Developmental dyspraxia is one or all of a
heterogeneousHeterogeneous is an adjective used to describe an object or system consisting of multiple items having a large number of structural variations. It is the opposite of homogeneous, which means that an object or system consists of multiple identical items...
range of development disorders affecting the initiation, organization, and performance of action. It is a
diagnosis of exclusionThe term diagnosis of exclusion refers to a medical condition whose presence cannot be established with complete confidence from examination or testing...
which entails the partial loss of the ability to coordinate and perform certain purposeful movements and gestures, in the absence of other motor or sensory impairments like cerebral palsy, muscular dystrophy,
multiple sclerosisMultiple sclerosis is an idiopathic disease of suspected autoimmune cause, in which the body's immune response attacks a person's central nervous system , leading to demyelination. Disease onset usually occurs in young adults, and it is more common in females...
or
Parkinson's diseaseParkinson's disease is a degenerative disorder of the central nervous system that often impairs the sufferer's motor skills, speech, and other functions....
.
The concept of developmental dyspraxia has existed for more than a century, but differing interpretation of the terminology remains.
The Dyspraxia Foundation defines developmental dyspraxia as "an impairment or immaturity of the organisation of movement.
Developmental dyspraxia is one or all of a
heterogeneousHeterogeneous is an adjective used to describe an object or system consisting of multiple items having a large number of structural variations. It is the opposite of homogeneous, which means that an object or system consists of multiple identical items...
range of development disorders affecting the initiation, organization, and performance of action. It is a
diagnosis of exclusionThe term diagnosis of exclusion refers to a medical condition whose presence cannot be established with complete confidence from examination or testing...
which entails the partial loss of the ability to coordinate and perform certain purposeful movements and gestures, in the absence of other motor or sensory impairments like cerebral palsy, muscular dystrophy,
multiple sclerosisMultiple sclerosis is an idiopathic disease of suspected autoimmune cause, in which the body's immune response attacks a person's central nervous system , leading to demyelination. Disease onset usually occurs in young adults, and it is more common in females...
or
Parkinson's diseaseParkinson's disease is a degenerative disorder of the central nervous system that often impairs the sufferer's motor skills, speech, and other functions....
.
The concept of developmental dyspraxia has existed for more than a century, but differing interpretation of the terminology remains.
The Dyspraxia Foundation defines developmental dyspraxia as "an impairment or immaturity of the organisation of movement. It is an immaturity in the way that the brain processes information, which results in messages not being properly or fully transmitted. The term dyspraxia comes from the word praxis, which means 'doing, acting'. Dyspraxia affects the planning of what to do and how to do it. It is associated with problems of perception, language and thought."
Developmental dyspraxia (referred to as developmental coordination disorder (DCD) in the US and Europe) is a life-long condition that is more common in males than in females, with a ratio of approximately 4 males to every female. The exact proportion of people with the disorder is unknown since the disorder can be difficult to detect due to a lack of specific laboratory tests, thus making diagnosis of the condition one of elimination of all other possible causes/diseases. Current estimates range from 5% - 20% with 5-6% being the most frequently quoted percentage in literature(Gaines, Missiuna,Egan & McLean 2008). 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
neuronA neuron is an excitable cell in the nervous system that processes and transmits information by electrochemical signaling. Neurons are the core components of the brain, the vertebrate spinal cord, the invertebrate ventral nerve cord, and the peripheral nerves...
development. The word "dyspraxia" comes from the Greek words "dys" meaning impaired or abnormal 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 milestonesDevelopmental milestones are tasks most children learn, or physical developments, that commonly appear in certain age ranges. For example:* Ability to lift and control the orientation of the head is attained at about 3 months...
, such as
crawlingCrawling may refer to:*Limbless locomotion, the movement of limbless animals over the ground*Sprawling locomotion, the movement of limbed animal with a belly close to the ground...
and
walkingWalking is the main form of animal locomotion on land, distinguished from running and crawling. When carried out in shallow waters, it is usually described as wading and when performed over a steeply rising object or an obstacle it becomes scrambling or climbing...
, 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 (down syndrome e.g Gabriel jones)
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."
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 . Key problems include:
- Difficulties controlling the speech organ
Speech organs produce the many sounds needed for language. Organs used include the lips, teeth, tongue, alveolar ridge, hard palate, velum , uvula and glottis....
s.
- Difficulties making speech sounds
- Difficulty sequencing sounds
- Within a word
- Forming words into sentences
- Difficulty controlling breathing and phonation
Phonation has slightly different meanings depending on the subfield of phonetics. Among some phoneticians, phonation is the process by which the vocal folds produce certain sounds through quasi-periodic vibration. This is the definition used among those who study laryngeal anatomy and physiology...
.
- 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 grapheme
A grapheme is a fundamental unit in a written language. Examples of graphemes include alphabetic letters, Chinese characters, numerical digits, punctuation marks, and the individual symbols of any of the world's writing systems, although arguably a diacritical mark or ancillary glyph does not...
s – e.g. the letters of the Latin alphabetThe Latin alphabet, also called the Roman alphabet, is the most widely used alphabetic writing system in the world today. It evolved from the western variety of the Greek alphabet called the Cumaean alphabet, and was initially developed by the ancient Romans to write the Latin language.During the...
, as well as numbers.
