Developmental dyspraxia

Developmental dyspraxia

ICD-10	F82
ICD-9	315.4
OMIM	[1]
DiseasesDB	31600
MedlinePlus	[2]
eMedicine	/
MeSH	{{{MeshNumber}}}

Developmental dyspraxia, also known as developmental coordination disorder (DCD), is a developmental disorder affecting the initiation, organization and performance of action. It impedes the ability to coordinate and perform certain purposeful movements and gestures.

The concept of developmental dyspraxia has existed for more than a century, but differing interpretation of the terminology remains.

Art by MissLunaRose, an autistic and dyspraxic artist

Developmental dyspraxia is a lifelong condition that is more common in males than in females. Current estimates range from 5% - 20% with at least 2% being affected severely.

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 neuron 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:

1. Ideational dyspraxia: Difficulty with planning a sequence of coordinated movements.
2. Ideo-Motor dyspraxia: Difficulty with executing a plan, even though it is known.

Epidemiology

Developmental dyspraxia is a lifelong neurological condition that is more common in males than in females, with a ratio of approximately four males to every female.

Dyspraxia is a diagnosis of exclusion. Since there is no specific test for it, experts must rule out other conditions like cerebral palsy, muscular dystrophy, multiple sclerosis, or Parkinson's disease first. This makes it hard to know exactly how many people have dyspraxia. Experts estimate that around 5–6% of children are affected by this condition.

Assessment and diagnosis

Assessments for developmental coordination disorder typically require a developmental history, detailing ages at which significant developmental milestones, such as crawling and walking, 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 typical 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, and deficits in attention, motor control and perception (DAMP). The earlier that difficulties are noted and timely assessments occur, the quicker support 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."

Signs

Dyspraxic people may experience developmental delays. Impairments will persist into adulthood. However, they may develop coping strategies through therapy, family/educational support, and/or individual experimentation.

The ICD-11 defines it as follows:

6A04 Developmental motor coordination disorder Developmental motor coordination disorder is characterised by a significant delay in the acquisition of gross and fine motor skills and impairment in the execution of coordinated motor skills that manifest in clumsiness, slowness, or inaccuracy of motor performance. Coordinated motor skills are substantially below that expected given the individual's chronological age and level of intellectual functioning. Onset of coordinated motor skills difficulties occurs during the developmental period and is typically apparent from early childhood. Coordinated motor skills difficulties cause significant and persistent limitations in functioning (e.g., in activities of daily living, school work, and vocational and leisure activities). Difficulties with coordinated motor skills are not solely attributable to a Disease of the Nervous System, Disease of the Musculoskeletal System or Connective Tissue, sensory impairment, and not better explained by a Disorder of Intellectual Development.

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. In the USA the usual term is apraxia of speech. Key problems include:

• Difficulties controlling the speech organs.
• Difficulties making speech sounds
• Difficulty sequencing sounds
  • Within a word
  • Forming words into sentences
• Difficulty controlling breathing and phonation.
• 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, as well as numbers.
• Establishing the correct pencil grip
• Hand aching while writing (dysgraphia).

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 are affected. Problems associated with this area may include

• 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.
• Trouble picking up and holding onto simple objects such as pencils, owing to poor muscle tone and/or proprioception.
• Clumsiness, potentially including knocking things over and bumping into people accidentally.
• Trouble figuring out left vs. right
• Poor sense of direction
• Cross-laterality, ambidexterity, and a shift in the preferred hand
• Problems with chewing foods
• Associative movement (unused body parts twitching while another moves, e.g. other fingers twitching while the person raises one finger)
• Trouble determining the distance between themselves and other objects.

Judging speed and distance can also be difficult. This may affect their ability to navigate crowds, cross streets, and learn to drive a car.

Sensory difficulties

Dyspraxic people may have Sensory Integration Dysfunction, a condition that creates 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)
• Discomfort when someone touches them (in the case of touch oversensitivity)
• Use of sunglasses to block out bright lights (for visual oversensitivity)
• Avoiding loud music and environments like clubs or bars (for auditory oversensitivity)
• Discomfort in hot or cold environments (for temperature oversensitivity)
• Not realizing when they are injured (for pain undersensitivity)

Some dyspraxic people may be oversensitive to some stimuli and undersensitive to others.

Sensory hypersensitivity can be overwhelming. Some dyspraxic people may experience sensory overload, which may resemble a panic attack.

Fatigue

Difficulty with doing physical tasks can lead to fatigue since it takes more energy to do things correctly. Some develop hypotonia (low muscle tone), which reduces their strength and endurance. Thus, even small physical activities may quickly cause soreness and fatigue, depending on the severity of the hypotonia. It may also impede their balance.

Memory

In addition to the physical impairments, developmental coordination disorder 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. Many dyspraxics benefit from working in a structured environment, as repeating the same routine minimizes difficulty with time-management and allows them to commit procedures to long-term memory.

However, many dyspraxics have excellent long-term memories, despite poor short-term memory.

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. This can affect their learning.

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.

Overlap with other conditions

Many people with dyspraxia have co-occurring conditions. This is sometimes referred to as comorbidity. Many people with dyspraxia will also experience one or more of the following:

• ADHD (trouble regulating attention, sometimes with impulsive behaviour) Some estimates show that up to 50% of dyspraxics have ADHD.
• Autism (social, sensory, and behavior differences)
• Dyscalculia (difficulty with mathematics)
• Dyslexia (difficulty with reading and spelling)
• Dysgraphia (an inability to write neatly and/or draw)
• Sensory processing disorder
• Specific language impairment (SLI, difficulty learning language)

However, one individual is unlikely to experience all of these. While some dyspraxic people may struggle with a specific area (e.g. reading or math), others may be average or gifted in these areas.

Similarly, some have autistic traits such as lacking an appreciation of irony or social cues. Others thrive on an ironic sense of humour as a bonding tool and a means of coping.

Support

Dyspraxic people may benefit from occupational therapy, physical therapy, and/or speech therapy. Mental health counseling may be appropriate for those who struggle with self-esteem or mental health issues.

Other names

Collier first described developmental dyspraxia as 'congenital maladroitness'. A. Jean Ayres referred to it as a disorder of sensory integration in 1972. Names no longer in use include "clumsy child syndrome" (used by Dr. Sasson Gubbay in 1975) and "minimal brain dysfunction." Other names include:

• Dyspraxia
• Developmental Coordination Disorder (DCD)
• 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 developmental coordination disorder include actor Daniel Radcliffe, photographer David Bailey, Florence Welch from Florence and the Machine, and actress Hannah McDonnell.

Writers suspected to have had the condition include Emily Brontë, Charlotte Brontë, poet Samuel Taylor Coleridge, G.K. Chesterton, Ernest Hemingway, Jack Kerouac and George Orwell.

Helen Burns, a character from Charlotte Brontë's Jane Eyre, is alleged to have been based on the author's dyspraxic elder sister Maria Brontë.

See also

• Apraxia
• Deficits in attention, motor control and perception
• Motor coordination
• Motor skills disorder
• Movement disorders
• Sensory-motor coupling
• Working memory

External links

• Dyspraxia Foundation
• DANDA The Developmental Adult Neuro-Diversity Association
• United States organization for those with Developmental Dyspraxia
• [3]Dyspraxia page for people in Scotland