Louis Center for Children with
Dyspraxia is a specific learning difficulty (SpLD) so it does not affect
overall intelligence or ability, but just affects particular aspects of
development. The concept of developmental dyspraxia has existed for more than a
century, but differing interpretations of the terminology remain.
The Dyspraxia Foundation defines developmental dyspraxia as "an impairment or
immaturity of the organisation of movement. It is an immaturity in the way that
the brain processes information, which results in messages not being properly or
fully transmitted. The word 'dyspraxia' comes from the Greek words 'dys',
meaning impaired or abnormal, and 'praxis', meaning action or deed.
Dyspraxia affects the planning of what to do and how to do it. It is associated
with problems of perception, language and thought". Dyspraxia is described as
having two main elements:
Ideational dyspraxia: difficulty with planning a sequence of coordinated
Ideo-Motor dyspraxia: difficulty with executing a plan, even though it is known.
"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.
Developmental dyspraxia (referred to as developmental coordination disorder
(DCD) in the US and Europe) is a life-long condition that is more common in
males than in females, with a ratio of approximately four males to every female.
The exact proportion of people with the disorder is unknown since the disorder
can be difficult to detect due to a lack of specific laboratory tests, thus
making diagnosis of the condition one of elimination of all other possible
causes/diseases. Current estimates range from 5%20% with 56% being the most
frequently quoted percentage in the literature. Some estimates show that up to 1
in 30 children may have dyspraxia.
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
However, research in the British Journal of Special Education has shown that
knowledge is severely limited in many who should be trained to recognise and
respond to various difficulties, including Developmental Coordination Disorder,
Dyslexia and DAMP. The earlier that difficulties are noted and timely
assessments occur, the quicker intervention can begin. A teacher or GP could
miss a diagnosis if they are only applying a cursory knowledge.
"Teachers will not be able to recognise or accommodate the child with learning
difficulties in class if their knowledge is limited. Similarly GPs will find it
difficult to detect and appropriately refer children with learning
Various areas of development can be affected by developmental dyspraxia and
these will persist into adulthood, as dyspraxia has no cure. Often various
coping strategies are developed, and these can be enhanced through occupational
therapy, physiotherapy, speech therapy, or psychological training.
Speech and language
Developmental verbal dyspraxia is a type of ideational dyspraxia, causing
linguistic or phonological impairment. This is the favoured term in the UK;
however it is also sometimes referred to as articulatory dyspraxia and in the
United States the usual term is childhood apraxia of speech (CAS).
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.
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
Establishing the correct[dubious discuss] pencil grip
Hand aching while writing
Fine-motor problems can also cause difficulty with a wide variety of other tasks
such as using a knife and fork, fastening buttons and shoelaces, cooking,
brushing one's teeth, applying cosmetics, styling one's hair, opening jars and
packets, locking and unlocking doors, shaving and doing housework.
Whole body movement, coordination, and body image
Issues with gross motor coordination mean that major developmental targets
including walking, running, climbing and jumping can be affected. The
difficulties vary from child to child and can include the following:
Poor balance (sometimes even falling over in mid-step). Tripping over one's own
feet is also common.
Difficulty combining movements into a controlled sequence.
Difficulty remembering the next movement in a sequence.
Problems with spatial awareness, or proprioception.
Some people with dyspraxia have trouble picking up and holding onto simple
objects such as picking pencils and things up, owing to poor muscle tone and or
This disorder can cause an individual to be clumsy to the point of knocking
things over and bumping into people accidentally.
Some people with dyspraxia have difficulty in determining left from right.
Cross-laterality, ambidexterity, and a shift in the preferred hand are also
common in people with dyspraxia.
People with dyspraxia may also have trouble determining the distance between
them and other objects.
