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Sally Payne examines the different ways dyspraxia affects people across their lifespan 

Developmental coordination disorder (DCD), also known as dyspraxia in the UK, used to be thought of as a childhood condition. However, evidence now suggests that it is often found in adolescents and adults. 

A specific learning difficulty which affects gross and fine motor coordination, the condition is often associated with issues with memory, planning, organisation and perceptual skills. It can also affect speech. Although it is believed to affect between five and ten per cent of school-age children, awareness of the condition is still poor, meaning that children can struggle to get the support they need at school and beyond.

DCD/dyspraxia presents different challenges at different life stages. A range of intervention and support strategies are therefore needed to ensure that the condition does not present a barrier to opportunity and achievement. 

Pre-school

Diagnosis of DCD/dyspraxia is unusual before five years of age because children vary widely in their movement opportunities and the rate of their development. It is important that a diagnosis isn’t given too soon as poor motor coordination could be an early indicator of another condition, such as cerebral palsy, muscular dystrophy or an attention disorder and these require different intervention approaches.

Whilst a diagnosis of DCD/dyspraxia is unusual in the preschool population, much can be done to promote the development of children who are at risk of receiving the diagnosis. Children with poor balance will benefit from participation in physical activities such as obstacle courses, soft play sessions, swimming and ride-on toys. Games with a bat and ball, soap bubbles and balloons will help develop eye-hand coordination and strength, while role-play activities help develop skills for dressing, turn-taking and communication. These activities will help children develop the fundamental skills they need to manage the more complex tasks they will encounter as they grow older.

Primary school

Difficulties associated with DCD/dyspraxia typically become more apparent during the primary school years as motor coordination, sequencing and planning difficulties affect children’s ability to learn and perform motor tasks in the same way as their peers. Children with DCD/dyspraxia often lack core stability, so they might fall over in the playground, have difficulty learning to ride a bike and struggle with PE and sports. Many have difficulty maintaining a good sitting posture and lack stamina for gross motor activities. Poor fine motor skills affect children’s ability to produce fluent writing, manage buttons, use cutlery and handle scissors. Children with DCD/dyspraxia may also be slow to process instructions because of the extra effort required to organise their thoughts, ideas and movements, leading to frustration when a task is not performed as intended. Without appropriate recognition and support, these difficulties can affect a child’s academic achievement, peer relationships and self-esteem. 

Children with (or at risk of) DCD/dyspraxia will benefit from participation in targeted gross and fine motor programmes to help them develop the motor skills necessary for daily life. They often require help to establish a good pencil grip and the dynamic finger movements necessary for fluent writing. Provision of tools such as a writing slope, pencil grip and easy-grip scissors can help to reduce the “motor load” of classroom tasks, enabling the child to focus on learning. Support and extra time to master everyday activities such as getting dressed and using cutlery is vital, while identifying extra-curricular physical activities that interest the individual will provide additional movement opportunities and support their social development. These approaches will boost a child’s confidence and self-esteem whilst also teaching them the skills necessary to manage the more complex activities and situations they will encounter at secondary school.   

Secondary school

Secondary school presents particular challenges for young people with DCD/dyspraxia as they are expected to take increasing responsibility for themselves and their learning. Students with DCD/dyspraxia often struggle to cope with the increased pace and volume of written work and may have difficulty learning how to handle specialist equipment such as that used during technology lessons. Teenagers with DCD/dyspraxia frequently struggle to organise themselves and their equipment and may be late for lessons or forget to hand in assignments. Teenagers with DCD/dyspraxia are often embarrassed at their inability to perform motor tasks to the same standard as their peers and may avoid situations for fear of exposing their difficulties, putting them at risk of social isolation and limiting opportunities for skill development. 

During adolescence, intervention shifts from developing a person’s underlying skills, to helping them to identify and use strategies that enable their performance. Strategies might include using technology (such as a computer) to record work, help with time management and organisational skills, or support from a technician when learning to use woodwork tools. It is essential that students with DCD/dyspraxia are involved in identifying appropriate tools and approaches if they are to be effective. Raising awareness of DCD/dyspraxia will also help teaching and support staff to create an environment that supports, rather than hinders students’ performance and development. 

Adulthood

By adulthood many people with DCD/dyspraxia have developed strategies to cope with (or avoid) their motor difficulties; however, physical difficulties often re-emerge when under stress, when learning new skills or in distracting environments. The non-motor aspects of DCD/dyspraxia however, including poor time management, planning and organisational skills tend to present more of a challenge in their daily lives. 

Adults with DCD/dyspraxia benefit from understanding their own unique profile of difficulties and strengths. Being able to link positive performance to successful strategy use enables them to request and use appropriate reasonable adjustments in the workplace and in other settings. Many adults with DCD/dyspraxia benefit from using technology to help with organisational skills. Identifying a physical activity that individuals enjoy, for example cycling, running or martial arts, can also help with fitness. Some individuals benefit from access to counselling and support for their mental wellbeing.  

Support for life

DCD/dyspraxia is a life-long condition, but its impact varies according to a person’s life stage. The focus of support shifts over time from building underlying skills in the early years, to identifying and ensuring access to tools and strategies that enable an individual’s performance during adolescence and adulthood. Understanding this changing pattern of need will enable parents and professionals to provide the right help for an individual at the right time.   

Focus of dyspraxia interventions by life stage

Preschool:

  • developing fundamental movement skills through play.

Primary school:

  • targeted gross and/or fine motor programmes
  • support to master daily activities
  • involvement in after-school activities.

Secondary school:

  • empowering young people to identify and use strategies that enable their performance.
  • tools to reduce the impact of motor difficulties
  • extra time and support to master new skills and activities
  • organisational strategies.

Adulthood:

  • awareness of individual strengths and difficulties
  • awareness of tools/strategies that enable successful performance
  • access to psychological support, if indicated.

Dyspraxia Awareness Week 2016

9 to 15 October 2016
The annual dyspraxia awareness campaign, organised by the Dyspraxia Foundation, this year focusses on adult issues and employment and is supported by a survey to find out about experiences of people in the workplace with DCD/dyspraxia.

Further information

Dr Sally Payne is Head Paediatric Occupational Therapist at the Heart of England Foundation NHS Trust and a Trustee of the Dyspraxia Foundation:
www.dyspraxiafoundation.org.uk


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