What is Dyspraxia?

Dyspraxia, also known as developmental coordination disorder (DCD), is a disorder affecting fine and gross motor coordination. It is a neurological disorder that impacts a person’s ability to plan, process and perform motor tasks. Dyspraxia is caused by the brain not processing information properly. Neural messages are not transmitted fully, causing difficulty in planning and organising movement.

A person with dyspraxia may encounter problems with movement, coordination, spatial awareness, perception, memory and processing. Dyspraxia can also affect an individual’s immune system and nervous system. In many situations, dyspraxia can also affect a person’s speech or cause speech difficulties. Although dyspraxia does not affect an individual’s intelligence, because of the many difficulties a child with dyspraxia may face, they may experience learning problems or a learning delay.

Dyspraxia is recognised in children and adults and is a lifelong condition. Symptoms can vary widely from person to person. Symptoms may also change over time and improve or worsen depending on several factors, including life experiences, environmental demands and coping strategies.

Although many people remain undiagnosed, it is thought that dyspraxia affects up to 10% of the population, with 2% experiencing severe symptoms. It is thought to affect boys 3 to 4 times more frequently than it affects girls. However, there is some debate as to whether this gender disparity is at least in part due to boys being more likely to receive a diagnosis than girls.

Even though there is no one specific known cause of dyspraxia, there are several risk factors that may make a diagnosis more likely.

• Premature birth – usually before 37 weeks gestation.
• Being born with a low birth weight.
• A mother drinking alcohol excessively or taking drugs during pregnancy.
• If other family members also have dyspraxia. It is not known why a genetic link may be present.

Dyspraxia has been linked with several other conditions:

• Dyslexia – A research study by Kaplan (1998), found that symptoms of dyspraxia were seen in 52% of children already diagnosed with dyslexia.
• Attention Deficit Hyperactivity Disorder (ADHD) – ADHD and dyspraxia are both linked with executive function difficulties. For this reason, they are thought of as coexisting disorders and are often diagnosed together.
• Autism Spectrum Disorder (ASD) and Asperger’s Syndrome – Some individuals with these conditions also have difficulties with movement, coordination and organisation, so may also receive a diagnosis of dyspraxia.

What are the signs and symptoms?

Dyspraxia has a wide range of symptoms, and these symptoms can vary significantly depending on the age of the individual. This can make dyspraxia difficult to diagnose, as many of the symptoms can also be attributed to other conditions.

Babies and young infants 

• Delays in hitting early developmental milestones, such as rolling over and sitting up unaided.
• Feeding and sleeping problems.
• Demonstrating unusual body posture.
• An unusually high amount of movement of their arms and legs.
• Difficulties or delays when learning to crawl, walk, feed themselves and get dressed unaided.

Children

As an individual with dyspraxia grows, symptoms are likely to change significantly. Once a child begins school, symptoms may become more apparent.

Children with dyspraxia are likely to experience problems with movement and coordination.

• Difficulty with fine motor skills such as writing, drawing, painting and using scissors. Their handwriting may be illegible or difficult to read.
• Difficulty with coordination, which may affect their gross motor skills. They could demonstrate difficulties with activities such as jumping, running, hopping, skipping and catching or kicking a ball. Hand-eye coordination is also a common symptom. This can affect their ability to participate in sports, playground games and PE lessons.
• Speech difficulties. This could include poor expressive language, difficulty saying certain speech sounds and difficulty responding to questions.
• Difficulty getting dressed independently. Buttons, zips, and shoelaces may present particular issues.
• Difficulty keeping still. Children may appear to constantly fidget, flap their hands or swing their arms and legs.
• Difficulty going up and down stairs.
• Children with dyspraxia may appear clumsy. Others are likely to observe them walking into furniture, frequently dropping things, and falling over.
• Poor spatial awareness and showing difficulties with directions.

As well as difficulties with movement and coordination, children with dyspraxia may also experience difficulties in other aspects.

