Understanding Developmental Dyspraxia

A Textbook for Students and Professionals

Madeleine Portwood

• Publisher: David Fulton Publishers
• Year: 2013
• eBook ISBN: 9781136605697
• Edition: 1
• Topic: Education
• Subtopic: Education General

In this text, the emphasis is placed on the theoretical aspects of developmental dyspraxia, the latest research data and the neurological basis of the condition. The focus is to enable professionals to diagnose the disorder and determine the most appropriate and effective methods of intervention.

Chapter 1
Defining dyspraxia

The purpose of this text is to provide clinicians with current research information and facilitate the diagnosis of developmental dyspraxia. The most appropriate starting point is to consider the acknowledged diagnostic criteria in the Manual of the American Psychiatric Association.

Dyspraxia is a developmental condition and the comorbidity with autistic spectrum disorders, dyslexia and ‘Attention Deficit and Hyperactivity Disorder’ (ADHD) is high. My own research between 1988 and 1999 (Portwood 1999) suggests that it is probably between 40 per cent and 45 per cent.

Szatmari et al. (1989a) state that the comorbidity of ADHD with other disorders is common with up to 44 per cent of those identified having at least one other condition and 32 per cent having two or more.

Barkley (1990) comparing ADHD children with controls found they were considerably more likely to display associated problems with academic achievement, language and motor co-ordination, as many as 25 per cent having significant delays in the development of maths, reading or spelling and up to 30 per cent showing problems with language.

In addition, parents of ADHD children described their youngsters as being less co-ordinated than expected for their age.

The overlap between dyspraxia, ADHD, and other developmental disorders is evident when comparing the descriptions contained in the American Psychiatric Association Diagnostic and Statistical Manual (DSM-IV 1994). An overview is essential before attempting to determine which conditions are present.

‘Learning Disorders’ describes specific difficulties in reading (dyslexia), mathematics and handwriting.

‘Developmental Co-ordination Disorder (DCD)’ identifies as its essential feature a marked impairment in the development of motor co-ordination (dyspraxia).

Diagnostic features of Developmental Co-ordination Disorder (315.4)

The essential feature of Developmental Co-ordination Disorder is a marked impairment in the development of motor co-ordination (Criterion A). The diagnosis is made only if this impairment significantly interferes with academic achievement or activities of daily living (Criterion B). The diagnosis is made if the co-ordination difficulties are not due to a general medical condition (e.g., cerebral palsy, hemiplegia, or muscular dystrophy) and the criteria are not met for Pervasive Developmental Disorder (Criterion C). If Mental Retardation is present, the motor difficulties are in excess of those usually associated with it (Criterion D). The manifestations of this disorder vary with age and development. For example, younger children may display clumsiness and delays in achieving development motor milestones (e.g., walking, crawling, sitting, tying shoelaces, buttoning shirts, zipping trousers). Older children may display difficulties with the motor aspects of assembling puzzles, building models, playing ball, and printing or writing.

Associated features and disorders

Problems commonly associated with Developmental Co-ordination Disorder include delays in other non-motor milestones. Associated disorders may include Phonological Disorder, Expressive Language Disorder, and Mixed Receptive-Expressive Language Disorder. Prevalence of Developmental Co-ordination Disorder has been estimated to be as high as 6 per cent for children in the age range of 5–11 years. Recognition of Developmental Co-ordination Disorder usually occurs when the child first attempts such tasks as running, holding a knife and fork, buttoning clothes, or playing ball games. Its progression is variable. In some cases, lack of co-ordination continues through adolescence and adulthood.

Differential diagnosis

Developmental Co-ordination Disorder must be distinguished from motor impairments that are due to a general medical condition. Problems in co-ordination may be associated with specific neurological disorders (e.g., cerebral palsy, progressive lesions of the cerebellum), but in these cases there is definite neural damage and abnormal findings on neurological examination. If Mental Retardation is present, Developmental Co-ordination Disorder can be diagnosed only if the motor difficulties are in excess of those usually associated with the Mental Retardation. A diagnosis of Developmental Co-ordination Disorder is not given if the criteria are met for a Pervasive Developmental Disorder. Individuals with Attention Deficit Hyperactivity Disorder may fall, bump into things, or knock things over, but this is usually due to distractibility and impulsiveness rather than to a motor impairment. If criteria for both disorders are met, both diagnoses can be given.

Summary of diagnostic criteria for Developmental Co-ordination Disorder (315.4)

A. Performance in daily activities which require motor co-ordination is substantially below that expected given the person’s chronological age and measured intelligence. This may be manifested by marked delays in achieving motor milestones (e.g., walking, crawling, sitting), dropping things, ‘clumsiness’, poor performance in sports, or poor handwriting.

