DYSPRAXIA


Definition

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Praxis is a Greek word which is used to describe the learned ability to plan and to carry out sequences of coordinated movements in order to achieve an objective.

Dys is the Greek prefix 'bad' so dyspraxia literally means bad praxis.

A child with difficulties in learning skills such as eating with a spoon, speaking clearly, doing up buttons, riding on a bike or handwriting may be described as dyspraxic. The movements which are involved in these activities are all skilled movements, which are voluntary and may be affected by dyspraxia. Voluntary movements, unlike reflexes, are under the conscious control of the individual who carries them out.

Developmental dyspraxia is found in children who have no clear neurological disease. Miller (1986), a neurologist, gave the following formal definition of dyspraxia: 'A disorder of the higher cortical processes involved in the planning and execution of learned, volitional, purposeful movements in the presence of normal reflexes, power, tone, coordination and sensation'.

Some researchers (Dawdy, 1981) describe children with developmental dyspraxia as showing impaired performance of skilled movements despite abilities within the average range and no significant findings on standard neurological examination. Other researchers have identified links with learning, language, visual-perceptual and behavioural problems (Henderson and Sugden, 1992). It is important to remember that all children are different, and that some difficulties may not become apparent until specific demands are made, such as learning to use a pencil. A difficulty becomes significant when it interferes with the way that a child is able to carry out the normal range of activities which is expected at his or her age: the usual developmental goals.

The idea of a developmental profile may be helpful when considering a child who has difficulties with co-ordinated movements. If motor skills are at a different level from the other areas of development, there may be a specific problem such as developmental dyspraxia.

The term dyspraxia is used differently by professionals within and across occupational therapy, speech and language therapy, psychology and medicine. There is also a range of other labels which may be used to describe developmental dyspraxia but they have no clear definition (i.e. clumsy, minimal brain damage, motor learning, cerebella deficits, developmental co-ordination disorder etc.)

In this book we have used the term developmental dyspraxia to refer to difficulties associated with a vital area of development in children, the development of co-ordination and the organisation of movement. That is, problems with getting our bodies to do what we want when we want them to do it.


Assessment

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Parents say:

He's so slow I still have to dress him

I send him upstairs to get his coat and he starts to play or comes down with the wrong things

I have to buy clothes with velcro fastenings

He often puts things on in the wrong order - shoes before trousers

He makes such a mess when eating

We never arrive on time because I have to hunt for him

He is set at one speed - 'slow'

He can only do one thing at a time

Teachers say:

His books are such a mess

He always loses his pencil

She can never find her place in the book

Why won't he keep his numbers in the right boxes, he can do his sum but only if I write it down

He's just the class clown

He can't seem to stay on his chair without falling off

His shoes are always on the wrong feet, his shirt inside out, back to front and hanging out of his trousers

He's never got his kit for PE and is always last into the Hall

He puts more paint on him and his friends than on the paper

He is more interested in what other people are doing

When he works on the computer, I can begin to see his true ability

Children say:

Someone's nicked my pencil

My mum forgot to give me my PE / swimming kit

Nobody will play with me

I don't like PE

It was an accident, Miss, I just bumped into him

I left my brain in the taxi today

Assessment of dyspraxia can involve a range of professionals:

A Speech and Language Therapist is often the first professional to see a child with dyspraxia because of early feeding difficulties or lack of speech. S/he would refer the child for assessment by others if the dyspraxia was affecting other areas of motor development.

A child will be referred to an Occupational Therapist because someone has noticed they have difficulty in coping with school, self-care and/or play activities. For example: handwriting, PE, dressing, using a knife and fork or riding a bicycle. As these children have difficulties in these areas they may also have problems making friends, show poor motivation for some classroom tasks and have low self-esteem. When assessing a child, the occupational therapist considers their ability to cope in all aspects of life including home, school and at play.

A Paediatric Assessment is important because a wide range of medical conditions can give rise to symptoms of dyspraxia. Each child should have a comprehensive medical examination, looking particularly for signs of medical and neurological disease and epilepsy. Neurological examination assesses physical function (muscle tone, reflexes, range of movement, power, involuntary movements, sensations). Developmental assessment is needed to evaluate the child's level of mental functioning against the motor developmental level and to specify particular developmental deficits, for example in language. Checks of vision and hearing are included.

The Educational Psychologist will explore how a child is functioning in terms of a developmental perspective. All developmental goals will be considered and not just those which obviously relate to motor functioning such as ball skills or handwriting. This is important because some forms of developmental dyspraxia can affect how children organise their tasks, their equipment and even their ideas. The educational psychologist will use a range of strategies as part of the assessment, which may include:


Interventions

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A child with dyspraxia may need help in any or all of the following areas:

personal organisation

exam concessions

modifying the curriculum

handwriting and alternatives to handwriting

visual perceptual difficulties

routine classroom activities

PE and games

non-verbal communication

psychosomatic difficulties

social relationships and self-esteem


Resources

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The following books are available from the IPS OnLine Bookstore via a secure ordering system; prices are shown in £ sterling; an approximate exchange rate for US$ is £1 = US$1-50. Postage is £1 per book for UK domestic orders, and £2 per book for overseas surface postage. Queries may be sent to: pubs@devdis.com

Publications

The majority of the material in the information section above was taken, with permission from the authors, from :

Dyspraxia, A Guide for Teachers and Parents - Kate Ripley, Bob Daines and Jenny Barrett. David Fulton, 1997. (An excellent book which assists understanding, diagnosis and management of dyspraxia £14

Another recommended title in the field is:

Developmental Dyspraxia (2nd edition)- Madeleine Portwood. David Fulton, 1999. (There are numerous practical teaching suggestions in this useful book, as well as information on identification) £15

Excellent and economical leaflets, and a range of books on dyspraxia, are available from:

Dyspraxia Foundation, 8 West Alley, Herts, England SG5 1EG. Tel. 01462 455052 Fax 01462 455052

Support

Dyspraxia Foundation Helpline: tel. 01462 454986

Weblinks

Dyspraxia Foundation: www.emmbrook.demon.co.uk/dysprax/homepage.htm

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©2000 IPS

Updated 26dec00 2200gmt - rl