Dyspraxia
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| ICD-10 | F82. |
|---|---|
| ICD-9 | 315.4 |
Dyspraxia is the generic term used to cover a heterogeneous range of disorders affecting the initiation, organization and performance of action[1]. It is an immaturity of the way the brain processes information, resulting in messages not being fully transmitted to the body and is a learning difficulty that can be present from birth (developmental dyspraxia) or as a result of brain damage suffered from a stroke or other trauma (acquired dyspraxia).
Developmental dyspraxia is a life-long developmental coordination disorder (DCD) that is more common in males than in females, and has been believed to affect 8% to 10% of all children (Dyspraxia Trust, 1991). 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 bad and "praxis", meaning action or deed.
Part of a continuum of related disorders, dyspraxia is also known as developmental coordination disorder, and may also be present in people with autism spectrum disorder, dyslexia and dyscalculia, among others. 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.
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[edit] Assessment and diagnosis
Assessments for dyspraxia 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 normal rates of development may help to establish areas of significant difficulty.
[edit] Developmental Profiles
There are six main areas of difficulty which can be profiled within dyspraxia; the four main areas are listed below:
[edit] Speech and language
Developmental verbal dyspraxia is a type of ideational dyspraxia, causing linguistic or phonological impairment. 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.
[edit] 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
[edit] Whole body movement, coordination, and body image
Issues with fine motor coordination mean that major developmental targets include walking, running, climbing and jumping. One area of difficulty involves associative movement, where a passive part of the body moves or twitches in response to a movement in an active part. For example, the support arm and hand twitching as the dominant arm and hand move, or hands turning inwards or outwards to correspond with movements of the feet. Problems associated with this area may include:
- Poor timing
- Poor balance
- Difficulty combining movements into a controlled sequence.
- Difficulty remembering the next movement in a sequence.
[edit] Physical play
Difficulties in areas relating to physical play may lead to dyspraxic children standing out from their peers. Major developmental targets include ball skills, use of wheeled toys and manipulative skills, including pouring, threading and using scissors.
- Problems with spatial awareness, or proprioception
- Mis-timing when catching
- Complex combination of skills involved in using scissors
The other two developmental profiles concern dressing and feeding.
[edit] General difficulties
Due to poor muscle control, many people with dyspraxia have trouble picking up and holding onto simple objects [2] -- quite often, objects literally slip through a dyspraxic's fingers. This disorder causes an individual to be clumsy to the point of knocking things over and bumping into people accidentally. Tripping over one's own feet is also not uncommon, as is a poor sense of balance in general. [3]
Dyspraxics often have difficulty in determining left from right, and this may cause problems that persist through life[citation needed]. Cross-laterality, ambidexterity, and a shift in the preferred hand are also common in people with dyspraxia[citation needed].
Some people with this condition have poor spatial awareness in that it may be difficult to determine the speed and position of a particular object, such as potentially a baseball. Dyspraxics may also have trouble determining the distance between them and other objects.
Dyspraxic people may have Sensory Integration Dysfunction, a condition that creates abnormal oversensitivity or undersensitivity to physical stimuli, such as touch, light, and sound [citation needed]. This may manifest itself as an inability to tolerate certain textures such as sandpaper or certain fabrics, 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 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. This typically occurs if the dyspraxia is comorbid to an autistic spectrum disorder (PDD) such as autistic disorder or Asperger syndrome [citation needed]. Otherwise, these symptoms tend not to be present in the individual who has dyspraxia[citation needed].
Dyspraxic people 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[citation needed]. Having other autistic traits (which is common with dyspraxia and related conditions[citation needed]) may also contribute to sensory-induced panic attacks.