• Difficulty concentrating or a short attention span. This may be particularly evident during tasks they find difficult.
• A lack of organisational skills.
• Difficulty remembering or following instructions. This may be particularly evident in school.
• Encountering significant problems when trying to learn new skills. Children with dyspraxia may be more likely to give up and will need encouragement, reassurance and repetition to help them master the skill.
• Difficulties learning new routines or remembering sequences.
• Low self-esteem. This could be as a result of the embarrassment or anxiety they feel about their symptoms and the lack of understanding and awareness that other people have about dyspraxia.
• Exhibiting behaviour that challenges. This could be a result of their frustration with their symptoms.
• Difficulty making friends or social isolation. Children with dyspraxia are more likely to experience bullying and may avoid situations where their symptoms will be particularly evident.
• Not picking up on social cues such as facial expressions, body language etc.
• Demonstrating anxiety, embarrassment or refusal when asked to perform certain tasks.
• Mental health difficulties that may occur as a result of their experience of dyspraxia. For more information about mental health problems in children, consult our knowledge base.

Adults

Symptoms of dyspraxia in adults can be widely varied. Symptoms usually change over time and may be environmentally based. Furthermore, adults often develop coping strategies in areas they find difficult or implement avoidance tactics and rarely partake in activities they may find challenging, such as sport or art.

Symptoms of dyspraxia in adults may include:

• Issues with coordination, hand-eye coordination and fine motor skills.
• Difficulties with movement, balance and other gross motor skills.
• Abnormal posture.
• Difficulty coordinating both sides of the body.
• Regularly experiencing tiredness and fatigue.
• Difficulties learning new skills.
• Difficulties remembering information and instructions. This can present a particular problem at work.
• Poor memory skills.
• Concentration difficulties.
• Poor writing or typing skills.
• Poorly established dominant hand.
• Problems with organisation and planning. This can include difficulties with time management.
• Poor life skills on a daily basis. This may include difficulties dressing, self-grooming, cooking and performing household chores.
• Oversensitivity or under sensitivity to light, noise, touch, smell and taste.
• Poor sense of direction.
• Slow to adapt to new situations or environments.
• Social awkwardness or social isolation.

Adults with dyspraxia may be more likely to experience depression and anxiety. They may also be prone to low self-esteem, obsessions, phobias and addictive behaviour.

The effects of dyspraxia

The difficulties that an individual with dyspraxia faces can affect every aspect of their lives. Children may face difficulties in school and adults may face difficulties in work. The emotional impact of dealing with the symptoms of dyspraxia and the social isolation that some individuals feel can result in mental health difficulties. Anxiety and depression are fairly common in individuals with dyspraxia.

The Dyspraxia Foundation reports that “there is increasing evidence of associated anxiety, depression, behavioural disorders and low self-esteem in children, teenagers and young adults with dyspraxia”.

The associated mental health difficulties that people with dyspraxia are experiencing could be a result of several significant factors:

• Anxiety, related to feelings of fear or embarrassment.
• Anxiety about learning new skills or being unable to do the same activities as their peers.
• Feelings of inadequacy.
• Feelings of tiredness and fatigue that may be associated with dyspraxia.
• Social isolation.
• Experiences of bullying in school or the workplace.
• Low confidence and self-esteem.
• Associated communication difficulties.
• Anger and frustration directed at their condition.
• Lack of educational, physical and emotional support.
• Lack of understanding of the condition from other people.

Teenagers with dyspraxia are significantly more likely to experience social and emotional difficulties compared to their peers. Similarly, adults with dyspraxia often experience social isolation and find it more difficult to succeed in the workplace. Maintaining a job for a significant period of time can be difficult for individuals with dyspraxia.

The effects of dyspraxia can be seen in children, teenagers and adults. Aside from the symptoms we have already looked at, the effects of dyspraxia may include:

• Exhibiting behaviour that challenges – Frustration can result in outbursts or aggression, especially in children and teenagers.
• Disengagement from activities or refusing to partake in activities – This could be because of embarrassment or anxiety.
• Social isolation from peers – This can include having no significant relationships, avoiding social situations, and having few or no friends. This effect can be seen in individuals of all ages.
• Social withdrawal as a result of fatigue – The physical and cognitive effort that people with dyspraxia exhibit throughout the day and the extra energy they use can result in extreme tiredness. Many individuals will want to rest or sleep after finishing work or school, resulting in them withdrawing from social events.
• Difficulty regulating emotions – This can be a result of fatigue, stress or the sensory overload that people with dyspraxia often experience.
• Exhibiting addictive behaviour – Some people with dyspraxia experience obsessions and addictive behaviour, which can be particularly problematic for teenagers and adults. The obsession or addiction could be something physically harmless, but may still have a negative impact on the individual’s life. Alternatively, some people with dyspraxia may become addicted to alcohol or drugs.

