Developmental co-ordination disorder (dyspraxia) in children

Dyspraxia, a type of developmental co-ordination disorder (DCD), is a disability that affects affects basic motor skills (such as walking or sitting upright) and fine motor skills (such as writing or picking up small objects) in children and adults.

It is a condition that will last for life and is recognised by international organisations, including the World Health Organization. Read more about dyspraxia in adults.

Although the exact causes of dyspraxia in children are unknown, it is thought to be caused by a disruption in the way messages from the brain are transmitted to the body.

Dyspraxia is characterised by difficulty in planning smooth, co-ordinated movements. This leads to clumsiness and lack of co-ordination. Often, it can lead to problems with language, perception and thought.

The symptoms of dyspraxia in children are normally noticeable from an early age. The condition used to be known as clumsy child syndrome.

Who is affected?

Dyspraxia is more common in boys and sometimes runs in families. It may also occur alongside other conditions, such as:

• attention deficit hyperactivity disorder (ADHD) – a group of behavioural symptoms of inattentiveness, hyperactivity and impulsiveness
• a specific learning difficulty such as dyslexia – which affects the skills involved in reading and spelling words
• autistic spectrum disorder – a range of developmental disorders
• other chromosome disorders

Many children with dyspraxia also have ADHD.

It is hard to estimate exactly how many children are affected by dyspraxia. Some studies have argued around one in 50 children are affected. Others think the true figure could be as high as one in 12.

Read more about diagnosing dyspraxia in children.

Treating dyspraxia

There is no cure for dyspraxia, but a number of therapies can make it easier for the child to cope with their problems. These include:

• speech and language therapy to improve speech and communication skills
• occupational therapy to find ways to remain independent and complete everyday tasks

For children with mild problems, these may disappear as they grow up. However, up to nine out of 10 children with dyspraxia will continue to have difficulties as a teenager and adult.

Having dyspraxia does not change how intelligent a child is, but it does affect their learning ability. They may need extra help at school to keep up with classmates.

Read more information about how dyspraxia in children is treated.

Problems caused by dyspraxia, a type of developmental co-ordination disorder (DCD), may be visible from an early stage.

Development problems

An early sign of dyspraxia may be that your child does not reach the normal stages of development. For example, they may take slightly longer than expected to:

• roll over
• sit
• crawl
• stand
• walk
• speak
• toilet train

Your child's speech may be very immature or impossible to understand in their early years, and language and vocabulary skills may take longer to develop.

Problems in childhood

As your child gets older, they may find it harder than other children of the same age to join in playground games and to perform fine (detailed) movements, such as handwriting. They may also have difficulty processing thoughts and concentrating.

Some children may also start to avoid activities at home or school to avoid feeling embarrassed in front of friends or family.

Movement and co-ordination

If your child has dyspraxia, they will have problems with movement and co-ordination. They may find the following difficult:

• playground activities such as hopping, jumping, running, and catching or kicking a ball (they often avoid joining in because of their lack of co-ordination and may be at risk of becoming unfit)
• games including shape-sorter toys, building blocks and jigsaws
• using scissors and colouring pens (their drawings may appear scribbled and more childish than they should be for their age)
• fine movements such as handwriting, tying shoelaces, doing up buttons and using a knife and fork
• keeping still (they may swing or move their arms and legs a lot and find it hard to sit still)
• walking up and down stairs
• getting dressed

A child with dyspraxia may also bump into objects or drop things, and may fall over a lot. This makes them appear awkward and clumsy.

Concentration and learning

If your child has dyspraxia, they will have difficulty concentrating and learning. They may:

• do better at school in a one-to-one situation than in a group, as they are able to be guided through work
• have a poor attention span, finding it difficult to concentrate on one thing for more than a few minutes
• not automatically pick up new skills and need encouragement and repetition to help them learn
• have problems with writing stories and copying from the blackboard

These problems can be upsetting for the child.

