Dyspraxia is primarily a developmental disorder affecting the organisation of movement. Typically children will have difficulty in learning and executing physical activities, so at school they may be slower than others to get changed, they will not do well at games and fine motor skills such as handwriting will be a challenge. Often they can be very good verbally, but get very little written down on paper and what they write may be messy and difficult to read or executed carefully but very slowly. At home it will be clear that they are a bit clumsy and may have had difficulty with activities such as dressing skills, tying laces, running, hopping, riding a bike or leaning to swim. Sometimes it looks as if they are just not interested in physical activity and this can mask their difficulties.

The most challenging issues in dyspraxia are the problems the child has with motor planning. This is the process by which the child forms an understanding of the given task, processes what is required and then produces a motor output. Any aspect of this process is capable of being disrupted, and this will prevent the child from achieving the required result. This may be simply reproducing a physical activity which has been modelled or producing a piece of writing according to a teacher’s instructions. The more organisation that is required, the more difficult the child will find the task, so project work is particularly difficult.

There are major visual processing difficulties as well as motor problems underlying dyspraxia, so even in children who are functioning at a very high level there are likely to be visual spatial processing and visual memory issues. These can affect the acquisition of maths concepts, the recall of maths algorithms (the way sums are laid out) and areas of the curriculum in geography and science. Visualisation difficulties may affect the child’s ability to ‘see’ the plot for a story, so they are likely to have problems with the content of free writing as well as the execution. This will also affect their ability to visualise where they left things, so not being able to find things and constantly losing possessions can be problem.

Generally children with dyspraxia are much more able with verbal tasks than non-verbal ones, so there is usually a big difference in the two IQ scales if a child’s IQ is assessed. Teachers and parents can get very frustrated at the poor level of output from an apparently bright child if they are not aware of the underlying difficulties. Often dyspraxic children have no difficulty with reading or spelling, although visual processing difficulties may cause them to lack reading stamina and to miss out or transpose letters in words they are spelling, and it may take a while for people to realise that there is something not quite right.

Dyspraxic children often have difficulty with peer group relations. This is particularly true of boys, who can be isolated because they are unable to join in with the football games at break and develop different interests. From the child’s point of view this is often their biggest problem. Many dyspraxic children also have some difficulties with listening and expressing themselves and some have a speech and language difficulty known as speech dyspraxia.

Suggested action

It is important that the full implications of dyspraxia are understood by both teachers and parents of dyspraxic children because they are so often in trouble for behaviour which it is not in their power to alter. They need a lot of support for their organisational and motor planning issues if they are to reach their potential and it is very important that their work is judged on its content rather than its presentation. They should be given frequent opportunities to demonstrate what they know without having to write it down and not held back in their progress in a subject simply because they are too slow with their writing.

Case Histories

NIGEL

Presenting problems

Nigel was nearly fourteen and had been assessed as dyspraxic, with an auditory processing delay and some difficulties in relating to his peer group. He was articulate, but sometimes struggled to find the words he needed and express himself adequately and had difficulty in listening effectively. Although he could stay focused at school he was easily distracted and had to work hard to pay attention. He was very tired at the end of the school day. He found it hard to respond to a set verbal task, such as telling a story or defining a word, or to understand, retain and recall a sequence of events and his long term memory was poor. Planning and organising with a cause/effect relationship and turning a visual stimulus into a verbal task also produced clear difficulties. As a result of his processing difficulties he tended to react impulsively, without attempting to think things through properly.

Nigel was clumsy, with poor posture and low muscle tone and his athletic skills were poor. He hated competitive games, could not catch a ball easily and would cover his face if a ball came in his direction, so he could not play football. 3D spatial awareness was a particular problem. The educational psychologist’s assessment revealed a 35 point discrepancy between a high average verbal IQ and low non-verbal IQ.  In school he had particular difficulties with maths, geography and science. He suffered from poor self-confidence and low self-esteem.

Assessment

Nigel displayed a typical sensory integration profile for dyspraxia. He had a number of hypersensitivities – to touch, odours and light - which would cause him to be very distractible. He had major issues with muscle tone and body in space awareness which would result in clumsiness and poor motor skills. At the organisational level the two halves of his brain were not working together effectively, he had not established a mature dominance profile and he could not isolate the muscle groups required for a task. This would cause problems with any academic task that needed planning and would affect personal organisation also.

