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Developmental dyspraxia, referred to as developmental coordination disorder (DCD) in the US and Europe, is a chronic neurological disorder beginning in childhood that can affect planning of movements and co-ordination as a result of brain messages not being accurately transmitted to the body.
Developmental dyspraxia is a lifelong neurological condition that is more common in males than in females, with a ratio of approximately four males to every female. The exact proportion of people with the disorder is unknown since the disorder can be difficult to detect due to a lack of specific laboratory tests, thus making diagnosis of the condition one of elimination of all other possible causes/diseases. Approximately 5–6% of children are affected by this condition.
Assessment and diagnosis
Assessments for dyspraxia typically require a developmental history, detailing ages at which significant developmental milestones, such as crawling and walking, occurred. Motor skills screening includes activities designed to indicate dyspraxia, including balancing, physical sequencing, touch sensitivity, and variations on walking activities. A baseline motor assessment establishes the starting point for developmental intervention programs. Comparing children to normal rates of development may help to establish areas of significant difficulty.
Speech and language
Developmental verbal dyspraxia (DVD) is a type of ideational dyspraxia, causing linguistic or phonological impairment. This is the favoured term in the UK; however, it is also sometimes referred to as articulatory dyspraxia, and in the United States the usual term is childhood apraxia of speech (CAS).
Key problems include:
- Difficulties controlling the speech organs.
- Difficulties making speech sounds
- Difficulty sequencing sounds
- Difficulty controlling breathing, suppressing salivation and phonation when talking or singing with lyrics.
- Slow language development.
- Difficulty with feeding.
Fine motor control
Difficulties with fine motor co-ordination lead to problems with handwriting, which may be due to either ideational or ideo-motor difficulties. Problems associated with this area may include:
- Learning basic movement patterns.
- Developing a desired writing speed.
- The acquisition of graphemes.
- Establishing the correct pencil grip
- Hand aching while writing.
Fine-motor problems can also cause difficulty with a wide variety of other tasks such as using a knife and fork, fastening buttons and shoelaces, cooking, brushing one's teeth, applying cosmetics, styling one's hair, opening jars and packets, locking and unlocking doors, shaving, and doing housework.
Whole body movement, coordination, and body image
Issues with gross motor coordination mean that major developmental targets including walking, running, climbing and jumping can be affected. The difficulties vary from child to child and can include the following:
- Poor timing
- Poor balance (sometimes even falling over in mid-step). Tripping over one's own feet is also common.
- Difficulty combining movements into a controlled sequence.
- Difficulty remembering the next movement in a sequence.
- Problems with spatial awareness, or proprioception.
- Some people with dyspraxia have trouble picking up and holding onto simple objects such as picking pencils and things up, owing to poor muscle tone and/or proprioception.
- This disorder can cause an individual to be clumsy to the point of knocking things over and bumping into people accidentally.
- Some people with dyspraxia have difficulty in determining left from right.
- Cross-laterality, ambidexterity, and a shift in the preferred hand are also common in people with dyspraxia.
- Problems with chewing foods
- People with dyspraxia may also have trouble determining the distance between themselves and other objects.
In addition to the physical impairments, dyspraxia is associated with problems with memory, especially short-term memory. This typically results in difficulty remembering instructions, difficulty organizing one's time and remembering deadlines, increased propensity to lose things or problems carrying out tasks which require remembering several steps in sequence (such as cooking).
Whilst most of the general population experience these problems to some extent, they have a much more significant impact on the lives of dyspraxic people. However, many dyspraxics have excellent long-term memories, despite poor short-term memory. Many dyspraxics benefit from working in a structured environment, as repeating the same routine minimises difficulty with time-management and allows them to commit procedures to long-term memory.