Dyspraxia: Is your child clumsy? A reason for this could be this condition

Dyspraxia. It is commonly seen nowadays: On the one hand, you have the group of children that seems to be able to have no problems picking up new tasks quickly, dominate several kinds of sports at once or manage to perform well the tasks involving fine motor movements. In school, these kids also somehow manage to get good grades even though the effort they put in is below average.
On the other hand, we see children of the same age having difficulties doing any of these things listed above and are therefore simply considered clumsy or stupid. As a consequence, they are laughed at by their peers. Performing worse in such tasks do not necessarily have an origin in the lack of discipline or repetition, but those inabilities could as well be a reason for a developmental disorder: dyspraxia (also: developmental coordination disorder or DCD).

What is dyspraxia?

The term dyspraxia indicates a problem with “praxis” referring to an impairment of planning and executing physical movements.

The problem of dyspraxia dates back to the beginning of the 20^th century. For the same condition, however, different terms were used throughout the decades. While in 1925 the term debilite mortice (motorically deficient) came up, in 1962 the same disorder was simply referred to as Clumsy Child Syndrome. As the term implies, it described to be found in clumsy children  which refers to a previous paper published in the 1940s describing the child as follows:

“… awkward in movements, poor at games, hopeless in dancing and gymnastics, a bad writer and defective in concentration. He is inattentive, cannot sit still, leaves his shoelaces untied, does buttons wrongly, bumps into furniture, breaks glassware, slips off his chair, kicks his legs against the desk, and perhaps reads badly.”

Nowadays the condition is known by the name dyspraxia or DCD (Developmental Coordination Disorder), with the former being used more frequently in the UK and the latter being the more formal and international term according to the WHO.

The organization states an incidence rate of 6% in all children however the degree of symptoms varies from patient to patient significantly. Nevertheless, it has to be noted that this number does most likely not reflect the true incidence rate. Only the children in which difficulties have been recognized and classified as dyspraxia are taken into account in the statistics which makes a true estimation rather difficult. However, it is reported boys to be more likely affected than girls by the disorder.

Signs and symptoms of dyspraxia:

A quick checklist

 The symptoms of dyspraxia are dependent on the age of the child and therefore have to be checked for each age group individually.

By the age of 3, children are likely to exhibit one or more of the following symptoms:

• Significant feeding problems
• Slower in reaching milestones in development (e.g. independent sitting by the age of 8 months)
• Failure to go through crawling stages
• Are repelled by tasks involving good dexterity

Children before entering school (3 years to 5 years): 

• Poor fine motor skills (difficulty using scissors or holding a pencil)
• No apparent right (or left) hand dominance
• Messy eating (prefer using the hands and frequently spill drinks)
• When running, their hands flap
• No sense of danger

Children with dyspraxia at the age of 7: 

• Unable to tie shoes alone
• Take longer to get dressed
• Difficulties to adapt to the hours of school (establishing a routine in general)
• Need more time to complete class work
• Sleeping difficulties

For all age groups, the possibility exists that more symptoms could present themselves than the ones found in this list as it is only a collection of the most common symptoms associated with dyspraxia. Symptoms which do not appear in the list are for instance the psychological side effects. Dyspraxia is also not just a problem in children but in adults where symptoms can extend from difficulty listening to people, impulsiveness to anxiety and depression, leading towards secondary complications. In the section of “comorbidities” these problems will be listed.

Does my child have dyspraxia?

First of all, definite diagnoses for dyspraxia are difficult to make when the child is younger than 4 or 5 years. However, when they have reached this age, an assessment can be made using the following diagnostic criteria:

1. The general motor performance is below average when compared to peers. Basic motor skills such as catching, throwing, kicking etc. are impaired.
2. The impairments mentioned in “A” lead to persistent interferences with activities in everyday life and school.
3. The symptoms are visible in the early stages of development.
4. The symptoms are not due to mental disability or visual impairment. There is no connection to a neurological condition affecting movement.

What causes dyspraxia?

Dyspraxia can either gradually develop from birth or present itself suddenly e.g. due to a stroke or other trauma (acquired dyspraxia).

The exact cause of dyspraxia has not been revealed yet. As the co-ordinated movements involve the interplay of many different muscles at once, it becomes difficult to pinpoint the defective nerves and the parts of the brain responsible for the impairment. One finding to explain the impairments of children with dyspraxia involves the difficulty in learning and failure to adapt the internal models. Normally, these models are crucial when it comes to linking information from the body sensors (such as muscles, eyes, joints) with the motor commands to activate muscle contractions (the prerequisite for movement). To perform any meaningful action, these muscle contractions have to be mobilized in the correct order, at the right time and with the adequate force. It is the interplay of those factors that make a simple movement successful such as lifting up a glass to take a sip of water. Healthy individuals learn these internal models automatically through repetitions; both their speed and accuracy in executing the correct movements become higher. Dyspraxia patients however, require additional guided practice to successfully perform the same actions.

Dyspraxia-what goes wrong?

