Introduction 
 


Dyspraxia in children


 

Developmental co-ordination disorder (DCD), also known as dyspraxia, is a condition affecting physical co-ordination that causes a child to perform less well than expected for his or her age in daily activities and appear to move clumsily.

Early developmental milestones of crawling, walking, self-feeding and dressing may be delayed in young children with DCD, and drawing, writing and performance in sports are usually behind what is expected for their age.

The problem is not due to general delays in development or a learning disability, and is not caused by cerebral palsy or another neurological disorder (conditions affecting the nervous system).

Although signs of the condition are present from an early age, children vary widely in their rate of development and DCD is not usually definitely diagnosed until a child with the condition is around five years old or more.

 

This information is about DCD in children, although the condition often causes continued problems into adulthood. There is a separate topic on DCD in adults.

Getting help for your child

Talk to your GP or health visitor – or a nurse, doctor or special educational needs co-ordinator (SENCO) at your child's school – if you have any concerns about your child's health or development.

If necessary, they can refer your child to a community paediatrician, who will try to identify any developmental problems and arrange for an assessment of the child's motor (movement) skills if appropriate.

 

What causes DCD?

Carrying out co-ordinated movements is a complex process that involves many different nerves and parts of the brain. It is not usually clear why co-ordination doesn’t develop as well as other abilities in children with DCD.

However, a number of risk factors that can increase a child’s likelihood of developing DCD have been identified, including being born prematurely (before the 37th week of pregnancy) and being born with a low birth weight.

 

Who is affected

It is hard to estimate exactly how many children are affected by DCD, although a study carried out in the UK in 2009 suggested that up to one in every 20 children between seven and eight years of age may be affected by the condition to some degree.

DCD is thought to be around three or four times more common in boys than girls and the condition sometimes runs in families.

How DCD is treated

There is no cure for DCD, but a number of therapies can make it easier for children to manage their problems.

These include:



being taught ways of carrying out troublesome activities, such as breaking down difficult movements into much smaller parts and practising them regularly



adapting tasks to make them easier, such as using special grips on pens and pencils so they are easier to hold



Although DCD does not affect how intelligent a child is, it can make it more difficult for them to learn and they may need extra help to keep up at school.

Treatment for DCD will be tailored to your child and usually involves a number of different healthcare professionals working together.

Most children with DCD will continue to have difficulties as teenagers and adults but those with mild problems might find things improve as they grow up.

 



 




Childhood dyspraxia: James's story


 


James was diagnosed in 2005 with dyspraxia, a disability that can affect movement and co-ordination. His mother describes James’s symptoms and the methods used to improve his condition. Note: this video represents the parent's view of her child.


Media last reviewed: 07/10/2014

Next review due: 07/10/2016






Dyspraxia or developmental co-ordination disorder (DCD)?

While many people in the UK use the term 'dyspraxia' to refer to the difficulties with movement and co-ordination that first develop in young children, the term is used less often by health professionals nowadays.

Instead, most healthcare professionals use the term 'developmental co-ordination disorder (DCD)' to describe the condition.

This term is generally preferred by healthcare professionals because, strictly speaking, 'dyspraxia' can have several meanings. For example, dyspraxia can be used to describe movement difficulties that occur later in life as a result of damage to the brain, such as from a stroke orhead injury.

Some health professionals may also use the term ‘specific developmental disorder of motor function (SDDMF)’ to refer to DCD.

Symptoms of DCD in children 

Developmental co-ordination disorder (DCD) can cause a wide range of problems. Some of these may be noticeable at an early age, while others may only become more obvious as your child gets older.

Problems in infants

Delays in reaching normal developmental milestones can be an early sign of DCD in young children. For example, your child may take slightly longer than expected to:



roll over



sit



crawl



walk



You may also notice that your child appears unusually stiff (hypertonia) or floppy (hypotonia), has difficulty playing with toys that involve good co-ordination (such as stacking bricks), and they may have some difficulties learning to eat with cutlery.

Problems in older children

As your child gets older, they may develop more noticeable physical difficulties in addition to a number of other problems.

Movement and co-ordination problems

Problems with movement and co-ordination are the main symptoms of DCD and children may have difficulties:



with 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 find PE (physical education) difficult



walking up and down stairs



writing, drawing and using scissors – their handwriting and drawings may appear scribbled and more childish than other children their age



getting dressed, doing up buttons and tying shoelaces



keeping still – they may swing or move their arms and legs a lot and find it hard to sit still



A child with DCD may appear awkward and clumsy as they may bump into objects, drop things and fall over a lot – although this in itself is not necessarily a sign of DCD, as many children who appear clumsy actually have all the normal motor (movement) skills for their age.

Some children with DCD may also become less fit than other children as their poor performance in sport may result in them being reluctant to exercise.

