Dyspraxia
Encyclopedia
Developmental dyspraxia is a motor learning difficulty that can affect planning of movements and co-ordination as a result of brain messages not being accurately transmitted to the body. It may be diagnosed in the absence of other motor or sensory impairments like cerebral palsy
Cerebral palsy
Cerebral palsy is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement....

, muscular dystrophy
Muscular dystrophy
Muscular dystrophy is a group of muscle diseases that weaken the musculoskeletal system and hamper locomotion. Muscular dystrophies are characterized by progressive skeletal muscle weakness, defects in muscle proteins, and the death of muscle cells and tissue.In the 1860s, descriptions of boys who...

, multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...

 or Parkinson's disease
Parkinson's disease
Parkinson's disease is a degenerative disorder of the central nervous system...

.

Terminology

Dyspraxia is a specific learning difficulty (SpLD) so it does not affect overall intelligence or ability, but just affects particular aspects of development.
The concept of developmental dyspraxia has existed for more than a century, but differing interpretations of the terminology remain.

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 word 'dyspraxia' comes from the Greek words 'dys', meaning impaired or abnormal, and 'praxis', meaning action or deed.

Dyspraxia affects the planning of what to do and how to do it. It is associated with problems of perception, language and thought". 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.


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.

Epidemiology

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 four 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 the literature. Some estimates show that up to 1 in 30 children may have dyspraxia.

Assessment and diagnosis

Assessments for dyspraxia typically require a developmental history, detailing ages at which significant developmental milestones, such as crawling and walking
Walking
Walking is one of the main gaits of locomotion among legged animals, and is typically slower than running and other gaits. Walking is defined by an 'inverted pendulum' gait in which the body vaults over the stiff limb or limbs with each step...

, 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.

However, research in the British Journal of Special Education 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
Dyslexia
Dyslexia is a very broad term defining a learning disability that impairs a person's fluency or comprehension accuracy in being able to read, and which can manifest itself as a difficulty with phonological awareness, phonological decoding, orthographic coding, auditory short-term memory, or rapid...

 and DAMP
Deficits in Attention, Motor control and Perception
DAMP—deficits in attention, motor control and perception—is a controversial psychiatric concept conceived by Christopher Gillberg.DAMP is similar to Minimal Brain Dysfunction , a concept that was formulated in the 1960s. Both concepts are related to certain psychiatric conditions, such as...

. The earlier that difficulties are noted and timely assessments occur, the quicker intervention can begin. A teacher or GP
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...

 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 these will persist into adulthood, as dyspraxia has no cure. Often various coping strategies are developed, and these can be enhanced through occupational therapy, physiotherapy, speech therapy, or psychological training.

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 United States the usual term is childhood apraxia of speech (CAS). Key problems include:
  • Difficulties controlling the speech organ
    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
    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 graphemes – e.g. the letters of the Latin alphabet
    Latin alphabet
    The Latin alphabet, also called the Roman alphabet, is the most recognized alphabet used in the world today. It evolved from a western variety of the Greek alphabet called the Cumaean alphabet, which was adopted and modified by the Etruscans who ruled early Rome...

    , 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 common.
  • Difficulty combining movements into a controlled sequence.
  • Difficulty remembering the next movement in a sequence.
  • Problems with spatial awareness, or proprioception
    Proprioception
    Proprioception , from Latin proprius, meaning "one's own" and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement...

    .
  • Some people with dyspraxia have trouble picking up and holding onto simple objects such as picking pencils and things up, 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 processing disorder
Sensory processing disorder
Sensory processing disorder or SPD is a neurological disorder causing difficulties with taking in, processing and responding to sensory information about the environment and from within the own body .For those with SPD, sensory information may be sensed and perceived in a way that is different from...

, 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. These are commonly associated with autism
Autism
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...

 spectrum conditions.

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 hypotonia
Hypotonia
Hypotonia is a state of 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 dyslexia
Dyslexia
Dyslexia is a very broad term defining a learning disability that impairs a person's fluency or comprehension accuracy in being able to read, and which can manifest itself as a difficulty with phonological awareness, phonological decoding, orthographic coding, auditory short-term memory, or rapid...

 (difficulty with reading and spelling), dyscalculia
Dyscalculia
Dyscalculia is a specific learning disability involving innate difficulty in learning or comprehending simple arithmetic. It is akin to dyslexia and includes difficulty in understanding numbers, learning how to manipulate numbers, learning maths facts, and a number of other related symptoms...

 (difficulty with mathematics), dysgraphia
Dysgraphia
Dysgraphia is a deficiency in the ability to write primarily in terms of handwriting, but also in terms of coherence. It occurs regardless of the ability to read and is not due to intellectual impairment...

 (an inability to write neatly and/or draw) expressive language disorder
Expressive language disorder
Expressive language disorder is a communication disorder in which there are difficulties with verbal and written expression. It is a specific language impairment characterized by an ability to use expressive spoken language that is markedly below the appropriate level for the mental age, but with a...

