Dyspraxia is a neurological disorder of motor coordination usually apparent in childhood that manifests as difficulty in thinking out, planning out, and executing planned movements or tasks. The term dyspraxia derives from the Greek word praxis, meaning "movement process."
Description
The earliest description of a syndrome of clumsiness, termed "congenital maladroitness," dates back to the turn of the twentieth century. Since that time, numerous names have been given to this syndrome of impaired coordination, including dyspraxia, developmental dyspraxia, developmental coordination disorder, clumsy child syndrome, and sensory integration disorder. Some sources ascribe different meanings to these terms, while others use them interchangeably. Researchers commonly use the term developmental coordination disorder (DCD); DCD is classified by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSMIV-TR) as a motor skills disorder.
Dyspraxia is a variable condition; it manifests in different ways at different ages. It may impair physical, intellectual, emotional, social, language, and/or sensory development. Dyspraxia is often subdivided into two types: developmental dyspraxia, also known as developmental coordination disorder, and verbal dyspraxia, also known as developmental apraxia of speech. Symptoms of the dyspraxia typically appear in childhood, anywhere from infancy to adolescence, and can persist into adult years. Other disorders such as dyslexia, learning disabilities, and attention deficit disorder often co-occur in children with dyspraxia.
Demographics
Estimates of the prevalence of developmental coordination disorder are approximately 6% in children aged 5–11. Some reports indicate a higher prevalence in the 10–20% range. Males are four times more likely than females to have dyspraxia. In some cases, the disorder may be familial.
Causes and symptoms
Developmental dyspraxia is apparent from birth or early in life. As of 2004, the underlying cause or causes for dyspraxia remain largely unknown. It is thought that any number of factors such as illness or trauma may adversely affect normal brain development, resulting in dyspraxia. Genes may also play a role in the development of dyspraxia. It is known that dyspraxia can be acquired (acquired dyspraxia) due to brain damage suffered as a result of stroke, an accident, or other trauma.
Symptoms of dyspraxia vary and may include some or all of the following problems:
The symptoms of dyspraxia depend somewhat on the age of the child. Young children will have delayed motor milestones such as crawling, walking, and jumping. Older children may present with academic problems such as difficulty with reading and writing or with playing ball games.
Developmental verbal dyspraxia (DVD), a type of dyspraxia, can manifest as early as infancy with feeding problems. Children with DVD may display delays in expressive language, difficulty in producing speech, reduced intelligibility of speech, and inconsistent production of familiar words.
Diagnosis
The diagnosis of dyspraxia is based on observation of a patient's symptoms and on results of standardized tests. Findings from a neurological or neurodevelopmental evaluation may also be used to confirm a suspected diagnosis. The process of making a diagnosis of dyspraxia can be complex for a number of reasons. Dyspraxia may affect many different body functions, it can occur as a part of another syndrome, and symptoms of dyspraxia overlap with similar disorders such as dyslexia.
Diagnostic criteria
Various health professionals and organizations define the term dyspraxia differently. The Dyspraxia Foundation (England) describes it as "an impairment or immaturity of the organization of movement," and further adds that it may be associated with problems in language, perception, and thought. Other advocacy groups such as the Dyspraxia Association of Ireland and the Dyspraxia Foundation of New Zealand, Inc. offer slightly different definitions. The American Psychiatric Association lists four criteria in the DSM-IV-TR for the diagnosis of developmental coordination disorder:
marked impairment in the development of motor coordination
the impaired coordination significantly interferes with academic achievement or activities of daily living
the coordination difficulties are not due to a general medical problem such as cerebral palsy or muscular dystrophy and do not meet the criteria for pervasive developmental disorder
if mental retardation (MR) is present, the motor coordination problems exceed those typically associated with the MR
Treatment team
Treatment for individuals with dyspraxia is highly individualized because the manifestations vary from patient to patient. The treatment team for a child with dyspraxia may include a pediatric neurologist, a physical therapist, an occupational therapist, and a speech therapist, in addition to a family doctor or pediatrician. In some cases, the treatment team may also include a psychologist, a developmental optometrist, and specialists in early intervention or special education.
Treatment
Currently there is no cure for dyspraxia. Treatment mainly consists of rehabilitation through physical, occupational, and speech therapies. Other interventions such as special education, psychological therapy, or orthoptic exercises may be recommended on a case-by-case basis. The purpose of treatment for dyspraxia is to help the child to think out, plan out, and execute the actions necessary to try out new tasks or familiar tasks in novel ways.