It is important to note that the effects of dyspraxia can vary greatly from one person to the next. Some individuals may find that having dyspraxia has little or no negative effect on their life, whereas others may find that dyspraxia has a significant impact on their lives.

Diagnosis

If you think your child has dyspraxia, talk to your GP, health visitor or the Special Educational Needs Co-ordinator (SENCO) at your child’s school. Alternatively, if you are an adult and you believe that you have undiagnosed dyspraxia, arrange an appointment with your GP and explain your symptoms.

Your GP will then refer you to another healthcare professional, who can conduct an assessment and make a formal diagnosis. For children, a diagnosis cannot usually be made until a child is 4 or 5 years old so your GP may not make a referral until your child reaches this age.

Healthcare professionals who can conduct an assessment include:

• Occupational Therapist.
• Physiotherapist.
• Clinical Psychologist or Child and Adolescent Mental Health Services (CAMHS) clinician.
• Educational Psychologist (children only).
• Paediatrician (children only).

Occasionally, the healthcare professional may also enlist the services of a neurodevelopmental paediatrician or a neurologist. They can assist in ruling out any other conditions that may be causing the symptoms and will provide further expertise on the neuro aspect of dyspraxia.

During the assessment, your child will undergo a norm-referenced assessment of their motor skills. This will likely involve a Movement Assessment Battery for Children (Movement ABC) test. This tool is used to identify any impairments in motor development and how these impairments are impacting your child.

During the test, the healthcare professional will focus specifically on:

• Gross motor skills.
• Fine motor skills.
• The impact of movement difficulties in the school environment.
• The impact of movement difficulties at home.
• The impact of movement on the child’s physical function.
• Any social or behavioural implications.

For more information regarding Movement ABC, visit here.

The healthcare professional will also want to know your child’s medical history, including when you first noticed symptoms and whether there were any developmental delays. If your child meets the criteria, a formal diagnosis will be made, and a report will be sent to you.

Treatment

There is no cure for dyspraxia. However, treatment can help an individual to manage their symptoms. The earlier a diagnosis is made, the more successful treatments are likely to be. Once a diagnosis has been made, healthcare professionals will work together to create a treatment plan specific to the individual’s needs. This treatment plan is likely to involve several specialists and different therapies.

Occupational Therapist (OT)

Both children and adults are likely to receive support from an occupational therapist. An OT will evaluate how you manage everyday functions and tasks. They will then work with you to find practical ways to overcome any difficulties you face and to become as independent and successful as possible.

A paediatric occupational therapist will evaluate how well a child with dyspraxia copes with everyday activities at home and school. They will then work with the child, their parents/carers, and their teachers to find ways to manage the difficulties and help the child to develop the necessary skills. A child with dyspraxia may need OT intervention regularly, as the difficulties they face are likely to change as they grow.

OT treatment may include a task-oriented approach or a process-oriented approach.

• Task-Oriented Approach – This is the most popular approach for treating dyspraxia in the UK. It involves working with the individual to identify the specific tasks or activities that they find difficult and then working together to find ways to overcome the difficulties. Sometimes, the task will be broken down into small, easier-to-manage steps. The individual can then practise each step separately and work on the individual movements that are required. Alternatively, tasks can be adapted to make them easier for the individual. For example, those who experience writing difficulties may be given special grips that can be added to a pen or pencil or a writing slope to help with the task.
• Process-Oriented Approach – This approach works particularly well for individuals who find tasks more difficult as a result of their senses or their perception of their own bodies. This approach differs from a task-oriented approach as it encourages the all-round development of the individual’s gross motor skills. Rather than focusing on specific skills that the individual struggles with, they will be encouraged to do regular activities focused on improving their general movement.

Physiotherapist

A physiotherapist can help an individual with specific activities they find challenging. This could include walking, balance and overall coordination.

Speech and Language Therapist (SLT)

A SLT will only be involved in the treatment plan if the individual experiences language or communication difficulties. They will conduct a speech and language assessment and work with the individual to overcome or improve any speech difficulties they face.

Cognitive Behavioural Therapy (CBT)

CBT can help individuals to manage any problems they face as a result of their dyspraxia. This could include mental health difficulties, issues with behaviour and regulating emotions, social isolation and any negative thoughts they experience.

Educational Psychologist

If dyspraxia is having a negative impact on a child’s education, an educational psychologist will be part of the treatment plan. The difficulties the child faces in the school environment or any emotional, psychological, social or behavioural factors that are impacting the child’s education can be addressed by the educational psychologist.