Angela Kelly on a relatively common neurodevelopmental condition which, because of its overlap with other conditions,
is easily misdiagnosed or missed altogether.
Dyspraxia, also called Developmental Coordination Disorder (DCD), is a neurodevelopmental condition characterised by a marked impairment in the development of motor skills or coordination that first manifests itself in childhood. But here isn’t a single, generally agreed definition of DCD. You may also see it referred to as Specific Developmental Disorder of Motor Function. The truth is that we are going through a period of rapid discovery, and it is entirely possible that tomorrow’s DCD will be known as something else completely. One of the challenges with this complex condition is its overlap with other conditions such as ADHD, slow working memory, fatigue and even sensory processing disorder that can lead to misdiagnosis of an alternative condition or a missed diagnosis altogether, where in fact there may be co-morbidity of more than one condition. This can be problematic if management strategies or medication are prescribed incorrectly.
DCD first manifests in childhood. It is lifelong and it interferes in an individual’s activities of daily living. In order to qualify for a diagnosis, motor skills will be below expected age related standards and the presentation must not be better explained by any other condition. The deficits must significantly interfere with daily life (self care, scholastics, work, leisure and play). It is important to remember that for many neurodivergent conditions such as autism, dyslexia and ADHD, by comparison, it is a requirement that the person is struggling to cope or is asking for help. A multitude of traits is insufficient if the person is adapting well by themselves. As such, while there is a valid argument that differences in cognition are biological facts (conditions rather than disorders) and that we should be mindful of the impact of neurotypical dominance and the nuances of ableism which I recognise, the reality for many is that the recognition of a condition can be insufficient to positively impact quality of life and so a diagnosis of a disorder is often needed in order to access treatment and support.
DCD entails differences in brain function that affect thinking, learning and movement. More well known signs include toddlers who are late or excessively wobbly walkers, those who completely miss the crawling stage, getting lost easily and walking into people or static objects, delays in reaching independence milestones such as dealing with buttons and laces, the struggle to hold a pencil, frequent spills and breakages despite trying hard to be careful and tripping easily. More subtle signs of mixed brain messaging include applying too little or too much strength to everyday tasks such as pouring a drink, hypermobility is common which leads to muscle ache, low muscle tone, differences in gait, uneven skills such as being able to read music but not being able to play an instrument and difficulties in kicking a ball or riding a bike.
Often it is the secondary symptoms that cause the most concern for parents and caregivers. Low physical fitness, obesity, poor self esteem, excessive self awareness, fatigue, stress, frustration, accusations of naughtiness and laziness, an inability to develop a growth mindset and have a go at things, which has knock-on consequences on other aspects of life, anxiety, depression, withdrawal from social relationships such as going out to kick a ball or ride a bike with friends and the need for extra time for what feels like every area in life. There can become a need to unpick this presentation first by working backwards from the secondary symptoms towards a root cause in the quest for diagnosis.
The path to a DCD diagnosis is beset with distractions and diversions. A child whose dyspraxia causes a struggle to hold a pencil may have poor handwriting, meaning that dysgraphia is suspected. A child who struggles to track the reading line and sees blurry words may in fact have dyspraxia rather than dyslexia. Fatigue can have a multitude of causes, but dyspraxia could be one of them. Executive function and learning problems such as the inability to process and concentrate on multiple instructions may not be down to ADHD, or not solely down to ADHD. Overwhelm from multiple brain signals may have dyspraxia as a root cause, but it is possible to erroneously link this to sensory processing disorder.
To add to this confusion, there is no single gold standard diagnostic test for DCD. Screening tests vary from country to country and different assessments are deployed depending on the person’s age. These include the DCD-Q, MABC-2 or BOT-2 tests, to name but a few. Outcomes in diagnoses can be patchy depending on where you live and the age of the subject. There needs to be much more development, research and international collaboration to make significant progress in testing and diagnosis.
The prevalence of DCD is currently estimated at 5% of the population, but it could be much higher, given the inconsistent diagnostic tests applied globally, the low levels of awareness compared with other conditions and the overlap in presentation symptoms with other conditions. It’s important to push for a correct diagnosis if the child continues to struggle, as barriers to current and future independence should be removed as much as possible through early and appropriate intervention. A correct diagnosis brings a multitude of benefits to the individual. It offers the chance to know thyself, including the strengths as well as the weaknesses. Just knowing that you are not less than anyone or somehow “stupid” prevents deterioration in mental health and can improve physical health too. The doors to support can then start to open and the right knowledge can aid in requesting the right adjustments, treatment and therapy in a less disabling environment as well as perhaps seeking financial support in some cases.
Strengths in the condition do exist, with dyspraxics often being outside-the-box thinkers and early problem solvers. They typically show excellent long term learning and can develop awareness of the struggles of others through their own experiences. But investment in research has lagged behind other conditions, so… watch this space.
How to help
So you have a diagnosis (or maybe dyspraxia is just suspected), and you want to put some support strategies in place so that the child makes steady progress through just the right challenge. Expert advice which is personalised to the child should be incorporated as far as possible but where this is unavailable, keep in mind that most Occupational Therapists will state that there are two ways of dealing with difficulties; avoidance due to fear of failure or adaptation which requires self confidence and external support through encouragement, understanding and patience to keep trying. Specially designed scissors and access to a laptop for typing instead of writing are examples of the latter by way of physical equipment.
Extra time is often the default accommodation for tests in schools because it is easily deployed, but it is not a wholly considered or complete reasonable adjustment. It has its place and it allows more time for learning and processing, but should not be deployed in isolation.
Break activities up into smaller parts which are small and progressive. Consider whether the child may need overlearning (repeated practice which cements skills into long term learning) to establish muscle memory and habit
Offer choices, but not too many, to help with motivation and give a sense of control to try new things.
Anyone who struggles benefits from opportunities to develop what they love rather than over labouring on what they find hard. Try to find a way to incorporate strengths in their tasks.
Tactile messy play is important for early years children.
Factor in plenty of movement breaks.
Exercises that develop gross and fine motor skills should be timetabled regularly into the day (playing with putty, throwing, bouncing and catching small and large balls, threading beads on string, coordination games with small pieces are available from resources such as Twinkl etc). Be careful not to introduce tasks that make the child feel overly infantilised if they are working at a level of a younger child in these areas.
Consider what other factors may be causing a negative impact and take steps to remove them. Schools can be punitive environments where behaviour management policies involve detentions or additional scrutiny such as getting each teacher to sign a weekly report are implemented for persistent lateness or not getting homework done. Are these approaches helping the child or adding to the problem? Are you teaching the child the skills they need or simply punishing them for not being able to do them? Take a holistic view.
Consider additional lists, reminders and colour coded schedules to help organisation. Teach them the skills they need before punishing them for not being able to do them.
Communicate with parents who will have more knowledge about any difficulties in independence skills seen at home and vice versa. Schools do not have a complete lens into all aspects of a child’s life; many of the issues associated with DCD can present outside of the school setting. Likewise, parents need feedback on the academic and social challenges.
Muscle affectation can be as far reaching as affecting swallowing or the ability to blow hard. If this is the case then seek support from a Speech and Language Therapist if possible.
Help them to find their tribe: while inclusion is super important to all children to understand diversity, it is equally important for all of us to find others like us so that we can learn from each other and offer support.