Persistent problems

As your child gets older, these problems may start to have a different effect on them. For example, problems with muscle movement may mean they:

• find PE (physical education) difficult
• cannot take part in team games, which may have an effect how well they make friends
• may be bullied for being ‘different’ or clumsy
• may avoid certain activities or subjects, such as drawing
• are more tired, as they have to use more energy than other children to complete the same activities

Your child may also have low self-esteem (the way they feel about themselves) as a result of these problems.

Similar conditions

Sometimes, dyspraxia may be confused with other, similar conditions. However, dyspraxia is different to:

• a learning disability, where your child finds learning, understanding and communicating difficult, which can be caused by an illness or problem before or during birth, or during childhood
• a general developmental delay, where your child does not reach certain milestones of ‘normal development’ which can affect a number of areas, such as speech or social skills

Dyspraxia specifically relates to the development of a child’s motor skills (their ability to make smooth, co-ordinated movements).

Children with dyspraxia may also have other conditions, such as:

• attention deficit hyperactivity disorder (ADHD) – a group of behavioural symptoms of inattentiveness, hyperactivity and impulsiveness
• dyslexia – a common type of learning difficulty that mainly affects the skills involved in the reading and spelling of words
• autistic spectrum disorder – a range of related developmental disorders that begin in childhood, such as Asperger syndrome (which causes difficulty with social interaction and behaviour)

Little is known about the cause of dyspraxia, a type of developmental co-ordination disorder (DCD).

Performing smooth, planned movements involves a number of different processes, including using your senses to plan movements. All the information is then processed by the wiring in your central nervous system (brain, nerves and spinal cord).

Dyspraxia is a disability that affects movement and co-ordination. People with the condition have a problem with the processes in the brain that help co-ordinate movement. This means they are unable to perform movements in a smooth, co-ordinated way.

Developments in the brain

Dyspraxia may be caused by motor neurones in the brain not developing properly. Motor neurones are specialised nerve cells that pass signals from your brain to your muscles, allowing you to move them.

It is thought that motor neurones in people with dyspraxia fail to form proper connections and are less effective at transmitting electrical signals from the brain to the muscles.

Sometimes, the electrical signal from the brain does not reach the muscle at all and your muscles fail to respond to requests from your brain to move.

Risk factors

Although it is not known what causes dyspraxia, there may be a link between dyspraxia and:

• being born prematurely (before week 37 of pregnancy)
• being born with a low birth weight
• having a family history of dyspraxia
• the mother drinking alcohol, smoking or taking illegal drugs while pregnant, which is increasingly being reported

The earlier your child is diagnosed with dyspraxia, a type of developmental co-ordination disorder (DCD), the greater their chances of improvement.

Talk to your doctor, health visitor or special needs co-ordinator if you think your child has dyspraxia. They may refer your child to another healthcare professional who cannot confirm the diagnosis by themselves, but can provide additional information to help with the diagnosis process.

These may include:

• an occupational therapist – a healthcare professional who works out practical solutions to everyday problems
• a paediatrician – a doctor who specialises in the health of children and babies
• a physiotherapist – a healthcare professional who is trained to use physical methods, such as massage, to promote healing
• a clinical psychologist – a healthcare professional who specialises in the assessment and treatment of mental health conditions to deal with emotional problems
• an educational psychologist – a healthcare professional who assists children who are having difficulty progressing with their education as a result of emotional, psychological or behavioural factors

Other doctors who may be involved include a neurodevelopmental paediatrician or a paediatric neurologist. These are paediatricians (see above) who also specialise in the development of the central nervous system (the brain, nerves and spinal cord).

A neurologist can also rule out other neurological conditions (conditions that affect the brain and nervous system) that may be causing your child’s symptoms.

