Developmental Dyspraxia

A lifelong condition which has been formally recognised by the World Health Organisation, dyspraxia or development co-ordination disorder as it is also known, affects fine and gross motor movements, both separately or together, as well as speech.

Dyspraxia is distinct as it is a stand-alone condition, rather than arising as a result of another illness or disease although it may be seen more frequently in individuals who have other specific learning disabilities such as Attention Deficit (Hyperactivity) Disorder.

The presenting symptoms and features can vary significantly with each individual and can alter and adapt during the course of a lifetime.

Understanding how dyspraxia affects the individual

A relatively common disorder affecting around one in every 20 children, dyspraxia occurs as an isolated condition rather than as a symptom of other motor diseases such as cerebral palsy. There is no associated loss of intellectual function.

Like many other conditions, individuals with dyspraxia may experience a great range of symptoms which vary in severity. Some are affected to a very great degree while others only have a mild impairment.

However, the extent of activities that can be potentially affected by dyspraxia is great; the condition carries the possibility of being extremely disruptive to everyday life. Self-care as well as education, work and leisure can all be affected by the symptoms of dyspraxia and this may continue for an entire lifetime.

The symptoms that an individual with dyspraxia suffers means that employment can be challenging  and there may be significant social difficulties too.

Associated conditions
Although dyspraxia is a condition which impairs motor movement, both fine and gross, there can sometimes be an associated loss of function with non-motor abilities too. More specifically, there can be difficulties with perception, memory and processing.

Dyspraxia can present in isolation but it can also occur in tandem with other conditions which could be described as specific learning disorders. These include dyslexia and Attention Deficit (Hyperactivity) Disorder along with emotional, social, behavioural and language impairments.

Verbal dyspraxia can occur either on its own or with the motor form of dyspraxia.

Acquired dyspraxia typically refers to co-ordination and movement difficulties which occur following a head injury. These cases are very different to the other type of dyspraxia discussed here.

Identifying dyspraxia

Like many other specific learning difficulties, dyspraxia can be difficult to identify unless you understand what to look for. This is because many of the presenting features are non-specific and could be easily attributable to a number of different causes.

In pre-school children dyspraxia may present as the following:

1. Delayed milestones
2. Poor behaviour in company
3. Unable to walk up and down stairs without difficulty
4. Unable to carry out activities their peers can do such as hopping, running, jumping, catching a ball etc
5. Difficulty in maintaining friendships
6. Actions are hesitant and slow
7. Immature drawings
8. Difficulty with gripping pencil properly
9. Frequent falls
10. Poor at dressing self
11. No innate skills apparent, needs to be taught every action
12. Shape sorting or jigsaw games difficult
13. Easily distracted with high levels of anxiety

Although signs and symptoms may be identified in young children, a concrete diagnosis is often not provided until the age of 5 years or later.

In school age children, in addition to some or all of the above features dyspraxia can present as:

1. An avoidance of PE and sports
2. Performs well on a one-to-one basis but poorly in class
3. Poor attention span
4. Difficulty in copying text such as from the blackboard
5. Writing is slow and immature
6. Poor organisational skills
7. Structured stories or maths may be challenging
8. Unable to follow or recall instructions

Why does dyspraxia occur?

There’s currently no known cause for dyspraxia but research suggests it may be due to the immature development of neurones within the brain, as opposed to any kind of damage. Investigations show no discernible visible neurological abnormality which could account for the impairments.

Premature birth and a low birth weight are believed to be predisposing factors, as is a positive family history. It is also more prevalent in males than females.

To understand the chain of events within the body which causes dyspraxic symptoms to occur, it’s necessary to understand the function of the various areas of the brain.

The large upper part of the brain is known as the cerebral cortex which is split into four separate areas: the frontal love, the sensory area, the hind cerebral cortex and the motor area. The motor and sensory portions stretch across the brain, sitting immediately behind the frontal lobe. The hind cerebral cortex slots in at the back, lying behind the sensory cortex, and it’s within this area that the visual and auditory areas are deeply buried.

Signals from the body’s sensory organs travel up to the cerebral cortex via a network of nerve fibres which form a pathway throughout the body. As an individual grows and develops, neural pathways become established. These same pathways are strengthened further when the individual is able to perform the action they were attempting. Repeated actions mean that the pathways become so established that the string of movements required no longer has to be consciously considered, becoming almost automatic.

The cerebral cortex uses the pathways together with sensory input to determine the motor actions which are required.

This area of the brain is divided into two sections, the right and left hemispheres, both of which have specific functions. Despite being two halves of the same part of the brain and sharing functions, they operate almost independently. However, it’s only when the two sides join together that the complete picture can be formed. this co-operation between the hemispheres is required in order to interpret images in the right order.

Individuals who are affected by dyspraxia do not appear to have this smooth co-operative relationship between the two hemispheres. Additionally, the dominance of one hemisphere over the other, which is a normal development and which dictates whether an individual is right or left handed, appears to be missing in dyspraxia. This lack of dominance helps to explain why many individual with dyspraxia do not favour one particular side. This may sound like an advantage but for a child it can weaken the development of fine motor skills such as handwriting even further.

Where to get help

Depending on the age of the child, the GP or the health visitor should be the first port of call. If dyspraxia is suspected an onward referral to a paediatrician, occupational therapist, speech therapist or physiotherapist. School age children can also be referred via the Special Needs Co-ordinator at the school or the school nurse.

A referral to a neurologist may also be made to rule out any other underlying causes for the clumsiness and difficulties with movement.

To be diagnosed the following criteria will typically have to be fulfilled:

1. Motor skills significantly beneath the expected range for both the age of the child and also their exposure to having previously had the opportunity to engage in the activity
2. Day to day functions and performance in school is con sisterly affected by motor skill difficulties
3. Symptoms of dyspraxia began during early development
4. There is an absence of other explanations for motor skill problems such as cerebral palsy

Where there is also a generalised learning difficulty present, dyspraxia should only be diagnosed when their physical ability and co-ordination is substantially below the level of impairment of their intellectual function.

Adults who believe they may be affected should contact their GP who can make an onward referral to Occupation Therapy, Neurology, Physiotherapy or Psychology, or a combination of them all.

Any individual diagnosed with dyspraxia will receive exercises and treatment, as well as potential modifications on activities, which when practiced regularly can help to improve motor skills and overcome the daily challenges. Nevertheless, dyspraxia is typically a lifelong condition which will need ongoing support.