Dyspraxia is the term used when someone finds it difficult to carry out and co-ordinate skilled, purposeful movements and gestures with normal accuracy. Someone with dyspraxia has difficulty planning and organising their thought processes (planning what to do and how to do it). They may also have language problems. Dyspraxia is also known as developmental co-ordination disorder (DCD). Symptoms in childhood can include a delay in reaching developmental milestones such as sitting up, standing or walking. Diagnosis as quickly as possible in a child's life means that treatment can be started early which may improve outlook.
What is dyspraxia?
Dyspraxia is the medical term used when someone finds it difficult to carry out and co-ordinate skilled, purposeful movements and gestures with normal accuracy. There may be problems with:
- Gross motor skills - this means problems with the ability to carry out movements that involve the large muscles of the body or groups of muscles. Examples of gross motor skills are walking, jumping, running, hopping on one leg and throwing an object.
- Fine motor skills - this means problems with performing tasks that are carried out by the smaller muscles of the body, including the muscles of the hands, feet and head or face (including the tongue and the lips). They are more difficult and delicate movements. Examples include writing, drawing, painting, doing a jigsaw puzzle, pronouncing words and whistling.
Someone with dyspraxia has difficulty organising their thought processes (planning what to do and how to do it). They may also have language problems.
Dyspraxia may be a problem that comes on later in life (an acquired problem) - for example, as a result of brain damage due to a stroke or head injury. Or, it may be due to a delay or problem with normal brain and nervous system (neurological) development. The name given to the condition where there is dyspraxia as a result of a problem with normal neurological development is developmental co-ordination disorder (DCD) in children. In popular English, when the word dyspraxia is used, it is usually used to mean this condition.
The rest of this leaflet is about DCD in children, which will simply be called dyspraxia from now on. Dyspraxia is classed as a motor learning disability.
What causes dyspraxia?
Dyspraxia is not thought to be due to any damage to the brain but a problem with the development of certain neurons in the brain. Neurons are the nerve cells of the body. They send signals to each other to allow the passage of information between different parts of the body. Connections between the neurons allowing the passage of these signals start to develop as we learn how to do things as a child. For example, when children learn to pick up a spoon and feed themselves or when they learn to pick up a cup and drink from it. The connections are reinforced when an action is carried out correctly.
The co-ordination of the skilled movements that the body makes is complex. It requires a number of different processes to work smoothly together. There needs to be:
- Input from the senses - for example, the sense of touch as a person touches an object. Vision and sound can also be involved.
- The passage of these sensory signals to the brain.
- The processing of these sensory signals within the brain.
- The planning of a movement activity within the brain.
- The passage of signals from the brain to make the muscles in the body work to carry out the movement.
If one part of this complex process is not working properly then the resulting movement may not be carried out smoothly.
Certain neurons in the brain, called motor neurons, do not seem to develop and mature as quickly in someone with dyspraxia. As a result, they are not as effective in transmitting information from the brain telling the muscles to move.
For most people with dyspraxia, the exact cause of this problem in neuron development is not known. However, a number of things have been suggested that may increase the risk of dyspraxia:
- Exposure to alcohol and drugs (including cocaine and metamfetamine) whilst a baby is developing in its mother's womb.
- Being born prematurely.
- Having another family member with dyspraxia. (Dyspraxia can run in some families.)
How common is dyspraxia and who develops it?
Dyspraxia is probably an underdiagnosed condition. It is thought that around 1 in 10 children in the UK may have some degree of dyspraxia. Boys seem to have more of a tendency than girls to develop dyspraxia.
What are the symptoms of dyspraxia?
Dyspraxia can affect different children in different ways and to different degrees. Some children may just have mild problems with co-ordinating their movements, whilst others are more severely affected. The problems may interfere with a child's ability to participate and function in daily activities and life skills, including education. For many people, dyspraxia continues into adulthood and so work and employment may be affected. Having dyspraxia doesn't mean that a child is any less intelligent but it does mean that their learning ability is affected.
Particular symptoms or signs that may be present in babies and toddlers with dyspraxia include:
- Muscle tone that is too high (this is known as hypertonia - the muscles seem hard or tense). Muscle tone that is too low (this is known as hypotonia - a baby may appear floppy or like a rag doll when being held).