There have been great advances over the decades regarding the nature of the disorder.

Today scientists generally agree on motor neurons not developing fully to be the primary cause rather than one damaged brain area. These neurons do not form proper connections and are less effective in doing their job: The transmission of electrical signals from the brain to the muscles.

If clinicians take a close look at the brains of these patients and compare them to a normal healthy brain they would not find any deviations. The combination of the neurons being too small and the very fast processes between the neurons make interventions on the neuronal level impossible. The fact it is often seen to run in families makes a genetic cause a probable explanation though. Like with many disorders and when a sound explanation remains to be found we can only speculate and provide society with risk factors.

Risk factors for dyspraxia

• Child is born prematurely (born before 37 weeks of pregnancy)
• Low weight at birth
• Consumption of alcohol, nicotine or abusive drugs of the mother when pregnant
• A family history increases the risk for dyspraxia

Disorders associated with dyspraxia?

People with dyspraxia might have to deal with several complications directly connected to the condition, however, the spectrum and severity of the comorbidities vary from person to person and is not to be generalized. Here is a list of likely disorders that patient could experience alongside dyspraxia:

• Autistic traits: Unlike fully autistic people, patients have the wish to connect with their peers. The problem is their lack of social skills as they have emotional problems such as reading body language and failure to understand non-literal language (sarcasm, idioms, etc.)
• Dyspraxics might be insomniacs. Their brains are always active even if there is no need to. An easy distractibility can be seen in the patients and they can get lost in a meaningless thought.
• Many individuals experience short-term memory issues leading them to misplace items or forget important deadlines.
• A few patients experience sensory integration dysfunction, a condition where physical stimuli are perceived stronger or weaker. As a result, dyspraxics are sometimes seen consistently wearing sunglasses outside in the case of light oversensitivity.

As mentioned before dyspraxia can be diagnosed as an adult, watch the following video about living with dyspraxia at work.

Treatment of dyspraxia

Generally speaking, treatment is essential if one wants to see improvements in the patient’s symptoms and if applied effectively it proves to have a high success rate. Parents are best advised to first take their child to the GP to evaluate the symptoms. The GP will decide on the relevant professionals. In the case of dyspraxia, they are a pediatrician, occupational therapist, physiotherapist and speech, and language therapist. This diversity in professionals is necessary as the dyspraxics’ symptoms can be quite broad (the motor symptoms are assessed by the occupational therapist and the physiotherapist whereas the impairments in speech are evaluated by the speech and language therapist). Each of the professionals alone, however, is not able to give a definite diagnosis but can only contribute helping along the process. Once the patient receives the diagnosis, a number of opportunities exist to increase the patient’s quality of life. It is important to note even though the strategies may be effective for some children, big variations in progress can be seen and parents should not lose their patience with their child. Here we have compiled 4 strategies that professionals conduct to combat dyspraxia.

1. Sensory Integrative Treatment: This is a technique with the goal to improve the child’s body awareness and where it is positioned in space. The therapist uses special equipment helping the patient to have greater opportunities to take in sensory information (touch, deep pressure, visual information and movement experiences). When doing the tasks, great emphasis is put on meaningful actions so the child sees a connection to tasks in daily life.
2. Perceptual Motor Approach: A procedure where the child practices specific tasks over and over with gradual increasing difficulty. Both gross motor and fine motor skills are trained and the processes become automatized.
3. Cognitive Goal Directed Approach: The patient learns problem-solving skills through identifying, developing and using cognitive strategies. This allows the child to perform daily activities more effectively.
4. Speech therapy: This therapy is for targeting the speech impairments. The first part involves the presentation of the different sounds and how they change the meaning of the word. After the child is aware of the fine deviations, he/she attempts to produce given sounds using various and verified speech exercises.

5 Tips for parents

• Enhance perceptual & spatial skills with games like a jigsaw, block building or mazes.
• Play pretend e.g. the child is a rabbit jumping around the house.
• Teach the correct pencil grip early on.
• Improve fine motor skills such as drawing, painting, coloring or dot-to-dot.
• And most importantly: Don’t wait that he/she will improve on his/her own! If training is started early in development, there is a high chance that your child will live symptom-free later on.

Known people with dyspraxia

If you get the impression that your child will not be happy and will not be able to lead a successful life, later on, think again! Dyspraxia was diagnosed to be present also for the following people that we have all seen once or twice. No one would have thought of these individuals to have dyspraxia as their symptoms are/were barely visible to non-existent:

• † Albert Einstein
• Bill Gates
• Daniel Radcliffe
• † Isaac Newton
• † Pablo Picasso
• Richard Branson
• † Robin Williams
• Stephen Fry

If you think your child or you might suffer from dyspraxia, consult your physician. We hope you like the article and feel free to leave a comment below.

Patrick Agresz

Patrick has completed a Master in Cognitive Neuroscience and is currently doing an online course in journalism. His aim is to inform the general public about science-related topics. He looks to achieve this by keeping his work simple, yet precise and informative for everyone.