What is Dyspraxia
Dyspraxia is an enigma many people, both professional and lay alike. What is it, how does it come about, how is it related to their child's learning disabilities, Autism testing centre in India and how is it recognised and diagnosed and how should it be managed - are key issues that create a considerable degree of confusion in the minds of parents.
In simple words - Developmental Dyspraxia is an impairment or immaturity of the organisation of movement. It is an immaturity in the way that the brain processes information, which results in messages not been properly or fully transmitted. The term Dyspraxia comes from the word praxis, which means doing, acting. Dyspraxia affects the planning of what to do and how to do it. For a child who is assessed to have Dyspraxia this developmental disorder really affects the planning of what to do and how to do it - and will be associated with problems of perception of language and thought.
Dyspraxia sometimes runs in families, and there is considerable agreement on the fact that males are four times more likely to be affected than females. Other names that have been used for this disability are perceptuo motor dysfunction, motor learning difficulties and at one point of time it used to also be known as the clumsy child syndrome.
Within the medical and scientific community, Autism testing centre in India dyspraxia is generally considered to mean an impairment of, or difficulty with, the organisation, Planning and execution of physical movement with a developmental rather than an acquired original. We find that most children with Dyspraxia manifest a combination of both ideational or planning dyspraxia and ideomotor or executive dyspraxia which effects the fluency and speed of mortar activities.
In the performance of everyday physical activities, there will be a spectrum of normality and some children with dyspraxia may lie at one end of the normal spectrum. When parents question us - that is my child normal? It is very difficult to give the defined answer, as determining what constitutes normal may be difficult. One criterion that may be used to determine whether the child’s motor skills fall outside the spectrum or range of normality is whether the difficulties have any functional effect and intrude on school and leisure activities. This is a very difficult one to prove because in a country like India, the child's functional abilities may be interpreted differently depending upon his family background culture and expectations - not to mention the expectation of the school and the parents as a result of which two children with the same developmental profile and the same profile of motor disabilities can be labeled differently.
Most children who are screened, and are assessed to be Dyspraxic, may have difficulty with behaviour or learning for example Dyslexia, but these have to be regarded as co morbidities rather than being an integral part of the main problem of dyspraxia that is being shown.
Children will also have attention problems, and these combined problems may be sufficiently pervasive to justify remedial intervention as soon as possible. Other behavioural problems, which are commonly seen in children with dyspraxia, are overlaps with oppositional defined disorder and anger management issues.
Children will also demonstrate significant difficulty with self-care tasks (e.g., dressing, using utensils), school-related tasks (e.g., handwriting, organizing seatwork, physical education class), leisure activities (e.g., sports, playground activities, social interaction), or with a combination of the above.
Dyspraxia can result in deficits in many areas of performance, including postural control visual attention and visual-spatial perception, proprioceptive or kinesthetic deficits, sensory motor deficits, motor execution and internal representation of movements . Each of these may be the possible cause for the ‘clumsiness’ seen in children with Dyspraxia.
Dyspraxia has been referred to as a hidden problem, as most of the time the focus of the parents is on observing how well is the child performing academically and cognitively, that they tend to overlook ideomotor problems as also being a factor, which may be contributing to the learning disability of the child. As we have mentioned dyspraxia is reported to affect male children four times as frequently as girls, with children being born prematurely and with extremely low birth weight being at a significantly increased risk of the problem.
Children who are brought to us, show functional difficulties in all aspects of daily living, starting with preschool, where the common features reported by parents include a history of delayed developmental milestones, particularly crawling walking and speech, difficulty with dressing poor ball skills immature artwork and difficulty making friends.
Something is not quite right, is what we get to hear most frequently when parents bring the child to us, but unfortunately they are not able to be more specific. In all the situations that eventually come to light, the child may or may not have been brought to the attention of a competent professional who would have had the ability to screen and guide the Parents in the correct manner. Alternately, as happens most often, the parents may have been told not to worry or to simply wait and see how the child develops which again results in the delay for specialist advice.
The management of children with dyspraxia must begin with an accurate diagnosis. Two principal questions that need to be answered when assessing the child are, is there an underlying neurological or physical disorder, and second does the child have significant coordination difficulties that are beginning to impact day-to-day life and Academic output. Children with dyspraxia can experience considerable difficulties at school and it is therefore important to educate the educators about this condition, so that rather than saying that all children develop ‘like this’ or pressurizing the child to do even better without clearly outlining how he has to perform better, they are able to appreciate the nuances of the disorder, and encourage the parents to seek professional assistance for the children. Early diagnosis, treatment and educational support are so significant, that failure to assess and address the motor and other commonly associated co morbid features seen in children with dyspraxia, may have major consequences in adult life, including unemployment, psychiatric disorders, substance misuse, poor interpersonal skills and conduct disorders.
We also notice of direct relation or the link between dyspraxia and the avoidance of physical activity by the child. By addressing issues of self-esteem and self-efficacy, towards physical activity, children can be encouraged to understand and accept their limitations. These strategies help children to manage and cope with the problem that will persist into adult life.
At the Dyslexia Association of India™ we systematically assess children exhibiting different categories of sensory motor deficits along with academic, language, cognitive, visual-spatial, and visual-motor perception skills, while using additional standardized neuro-developmental psychomotor tests, including motor coordination, neuro-visual, and neuromuscular tone screening.
