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07-SEPTEMBER-2008 03:17:44 - dyspraxia January 2008 Part of a series on Dyslexia and related disorders Education · Neuropsychology RELATED CONDITIONS Alexia Auditory Processing Disorder Dyscalculia · Dysgraphia Dyslexia · Dyspraxia THEORIES Double deficit · Magnocellular Perceptual noise exclusion Phonological deficit RELATED TOPICS IDEA · Literacy Reading acquisition · Spelling Recording for the Blind Dyslexic LISTS Assessments · Fields People · Publications Topics Fiction · Treatments view talk Developmental dyspraxia Classification and external resources ICD-10 F82. ICD-9 315.4 DiseasesDB 31600 MeSH D001072 Developmental dyspraxia is one or all of a heterogeneous range of development disorders affecting the initiation, organization and performance of action.1 It is a diagnosis of exclusion which entails the partial loss of the ability to coordinate and perform certain purposeful movements and gestures, in the absence of other motor or sensory impairments like multiple sclerosis or Parkinson's disease. The concept of developmental dyspraxia has existed for more than a century, but differing interpretation of the terminology remains.2 Developmental dyspraxia referred to as developmental coordination disorder DCD in the US is a life-long condition that is more common in males than in females; the exact proportion of people with the disorder is unknown since the disorder can be hard to detect. Current estimates range from 5% - 20% with at least 2% being affected severely. Ripley, Daines, and Barrett state that 'Developmental dyspraxia is difficulty getting our bodies to do what we want when we want them to do it', and that this difficulty can be considered significant when it interferes with the normal range of activities expected for a child of their age. Madeline Portwood makes the distinction that dyspraxia is not due to a general medical condition, but that it may be due to immature neuron development. The word dyspraxia comes from the Greek words dys meaning impaired or abnormal and praxis, meaning action or deed. Dyspraxia is described as having two main elements: Ideational dyspraxia Difficulty with planning a sequence of coordinated movements. Ideo-Motor dyspraxia Difficulty with executing a plan, even though it is known. Contents 1 Assessment and diagnosis 2 Developmental profiles 2.1 Speech and language 2.2 Fine motor control 2.3 Whole body movement, coordination, and body image 3 General difficulties 4 Overlap with other conditions 5 Other names 6 References 7 External links 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. However, research in the BJSE has shown that knowledge is severely limited in many who should be trained to recognise and respond to various difficulties, including Developmental Coordination Disorder, Dyslexia and DAMP. The earlier that difficulties are noted and timely assessments occur, the quicker intervention can begin. A teacher or GP could miss a diagnosis if they are only applying a cursory knowledge. Teachers will not be able to recognise or accommodate the child with learning difficulties in class if their knowledge is limited. Similarly GPs will find it difficult to detect and appropriately refer children with learning difficulties.3 Developmental profiles Various areas of development can be affected by developmental dyspraxia and many or all can persist into adulthood. Often various coping strategies are developed, and these can be enhanced through physiotherapy. Speech and language Developmental verbal dyspraxia 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 USA the usual term is apraxia of speech 4. Key problems include: Difficulties controlling the speech organs. Difficulties making speech sounds Difficulty sequencing sounds Within a word Forming words into sentences Difficulty controlling breathing and phonation. 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 - e.g. the letters of the Latin alphabet, as well as numbers. Establishing the correct pencil grip Hand aching while writing Whole body movement, coordination, and body image Issues with gross motor coordination mean that major developmental targets including walking, running, climbing and jumping are affected. One area of difficulty involves associative movement, where a passive part of the body moves or twitches in response to a movement in an active part. For example, the support arm and hand twitching as the dominant arm and hand move, or hands turning inwards or outwards to correspond with movements of the feet. Problems associated with this area may include: Poor timing. Poor balance sometimes even falling over in mid-step. Tripping over one's own feet is also not uncommon. 