Signs of Dyspraxia in Children

A child, who experiences difficulties with fine motor tasks such as fastening buttons, handwriting, or tying shoelaces, and gross motor tasks such as catching a ball, climbing stairs and riding a bike, may have an underlying movement difficulty such as Dyspraxia. In the UK around 10% of people are thought to have Dyspraxia with up to 2% being severely affected by the condition. In children, Dyspraxia affects around 5% of school-aged children. 

In this article, we will explain what Dyspraxia and Dyspraxia DCD are, identify the signs and causes of Dyspraxia and examine challenges that children may encounter with Dyspraxia. 

What is Dyspraxia?

Dyspraxia is a term that you may hear when a child struggles with certain skills in development. These skills can include movement and coordination. Dyspraxia is a more commonly used name for a condition that causes children to appear clumsy and uncoordinated compared to other children their age. They frequently drop things, break things, or bump into things. But they might also experience problems with organisation, speech, memory, social and emotional skills, sensory processing, and other skills.

Dyspraxia affects each child differently, and often the effects of Dyspraxia can alter daily. Children with Dyspraxia often find it difficult to get their body to do what they want, when they want to do it, having difficulty with the processes of deciding what physical action needs to be done, how they are going to do it, and then carrying out the action. 

Dyspraxia will affect every part of a person’s life, making it hard for that person to do activities that others will take for granted. The term Dyspraxia has been, and is still often commonly used to describe these difficulties with motor coordination and planning however, the term Developmental Coordination Disorder (DCD) Dyspraxia is the preferred clinical term, especially among medical professionals. As both terms are used interchangeably, we have chosen to provide a more detailed explanation of what Dyspraxia is under the heading below, “What is DCD Dyspraxia?”

What is DCD Dyspraxia?

Developmental Coordination Disorder (DCD) is the term used in latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), to refer to a condition in which an individual has severe difficulties in learning everyday motor skills, which cannot be explained by physical, sensory or intellectual impairment. DSM-5 classifies DCD as a discrete motor disorder under the broader heading of neurodevelopmental disorders. The specific DSM-5 criteria for DCD are as follows:

• Acquisition and execution of coordinated motor skills are below what would be expected at a given chronologic age and opportunity for skill learning and use; difficulties are manifested as clumsiness, such as dropping or bumping into objects, and as slowness and inaccuracy of performance of motor skills such as catching an object, using scissors, handwriting, riding a bike, or participating in sports
• The motor skills deficit significantly or persistently interferes with activities of daily living appropriate to the chronologic age such as self-care and self-maintenance, and impacts academic / school productivity, prevocational and vocational activities, leisure, and play
• The onset of symptoms is in the early developmental period
• The motor skills deficits cannot be better explained by intellectual disability or visual impairment and are not attributable to a neurologic condition affecting movement such as, cerebral palsy, muscular dystrophy, or a degenerative disorder

Neurologically, DCD Dyspraxia affects the Cerebellum; this is tucked behind the brainstem, and is small and roughly shaped like a walnut. Interestingly there are more neurons here than in any other part of the brain, its primary role being to coordinate posture, balance, speech and movement. Those with DCD Dyspraxia experience misfiring between those neurons controlling their voluntary movements, leading to the physical symptoms.

The cerebellum is not the only area of the brain affected; DCD Dyspraxia can also affect the prefrontal cortex (PFC) in the front part of the brain. This is the area of the brain responsible for how we think. It aids in our decision making and planning, as well as time management and how we regulate our emotions. Medical professionals refer to these as our executive functioning. The prefrontal cortex is the last area of the brain to fully mature, this generally happens around 25 – 26 years of age and as such, with a condition such as DCD Dyspraxia, it can be underdeveloped or impaired, making life more of a challenge.

DCD Dyspraxia is a lifelong condition which doesn’t just affect gross motor skills which require whole body movements and involve the large muscles of the body to perform everyday functions, such as standing and walking, running and jumping, and sitting upright, it also affects fine motor skills. These are the ability to make movements using the small muscles in our hands and wrists. We rely on these skills to do key tasks in everyday life such as holding a pen or pencil for writing or drawing, operating a keyboard, using scissors, rulers, and other tools, getting dressed and brushing our hair and teeth. 

DCD Dyspraxia is different for everyone, with each person demonstrating their own strengths and challenges across the following areas:

• Fine and gross motor skills
• Coordination and balance
• Speech
• Organisational skills
• Planning
• Sequencing
• Auditory and verbal processing
• Memory
• Social and emotional skills

Children do not grow out of this disorder, they can however develop strategies to combat symptoms of the condition, and some symptoms may change over time. There are however many strengths that are associated with this condition, such as big picture thinking, problem solving, tenacity, creativity, an eye for detail, and empathy, these are all qualities associated with having DCD Dyspraxia.

