Dyspraxia : General Information and Guidelines
These notes were prepared in response to a request for information concerning the nature of dyspraxia, its signs and symptoms, and the effects of the condition upon day to day activities including classroom performance.
General guidelines are offered in respect of intervention, but early identification is important in order to establish an individualised and structured programme for the use of parents, teachers and support staff under the guidance of a specialised therapist.
Dyspraxia is a condition which affects motor development and skills. Typically, the child in question may be seen to be clumsy and poorly co-ordinated; and there is a risk that (s)he could be misperceived as deliberately awkward or provocative, as a result of inadvertently pushing other children for example.
Key words are "Muscles, Motor and Movement".
The most significant educational effects of the condition involve fine skills such as those used in writing or drawing, or planning and self-organisation. Weaknesses may also be observed in the mechanisms of speech production such that articulation is impaired and expressive language is inhibited.
There may be secondary effects in terms of poor self image and limited social acceptance by peers.
It would usefully be underlined that Dyspraxia is not simply a language disorder, but that the speech disabilities ("Verbal Dyspraxia") represent one constellation of symptoms of this widely pervasive motor condition.
A simple definition might be: "Impairment or immaturity of the organisation of movement, with associated problems of language, perception and thought".
Dyspraxia may also have been implicated in the following diagnostic categories:-
Clumsy Child Syndrome
Minimal brain dysfunction
Motor learning difficulty
Therefore "Dyspraxia" describes difficulty with controlling and co-ordinating learned patterns of movement, despite the lack of observed damage to muscles or nerves.
"Verbal/Articulatory Dyspraxia" is a condition where the child has difficulty making and co-ordinating the precise movements which are used in the production of spoken language ... again without damage to muscles or nerves.
There may be a problem with producing individual sounds as well as in co-ordinating the increasingly complex sequences used in words, phrases, and sentences.
One might characterise the dyspraxic child as being unable to think and act simultaneously; much (motor-planning and effort are required for actions which are taken for granted among other children of a similar age.
A child diagnosed as having dyspraxia by a paediatrician, physiotherapist and occupational therapist will usually have generalised motor difficulties - where the child has problems co-ordinating gross and fine body movements. (These children were once called "clumsy children").
A child who has been diagnosed as dyspraxic by a speech and language therapist will havedevelopmental verbal dyspraxia (sometimes referred to as "developmental articulatory dyspraxia"). This is characterised by marked difficulties in producing speech sounds and in sequencing them together in words. Expressive language is often delayed. Such children will often (but not always) have an oral (or oro-motor) dyspraxia - a difficulty in making and co-ordinating the precise movements of the lips, tongue and palate required to produce speech. [Verbal dyspraxia may have become an umbrella term for children with persisting and serious speech difficulties in the absence of obvious causation regardless of the precise nature of their unintelligibility.]
Some children may have both verbal dyspraxia and generalised dyspraxia. However, it is important to recognise those different forms of the condition because advice and guidelines that focus on the generalised motor dyspraxia may have little relevance to a child whose primary difficulty is with speech.
Dyspraxic children are at risk of having problems in developing reading, writing and spelling skills, particularly those with a persisting problem at five years and/or who have a family history of speech or literacy difficulties. Spelling is often particularly at risk. In addition, children with generalised motor dyspraxia are likely to have handwriting difficulties.
It may not be possible accurately to determine whether any given individual child with dyspraxia will have problems with literacy.
Further, like other speech and language difficulties, verbal dyspraxia is not a static condition, but there will be changes over time. Therefore, all encompassing labels may not be helpful; instead, one may seek to identify a particular pattern of strengths and weaknesses at any given time. The very title "developmental dyspraxia" implies that particular needs will become apparent with the passage of time.
[It should be noted that some research evidence suggests that there are two dyspraxic conditions. "True Dyspraxia" is a lifelong condition, albeit amenable to some compensation as a result of consistent, early, and structured intervention; "Immature Articulatory Praxis" is a matter of neurological immaturity, i.e. a delay rather than a deficit ... and which can be resolved over time, with appropriate treatment. The problem is that only time will determine the difference]
Areas of difficulty for the dyapraxic child
Movement:Gross and fine motor skills are hard to learn, difficult to retain and generalise and hesitant and awkward in performance.
Language:Articulation may be immature or even unintelligible in early years. Language may be late to develop also.
Perception:There is poor understanding of the messages that the senses convey and difficulty in relating those messages to actions.
Thought:Dyspraxic children of normal intelligence may have great difficulty in planning and organising thoughts. Those with moderate learning difficulties have such problems to a greater extent.
Motor planning is, in some ways, the highest and most complex form of function in children. Because it involves conscious attention, it is closely linked to mental and intellectual functions. It depends upon very complex sensory integration throughout the brain stem and cerebral hemispheres. The brain tells the muscles what to do, but the sensations from the body enable the brain to do the telling. Motor planning is the "bridge" between the sensory-motor and intellectual aspects of brain function.
