What is Dyspraxia?

Dyspraxia (also known as developmental coordination disorder – DCD) is a surprisingly common condition affecting movement and coordination in children and adults. It is a hidden condition which is still poorly understood.

Dyspraxia affects all areas of life, making it difficult for people to carry out activities that others take for granted. Signs of dyspraxia/DCD are present from a young age but may not be recognised until a child starts school – or even later in adulthood.

Signs of dyspraxia/DCD

Each person’s experience of dyspraxia/DCD is different and will be affected by a person’s age, the opportunities they have had to learn skills, environmental demands and the support/understanding shown by people around them. There are, however, some common signs of dyspraxia/DCD.

Movement

Difficulty coordinating large and small body movements is the main feature of dyspraxia/DCD. Physical signs of dyspraxia/DCD include the following:

• Movements appear awkward and lack smoothness
• Extra physical and mental effort is required to carry out movements that others manage easily
• Poor spatial awareness means more trips, bumps and bruises.
• Difficulty learning the movements required to carry out new practical tasks.
• Difficulty transferring motor skills to new situations or activities.
• Organisation and planning

Many people with dyspraxia/DCD have difficulty organising themselves, their equipment and their thoughts. Some also experience problems with attention, memory and time management. Many adults with dyspraxia/DCD say these difficulties present more of a challenge in their daily lives than their underlying movement difficulties.

Speech and language

Some people with dyspraxia/DCD have difficulty keeping up with conversations and there may be long, awkward pauses before they respond to a question or comment.

People with verbal dyspraxia have severe and persistent difficulty coordinating the precise movements required to produce clear speech. It is possible to have verbal dyspraxia on its own or alongside other movement difficulties associated with dyspraxia/DCD.

How many people are affected?

Dyspraxia/DCD affects around 5% of school-aged children. Around 2% of children are more severely affected.

Difficulties continue into adolescence and adulthood in most cases.

Males are more like to be affected by dyspraxia/DCD than females, but females are often older when their difficulties are identified.

Although dyspraxia/DCD is a unique and separate condition people will often (but not always) have another diagnosis too.

Identifying dyspraxia/DCD early means that a person’s physical, learning, social and emotional needs can be identified, and support provided to help them reach their potential.

What causes dyspraxia/DCD?

Dyspraxia/DCD is the result of a disruption in the way that messages are passed between the brain and the body. The cause of this disruption is not yet clear although being born early, having a low birth weight and a family history of coordination difficulties increases the likelihood of someone having the condition. Dyspraxia/DCD is not caused by brain damage, illness or injury.

In most cases, the cause of a person’s dyspraxia/DCD is not known. It’s likely that there isn’t one single reason to explain why a person’s movement skills are not as well developed as their abilities in other areas.

How would I recognise a child with dyspraxia/DCD?

The presence of many (although not all) of these signs might suggest that a child has dyspraxia/DCD:

• Delay in acquiring early motor skills such as sitting, crawling, walking
• Difficulty running, jumping, hopping, catching/throwing compared to other children
• Movements appear awkward, slow, hesitant
• Needs to be taught physical skills rather than picking them up instinctively
• Frequently trips and falls
• Poor pencil grip. Writing is slow and immature.
• Difficulty getting dressed and using cutlery.
• Poor understanding of spatial concepts such as on/under/over/in front of.
• Difficulty keeping friends and judging how to behave in company.
• Anxious and has low self-esteem.
• Difficulty paying attention reacts to all stimuli without discrimination
• Works better 1:1 or in a small group
• Has difficulty following instructions
• Has difficulty managing time.
• Often loses things
• How would I recognise an adult with dyspraxia/DCD?

The presence of many (although not all) of these signs might suggest that an adult has dyspraxia/DCD:

• History of physical awkwardness as a child, but may have developed coping or avoidance strategies as an adult
• Difficulty learning new motor skills or applying skills in a different or busy environment
• Difficulty handling tools and equipment such as a tin opener.
• Poor balance, tires easily.
• Can produce lots of writing or neat writing, but not both at the same time.
• Anxious and may avoid social situations where difficulties might be exposed
• Poor organisation and time management skills.
• Misses deadlines, late for appointments.
• Awkward pauses before answering questions
• Underachieves academically and in the workplace.

Diagnosis

Talk to a GP, health visitor or special educational needs co-ordinator (SENCO) if you think your child has developmental co-ordination disorder (DCD).

They may refer your child to another healthcare professional who can do an assessment.

This could be:

• a paediatrician – a doctor specialising in the care of babies and children who will usually be based locally (community paediatrician)
• a paediatric occupational therapist – a healthcare professional who can assess your child's functional abilities in daily activities, such as handling cutlery and getting dressed
• a paediatric physiotherapist – a healthcare professional who can assess your child's movement (motor) skills
• an educational psychologist – a professional who assists children who are having difficulty progressing with their education because of emotional, psychological or behavioural factors

Other doctors who may be involved in this process include a neurodevelopmental paediatrician or a paediatric neurologist.

These are paediatricians who also specialise in the development of the central nervous system, which includes the brain, nerves and spinal cord.

A neurodevelopmental paediatrician may work at a child development centre or local health clinics.

Occasionally, a neurologist is needed to help rule out other conditions that affect the brain and nervous system (neurological conditions), which may be causing your child's symptoms.

It's important to get a correct diagnosis so you can develop a better understanding of your child's problems and appropriate support can be offered.

Getting a diagnosis can also help reduce the stress experienced by both parents and children with DCD.

Assessment

The diagnosis of DCD is usually made by a paediatrician, often in collaboration with an occupational therapist.

Generally, a paediatrician is involved in diagnosis and an occupational therapist is involved in both diagnosis and treatment.

For a diagnosis to be made, it's essential for the child to have what is called a norm-referenced assessment of their motor skills. This may be done by an occupational therapist, physiotherapist or paediatrician.

Children with suspected DCD are usually assessed using a method called the Movement ABC, which involves tests of:

• gross motor skills – their ability to use large muscles that co-ordinate significant body movements, such as moving around, jumping and balancing
• fine motor skills – their ability to use small muscles for accurate co-ordinated movements, such as drawing and placing small pegs in holes

Your child's performance in the assessment is scored and compared with the normal range of scores for a child of their age.

There also needs to be evidence that the child's mental ability is within the normal range for their age.

Sometimes your child may also have an assessment of their mental ability by a psychologist, or if they're very young, by a paediatrician.

The healthcare professional doing the assessment will take your child's medical history into account. This includes any problems that may have happened during their birth and any delays reaching developmental milestones.

Your family medical history, such as whether any family members have been diagnosed with DCD, will also be considered.

Once the assessment process is complete, the healthcare professionals involved will produce a report on your child's condition.

Diagnostic criteria

For a diagnosis of DCD to be made, your child will usually need to meet all of the following criteria:

• their motor skills are significantly below the level expected for their age and opportunities they have had to learn and use these skills
• their lack of motor skill significantly and persistently affects their day-to-day activities and achievements at school
• their symptoms first developed during an early stage of their development
• their lack of motor skills isn't better explained by long-term delay in all areas (general learning disability) or rare medical conditions, such as cerebral palsy or muscular dystrophy

DCD should only be diagnosed in children with a general learning disability if their physical co-ordination is more impaired than would be expected for their mental (cognitive) ability.

Although DCD may be suspected in the pre-school years, it's not usually possible to make a definite diagnosis before a child is aged 5.