Nigel had no problems with reading and spelling and unusually his handwriting was quick and easy to read, although his  fine motor ability was quite poor. There were a number of visual processing issues however, including a slow speed of processing, poor eye teaming and lack of eye dominance.  These difficulties would make it hard for him to maintain visual focus. There were also a number of auditory processing issues. He had a slow speed of processing which was causing sound discrimination difficulties, particularly in conditions of background noise. This would make it hard for him to listen effectively in the classroom. His ability to repeat sentences and directions accurately was poor too, so there were problems with organising and processing language.

Progress

Nigel was on the Edutherapy programme for a couple of years before he took his GCSE examinations, by which time his non-verbal IQ had risen to the level of his verbal IQ and most of the problems were resolved. There were still some issues with processing questions fully and organisation for revision, but he had some support with study skills and he did extremely well. He now has a nice group of friends and has settled down very confidently to work in the sixth form. He is an exceptionally charming young man with excellent social skills and a strong sense of purpose.

JUSTIN

Presenting problems

Justin had motor control difficulties and there were real concerns in school about his ability to record ideas and information. Writing was a huge problem and he was reversing many of his letters, but he was a bright boy. He also now had problems with maths, although there did not seem to have been any problems earlier. He was fidgety, distractible, inattentive and a poor judge of time, with very poor organisational skills. He found it hard to follow a series of instructions and really struggled to finish his work. Nothing much was working for Justin. He knew all the answers in oral discussion, he was very sharp, but he was unable to demonstrate his ability in any of his written schoolwork.

Justin had been assessed earlier by an occupational therapist who found a number of immaturities in his processing. In particular he had problems with balance, laterality, pincer control, wrist and hand coordination and the quality and fluency of his movement was poor. Problems were noted in visual discrimination. He had also retained some spinal reflexes which would impact on his motor coordination. He did not follow a programme of occupational therapy exercises.

Assessment

The assessment revealed global difficulties in visual and auditory processing, the short-term memory of a child four years younger and severe visual-spatial difficulties. His near-point visual perception in two dimensions was very different from that of his classmates. This would have a major effect on his handwriting and copying skills, but it would also affect his maths, because visual spatial ability becomes very important as maths concepts become more complex. He also performed very poorly on tests of balance skills, managing only eight seconds on each foot and he was quite incapable of achieving a stance with one foot in front of the other, heel to toe.

Justin had no difficulty with verbal skills and his vocabulary age was within the top ten percent of his age group but his non-verbal reasoning ability was in the bottom ten per cent. No particular concerns had been voiced about his reading and spelling skills, but on testing he was found to be twenty months behind in reading accuracy, seventeen months behind in reading comprehension and nine months behind in spelling. He yawned a lot, too, when he tried to read – the oxygen wasn’t getting through. He had suffered from a virus at four years old which had affected him badly, and it took four months to recover his energy levels.

Progress

Justin did very well on the therapy programme. After five months when he was tested at school his spelling had improved by over two years, his reading comprehension had improved on SATS from 2b to 4, his maths from 2b to 2a and his writing from 2b to 3b. It always takes longer for maths skills to improve than it does for literacy, because if concepts have been poorly understood when they were originally introduced they need to be revisited, and number bonds and tables need to be practised. At that point the only practice that Justin had been given was to follow a perceptuo-motor programme, ‘Write from the Start’, to help with handwriting skills. He was doing this regularly with a support teacher at school, and it was going well

As Justin progressed through the programme his stamina improved and he began to do well in his swimming lessons. He was much more coordinated in games of badminton, and his throwing and catching improved. His laterality problems responded to the programme and he became fully right-handed. He took up skateboarding and became very keen. At school he became progressively more focussed and produced a lot more work. His non-verbal IQ rose to within the top 40% of his age group. There were no longer problems with maths concepts and his teacher was happy with his handwriting. He still finds it hard to lay out his work, copying skills are tricky and graphs are can be a challenge. His end of term report was excellent, but his art teacher thought he should try harder. That was probably a little unfair.