- A delay in reaching developmental milestones - for example, taking longer than normal to roll over, sit up, stand, walk or potty train.
- Difficulty when trying to use stairs.
- Difficulty performing physical activities such as running, hopping, jumping or playing with a ball when compared to other children of the same age.
- Difficulty chewing solid food.
- Difficulty picking up small objects using the index finger and thumb.
- Difficulty performing daily activities and self-care tasks such as getting dressed.
- Being slower to pick up new skills when compared to other children of the same age (taking longer to learn how to do things).
- Falling over a lot or appearing clumsy.
- Difficulty holding a pencil, drawing, etc. Their drawing may seem more childish or immature than other children's drawing at the same age.
- Problems with grasping the concepts of 'on', 'in', 'in front of', etc.
- Difficulty establishing relationships with friends or knowing how to behave in public.
- Anxiety or agitation.
- Delayed language development or problems with speech. For example, speech that seems immature or difficult to understand.
As well as the problems above, particular symptoms or signs that may be present in children of school age with dyspraxia include:
- Having difficulty when in group situations and being much better one-on-one.
- Having problems with maths and writing, including having trouble copying things from the board in school.
- Appearing disorganised.
- Having poor concentration and listening skills.
- Seeming unable to follow instructions.
- Trying to avoid physical education in school or physical activities with friends.
- Feeling angry, upset or frustrated with themselves.
In adulthood, particular symptoms or signs of dyspraxia may also include:
- Having problems with planning and organisation.
- Having difficulty learning new skills at work and at home (such as DIY).
- Having difficulty when learning to drive.
How is dyspraxia diagnosed?
If you are concerned that your child may have dyspraxia, you should discuss this with your health visitor or your GP. Your child's teacher or a special needs co-ordinator in school may also be a good person to speak to. Your GP may suggest that your child be referred to a paediatrician or to a Child Development Centre.
Dyspraxia is usually diagnosed after careful assessment of your child by one or more people from a team of healthcare professionals including a paediatrician, a physiotherapist, a speech and language therapist, an occupational therapist and a psychologist.
The assessment usually involves healthcare professionals observing your child and looking at your child's ability to carry out everyday activities and play. They may ask your child to perform certain tasks, depending on their age, such as throwing or kicking a ball, drawing, tying shoelaces and taking off and putting on their coat, etc. You may also be asked questions about your child's development and abilities.
There are no specific blood tests or other investigations that are usually needed unless the healthcare professionals want to rule out any other underlying problems.
What is the treatment for dyspraxia?
Treatment will usually involve one or more people from the same team of healthcare professionals who were involved in the diagnosis of dyspraxia. For example:
- An occupational therapist can help your child with everyday activities at home and school, such as eating, getting dressed and holding a pen or pencil to write.
- A speech and language therapist can work with your child to help their speech and communication.
- An educational psychologist may help if your child is having difficulty progressing at school.
One particular treatment approach that may be suggested is known as perceptual motor training. This training involves giving your child a series of different tasks that can help to develop their language, hearing, listening and movement skills.
What is the outlook (prognosis) for dyspraxia?
There is no cure for dyspraxia but the condition can improve as a child grows and adapts. Early diagnosis and treatment of dyspraxia are very important. This is because the brain changes and develops rapidly during a child's first few years of life. It is during this time that new connections are made within the brain and nervous system and a child starts to develop new skills and abilities. If dyspraxia is diagnosed and treated as early as possible in a child's life, they will have a greater chance of improvement.
Appropriate treatment and advice, particularly focused on how a child or adult can help to manage and deal with the difficulties that dyspraxia can cause in their everyday life, can help to improve quality of life and symptoms. Work on a child's self-confidence, feelings of belonging and helping them to participate in daily activities is very important.
Further reading and references
Kirby A; Dyspraxia series: part one. At sixes and sevens. J Fam Health Care. 2011 Jul-Aug21(4):29-31.
Engel-Yeger B, Hanna Kasis A; The relationship between Developmental Co-ordination Disorders, child's perceived Child Care Health Dev. 2010 Sep36(5):670-7. Epub 2010 Apr 15.
Langer K; Dyspraxia series: Part Two. One step forward. J Fam Health Care. 2011 Sep-Oct21(5):44, 46-8.
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