Dyspraxia is often referred to as ‘clumsy child syndrome’, but in practice it is more complex than that. It is a developmental difficulty that can overlap with other conditions such as dyslexia and attention deficit hyperactivity disorder (ADHD), and social and communication difficulties including Asperger’s syndrome.
Many children have a combination of co-ordination difficulties and other learning difficulties as well. Each child is unique – there is no classic child with dyspraxia.
The umbrella term DCD (developmental co-ordination difficulty) is often preferred by medical experts and is in common usage in some other countries (bear this in mind if you are searching the web); dyspraxia specifically means a motor-planning difficulty. Motor planning? Consider it as thinking about how to make a jam sandwich and the plan you need in order to do so; if you don’t have a plan, you may know what the result should look like, but you don’t know the steps to get there. Only a few children have this specific difficulty. However, dyspraxia is more generally used in the UK to describe the broader range of co-ordination difficulties.
How to spot the dyspraxic child
Early signs of co-ordination difficulties may include being late to sit and walk, and not crawling. Some babies with dyspraxia reach all their milestones, but still have some difficulties.
- May be a bit floppy (low-toned).
- Finds it hard to stay sitting up straight at the table or desk.
- Slouches when they eat (this usually provokes an argument in many families, being told to ‘sit up’ – it may be hard to sit up and eat at the same time).
- May be bendy or very flexible and so not so good at controlling the range of movement some of their joints can make (joint hyper-mobility syndrome). This often runs in families
- Finds completing more than one task at a time difficult, especially at speed.
- Has great difficulty in learning skills such as throwing and catching a ball, hopping and jumping, or riding a bike.
- May have a delay in language development or have ‘sloppy’ sounding speech.
- At school, handwriting becomes one of the major difficulties and is the one that tends to stay with the child.
- May find concentrating and staying on task difficult and may be fidgety, wanting to move around and fiddle with things around them.
However, children with dyspraxia are often of average or above-average intelligence, and can find it frustrating when they cannot achieve what they set out to do. Often they are articulate and can voice their ideas, but have difficulty transferring them to paper.
Incidence and diagnosis of dyspraxia
Dyspraxia affects about six per cent of the population, three times as many boys as girls.
The commonest test used to aid diagnosis is the Movement ABC Battery. This is a series of tests covering manual dexterity, ball skills and balance, usually carried out by an occupational therapist. Other tests look at vision and hearing. Symptoms of DCD/dyspraxia are usually grouped into those affecting small movements (eg dressing, eating, using scissors, writing), big movements (running, jumping, skipping), balance and co-ordination (riding a bicycle, standing on one leg, walking along a wall, climbing on playground equipment), and being in a moving environment (such as playing football with others). Some children will be more affected by big movements whereas other children may only have difficulties with smaller, finer movements. However, your child may have difficulties with all forms of co-ordination to varying degrees.
A paediatrician will also usually want to rule out any other causes of motor difficulties. Teachers sometimes watch the child in class and use a checklist to see where the difficulties lie and may refer to an educational psychologist for further testing as well.
Dyspraxia can’t be cured, and sadly there are no quick fixes. However, with appropriate help and understanding your child can improve a great deal, developing coping strategies to help them reach their potential.
At the first sign of difficulties enlist help.
‘I realised my child might have problems greater than most children when, aged 6, he was taught to hop and jump by his 3 year-old brother.’
If you are worried about your child’s progress, first talk to their school teacher and ask if they agree with your concerns. They may have a referral system in the school. Some schools run ‘motor programmes’ to help. You may need to see your GP, too; some know more than others, but they can refer you to an occupational therapist, paediatrician or physiotherapist – whichever is more appropriate.
It is always important to remember your child’s strengths as well as their difficulties – having an assessment can highlight all the bits your child cannot do and can be very stressful for the family.
Things you can do at home include:
- Practise skills with your child. Spending time with them can make a big difference and may even prove to be fun. Many of the tasks recommended by occupational therapists and physios – aimed at effectively rewiring your child’s brain - will entertain and amuse them. Little and often is frequently the route to success. You should soon start to see a difference, not just in performing the tasks but in your child's confidence.
- Encourage activities to enhance co-ordination. You don’t need to be an expert: playing ball in the garden, going swimming, teaching your child to ride a bike (try a balance bike without pedals first) can all be of great help. Physically showing a child, perhaps moving their limbs, rather than simply demonstrating a task, will help.
- Talk through activities with your child, such as putting on a piece of clothing or kicking the ball into a goal, and ask them how they think they could do something better or differently.
- Help them learn necessary social skills. Children with dyspraxia may be socially clumsy; they may find emotions difficult to read and have poor spatial awareness, literally 'invading the space of others'. You can help by encouraging your child to make friends and to take part in activities outside the home. If they are invited for a meal, mention to the parent that your child tends to be a little messy when eating (or whatever) - a little sharing of information can make life easier and less embarrassing.
What schools can do to help
A great deal can be achieved even with few obvious resources if there is a ‘can do’ attitude and a sensible, supportive approach.
- Reduce the number of tasks and allow additional time for their completion. It is a good idea to establish a need for extra time in exams from a young age - where appropriate.
- Provide extra supervision and encouragement if required, especially in practical subjects where there are health and safety implications and results may be poor – getting children to work in teams can be a help.
- Give single instructions rather than a string - which may result in a muddle - and reinforce verbal instructions by repetition.
- Never assume the child cannot achieve – break tasks down into more manageable parts and give children a bit longer to complete the task.
- Talk through with the child what is expected of them and check they have understood – ask them to explain what the teacher has said, rather than accepting a nod for yes.
- Place the child away from distractions and where they can easily see the teacher. A sloping desk or angle board may help.
- Teach the child strategies to help them remember and assist themselves, by use of lists and diaries, so they can tick off tasks as they go.
- Ensure the child is well prepared for any changes to routine, which can be both problematic and distressing – plan for changes rather than waiting for the problems. Extra visits to a new school, a map of the school and the names and pictures of the teachers may make starting a new school less stressful.
- Allowing the child to use a computer in the classroom can help reluctant writers get down what they are capable of - handwriting can cause hands and arms to ache, so dyspraxic children often write the minimum.
It may be a long road, so don’t try to do everything at once; patience, tolerance, praise and understanding will go a long way. Ask your child what is troubling them and what do they want to do better, and make that your starting point. Don’t tell them off if they spill something over themselves or others – they are not doing it on purpose. See your child for the kind and sensitive child they are, that the world around is making it harder, and that they are a different child not a difficult child. Take a break from therapy and try to incorporate helping your child into every day family life – if you like swimming together, do that rather than exercises without any meaning to the child. Set clear boundaries and have high but realistic expectations. Don’t worry about the small stuff; think about what skills your child will require for adult life. Getting from A to B on time will matter more than doing a 64-piece jigsaw or cutting out a circle perfectly.
Have fun. Remember your child has difficulties - they are not a difficult child - and do be patient, for all your sakes.
With thanks to Dr Amanda Kirby, doctor, lecturer and author in the field of dyspraxia for additional information.
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