We normally see children exhibiting specific motor coordination disorders with a variety in number of learning disorders where the motor planning and programming appear to be the core problem underlying children difficulties, and not performance or language based differences.
Parents of young children with Dyspraxia search for answers from a multitude of doctors and health care professionals. They want to know what is ‘wrong with their child’ and are not sure with whom they should be discussing their child’s movement problems. They ask about the causes of these movement difficulties, and because the disorder is not well known or well understood, they ask about possible diagnoses. Do all children with Dyspraxia experience similar difficulties? Are there associated developmental disorders involved in their child’s movement difficulties? Do children ‘grow out’ of this problem? What should they, as parents, be doing? How is it caused?
Several hypotheses have been proposed for the basis of Dyspraxia - however, the evidence to date for any particular mechanism is very weak. Experimental research has pointed to cerebellar involvement in children with dyslexia; this same mechanism may be involved in Dyspraxia where it is suggested that children have difficulty making motor behaviours automatic. Lack of automatization becomes particularly challenging when a secondary task is introduced because the child does not have the attentional resources to attend to more than one thing at a time. Given the cerebellum’s role in monitoring and automating movement, this explanation has some face validity.
Children with Dyspraxia form a heterogeneous group, but all have generalized motor and perceptual difficulties. Subgroups of children can be seen both in their range of motor difficulties and in the pervasiveness of the problem. Handwriting, written expression and organizational issues are the most commonly identified school issues. Teachers tend to notice these issues most easily, but they only represent the tip of the iceberg.
Children with Dyspraxia usually have slower reaction, movement and response times; difficulties with timing and force control; difficulty responding to unpredictable environments; variable motor performance; a tendency to over-rely on vision and proximal muscle control to stay balanced; poor integration of visual and proprioceptive information; a tendency to – fix - or -freeze - their joints during task performance; and difficulties with imagery. Despite these impairments, certain repetitive movements that do not have time constraints (e.g., swimming, running, skating, bicycling) may be performed equally well by children with and without Dyspraxia.
Recent evidence has shown conclusively that approximately 50% of children who have ADHD and learning disabilities also have Dyspraxia. However, we do not know how many children with Dyspraxia have other co morbidities because there are no epidemiological studies that begin by first identifying children as having a motor impairment and then examining them for other disorders.
The idea of labeling a child is controversial. With an under-recognized disorder, however, a diagnosis can be enlightening and reassuring. Doors begin to open, and individuals in the child’s environment can be educated and encouraged to understand and provide adaptations to assist the child with Dyspraxia. Possibly the most important aspect of receiving the label of Dyspraxia is that, in understanding the nature of this disorder, the secondary consequences of Learning Disabilities that may be prevented.
Parents describe their children as having early movement difficulties, but also report a lack of motivation to play with other children – along with come issues with not being able to read and write accurately and levels of Academic Difficulties in school and beyond. Reluctance to participate in typical childhood physical activities has been attributed to poor self-efficacy and lower perceived competence. These consequences of dyspraxia magnify with time, and as teenagers, these children have higher rates of emotional problems, are more isolated socially and are at greater risk of victimization and bullying.
It has now been recognized that Dyspraxia does not simply disappear, as children grow older. Evidence has surfaced that the motor difficulties of childhood are retained into adult life and can keep adults from performing important activities of daily life, such as driving a car. We can only conclude that early identification, effective intervention and vocational counseling are important for children diagnosed with Dyspraxia to avoid the negative experiences that can affect their academic and social life. If children with dyspraxia are neither identified nor offered any sort of intervention or management for their difficulties, there is an increased likelihood of secondary consequences that include behavioural problems, emotional distress, low self-worth, poor perceived competence, anxiety, depression, bullying and obesity.
Parents of children with Dyspraxia experience a number of problems on the road to understanding their child’s movement difficulties, including uncertainty in the ways they parent their child, recognize his or her difficulties, and support him or her in daily life.
Because the difficulties experienced by a child with dyspraxia encompass all daily activities, health professionals and people close to the child need to become involved and teachers and parents can positively influence children’s motor skills and academic skills. They are in a position to alter and adapt a child’s everyday environment, changing difficult activities into easier, more manageable tasks.
Parents with children who have messy handwriting and whose children just give up while writing as they are not able to ‘write any more’ may appreciate that the disorder that can impact significantly on the child’s performance on written evaluations. If the child appears to be inattentive due to postural instability or avoidance of motor-based tasks but does not have ADHD, it is particularly helpful to identify this. When a child’s balance and coordination are more impaired, safety issues should be highlighted to prevent injuries. Teachers pass remarks such as “They’re bright but can’t write.
Maybe it is time to stop for a moment and understand that he ‘cant write’ because he may not be ‘able’ to write. He ‘cant write’ not because he has a bad handwriting but he has a bad handwriting because he cannot motor plan the sequence required for writing.
The Dyslexia Association of India™ conducts screening for Dyspraxia in a very logical and systematic manner as has been described above. Parents are encouraged to take responsibility for their children and empower themselves with the knowledge that having a screening done is for the betterment of their own child.
Do you know that sometimes writing ‘P’ as ‘9’ can actually be a symptom of underlying Dyspraxia!
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