Dyspraxics (along with people who have similar conditions on the Autistic spectrum) may have difficulty sleeping since there is an inability to force the brain to stop thinking and "shut down"[citation needed]. A dyspraxic is nearly always thinking about several unrelated things at once, (the inverse is also possible, with only one dominant thought occupying the dyspraxic's entire attention span at any given time) so this may cause easy distractability and daydreaming[citation needed]. It is quite easy for someone with dyspraxia to concentrate entirely on a particular thought instead of on the situation at hand. For this reason, dyspraxia may be misdiagnosed as ADHD since on the surface both conditions have similar symptoms in some areas[citation needed]. Many people with dyspraxia have short-term memory issues and may forget instructions they received only seconds before, tend to forget important deadlines, and are constantly misplacing items[citation needed].
People with dyspraxia can have generally poor social skills due to emotional problems and/or a limited ability to 'read' situations and people's body language. [4] They may have a literal use of language and so find it hard to understand phrases, idioms and/or sarcastic conversation [5]. People with dyspraxia are not purely autistic in the sense that they normally desire to interact with others but merely lack the ability to do so to some extent[citation needed]. Due to this inability to understand other people, most dyspraxics find themselves alone because it may be more comfortable for them[citation needed]. This inability to be around and relate to other people may cause severe frustration in a dyspraxic that may manifest as unusual emotional immaturity in childhood[citation needed].
Moderate to extreme difficulty doing physical tasks is experienced by dyspraxics, and fatigue is common because so much extra energy is expended while trying to execute physical movements correctly [6]. Some (but not all) dyspraxics suffer from hypotonia, which in this case is chronically low muscle tone caused by dyspraxia[citation needed]. People with this condition 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 to the point where it is necessary to constantly lean on sturdy objects for support[citation needed].
[edit] Other Names
Collier first described dyspraxia as 'congenital maladroitness'. A. Jean Ayers referred to it as a disorder of sensory integration in 1972 while in 1975 Dr Sasson Gubbay called it the 'clumsy child syndrome' [7]. It has also been called minimal brain dysfunction although the two latter names are no longer in use. Other names include:
- Developmental Co-ordination Disorder
- Sensorimotor dysfunction
- Perceptuo-motor dysfunction
- Motor Learning Difficulties
The World Health Organisation currently lists dyspraxia as Specific Developmental Disorder of Motor Function [8].
[edit] Role of support agencies
Within the United Kingdom there are several agencies that are able to support children with dyspraxia. They may provide reports on the child’s progress, including:
- A developmental history with motor milestones
- Patterns of social interaction, communication and behaviour,
- Educational history and analysis of learning styles
- Views of the child, including their response to the current learning environment.
- The child’s level of overall special educational needs
- resources, equipment and facilities required to support the child.
The following people may be involved in supporting a dyspraxic child:
[edit] Paediatric occupational therapist
The paediatric occupational therapist provides information, advice and guidance on supporting dyspraxic children. They provide equipment for improving children’s access to activities and may implement programmes to support perceptual difficulties and develop fine motor co-ordination.
[edit] Speech-Language Pathologist
The Speech-Language Pathologist supports children whose dyspraxia has manifested in speech, and may provide a speech intervention program to be delivered in school.
[edit] Educational psychologist
The educational psychologist assesses children in relation to developmental profiles.
[edit] Health visitor
The health visitor may assist in a diagnosis of dyspraxia for pre-school age children.
[edit] References
[edit] External links
- Dyspraxia in Adults A modern discussion based forum for adults who have dyspraxia
- DANDA The Developmental Adult Neuro-Diversity Association, for adults with dyspraxia and related Aspergic conditions.
- Dyspraxia Chat Yahoo chat and support group for people with dyspraxia.
- Dyspraxia foundation
- Madeleine Portwood
- [9] Matthew Alden-Farrow is a teenager who suffers from dyspraxia and has set up his own website
- [10] Forum for dyspraxic teenagers
- [11] Coventry and Warwickshire Dyspraxia Society Website
- Dyspraxic USA Non Profit
- Nuffield Speech and Language Unit
- Infant Motor Dyspraxia as a Predictor of Speech in Childhood Autism (PDF)
- http://skillsforaction.com/ Resources for parents and teachers of children with movement difficulties