Signs of Dyspraxia in children

Signs of Dyspraxia can appear early in children, but they may not be noticed until a child starts school, for others this may happen later, even into adulthood. As we have stated, Dyspraxia is different for everyone however, some of the common signs and features of Dyspraxia that can be observed in children with Dyspraxia include:

• They may be late in reaching normal developmental milestones for example an early sign of Dyspraxia is a child taking longer to roll over, sit, crawl, stand, walk, speak and toilet train. Commonly children with Dyspraxia do not even go through the crawling stage.
• They may seem accident prone, for example they may trip frequently, or bump into things. They may also have poor posture, have difficulties with running, jumping and hopping compared to their peers, and may take longer to initiate movement when presented with a new task as they need time to process and plan. Physical movements and activities are hard to learn for a child with Dyspraxia and are difficult to maintain, so they can appear awkward and clumsy. 
• They may have difficulty with self-care activities such as using cutlery, tying shoe laces, brushing teeth, using scissors and doing up zips or buttons, and may have difficulty with pencil-based tasks such as holding and using a pencil/pen for handwriting, drawing etc. They may require more encouragement and repetition to help them learn new skills than others in their peer group.
• Children with Dyspraxia may have poor spatial awareness showing confusion between left and right, back and front, etc.They may also have perceptual difficulties such as visual perceptual difficulties that result in difficulties with reading fluency, copying and writing, and auditory perceptual difficulties that result in not being able to follow a set of oral instructions or being easily distracted by background sound.
• They may also have difficulties with language, this might include poor expressive language skills, their speech sounds are often not clearly articulated and the child may appear to have difficulties working out how to say specific sounds. Their words are sometimes articulated differently each time they attempt to say the word. Speech can be slow and laboured and they may be slow to respond to a question even if they know the answer.
• Children with Dyspraxia have difficulties getting things organised such as getting themselves ready on time and getting things organised at school for example getting all the equipment needed for an activity. They get distracted easily and can show poor attention to a task, this may appear lazy and non-cooperative when in fact they may not know how to start the activity. 
• A child with Dyspraxia may also have poor self-esteem and confidence often resulting in frustration and anxiety. They may have little awareness of how to act in social settings with other people, finding it hard to pick up on non-verbal communication such as body language. They may avoid socialising with their peers, or may not be included by peers in activities. 
• A child with Dyspraxia can experience anxiety when asked to participate in difficult activities and may seek out younger children to play with as their skills are of a similar level and they feel more confident playing with them. They will often lack interest or motivation to participate in physical activities, or it may be hard to engage in particular activities that they find difficult or that they have experienced failure at.

The symptoms of Dyspraxia can be commonly missed by teachers and GPs, so parents need to be alert for any signs that may be developmental problems and raise these issues with their GP who can arrange for further assessments.

Dyspraxia diagnosis for children

The earlier children with Dyspraxia are diagnosed the greater their potential is for improvement. Dyspraxia is not usually diagnosed in children that are under 5 years of age. However, children with speech or language difficulties may be identified sooner. The assessment for Dyspraxia involves the medical professional taking a detailed account of the child’s developmental history and at what ages developmental milestones such as rolling, sitting, walking were reached. 

Dyspraxia can be diagnosed by professionals including paediatricians, psychologists and learning specialists. More severe cases may be diagnosed by a neurologist, who can determine if a more significant neurological problem is causing the child’s challenges. 

A diagnostic assessment for Dyspraxia should include:

• A review of information from parents, teachers, and the child. It is about how the child manages at home, at school, and during leisure
• A standardised assessment of movement skills. This is often carried out by an occupational therapist and/or physiotherapist
• A developmental history provided by parents/carers
• A medical assessment to rule out other conditions that have similar symptoms, this is because Dyspraxia often overlaps with other types of neurodivergence. This may include Autism, ADHD, and Developmental Language Disorder. Also, Dyspraxia features, such as poor coordination, are seen in other conditions, for example, Cerebral Palsy.

Once the assessment process is complete, the healthcare professionals involved will produce a report on the child’s condition. It is important to get a correct diagnosis so that a better understanding of the child’s problems can be developed, and an appropriate level of support can be offered.

Causes of Dyspraxia in children

The cause of Dyspraxia is still unclear. It is believed that both genetic and environmental factors may play a role. Research suggests that Dyspraxia is caused by an immaturity of neurone development and neural pathways in the central nervous system. Neurones are responsible for providing the brain with information about our physical condition and the environment around us. Constant repetition of movement allows a more refined, controlled movement in response to a stimulus. If there are immaturities in these neurones and their pathways, the result will be difficulties in producing purposeful, co-ordinated and smooth movements. What causes these immaturities in the neurones is yet to be discovered.

Children born prematurely, or with low birth weight are at a higher risk of developing Dyspraxia as these factors can affect brain development in ways that impair motor coordination. Babies, particularly those born before 32 weeks, may experience developmental delays, including in the areas of motor coordination, due to incomplete neural development.

There may also be a genetic component to Dyspraxia, as it can run in families. Children with a family history of Dyspraxia or other developmental disorders are more likely to have the condition themselves. 

Dyspraxia can often co-occur with other developmental or learning conditions such as ADHD, Autism Spectrum Disorder (ASD), or Dyslexia. Although these conditions do not cause Dyspraxia, the presence of these co-occurring conditions may indicate shared underlying neurological differences.