Additional problems

As well as difficulties related to movement and co-ordination, children with DCD can also have a range of other problems, such as:



difficulty concentrating – they may have a poor attention span and find it difficult to focus on one thing for more than a few minutes



difficulty following instructions and copying down information – 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



being poor at organising themselves and getting things done



not automatically picking up new skills and needing encouragement and repetition to help them learn



difficulties making friends – they may avoid taking part in team games and may be bullied for being ‘different’ or clumsy



behaviour problems – often stemming from a child’s frustration with their symptoms



low-self esteem



However, although the child with DCD may have poor co-ordination and some of these additional problems, not all their abilities will be affected. For example, the child's abilities to think, talk and understand are not usually behind what is expected at his or her age. 

Related conditions

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



attention deficit hyperactivity disorder (ADHD) – a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness



dyslexia – a common learning difficulty that mainly affects the way people read and spell words



autism spectrum disorder (ASD) – a condition that affects social interaction, communication, interests and behaviour



Some children with DCD have difficulty coordinating the movements required to produce clear speech.

Getting help

Talk to your GP or health visitor – or a nurse, doctor or special educational needs co-ordinator (SENCO) at your child's school – if you have any concerns about your child's health or development.

If necessary, they can refer your child to a community paediatrician, who will try to identify any developmental problems and arrange for an assessment of the child's motor skills if appropriate.

Causes of DCD in children 

Little is known about the cause of developmental co-ordination disorder (DCD), although it is thought to be caused by a problem in the development of the brain.

Performing smooth, planned movements is a complex process, involving your senses, muscles and central nervous system (brain, nerves and spinal cord). Any problem in this process could potentially lead to difficulties with movement and co-ordination.

Increased risk

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



being born prematurely (before the 37th week of pregnancy)



being born with a low birth weight



having a family history of DCD, although it is not clear exactly which genes may be involved in the condition



the mother drinking alcohol or taking illegal drugs while pregnant



Acquired dyspraxia

The term 'dyspraxia' is sometimes used generally to refer to difficulties with movement and co-ordination.

When the term is used in this way, it can include problems caused by brain damage later in life, such as a head injury.

These cases are also called 'acquired dyspraxia' and are different to the developmental condition most people are referring to when they use the term dyspraxia.

Diagnosing DCD in children 

Talk to your GP, health visitor or special educational needs co-ordinator (SENCO) if you think your child has developmental co-ordination disorder (DCD).

They may refer your child to another professional who can help arrange an assessment.

This could be:



a paediatrician – a doctor specialising in the care of children and babies, who will usually be based in your local community (community paediatrician)



a paediatric occupational therapist – a healthcare professional who can assess a child's functional abilities in daily living activities, such as handling cutlery and getting dressed



a paediatric physiotherapist – a healthcare professional who can assess a child’s motor (movement) skills



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 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 in this process include a neurodevelopmental paediatrician or a paediatric neurologist. These are paediatricians who also specialise in the development of the central nervous system (the brain, nerves and spinal cord).

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

It’s important to get a correct diagnosis so you can develop a better understanding of your child’s problems and so appropriate support can be offered. Getting a diagnosis can also help reduce the stress experienced by both parents and children with DCD.

Assessment

The diagnosis of DCD is usually made by a paediatrician, often in collaboration with an occupational therapist. Generally the paediatrician is more involved in the diagnosis and the occupational therapist is involved in both diagnosis and treatment.

For a diagnosis to be made, it is essential for the child to have what is called a norm-referenced assessment of his or her motor ability, which may be carried out by an occupational therapist, a physiotherapist or a paediatrician.

The assessment method most used in the UK is known as the 'Motor ABC'. This will involve tests of your child’s:



gross motor skills – their ability to use large muscles that co-ordinate significant body movements, such as moving around, jumping and balancing



fine motor skills – their ability to use small muscles for accurate co-ordinated movements, such as drawing and placing small pegs in holes



Your child's performance on the assessment is scored and compared with what is the normal range of scores for a child of their age.

There also needs to be evidence that the child's mental ability is within the normal range for his or her age. This may be clear based on reports from the child’s school obtained by a paediatrician, although sometimes the child may also have a standard assessment of mental ability done by a psychologist or, in the case of young children, a paediatrician.

As part of an assessment, your child's medical history (such as any problems that occurred during their birth and whether there have been any delays reaching developmental milestones) and your family medical history (such as whether any family members have been diagnosed with DCD) may also be taken into account.

Once the assessment process is complete, the paediatrician will produce a report on the child's condition in collaboration with other professionals involved.

Diagnostic criteria

For a diagnosis of DCD to be made, your child will usually need to meet all of the following criteria:



your child’s motor skills are significantly below the level expected for their age and opportunities they have had to learn and use these skills



this lack of motor skill significantly and persistently affects your child’s day-to-day activities and their achievements at school



your child's symptoms first developed during an early stage of their development



the lack of motor skills is not better explained by a learning disability or another medical condition, such as cerebral palsy ormuscular dystrophy



DCD should only be diagnosed in children with a generalised learning disability if their physical co-ordination is significantly more impaired than their mental abilities.

