia
The symptoms of Dyspraxia can be evident from an early age. Babies may be irritable from birth and may exhibit significant feeding problems. They are slow to achieve expected developmental milestones. For example, by the age of 8 months they may still not be able to sit up independently. Many children with dyspraxia fail to go through the crawling stage, preferring to "bottom shuffle" and then walk. Later, they will avoid tasks that require good manual dexterity.
The essential features of dyspraxia are often linked and associated with Developmental Co-ordination Disorder (DCD). The two are often considered the same. This can be confusing and the terminology used may depend on which country you are living in. There are, however, some inherent differences between dyspraxia and DCD. Dyspraxia has been generally considered under the umbrella term of DCD which is outlined below as defined in the DSM-IV. A diagnosis of DCD can be made if the following criteria are met:
A marked impairment in the development of motor co-ordination
The impaired motor co-ordination significantly interferes with academic achievements or activities of daily living
The significant motor co-ordinationdifficulties are not due to general medical conditions such as cerebral palsy, hemiplegia or muscular dystrophy and the criteria are not met for Pervasive Developmental Disorder.
If mental retardation is present, the motor difficulties are in excess of those usually associated with it.
The difference between DCD and dyspraxia is that: "The term DCD describes a more generalised motor co-ordination difficulty which shows a marked difference between the levels of skills that would be expected for age or level of intelegence and significantly interferes with academic or activities of daily living. This is not caused by another medicalcondition (for example cerebral palsy) and it is not part of a pattern of general learning difficulties. The term dyspraxia describes an immaturity of the development of the organisation and sequencing of movement. It can also affect speech, perception and thought. Not all people with DCD have dyspraxia, but often the words are used interchangeably. Difficulties associated with both DCD and dyspraxia have an impact on living and learning in all areas of a child's life, at home, school and at play."Dyspraxia Foundation.
Jean Ayres (1965) defined dyspraxia as a disorder of sensory integration interfering with the ability to plan and execute skilled non-habitual tasks. The child with dyspraxia has a praxis/planning problem and does not know how to move, whereas the child with DCD has difficulty with co-ordination and execution. the child with DCD knows what to do, but does not do it very well. There is still some debate over terminology and the term dyspraxia tends to be used more generally in the UK.
The infant school child with dispraxia could display the following symptoms:
- Late in reaching developmental milestones as a baby e.g. rolling, sitting, standing walking and speaking
- May not be able to run, hop jump, kick a ball as their peers can
- Difficulty keeping friends or knowing how to behave in company
- Has difficulty understanding concepts such as "in", "on", "in front of" etc.
- Difficulty walking up and down stairs
- Poor at dressing
- Falls frequently
- Poor pencil grip
- very immature drawings
- Easily distressed and prone to temper tantrums
- Often bumps into things
- Hand flapping
- Difficulty pedalling a tricycle
- Lack of sense of danger (jumps from heights etc.)
- Messy eater (may prefer using hands and frequently spills drinks)
- Lack of imaginative play
- May be sensitive to sensory stimuli
The junior and senior school child will probably continue to have the difficulties experienced by the infant school child with little improvement if their needs are not addressed by this stage. It is unlikely that major changes in their ability would occur, but they can make good progress in school with understanding, support and good coping strategies. children with dyspraxia may lose self confidence and motivation as they find school work increasingly difficult. By the time they reach secondary school their attendance record is often poor.
Helping the Child with Dyspraxia
Occupational therapists are able to assess children with movement and co-ordination problems to determine the exact nature of the difficulties and how it impacts the child's day to day life. The intervention will focus on how the child manages daily activities at home, school and play and it will work on the assumption that children develop skills as a consequence of the interaction between the child, the environment and the task.
The use of Sensory Integration techniques will focus on the underlying impairment of which the treatment will aim to improve the functional performance.
The main areas of the school curriculum that children with dyspraxia struggle with are in the areas of literature, handwriting, mathematics and PE. Children with dyspraxia have difficulty with concentration and listening skills. They may have literal use of language and this will affect their reading and spelling ability. They may read well, but not understand some of the concepts in language. Some exercises such as those in Take Time by Mary Nash-Wortham and Jean Hunt may provide help in these areas. Computers can provide support and the Wordshark 2 is a programme available from the Dyspraxic Foundation.
Poor handwriting is one of the most common symptoms of dyspraxia. A child with poor handwriting does not need to be told that their writing is bad. They can see that they are not as good as their friends. It is important therefore to concentrate on the positive rather than the negative. Please see my previous posting on Handwriting for ways to support handwriting difficulties.
The following is a list of assessment tools often used by occupational therapists:
Perceived Efficacy and Goal Setting System (PEGS) Developed by MissiunaC, Pollock N, and Law M (2004) Available from The Psychological Corporation/Harcourt Assessment
Assessment of Motor and Process Skills (AMPS) and School Assessment of Motor and Process Skills (School AMPS) For information see www.AMPS-UK.com
Pediatric Evaluation of Disability Inventory (PEDI) – for children up to 7.5 years of age. Developed by Hayley et al(1992) available from The Psychological Corporation/Harcourt Assessments
Movement Assessment Battery for Children (Movement ABC). Developed by Henderson S and SugdenD (1992) available from The Psychological Corporation/Harcourt Assessment
DevelopmentalTest of Visual Motor Integration (VMI) developed by Beery K, Buktenica N, Beery N (5th Edition 2004) Available from Ann Arbour Publishers and nferNELSON
Bruininks-Osteretsky Test of Motor Proficiency developed by Bruininks R, (1978) published by American Guidance Service
Test of Visual Perceptual Skills – non-motor (TVPS) developed by Gardner M (1996) available from Ann Arbour Publishers
Motor-Free VisualPerceptual Test (MVPS) developed by Mercier L, Hebert R, Collarusso R, Hammil D (2002) available from Ann Arbour Publishers
Sensory Profile developed by Dunn W (1999) available from Harcourt Assessment (see also www.sensoryprofile.com)
On a recent course hosted by the COT (college of Occupational Therapists) it was considered that DCD is the official medical diagnosis of which dyspraxia is a symptom ("Is it DCD or isn't it?" Dido Green and Carolyn Dunford 16th April 2012 - London) - amendment added 24/04/2012.
Includes handouts on cognitive approaches to intervention, fine motor difficulties,
For 40 best online tools for occupational therapists