B. The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living.

C. The disturbance is not due to a general medical condition (e.g. cerebral palsy, hemiplegia, or muscular dystrophy) and does not meet criteria for a Pervasive Developmental Disorder.

D. If Mental Retardation is present, the motor difficulties are in excess of those usually associated with it.

Criteria for Attention Deficit Hyperactivity Disorder (ADHD) (314.01)

A. Either (1) or (2):
(1) Inattention: at least six of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:

• (a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
• (b) often has difficulty sustaining attention in tasks or play activities
• (c) often does not seem to listen to what is being said to him/her
• (d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions)
• (e) often has difficulties organising tasks and activities
• (f) often avoids or strongly dislikes tasks (such as schoolwork or homework) that require sustained mental effort
• (g) often loses things necessary for tasks or activities (e.g., school assignments, pencils, books, tools, or toys)
• (h) often easily distracted by extraneous stimuli
• (i) often forgetful in daily activities.

(2) Hyperactivity – Impulsivity: at least four of the following symptoms of hyperactivity – impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:

• (a) often fidgets with hands or feet or squirms in seat
• (b) leaves seat in classroom or in other situations in which remaining seated is expected
• (c) often runs about or climbs excessively in situations where it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
• (d) often has difficulty playing or engaging in leisure activities quietly.
• (e) often blurts out answers to questions before the questions have been completed
• (f) often has difficulty waiting in lines or awaiting turn in games or group situations.

B. Onset no later than age seven.

C. Symptoms must be present in two or more situations (e.g. at school, work, and at home).

D. The disturbance causes clinically significant distress or impairment in social, academic, or occupational functioning.

E. Does not occur exclusively during the course of PDD, Schizophrenia or other Psychotic Disorder, and is not better accounted for by Mood, Anxiety, Dissociative, or Personality Disorder.

Criteria for Autism Disorder (299.00)

A. A total of six (or more) items from (1), (2) and (3), with at least two from (1), and one each from (2) and (3).
(1) Qualitative impairment in social interaction, as manifested by at least two of the following:

• (a) marked impairments in the use of multiple non-verbal behaviours such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
• (b) failure to develop peer relationships appropriate to developmental level
• (c) lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
• (d) lack of social or emotional reciprocity (note: in the description, it gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or ‘mechanical’ aids).

(2) Qualitative impairments in communication as manifested by at least one of the following:

• (a) delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
• (b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
• (c) stereotyped and repetitive use of language or idiosyncratic language
• (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.

(3) Restricted, repetitive and stereotyped patterns of behaviour, interests and activities, as manifested by at least two of the following:

• (a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
• (b) apparently inflexible adherence to specific, non-functional routines or rituals
• (c) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
• (d) persistent preoccupation with parts of objects.

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age three years:

• 1. Social interaction
• 2. Language as used in social communication
• 3. Symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

Criteria for diagnosis of Asperger’s Disorder (299.80)

• At least two demonstrations of impaired social interaction. The patient:
  • – Shows a marked inability to regulate social interaction by using multiple non-verbal behaviours such as body posture and gestures, eye contact and facial expression.
  • – Doesn’t develop peer relationships that are appropriate to the developmental level.
  • – Doesn’t seek to share achievements, interests or pleasure with others.
  • – Lacks social or emotional reciprocity.
• Activities, behaviour and interests that are repetitive, restricted and stereotyped (at least one of):
  • – Preoccupation with abnormal (in focus or intensity) interests that are restricted and stereotyped (such as spinning things).
  • – Rigidly sticks to routines or rituals that don’t appear to have a function.
  • – Has stereotyped, repetitive motor mannerisms (such as hand flapping).
  • – Persistently preoccupied with parts of objects.
• The symptoms cause clinically important impairment in social, occupational or personal functioning.
• There is no clinically important general language delay (the child can speak words by age two, phrases by age three).
• There is no clinically imp...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Foreword
• Preface
• Acknowledgements
• 1 Defining dyspraxia
• 2 Dyspraxia: the neurological basis
• 3 Developmental differences between the sexes
• 4 Observable characteristics
• 5 Neuropsychological assessment
• 6 Parental observations and clinical assessment
• 7 The role of the Education and Health Authorities in identifying and making provision for children with special educational needs
• 8 Optimising the educational environment
• 9 Intervention in a residential setting: Elemore Hall School
• 10 The future
• Appendix 1: The Dyspraxia Foundation
• Appendix 2: Dyspraxia Foundation publications
• Appendix 3: List of local Dyspraxia Foundation co-ordinators
• Appendix 4: Useful names and addresses
• References
• Index