In addition to the physical impairments, dyspraxia is associated with problems
with memory, especially short-term memory. This typically results in difficulty
remembering instructions, difficulty organizing one's time and remembering
deadlines, increased propensity to lose things or problems carrying out tasks
which require remembering several steps in sequence (such as cooking.) Whilst
most of the general population experience these problems to some extent, they
have a much more significant impact on the lives of dyspraxic people. However,
many dyspraxics have excellent long-term memories, despite poor short-term
memory. Many dyspraxics benefit from working in a structured environment, as
repeating the same routine minimizes difficulty with time-management and allows
them to commit procedures to long-term memory.
People with dyspraxia may have sensory processing disorder, including abnormal
oversensitivity or undersensitivity to physical stimuli, such as touch, light,
and sound. This may manifest itself as an inability to tolerate certain textures
such as sandpaper or certain fabrics and including oral toleration of
excessively textured food (commonly known as picky eating), 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 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. Undersensitivity to stimuli may also cause problems. Dyspraxics
who are undersensitive to pain may injure themselves without realising.Some
dyspraxics may be oversensitive to some stimuli and undersensitive to others.
These are commonly associated with autism spectrum conditions.
People with dyspraxia 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. Having other autistic traits (which is common
with dyspraxia and related conditions) may also contribute to sensory-induced
Dyspraxia can cause problems with perception of distance, and with the speed of
moving objects and people. This can cause problems moving in crowded places and
crossing roads and can make learning to drive a car extremely difficult or
Many dyspraxics struggle to distinguish left from right, even as adults, and
have extremely poor sense of direction generally.
Moderate to extreme difficulty doing physical tasks is experienced by some
dyspraxics, and fatigue is common because so much extra energy is expended while
trying to execute physical movements correctly. Some (but not all)
dyspraxics suffer from hypotonia, which in this case is chronically low muscle
tone caused by dyspraxia. [Full citation needed] People with this condition can
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.
Overlap with other conditions
Dyspraxics may have other difficulties that are not due to dyspraxia itself but
often co-exist with it. This is sometimes referred to as comorbidity. Dyspraxics
may have characteristics of dyslexia (difficulty with reading and spelling),
dyscalculia (difficulty with mathematics), dysgraphia (an inability to write
neatly and/or draw) expressive language disorder (difficulty with verbal
expression), ADHD (poor attention span and impulsive behaviour, which up to 50%
of dyspraxics may have.), or Asperger syndrome (consisting variously of poor
social cognition, a literal understanding of language [making it hard to
understand idioms or sarcasm] and rigid, intense interests). However, they are
unlikely to have problems in all of these areas. The pattern of difficulty
varies widely from person to person, and it is important to understand that a
major weakness for one dyspraxic can be a strength or gift for another. For
example, while some dyspraxics have difficulty with reading and spelling due to
an overlap with dyslexia, or numeracy due to an overlap with dyscalculia, others
may have brilliant reading and spelling or mathematical abilities, however many
dyspraxics also struggle with maths. Some estimates show that up to 50% of
dyspraxics may have ADHD.
Students with Dyspraxia struggle most in visual-spatial memory. When compared to
their peers who dont have motor difficulties, students with dyspraxia are seven
times more likely than typically developing students to achieve very poor scores
in visual-spatial memory. As a result of this working memory impairment,
students with dyspraxia have learning deficits as well.
Some Students with dyspraxia can also have comorbid language impairments (SLI).
Research has found that students with dyspraxia and normal language skills still
experience learning difficulties despite relative strengths in language. This
means that for students with dyspraxia their working memory abilities determine
their learning difficulties. Any strength in language that they have is not able
to sufficiently support their learning.
Collier first described developmental dyspraxia as 'congenital maladroitness'.
A. Jean Ayres referred to it as a disorder of sensory integration in 1972 while
in 1975 Dr Sasson Gubbay called it the 'clumsy child syndrome'. 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 (DCD) - a subtly different condition by
definition, in practice, very similar.
Motor Learning Difficulties
The World Health Organisation currently lists Developmental Dyspraxia as
Specific Developmental Disorder of Motor Function.