An introduction to dyspraxia

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An introduction to dyspraxia

• Contributor
• Dr C M Ni Bhrolchain
• Huntingdon

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What is dyspraxia?

• Definition
• An impairment or immaturity in
• the organisation of movement
• Also known as
• Minimal brain dysfunction (MBD)
• Minimal cerebral dysfunction (MCD)
• The clumsy child
• Developmental Co-ordination Disorder (DCD)
• Deficits in attention, motor control and
  perception (DAMP)

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• Associated difficulties include
• Language delay
• Perceptual difficulties
• Difficulties in planning and
• organising thought
• Self-esteem and emotional
• Difficulties

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How common is it?

• Thought to be present to some extent in about 5
  of school entrants
• More common in premature
• Much more common in boys
• Often runs in families
• More common in disadvantaged areas

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Teachers may notice

• More clumsy than peers
• Drawing
• Dressing
• Disorganised
• Difference in verbal vs written work

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How do we diagnose it?

• Usually presented by parents or teacher
• Often a history of poor motor development e.g.
  late walking, falling over a lot, poor ball
  catching skills etc
• Start at school or nursery
• Immature or poor drawing skills
• Difficulty with personal skills especially
  dressing, eating, toileting, shoe laces etc

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Other signs

• Disorganised constantly losing things,
  forgetting equipment, cant follow timetables,
  forgets homework
• Late learning motor skills such as riding a bike
• Later on
• Failing at school
• Behaviour difficulties, disruption
• Truanting or school refusal

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When we examine them

• No signs of muscle or nerve problems such as
  cerebral palsy (otherwise CP is diagnosis)
• Co-ordination may be poor eg
• Hopping on 1 leg
• Walking heel to toe
• Telling left from right
• Following instructions (cant do tests)
• Tapping (dysdiadochkinesis)
• Finger-nose test

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• Drawing may be immature
• ? ? ? ?
• 2 3 5 7
• ? ?
• 9 11
• Test threading beads, building small blocks. It
  may be more revealing how the child attempts the
  tasks as much as what he/she achieves

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Assessment

• Paediatric assessment to make diagnosis and
  consider other co-existing problems
• Naming the problem may help
• Child/parents not to blame
• Can explain the difficulties and what may help
• Support available from other parents
• Structured way of looking at the problem

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Assessment

• Paediatrician may refer to
• Occupational therapy
• Physiotherapy
• Speech and language therapist
• Clinical Psychology
• Educational Psychology
• Paediatric neurology
• Occupational therapy will provide detailed
  assessment of where problems are and the extent
• Vision should be checked but usually normal. The
  problem is with perception

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Overlapping problems (co-morbidity)

• Self esteem and behaviour difficulties (more
  apparent in older children)
• Learning difficulties may exist but may be of
  normal ability.
• ADHD may co-exist
• Autism, especially Aspergers syndrome, may
  co-exist
• Hearing difficulty, especially glue ear, will
  compound

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Treatment

• Early intervention
• Avoids abnormal movement patterns
• Avoids sense of failure
• May improve eventual outcome
• Follow-up studies have shown continuing problems
  into adolescence and adulthood
• Many suggested treatments but no good evaluations
• Multi-disciplinary approach works best have to
  tackle learning, motor skills and self esteem

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Useful tips

• Interventions to make life easier and learn
  skills which are difficult eg
• List of equipment on inside of school bag or
  pencil case
• Velcro instead of laces/zips
• Practising ball skills, using cutlery, drawing,
  PC instead of handwriting