In the dyspraxic child, there is a defect within this process of CNS - muscle message-giving and feedback. The communication pathways are not established, and without consistent and guided repetition of movements, improvements will not be achieved because "gaps" in the neural pathways remain unclosed. Each time a neural message passes through a neuronal junction (synapse), the structure and chemistry of that synapse will change so that the message will be transmitted more effectively in future. The repetition of movements will be reflected by the repeated use of synapses for particular sensory-motor functions and a neural memory (a pathway) is consolidated.
For most children there is no known cause, although it is thought to be an immaturity of neurone development in the brain rather than brain damage. Dyspraxic children have no clinical neurological abnormality to explain their condition, but the source of dyspraxic difficulties is thought to be within immature neuronal development. Such immaturity within left hemsipheric development may be particularly implicated.
Possible aetiological factors may include:
Pre- and pen-natal trauma
Febrile illness in the early years ) in the early years
Neurological Trauma )
Unestablished cerebral dominance
Research evidence suggests that the incidence of dyspraxia [with varying degrees of severity] is around 5 or 6 per cent of all children.
As with other language related conditions, there is a predominance of males compared to females in groups of dyspraxic children identified ... dyspraxic "populations" appear to comprise between 70% to 90% boys.
Observations suggest a strong family incidence of language/learning problems ... in particular, a high percentage of dyspraxic children are found to have fathers or paternal family members with a history of delayed speech development, articulation difficulties, stammering, or dyslexic-type difficulties.
[It is noted that Developmental Articulatory Dyspraxia may be known as "DAD" ... seems very appropriate!]
Recent evidence supports the view that (verbal) dyspraxia is, to a large extent, a motor impairment, i.e. this condition is largely the result of a phonetically based articulation disorder resulting from impaired motor control, as opposed to a phonologically based language disorder as the major underlying mechanism.
Dyspraxia may affect different children in varying degrees, from mild to severe.
The following are the diagnostic features of verbal dyspraxia present in any permutation among children affected:
i) Difficulty in control of the speech apparatus (lips; tongue; soft palate; larynx; muscles used to control breath during speech and the muscles used for facial expression).
ii)Possible difficulty in feeding.
iii) Difficulty in speech sound production (limited sounds used arid inconsistent production).
iv) Difficulty in sequencing sounds to make a word.
v) Difficulty in regulating breathing and in controlling the speed, rhythm and volume for speech.
The Pre-School Child
There is usually a history of lateness in such activities as rolling over, sitting, walking and speaking. The child may not yet be able to run, hop or jump. He/she appears not to learn anything instinctively but must be taught all skills. Poor at dressing and slow and hesitant in most actions, he/she has a poor pencil grip and cannot do jigsaws or shape-sorting games. Art work is very immature. There is no understanding of in/on/behind/in front of, etc., and the child is unable to catch or kick a ball. Dyspraxic children are commonly anxious and distractible. They find it difficult to keep friends or judge how to behave in company.
However, the child's understanding of what is said is relatively normal. It is the slowness in the development of babbling, first words, and word joining that is critical. Difficulties with length and complexity of sentences and with grammatical structure, may be persistent over a long time scale.
The School Age Child
All of the problems of the pre-school child may still be present with little or no improvement. P.E. is avoided. The child does badly in class but significantly better on a one-to-one basis. Attention span is poor and the child reacts to all stimuli without discrimination. There may be trouble with maths and reading and great difficulty may be experienced in copying from the blackboard. Writing is laborious and immature. He/she is unable to remember and/or follow instructions and is generally poorly organised.
The longer the dyspraxic child goes without being identified, the greater the experience of failure, the more experience of being criticised or reprimanded, and the poorer the self esteem and self confidence.
Avoidance strategies may come into play... missing games or P.E., poor attendance, associating with younger children, et. There is a risk, therefore, that by secondary age, the dyspraxic who has not be identified or provided with support will be relatively isolated and generally frustrated. Such a student may well become involved in undesirable behaviour, i.e. (s)he will be prepared to join in deviant behaviours if that is the price for being accepted in a group. Many of the children and young people seen to be candidates for the label of emotionally and behaviourally disturbed may be dyspraxic but not recognised as such.
Thus, early identification and intervention are very important not only in dealing with the "primary" difficulties but also in minimising "secondary" disorders.
Dyspraxia is most readily recognised when the child in question may be directly observed alongside his/her peers during activities requiring balance or co-ordination. For example, the dyspraxic child may move too quickly or too slowly, will lack control, and will not appear to recognise environmental signals. Reaction time will be slower than the norm for the group.