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 due to poor muscle tone. This disorder can cause an individual to be clumsy to the point of knocking things over and bumping into people accidentally. Some dyspraxics have difficulty in determining left from right.citation needed Cross-laterality, ambidexterity, and a shift in the preferred hand are also common in people with dyspraxia.citation needed Dyspraxics may also have trouble determining the distance between them and other objects.citation needed Some dyspraxics have difficulty achieving and maintaining continence either of bladder or bowel or both. Bedwetting or nocturnal enuresis is common.citation needed General difficulties Dyspraxic people may have Sensory Integration Dysfunction, a condition that creates abnormal oversensitivity or undersensitivity to physical stimuli, such as touch, light, and soundcitation needed. This may manifest itself as an inability to tolerate certain textures such as sandpaper or certain fabrics, or even being touched by another individual in the case of touch oversensitivity or may require the consistent use of sunglasses outdoors since sunlight may be intense enough to cause discomfort to a dyspraxic in the case of light oversensitivity. An aversion to loud music and naturally loud environments such as clubs and bars is typical behavior of a dyspraxic individual who suffers from auditory oversensitivity, while only being comfortable in unusually warm or cold environments is typical of a dyspraxic with temperature oversensitivity. This typically occurs if the dyspraxia is comorbid to an autistic spectrum disorder PDD such as autistic disorder or Asperger syndromecitation needed. Dyspraxic people sometimes have difficulty moderating the amount of sensory information that their body is constantly sending them, so as a result these people are prone to panic attackscitation needed. Having other autistic traits which is common with dyspraxia and related conditionscitation needed may also contribute to sensory-induced panic attacks. Moderate to extreme difficulty doing physical tasks is experienced by dyspraxics, and fatigue is common because so much extra energy is expended while trying to execute physical movements correctly.5 Some but not all dyspraxics suffer from hypotonia, which in this case is chronically low muscle tone caused by dyspraxiacitation needed. People with this condition have very low muscle strength and endurance even in comparison with other dyspraxics and even the simplest physical activities may quickly cause soreness and fatigue, depending on the severity of the hypotonia. Hypotonia may worsen a dyspraxic's already poor balance to the point where it is necessary to constantly lean on sturdy objects for supportcitation needed. Dyspraxics may wish to live alongside others, although they often find it difficult. They can be messy and cluttered with a tendency to outburst including aggression, 'good and bad days' mood swings and difficulty in understanding the meaning of everyday interactions within a household6 Because of this, they sometimes end up arguing with people they care deeply about and regretting it when the mood swing is over. Often, their moods do not last too long, but they are very intense. When angered, a dyspraxic may feel beyond furious but soon the mood will be over and he\she may regret things they did when they were angrycitation needed. Overlap with other conditions Dyspraxics may have other difficulties that are not due to dyspraxia itself but often co-exist with it. They may have characteristics of dyslexia difficulty with reading and spelling, dyscalculia difficulty with mathematics, expressive language disorder difficulty with verbal expression, ADHD poor attention span, or Asperger syndrome poor social cognition and a literal understanding of language, making it hard to understand idioms or sarcasm. However, they are unlikely to have problems in all of these areas. The pattern of difficulty varies widely from person to person, and it is important to understand that a major weakness for one dyspraxic can be a strength or gift for another. For example, while some dyspraxics have difficulty with reading and spelling due to an overlap with dyslexia, or numeracy due to an overlap with dyscalculia, others may have brilliant reading and spelling or mathematical abilities. Similarly, some have autistic traits such as lacking an appreciation of irony or social cues, while others thrive on an ironic sense of humour as a bonding tool and a means of coping.7 Frustration and low self-esteem are common to many dyspraxics, whatever their profile of difficulties. 