- Establishing the correct pencil grip
- Hand aching while writing
Fine-motor problems can also cause difficulty with a wide variety of other tasks such as using a knife and fork, fastening buttons and shoelaces, cooking, brushing one's teeth, applying cosmetics, styling one's hair, opening jars and packets, locking and unlocking doors, shaving and doing housework.
Whole body movement, coordination, and body image
Issues with gross motor coordination mean that major developmental targets including walking, running, climbing and jumping can be affected. The difficulties vary from child to child and can include the following:
- Poor timing.
- Poor balance (sometimes even falling over in mid-step). Tripping over one's own feet is also not uncommon.
- Difficulty combining movements into a controlled sequence.
- Difficulty remembering the next movement in a sequence.
- Problems with spatial awareness, or proprioception
Proprioception is the sense of the relative position of neighbouring parts of the body...
.
- Some people with dyspraxia have trouble picking up and holding onto simple objects owing to poor muscle tone and or proprioception.
- This disorder can cause an individual to be clumsy to the point of knocking things over and bumping into people accidentally.
- Some people with dyspraxia have difficulty in determining left from right.
- Cross-laterality, ambidexterity, and a shift in the preferred hand are also common in people with dyspraxia.
- People with dyspraxia may also have trouble determining the distance between them and other objects.
General difficulties
In addition to the physical impairments, dyspraxia is associated with problems with memory, especially short-term memory. This typically results in difficulty remembering instructions, difficulty organizing one's time and remembering deadlines, increased propensity to lose things or problems carrying out tasks which require remembering several steps in sequence (such as cooking.) Whilst most of the general population experience these problems to some extent, they have a much more significant impact on the lives of dyspraxic people. However, many dyspraxics have excellent long-term memories, despite poor short-term memory. Many dyspraxics benefit from working in a structured environment, as repeating the same routine minimises difficulty with time-management and allows them to commit procedures to long-term memory.
People with dyspraxia may have
sensory integration dysfunctionSensory integration dysfunction is a term used to describe difficulty with sensory integration. The more current diagnostic nosology uses the term Sensory Processing Disorder to describe this condition.-As a symptom:...
, including abnormal oversensitivity or undersensitivity to physical stimuli, such as touch, light, and sound. This may manifest itself as an inability to tolerate certain textures such as sandpaper or certain fabrics and including oral toleration of excessively textured food (commonly known as picky eating), 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. Undersensitivity to stimuli may also cause problems. Dyspraxics who are undersensitive to pain may injure themselves without realising. Some dyspraxics may be oversensitive to some stimuli and undersensitive to others.
People with dyspraxia 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. Having other autistic traits (which is common with dyspraxia and related conditions) may also contribute to sensory-induced panic attacks.
Dyspraxia can cause problems with perception of distance, and with the speed of moving objects and people This can cause problems moving in crowded places and crossing roads and can make learning to drive a car extremely difficult or impossible.
Many dyspraxics struggle to distinguish left from right, even as adults, and have extremely poor sense of direction generally.
Moderate to extreme difficulty doing physical tasks is experienced by some dyspraxics, and fatigue is common because so much extra energy is expended while trying to execute physical movements correctly. Some (but not all) dyspraxics suffer from
hypotoniaHypotonia is a disorder that causes low muscle tone , often involving reduced muscle strength. Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders that affect motor nerve control by the brain or muscle strength...
, which in this case is chronically low muscle tone caused by dyspraxia. People with this condition can 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.
Overlap with other conditions
Dyspraxics may have other difficulties that are not due to dyspraxia itself but often co-exist with it. This is sometimes referred to as comorbidity. Dyspraxics may have characteristics of
dyslexiaDyslexia is a learning disorder that manifests itself primarily as a difficulty with reading and spelling. It is separate and distinct from reading difficulties resulting from other causes, such as a non-neurological deficiency with vision or hearing, or from poor or inadequate reading instruction....
(difficulty with reading and spelling),
dyscalculiaDyscalculia[p] or math disability is a specific learning disability involving innate difficulty in learning or comprehending mathematics. It is akin to dyslexia and can include confusion about math symbols...
(difficulty with mathematics),
dysgraphiaDysgraphia is a deficiency in the ability to write by hand, regardless of the ability to read, not a result of intellectual impairment....
(an inability to write neatly and or draw)
expressive language disorderExpressive language disorder is a communication disorder which is characterised by having a limited vocabulary and grasp of grammar...
(difficulty with verbal expression), ADHD (poor attention span and impulsive behaviour), or
Asperger syndromeAsperger syndrome is an autism spectrum disorder, and people with it therefore show significant difficulties in social interaction, along with restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and...
(consisting variously of poor social cognition, a literal understanding of language (making it hard to understand idioms or sarcasm) and rigid, intense interests). 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.
Other names
Collier first described developmental dyspraxia as 'congenital maladroitness'.
A. Jean AyresAnna Jean Ayres was an occupational therapist and developmental psychologist known for her work in the area of sensory integration dysfunction, a term she coined in the 1960s to describe a theory used in occupational therapy. She is the author of several books on the subject, including Sensory...
referred to it as a disorder of sensory integration in 1972 while in 1975 Dr Sasson Gubbay called it the 'clumsy child syndrome'. It has also been called minimal brain dysfunction although the two latter names are no longer in use. Other names include:
- Dyspraxia
- 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.
External links