Constant and involuntary movement may be commonly observed, particularly during quiet or formal occasions (such as assembly) when the effort expended to control movement will actually produce all the more nervous movement.
Alongside difficulties with self organisation, getting books out, taking messages, getting changed, etc., the child may be confused over time sequences, past, present and future. Recalling events will be challenging, and if a particular word or event is not remembered, the child will go off at a tangent.
Behaviour may appear disruptive as a result of the difficulties with planning or with maintaining attention to the task. (S)he is not able to anticipate the effect of behaviour, with consequences for integration within peers.
Particular difficulty may be observed in handwriting, in respect of positioning the work on the page, letter-spacing, confusion among similar letters, etc., but even if the writing is neat, it will have involved considerable effort and possible stress.
Further Diagnostic Indicators
Dyspraxia may be implicated if the child has not achieved (motor) milestones at an age comparable with the norm, e.g.
|4 Years||5 Years|
|Buttons easy buttons.||Puts on almost all clothes (except for tying shoe laces).|
|Fills glass from pitcher of water.||Draws a cross with a crayon.|
|Washes hands||Cleans himself at the toilet.|
|Cuts with scissors||Makes a tent or house out of furniture and blankets.|
|Climbs under, over and into chairs tables, boxes.||Cuts and pastes creative paper designs.|
Rides a tricycle
Jumps up with both feet together.
and if the following problems are also observed:-
Formal assessment measures may include:
It is worth repeating the term "'dyspraxia" may be applied to children who present a wide range of difficulties. Further, one would usefully note the caveat quoted by Portwood(1996).....
"It is hoped that the diagnosis of dyspraxia does not suffer the same fate as dyslexia so that every child who may be a little forgetful, disorganised, and clumsy is diagnosed as dyspraxic"
i.e., dyspraxia is a relatively severe condition, and awareness of, and concern for, the difficulties experienced by the dyspraxic child may be inhibited if the diagnosis is applied loosely and carelessly.
The following guidelines and implications for school experience have been set out in two sections. The first concerns children where the focus of difficulty is verbal, and the second is more concerned with the generalised form of dyspraxia.
However, it should be stressed that such a division is somewhat arbitrary (albeit designed to structure these notes more simply) and any dyspraxic child may show an individual pattern of motor, verbal, perceptual and social weaknesses, and will require an equally individual form of compensatory activities and "allowances".
The significance of consistent and structured support is reinforced by evidence for the benefits thereof; and it would appear that dyspraxia is not an immutable condition but can be overcome to a considerable extent. In other words, early referral to a specialist therapist is desirable in order that an individual programme can be prepared whose implementation may be shared by teachers and carers in liaison with the therapist. The need is to confront the very activities which the child finds difficult and provides consistent programme of activities.
Evidence exists that benefits accrue not simply as a result of time and greater maturity, but that the practice of motor movements will bring about further and more complex neuronal connections in the brain such that skills are learnt and consolidated.
Dyspraxic symptoms ... the awkwardness and lack of co-ordination in movement... are suggestive of miscommunication of messages in the central nervous system. The purpose of the exercises is to form the neural pathways such that skills can be fixed.
B. Generalised Motor
e.g. low apparatus in gymnastics
brightly coloured, large balls for throwing and catching
large headed, short-handled bats
games with few children on each side, etc.
General "handling" Implications
A major role of the teacher is that of reducing the potential stress of the dyspraxic child, not only by the kind of activities/structuring described in the previous sections, but also by:
Information on both aetiology and remedial strategies is available from:
The Dyspraxia Foundation, 8 West alley, Hitchin, Hertfordshire, 5G5 1 EG
AFASIC, 347 Central Markets, Smithfield, London, EClA 9NH
I-CAN Training Centre, New Road, Weybridge, Surrey, KT13 9BW
Stackhouse J (1992): Developmental Verbal Dyspraxia - A review and critique. European Journal of Disorders of Communication 27 19-34.
Portwood M. (1996). Development Dyspraxia. Educational Psychology Service. County Hall. Durham DL 1 5VJ
Connor M. (1991). Identifying and Differentiatng Dysphasia and Dyspraxia. Educational Psychology Service, Surrey County Council, County Hall, Kingston upon Thames, KT1 2DJ
Grunwell P. (editor) (1990). Development Speech Disorders. Churchill Livingstone. Edinburgh.
This paper does not claim to be original, but has attempted to bring together evidence and advice from a variety of sources to form a coherent whole for the use of colleagues within Surrey LEA. The absence of references (apart from those listed above) reflects this, especially as much of the material was not labelled or attributable.
However, it would be appropriate particularly to acknowledge the various notes provided by The Dyspraxic Foundation, The I-CAN Training Centre, and the Hampshire Educational Psychology Service.
M J Connor November 1996
© Mike Connor 1996.