Recovery and rehabilitation
There are specific therapies for dyspraxia. In physical therapy, a physical therapist may evaluate some or all of the following skill areas in order to formulate a plan of treatment with the patient's physician:
muscle tone
control of shoulders and pelvis
active trunk extension and flexion (posture)
hand-eye coordination (throwing a ball)
foot-eye coordination (kicking a ball)
midline crossing (writing)
directional awareness (ability to move in different directions)
spatial awareness (judge distances and direction)
integration (moving both sides of the body simultaneously)
knowledge of two sides/dominance of one side (knowing right from left)
short-term memory
motor planning (ability to plan movements needed to move from one position to another)
Physical therapy generally consists of activities and exercises designed to improve the specific skill weakness. For example, activities such as climbing, going through tunnels, and moving in and out of cones may assist a child who has poor spatial awareness. The physical therapist may also recommend that the child practice the treatment activities or exercises at home.
In occupational therapy, an occupational therapist may use standardized tests to evaluate the child's sensory integration skills. A therapeutic technique known as sensory integration may be recommended. Sensory integration techniques help a child to sort, store, and integrate information obtained by the senses so that it may be used for learning.
In speech therapy, a speech therapist may assist the child with areas such as muscle control, planning language, and forming concepts and strategies in order to communicate. The therapist may use language tests to assess language comprehension and production in order to develop a plan of treatment
Clinical trials
As of 2004, there was one clinical trial recruiting patients with a form of dyspraxia known as verbal dyspraxia. The aim of the study, entitled "Central Mechanisms in Speech Motor Control Studied with H2150 PET," is to use radioactive water (H2150) and positron emission tomography (PET) scan to measure blood flow to different areas of the brain in order to better understand the mechanisms involved in speech motor control. Information on this trial can be found at <http://www.clinicaltrials.gov> (see study number 92-DC-0178) or by contacting the National Institute on Deafness and Other Communication Disorders (NIDCD) patient recruitment and public liaison office at (800) 411-1010.
Prognosis
The prognosis for dyspraxia varies. Some children "outgrow" their condition, whereas others continue to have difficulties into adulthood. Though early diagnosis and prompt treatment may improve the outcome for a given patient, the precise factors that influence prognosis are not well understood. For example, it remains unclear how factors such as a child's specific deficits and the underlying cause for the disorder influence rehabilitation potential. Also, the prognosis for dyspraxia is situational; it depends on the age of the patient and the demands of a given setting or environment.
Special concerns
A child with a diagnosis of dyspraxia or developmental coordination disorder may be eligible to have an individual education plan (IEP). An IEP provides a framework from which administrators, teachers, and parents can meet the educational needs of a child with dyspraxia. Depending upon severity of symptoms and the presence of other problems such as learning difficulties, children may be best served by special education classes or by a private educational setting.
BOOKS
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Washington, DC: American Psychiatric Association, 2000.
Macintyre, C. Dyspraxia 5–11: A Practical Guide. London: David Fulton Publishers, 2001.
Portwood, M. Understanding Developmental Dyspraxia: A Textbook for Students and Professionals. London: David Fulton Publishers, 2000.
PERIODICALS
Cousins, M., and M. M. Smyth. "Developmental Coordination Impairments in Adulthood." Hum Mov Sci 22 (November 2003): 433–59.
Flory, S. "Identifying, Assessing and Helping Dyspraxic Children." Dyslexia 6 (July–September 2000): 205–8.
McCormick, M. "Dyslexia and Developmental Verbal Dyspraxia." Dyslexia 6 (July–September 2000): 210–4.
Payton, P., and M. Winfield. "Interventions for Pupils with Dyspraxic Difficulties." Dyslexia 6 (July–September 2000): 208–10.
American Speech Language Hearing Association (ASHA). 10801 Rockville Pike, Rockville, MD 20852-3279. (301) 897-5700 or (800) 638-8255; Fax: (301) 571-0457. actioncenter@asha.org. <http://www.asha.org>.
The Dyspraxia Foundation. 8 West Alley, Hitchin, Hertfordshire SG5 1EG, United Kingdom. +44 (0) 14 6245 5016 or +44 (0) 14 6245 4986; Fax: +44 (0) 14 6245 5052. dyspraxia@dyspraxiafoundation.org.uk. <http://www.dyspraxiafoundation.org.uk/>.
The Dyspraxia Support Group of New Zealand, Inc. The Dyspraxia Centre, P.O. Box 20292, Bishopdale, Christchurch, New Zealand. +64 3 359 7072; Fax: +64 3 359 7074. praxisnz@xtra.co.nz. <http://www.dyspraxia.org.nz/>