How is Dyspraxia in children treated?

It is not possible to cure Dyspraxia however, through treatment children can learn ways to get around their difficulties so they can achieve their full potential. Dyspraxia is often treated by an occupational therapist, with the goal being to help the child to build stronger motor skills. This will lead to the child making progress towards developmental milestones and other goals such as catching up with their peers.

Some health professionals divide Dyspraxia into different descriptive types, depending on which problems most affect the child. Some of the more common types include:

• Verbal (oromotor) Dyspraxia.
• Constructional Dyspraxia – this is to do with spatial relationships.
• Ideational Dyspraxia – this affects the ability to perform co-ordinated movements in a sequence.
• Ideomotor Dyspraxia – this affects organising single-step tasks.

These different types are all part of the same condition, but focusing on the areas of difficulty may be helpful for therapists trying to find the best strategies to help.

Treatment also focuses on building self-confidence to enable a child to willingly participate in activities by simplifying tasks. Then the therapist helps the child to practice each step and slowly build up to more complicated coordination. The therapist will also educate parents and carers on ways to simplify tasks to the smallest possible components and on how to use simple and concise language for instructions.

Treatment can include identifying accommodations and strategies that a child can use to overcome difficulties, such as a child who has a very hard time tying shoelaces could wear slip-on shoes instead, or a child being allowed to type instead of handwriting.

Introducing strategies such as choosing appropriate clothing such as loose fitting garments, larger buttons, Velcro fastenings, elastic waistbands etc. can all help simplify the task, help to avoid frustration, and can increase a child’s independence. Using cutlery is a skill which will require regular practice, and it can take a few months of regular practice to develop a good habit however, children who continue to have difficulty holding their cutlery in the correct way may benefit from using adapted cutlery. 

Speech assessment and therapy can look in depth at, and determine the child’s strengths and weaknesses in all areas of communication including play and interaction, attention and listening, understanding words and language, using words and language, social communication, pronunciation and talking as well as pre-literacy skills where appropriate. Then working together with parents, the therapists can devise goals and strategies to help develop areas of communication with which the child is having difficulty.

Whatever type of treatment the child is offered, it is important to encourage them to practise the skills being developed, as they will learn through repetition.

Complications of childhood Dyspraxia

In Dyspraxia various areas of a child’s development can be affected and some of the effects of Dyspraxia can continue as the child grows up. The earlier that Dyspraxia is diagnosed and treatment commences, the chance of improvement can be increased, and this will minimise the impact of their Dyspraxia on their everyday life as they get older.

If left undiagnosed and untreated the child with Dyspraxia will have difficulties with for example, but not limited to:

• Participating in activities particularly sporting leading to an inactive lifestyle, increasing the risks of other health related issues such as obesity, diabetes, cardiovascular disease or similar conditions
• Fine motor skills such as writing, drawing and cutting due to poor core stability, meaning they do not have a strong base to support the use of their arms and hands
• Self-regulation and behaviour, as the child is unable to regulate themselves appropriately to settle and attend to a task for extended periods of time
• Accessing the curriculum because they are unable to attend to tasks long enough to complete assessment criteria and difficulty developing literacy skills such as reading and writing and coping in the academic environment

Although Dyspraxia can occur on its own, as we have previously stated, Dyspraxia can also co-occur with other conditions, and this can cause complications as the combination of these conditions can exacerbate difficulties, making intervention and support more complex, for example, for a child who has ADHD and Dyspraxia. ADHD might impair a child’s ability to focus on instructions, whilst Dyspraxia complicates executing the necessary motor tasks. The child may struggle with both written tasks due to their Dyspraxia and have difficulties staying on task or completing work due to their ADHD.

The combined effects of Dyspraxia and other co-occurring conditions can lead a child to have low self-esteem, and behavioural issues; they may also experience fatigue and stress having to deal with multiple difficulties.

Treating and managing dyspraxia alongside co-occurring conditions requires a multidisciplinary approach such as occupational therapy, behavioural therapy and psychological support, and speech and language therapy.

Succeeding at school with Dyspraxia

Enabling all children to achieve their potential at school is the goal of all educators. Children with Dyspraxia may experience difficulties with handwriting legibility, organisation in the classroom, visual processing and physical education, and may struggle with certain aspects of their education which can impact social skills, peer relationships and self-esteem.

There are a variety of approaches and techniques which can be used to help children with Dyspraxia to overcome difficulties at school. Each child’s requirements, needs and abilities will need to be considered individually in order to unlock their potential. Educational and health professionals will need to work together to improve the functional skills of children with Dyspraxia, aiming to increase a child’s ability to carry out daily tasks effectively. 

Support can come in the form of adaptations to equipment, specific exercise, and strategies or advice and support for educational staff. One of the most useful things that staff at primary school can do, is to help pupils with Dyspraxia understand and articulate their own strengths and difficulties, and to identify the tools and strategies that work for them. This will help a child to know when to ask for help, and who to approach to help them access the adjustments they need to be successful in education. Feeling understood and empowered, and having a positive sense of agency will also support the child’s mental health and wellbeing.