 (difficulty with verbal expression), ADHD (poor attention span and impulsive behaviour, which up to 50% of dyspraxics may have.), or Asperger syndrome
Asperger syndrome
Asperger's syndrome that is characterized by significant difficulties in social interaction, alongside restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development...

 (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, however many dyspraxics also struggle with maths. Some estimates show that up to 50% of dyspraxics may have ADHD.

Students with Dyspraxia struggle most in visual-spatial memory. When compared to their peers who don’t have motor difficulties, students with dyspraxia are seven times more likely than typically developing students to achieve very poor scores in visual-spatial memory. As a result of this working memory impairment, students with dyspraxia have learning deficits as well.

Some Students with dyspraxia can also have comorbid language impairments (SLI). Research has found that students with dyspraxia and normal language skills still experience learning difficulties despite relative strengths in language. This means that for students with dyspraxia their working memory abilities determine their learning difficulties. Any strength in language that they have is not able to sufficiently support their learning.

Other names

Collier first described developmental dyspraxia as 'congenital maladroitness'. A. Jean Ayres
Anna Jean Ayres
Dr. Anna Jean Ayres , often referred to as "A. 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...

 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 (DCD) - 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.

Notable dyspraxics

Living people who have publicly stated they have been diagnosed with dyspraxia include actor Daniel Radcliffe
Daniel Radcliffe
Daniel Jacob Radcliffe is an English actor who rose to prominence playing the titular character in the Harry Potter film series....

,
photographer David Bailey, Florence Welch
Florence Welch
Florence Leontine Mary Welch is an English singer-songwriter, best known worldwide as the lead singer of Florence and the Machine...

 from Florence and the Machine
Florence and the Machine
Florence and the Machine is the recording name of English musician Florence Welch and a collaboration of other artists who provide music for her voice. Florence and the Machine's sound has been described as a combination of various genres, including rock and soul...

 and actress Hannah McDonnell.

It is difficult to ascertain whether someone now deceased, who was not diagnosed in his/her lifetime, was dyspraxic or not. However, some deceased people suspected to have been dyspraxic include physicist Albert Einstein
Albert Einstein
Albert Einstein was a German-born theoretical physicist who developed the theory of general relativity, effecting a revolution in physics. For this achievement, Einstein is often regarded as the father of modern physics and one of the most prolific intellects in human history...

  (although this is subject to some debate, as some have argued that he may have had Asperger's Syndrome, and others speculating that he had both of these conditions).

Writers suspected to have had the condition include Emily Bronte
Emily Brontë
Emily Jane Brontë 30 July 1818 – 19 December 1848) was an English novelist and poet, best remembered for her only novel, Wuthering Heights, now considered a classic of English literature. Emily was the third eldest of the four surviving Brontë siblings, between the youngest Anne and her brother...

, Charlotte Bronte
Charlotte Brontë
Charlotte Brontë was an English novelist and poet, the eldest of the three Brontë sisters who survived into adulthood, whose novels are English literature standards...

, poet Samuel Taylor Coleridge
Samuel Taylor Coleridge
Samuel Taylor Coleridge was an English poet, Romantic, literary critic and philosopher who, with his friend William Wordsworth, was a founder of the Romantic Movement in England and a member of the Lake Poets. He is probably best known for his poems The Rime of the Ancient Mariner and Kubla...

, G.K. Chesterton, Ernest Hemingway
Ernest Hemingway
Ernest Miller Hemingway was an American author and journalist. His economic and understated style had a strong influence on 20th-century fiction, while his life of adventure and his public image influenced later generations. Hemingway produced most of his work between the mid-1920s and the...

, Jack Kerouac
Jack Kerouac
Jean-Louis "Jack" Lebris de Kerouac was an American novelist and poet. He is considered a literary iconoclast and, alongside William S. Burroughs and Allen Ginsberg, a pioneer of the Beat Generation. Kerouac is recognized for his spontaneous method of writing, covering topics such as Catholic...

 and George Orwell
George Orwell
Eric Arthur Blair , better known by his pen name George Orwell, was an English author and journalist...

.

Helen Burns, a character from Charlotte Bronte
Charlotte Brontë
Charlotte Brontë was an English novelist and poet, the eldest of the three Brontë sisters who survived into adulthood, whose novels are English literature standards...

's Jane Eyre
Jane Eyre
Jane Eyre is a novel by English writer Charlotte Brontë. It was published in London, England, in 1847 by Smith, Elder & Co. with the title Jane Eyre. An Autobiography under the pen name "Currer Bell." The first American edition was released the following year by Harper & Brothers of New York...

, is alleged to have been based on the author's dyspraxic elder sister Maria Bronte
Maria Brontë
Maria Brontë was the eldest daughter of Patrick Brontë and Maria Branwell, a part of the Brontë family, and the older sister of Charlotte, Emily and Anne. She was born in Hartshead, Yorkshire.- Early life and education :...

.

Ross Patrick is alleged to be dyspraxic owing to the semi-autobiographical content of his book Don't Call Me Stupid, which details the life of a dyspraxic teen in education.

External links




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