8 Other names Collier first described developmental dyspraxia as 'congenital maladroitness'. A. Jean Ayres referred to it as a disorder of sensory integration in 1972 while in 1975 Dr Sasson Gubbay called it the 'clumsy child syndrome'.9 It has also been called minimal brain dysfunction although the two latter names are no longer in use. Other names include: Dyspraxia Developmental Co-ordination Disorder - a subtly different condition by definition, in practice, very similar. Sensorimotor dysfunction Perceptuo-motor dysfunction Motor Learning Difficulties The World Health Organisation currently lists Developmental Dyspraxia as Specific Developmental Disorder of Motor Function.9 References ^ Dyspraxia Info. Retrieved on 2008-04-05. ^ Dewey D 1995. What is developmental dyspraxia?. Brain Cogn 29 3: 254-74. doi:10.1006/brcg.1995.1281. PMID 8838385. ^ Kirby, Amanda; Davies, Rhys Bryant, Amy 2005-11, Do teachers know more about specific learning difficulties than general practitioners?, British Journal of Special Education, http://www.ingentaconnect.com/content/bpl/bjsp/2005/00000032/00000003/art00003 ^ Pam Williams, Developmental Verbal Dyspraxia, Nuffield Hearing Speech Centre ^ Dyspraxia. Retrieved on 2008-04-05. ^ Dyspraxia Foundation - Symptoms. Retrieved on 2008-04-05. ^ Dyspraxia Adults Action. Retrieved on 2008-04-05. ^ Dyspraxia - SCIPS. Retrieved on 2008-04-05. ^ a b What is Dyspraxia. Retrieved on 2008-04-05. External links Dyspraxia Foundation DANDA The Developmental Adult Neuro-Diversity Association United States organization for those with Developmental Dyspraxia v d e WHO ICD-10 mental and behavioral disorders F · 290-319 Neurological/symptomatic Dementia Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia, Elopement, Sundowning, Wandering · Delirium · Post-concussion syndrome · Organic brain syndrome Psychoactive substance alcohol drunkenness, alcohol dependence, alcoholic hallucinosis, Alcohol withdrawal, delirium tremens, Korsakoff's syndrome, alcohol abuse · opioids opioid dependency · sedative/hypnotic benzodiazepine withdrawal · cocaine cocaine dependence · general Intoxication, Drug abuse, Physical dependence, Withdrawal Psychotic disorder Schizophrenia disorganized schizophrenia · Schizophreniform disorder · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder Mood affective Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia Neurotic, stress-related and somatoform Anxiety disorder Agoraphobia, Panic disorder, Panic attack, Generalized anxiety disorder, Social anxiety, Social phobia · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder Ganser syndrome · Somatoform disorder Somatization disorder, Body dysmorphic disorder, Hypochondriasis, Nosophobia, Da Costa's syndrome, Psychalgia · Neurasthenia Physiological/physical behavioral Eating disorder: Anorexia nervosa · Bulimia nervosa Sleep disorder: Dyssomnia Hypersomnia, Insomnia · Parasomnia REM behavior disorder, Night terror · Nightmare Sexual dysfunction: Erectile dysfunction · Premature ejaculation · Vaginismus · Dyspareunia · Hypersexuality · Female sexual arousal disorder Postpartum depression · Postnatal psychosis Adult personality and behavior Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome · Ego-dystonic sexual orientation · Fetishism Mental retardation Mental retardation Psychological development developmental disorder Specific: speech and language expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp · Scholastic skills dyslexia, dysgraphia, Gerstmann syndrome · Motor function developmental dyspraxia Pervasive: Autism · Rett syndrome · Asperger syndrome Behavioral and emotional, childhood and adolescence onset ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech stuttering · cluttering Retrieved from http://en..org/wiki/Developmental_dyspraxia Categories: Neurological disorders | Special educationHidden categories: Articles needing additional references from January 2008 | All articles with statements | Articles with statements since October 2007 | Articles with statements since May 2008 | Articles with statements since February 2007 | Articles with statements since December 2007 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Esperanto Français Italiano Nederlands Suomi Svenska This page was last modified on 25 August 2008, at 15:55
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