Is your child's room a nightmare? Are you always buying plasters? Do you have trouble deciphering what they’ve written? Your child may have a Specific Learning Difficulty (SpLD) known as Development Co-ordination Difficulty (DCD), often referred to as dyspraxia.
Often referred to as ‘clumsy child syndrome’, it is actually much 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 autism. Many children with DCD have a combination of co-ordination difficulties and other specific learning difficulties. But each child is unique - there is no classic child with dyspraxia.
The umbrella term DCD 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). This is because the strict definition of dyspraxia is motor-planning difficulty. To understand motor-planning, think 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 or which order they go in. But in reality, only a few children have this specific difficulty, with dyspraxia generally used to describe the broader range of co-ordination difficulties.
Dyspraxic children may be more likely to fall or trip up or bump into things. They may be messy eaters, find it hard to use a knife and fork together, spill drinks and be slower at dressing than brothers and sisters.
Early signs of co-ordination difficulties may include being late to sit and walk, and not crawling and late to develop a dominant hand. Some babies with dyspraxia reach all their milestones, but still have some difficulties. Older children may be very disorganised and leave possessions and clothes all over the place. DCD is rarely diagnosed before five years of age.
Typical traits include:
- 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 speech sound difficulty (oral dyspraxia).
- At school, handwriting becomes one of the major difficulties and is the one that tends to stay with the child (previously known as dysgraphia).
- Many 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 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.
DCD affects about six per cent of the population, twice as many boys as girls and occurs across the range of intellectual abilities.
The most common 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 are usually grouped into those affecting small movements (such as 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, such as holding a pen. 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.
DCD can’t be cured, but with appropriate help and understanding your child can improve a great deal, developing coping strategies to help them reach their potential:
- Early identification of where your child has particular difficulties can minimise some of the problems, so do enlist support from school and treatment by either an occupational therapist or a physiotherapist. School may well be able to help with referrals, but if not seek the help of your GP or health visitor.
- Practise skills with your child. Spending time with them can make a big difference and may even prove to be great fun for both of you. 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. Often physically showing a child, perhaps moving their limbs, rather than simply demonstrating a task, will also 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.
How schools can 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 and visual aids.
- 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.
With thanks to Dr Amanda Kirby, doctor, lecturer and author in the field of dyspraxia