Dyspraxia: Developmental Co-ordination Disorder; Clumsy child syndrome; Perceptuo-Motor Dysfunction; Motor Learning Difficulty

Dyspraxia is a developmental disorder of organisation and planning of physical movement. The essential feature is the impairment of motor function that significantly interferes with academic achievement or activities of daily living, and is not due to a general medical condition, such as cerebral palsy or muscular dystrophy. Performance in daily activities that require motor co-ordination is substantially below that expected given the person's chronological age and general intelligence. This may be manifested in marked delays in achieving the main motor milestones of sitting, crawling and walking, or such problems as difficulty in self help skills, knocking over or dropping things, poor performance in sport or poor handwriting.

Dyspraxia is a disorder with great variation between one child and another. In severe cases there is global dysfunction affecting gross, fine and oro-motor skills. These children are likely to present early in the pre-school period with gross and fine motor delay, hypotonia and clumsiness with poor speech articulation. At the other end of the spectrum, problems become apparent at school age, with more subtle impairments in fine motor skills affecting buttoning, tying laces and poor handwriting.

Neuro-developmental examination may reveal signs such as left/right confusion, poor balance and postural maintenance, as well as hypotonia and weakness, poor rhythm and timing, and unusual patterns of sensory processing. Psychological assessment may show considerable discrepancies, typically with satisfactory verbal skills and relatively poor visual skills.

Besides the problems of motor control, there is usually significant impairment in skills relating to sequencing, organisation and planning as well as difficulties in attention control. These problems also contribute to the practical difficulties with skills such as dressing, and can have a major impact on written output and recording abilities at school.

The overall result is discrepant academic performance. The child shows ability by having good oral skills but is unable to achieve literacy or recording skills at the same level. Poor concentration and attention control and physical restlessness or over activity may be an additional problem. It is not uncommon for such children to be described by teachers as lazy or poorly motivated.

In older children and adolescents, there may be progressive educational underachievement for expected ability, avoidance of difficult tasks and disengagement from school life. Secondary emotional problems with low self esteem are more likely and this may be apparent from a young age.

In the past, dyspraxia was sometimes held to be a delay in maturation with motor problems resolving in the teen years. Recent longitudinal studies suggest that rather than resolving, dyspraxia may have important long term sequelae that persist into adult life. Motor problems may become ameliorated with therapy in childhood and practice, as well as with increasing neurological maturity. The organisational problems may continue to be a major impairment into adult life.

The risk of mental health problems, substance abuse and disruptive behaviour disorders are all increased.

Neuro-developmental disorders as a group do tend to show a great deal of overlap and therefore tend to have features in common. So problems seen in Dyspraxia may be also seen in other disorders. Common to many of these disorders are such problems of concentration, short term (especially auditory) memory, organisation and planning, specific learning difficulties, sensory processing abnormalities, language and communication, socialisation difficulties, motor tics and emotional disorders.

Sometimes these associated problems are severe enough to fulfil the criteria for a separate clinical diagnosis for example, Attention Deficit Hyperactivity Disorder, Autism Spectrum disorders, Dyslexia or Tourette syndrome. Because of these common associations, some practitioners have adopted the term 'DAMP', used in the Nordic countries, to describe those children with Deficits in Attention, Motor control and Perception. The complexity of presentation, use of different terms and the possibility of multiple diagnostic labels can lead to difficulties or delays in families getting a satisfactory diagnosis. For these reasons, a child presenting with features suggestive of Dyspraxia ideally should have access to a comprehensive multidisciplinary assessment.

Inheritance patterns
This has not been fully researched.

Prenatal diagnosis
None

Medical text written June 2001 by Dr D Keen. Last reviewed October 2005 by Dr D Keen, Consultant Paediatrician, St George's Hospital, London, UK.

DYSPRAXIA FOUNDATION

Dyspraxia Foundation
8 West Alley
Hitchin
SG5 1EG
Tel: 01462 454986 Helpline (Mon-Fri, 10am-1pm)
Fax: 01462 455052
e-mail: admin@dyspraxiafoundation.org.uk
Web: http://www.dyspraxiafoundation.org.uk

The Foundation is a National Registered Charity No. 1058352, established in 1987. It offers contact with other members locally and nationally. It publishes a regular newsletter and a twice yearly magazine. It has information available, details on request, please send SAE. The Foundation has over 2,000 members.

Group details last confirmed October 2007.

Direct services for children with Dyspraxia are also provided by the National Institute of Conductive Education (see Foundation for Conductive Education, under separate entry, Cerebral Palsy) .