Although DCD may be suspected in the preschool years, it is not usually possible to establish a definite diagnosis before the age of four or five years because it can be difficult to be certain whether a child has DCD if they still are very young.

Treating DCD in children 

Developmental co-ordination disorder (DCD) can't be cured, but there are ways your child can be helped to manage their problems.

A small group of children, usually those with mild symptoms of clumsiness, may eventually ‘grow out’ of their symptoms. But the vast majority of children will need long-term help and will continue to be affected as teenagers and adults.

Once DCD has been diagnosed, a treatment plan tailored to your child's particular difficulties can be drawn up, which may involve input from a variety of specialists (see below).

This, combined with extra help at school, can help your child manage many of their physical difficulties, improve their general confidence and self-esteem, and allow them to live as independently as possible as they get older.

Healthcare professionals

A number of healthcare professionals may be involved in your child’s care.

For example, your child may need help from a paediatric occupational therapist, who can assess their abilities in daily activities, such as handling cutlery, dressing, using the toilet, playing and school skills involving fine movement activities (such as writing), as well as other aspects of how the child functions in the school and the home.

The therapist can then work with the child, the parents and teachers to help find ways to manage any problems.

Your child may also recieve help from a paediatric physiotherapist. This is a healthcare professional primarily concerned with the child’s motor (movement) skills, who can help assess the child's abilities before devising an individualised therapy plan which may include – among others – activities to help improve walking, running, balance and co-ordination.

Other health professionals that may be involved in your child's care may include:



a paediatrician – a doctor who specialises in the care of babies and children



a clinical psychologist – a healthcare professional who specialises in the assessment and treatment of mental health conditions



an educational psychologist – a professional who assists children who are having trouble progressing with their education due to emotional, psychological or behavioural factors



Some of the interventions these health professionals may provide are outlined below.

Task-orientated approach

One of the main types of intervention used to help children with DCD manage their condition is known as a 'task-orientated approach'.

This involves working with you and your child to identify specific activities which cause difficulties and finding ways to overcome them.

For example, a therapist can help improve difficulties with specific movements by breaking the action down into small steps and teaching your child to plan these individual movements carefully and practise them regularly.

Your child may also benefit from adapting tasks to make them easier to perform, such as adding special grips to pens to make them easier to hold, or wearing loose-fitting clothes and Velcro fasteners rather than shoelaces to make dressing easier.

Your child may be encouraged to exercise regularly as well, as this is generally considered to be beneficial for children with DCD.

Process-orientated approach

An alternative method to the task-orientated approach is the 'process-orientated approach'. This approach is based on the theory that problems with your child's senses or perception of their body may be contributing to their movement difficulties.

A process-orientated approach may involve regular activities aimed at improving these potential problems, with the aim of trying to improve your child's more general motor (movement) skills, rather than helping them with a particular task or activity.

However, current evidence suggests that a task-orientated approach is likely to be more effective for children with DCD than this process-orientated approach.

Treating other conditions

Children with DCD often have other conditions as well, which may need to be treated separately. The treatments for some of these related conditions are described below.

Attention deficit hyperactivity disorder (ADHD)

If your child also has attention deficit hyperactivity disorder (ADHD), they may benefit from taking medication to help them concentrate better, be less impulsive, feel calmer, and learn and practise new skills.

Dyslexia

If your child also has dyslexia, they may benefit from special educational interventions designed to improve their reading and writing.

Autism spectrum disorder (ASD)

If your child also has autism spectrum disorder (ASD), they may benefit from special programmes designed to help improve their communication, social interaction, cognitive and academic skills.

Speech and language problems

Speech and language therapy may be useful if your child also has problems with their speech. A speech and language therapist can assess your child's speech, identify what problems they have, and help them find ways to communicate to the best of their ability.

This may involve exercises to move the lips or tongue in a certain way, practising producing certain sounds, and learning to control their breathing.

Treatment as your child gets older

Although the physical co-ordination of a child with DCD will remain below average, this in itself often becomes less of a problem as they get older. Usually by adolescence they are able to manage their daily activities much better, although difficulties in school – particularly producing written work – can become much more prominent.

A further treatment period by an occupational therapist for handwriting problems may be helpful when your child is a little older. In secondary school extra time in exams may need to be requested by the school. Use of a home computer may be helpful in producing homework and in some cases a laptop is provided in school.

A young person with DCD may also have one or more of the associated problems mentioned above, which may adversely affect their behaviour, socialisation and school achievement. These young people often require a significant degree of parental support in addition to the treatment they receive.

Alternative therapies

Due to the potential limitations of available treatments for DCD, and the fact it cannot be cured, some parents may be tempted to look into alternative therapies that claim to cure or greatly improve the condition.

However, there is usually no scientific evidence to support the use of such alternative therapies and they can be expensive as well as time-consuming. It is also important to bear in mind that in many cases the physical co-ordination problems associated with DCD will naturally improve over time anyway.