Assessment

After your child has been referred, the healthcare professionals involved will carry out an assessment. The assessment will usually involve a detailed account of your child's:

• developmental history, such as when they first sat up or crawled
• intellectual ability, such as how they are progressing with reading and writing

There will also be tests of your child’s gross and fine motor (movement) skills:

• gross motor skills are the ability to use large muscles that co-ordinate body movements, such as running, walking, jumping, throwing and maintaining balance
• fine motor skills are the ability to use small muscles for accurate co-ordinated movements, such as writing, tying a shoelace, doing up buttons and tracing and cutting out shapes

These skills will be tested by asking your child to carry out physical activities, such as throwing a ball or completing some handwriting. The healthcare professionals will be able to determine whether your child’s motor skills are abnormal for what is usually expected for children of their age and intellectual ability.

Diagnostic criteria

Since the mid-1990s, dyspraxia has been diagnosed using the following criteria:

• Your child’s motor skills are significantly below the level expected for their age and intelligence
• This lack of skill affects your child’s day-to-day activities and their achievements at school
• This lack of skill is not caused by another medical condition, such as cerebral palsy (a set of neurological conditions that affect a child's movement and co-ordination) or muscular dystrophy (an inherited condition that gradually causes the muscles to weaken)
• If your child also has a learning difficulty, their motor skills are worse than expected for someone with this learning difficulty

Your child may be diagnosed with dyspraxia if they match all these criteria.

Dyspraxia (a type of developmental co-ordination disorder) cannot be cured. However, there are ways to teach your child to cope with their problems. It is important a proper diagnosis is made, as your child may have a greater chance of improvement if treatment is started early.

A small group of children, usually those with mild symptoms of clumsiness, may ‘grow out’ of their symptoms. However, as many as 9 out of 10 children will continue to be affected as a teenager and an adult.

Once dyspraxia has been diagnosed, treatment is available from a variety of specialists (see below). This, combined with extra help at school, can help your child overcome many difficulties.

Healthcare professionals

A number of healthcare professionals may be involved in your child’s care, including:

• an occupational therapist – a healthcare professional who works out practical solutions to everyday problems
• a paediatrician – a doctor who specialises in babies' and children's health
• a physiotherapist – a healthcare professional trained in the use of physical methods, such as massage, to promote healing
• a clinical psychologist – a healthcare professional who specialises in the assessment and treatment of mental health conditions
• an educational psychologist – a healthcare professional who assists children who are having trouble progressing with their education due to emotional, psychological or behavioural factors

Occupational therapy

This therapy involves identifying problem areas in your child’s everyday life, and working out practical solutions.

Your child’s occupational therapist will watch your child at home, at school and when playing to identify when your child experiences problems. For example, your child may have difficulty:

• dressing themselves
• walking to the bus stop
• using a knife and fork
• riding a bike
• writing

Your child’s occupational therapist can then work out ways around the problem, for example by breaking the action down into small steps and practising individual movements. Alternatively your child may need some physical aids, such as crutches to help them walk, or a stairlift fitted at home.

Read more information about occupational therapy.

Speech and language therapy

Dyspraxia affects co-ordination, which includes co-ordinating muscles used to speak. Speech and language therapy may be useful if your child has problems with speech. For example, your child may:

• only be able to make certain sounds, such as being able to pronounce ‘T’ but not ‘D’
• miss out parts of words
• talk too slowly or too quickly
• talk too loudly or too quietly

A speech and language therapist will:

• assess your child's speech
• identify what problems they have
• help them communicate to the best of their ability

The therapist will arrange a programme to address your child’s needs. This may involve:

• exercises to move the lips or tongue in a certain way
• practising producing a certain sound
• learning to control their breathing

With speech and language therapy, your child could learn to manage their disability.

Perceptual motor training

Treatment may also involve perceptual motor training. This is a set of tasks that cover:

• language skills
• visual and auditory (hearing and listening) skills
• movement skills

Your child may be given a graduated series of exercises to develop these skills. Each exercise is difficult enough to challenge your child but not so difficult that they become frustrated.