Most of us learn to tie our shoelaces, eat with cutlery and use a pencil with relative ease. But for children with dyspraxia (also known as developmental coordination disorder or DCD), these tasks are incredibly difficult to master.
Dyspraxia is a neurodevelopmental disorder, meaning it affects brain function and unfolds as the person grows. It is diagnosed when a child’s movement skills are below that expected for their age and this impairment impacts on their everyday living or education.
Children with dyspraxia are more than just clumsy. They may have difficulty with tasks requiring involvement of their whole body (such as catching, running, riding a bike), their hands (writing, tying shoelaces) or both. It takes much more effort to learn skills, to retain them, and to transfer them to other contexts.
Roughly one child in every classroom has dyspraxia, though the majority remain undiagnosed. While some children outgrow the condition, up to 70% continue to experience movement difficulty as adolescents and adults. Tasks that require spatial awareness, such as driving therefore present new challenges.
The cause of dyspraxia remains unclear. Like other neurodevelopmental disorders such as attention-deficit hyperactivity disorder (ADHD) and autism, it seems to have a genetic component and is more common in children born prematurely.
Although there are few obvious changes in the brain structure of people with dyspraxia, imaging studies show the connections between, and activity within, key motor and sensory areas of the brain appear reduced. These include frontal and parietal areas (responsible for movement and spacial relationships) and the cerebellum (responsible for balance, coordination and fine muscle control).
No matter how much children with dyspraxia practise certain movements, they will still have difficulty because of reduced brain activity in these motor learning regions.
Early identification is important so therapy can begin. However, a diagnosis before age five can be unreliable.
Dyspraxia is diagnosed by a team of clinicians, including an occupational therapist or neuropsychologist to assess motor skills, and a paediatrician to rule out neurological conditions such as cerebral palsy.
No drug therapies are available for dyspraxia. The condition is best managed with task-oriented therapies, where children focus on learning specific tasks, and on aspects giving them difficulty.
The treatment team should work closely with parents and teachers to ensure strategies are in place and therapy techniques continue in the home, classroom and community-based settings.
Children with dyspraxia are aware of their physical limitations and report feeling less socially accepted. Their overall self-esteem is lower than their peers, while rates of depression and anxiety are higher.
Children with dyspraxia are less likely to engage in physical activity and free play. This further compounds their opportunity to develop movement skills, and has detrimental effects on physical health. They have lower levels of fitness, strength and endurance, increasing their risk of obesity and heart disease.
Families seeking a diagnosis face myriad obstacles: lack of understanding, misconceptions, and incorrect diagnoses.
A survey of 750 Canadian family doctors found 91% had never heard of dyspraxia. Families reported consulting ten or more specialists before receiving a diagnosis. Australia seems to be in a similar situation.
A diagnosis helps those working with the child to better understand their difficulties and provide appropriate support. A teacher may need to modify tasks, for example, to allow a child more time to complete writing activities. A diagnosis also helps the child better understand themselves.
If you’re concerned about your child’s motor skills, talk to your doctor or paediatrician and ask for a referral to a paediatric occupational therapist for an assessment.
Medicare provides allied health rebates for five chronic disease treatments sessions per year. There are also a select number of community-based programs to treat dyspraxia, such as the University of Western Australia’s UniGym program. But more programs and resources are needed.
Further help and support for families is available from Dyspraxia Kids Australia.
Authors: Jacqueline Williams, Senior lecturer, Victoria University