Dyspraxia in Children: Symptoms, Causes, and Treatment

Dyspraxia, named developmental coordination disorder (DCD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM), affects about 5-6% of school-aged children [*]. However, this may be an underestimation because there is a lack of awareness about the disorder. Thus, many children may be undiagnosed. Diagnosing dyspraxia in children who fit the profile of the disorder, though, is important because such children may suffer from various functional outcomes.

What Is Dyspraxia?

The definition of dyspraxia varies among scientific circles, but it is generally agreed upon that it is a disorder involving movement coordination. Whereas medical and scientific communities attribute dyspraxia to impairment in the areas of planning, organizing, and executing physical movement caused by developmental influences, in psychology, dyspraxia is viewed as difficulties in motor skills caused by problems in perception [*]. Although the clinical presentation of symptoms may vary across the lifespan, overall, dyspraxia indicates impairment in gross motor skills (large, coordinated movements involving the limbs and torso) or fine motor skills (smaller movements involving the fingers and hands) [*].

What Are the Symptoms of Dyspraxia in Children?

Generally, the symptoms of dyspraxia in children involve problems with motor coordination that significantly interfere with activities of daily living (ADLs). Such problems, according to the latest edition of the DSM (DSM-5-TR) must be discrepant with age and intelligence. That is, motor problems in these children should demonstrably be lower than what is expected for their age and intelligence [*]. Although not specifically outlined in the DSM-5-TR, some of the recognized symptoms of dyspraxia are the following:

• Delay in achieving motor milestones: Young children with dyspraxia may experience difficulty acquiring certain skills, such as riding a bike, walking up and down the stairs, buttoning or zipping their clothes, and finishing puzzles. These activities often require support and much practice for mastery and stamina. If the young child does not experience developmental delay in such areas, their movements may still appear slow, laborious, clumsy, or imprecise [*].
• Poor balance and coordination: Dyspraxia is much more than being clumsy. Execution of movement is considerably slow and awkward. For dyspraxia to be diagnosed, such motor difficulties must cause functional impairment in ADLs and academic achievement [*].
• Problems with vision and perception: One common manifestation of dyspraxia in children relating to vision and perception is difficulty assembling puzzles. Meanwhile, in adolescents, learning how to drive can prove to be difficult [*].

Other difficulties that individuals with dyspraxia may experience include difficulties with short-term memory, posture, and speech, as well as abnormal muscle tone [*]. More importantly, though, the DSM-5-TR requires that all symptoms must occur in the early developmental years. Furthermore, the motor difficulties should not be explained by a medical condition or a pervasive developmental disorder [*].

What Causes Dyspraxia?

Multiple factors influence the development of this disorder, such as environmental, genetic, and neurobiological contributions [*]. For example, prenatal alcohol exposure and birth complications, such as premature birth or low birth weight, are indicated as environmental risk factors for dyspraxia [*].

In the neurobiological dimension, dysfunction in the cerebellar cortex plays a role in dyspraxia as well. In addition, studies show that there is diminished activation of brain structures associated with motor learning [*]. One study specifically suggests that the mirror neuron system (MNS), which may be associated with imitation skills required in the learning of a new motor program, shows some dysfunction in children with dyspraxia [*].

Finally, studies have also hypothesized that dyspraxia in children may be attributed to genetic influences [*].

What Are the Complications of Dyspraxia?

Children with dyspraxia may suffer from complications that are not necessarily included as hallmark symptoms in the diagnostic criteria of the disorder. In practice, these complications are viewed as comorbid problems, some of which are the following:

• Problems with executive function: Dyspraxia in children may prevent learning in formal education settings, especially in early childhood, partly due to deficits in executive function [*]. Thus, there is a likelihood of impairment in academic performance [*].
• Attentional problems: Many children who experience problems in coordination also suffer problems with attention, with some developing attention-deficit/hyperactivity disorder (ADHD). In fact, between 30 and 50% of children with dyspraxia also have ADHD, which suggests that there may be a neurobiological contribution shared by both disorders [*].
• Risk of developing other disorders: Not only is it possible that dyspraxia co-occurs with ADHD, but children with such motor coordination difficulties are also at a greater risk for other neuropsychiatric conditions, such as autism, anxiety disorders, obsessive-compulsive disorder (OCD), or schizophrenia [*].
• Low self-esteem: Because dyspraxia in children causes difficulties in performing day-to-day activities, these children often feel personally inadequate. Some children may perceive themselves negatively, and they may be unwilling to engage in social and physical activities for fear that their motor coordination difficulties will be exposed. Meanwhile, other children may suffer from low self-esteem due to their need for assistance from their parents to perform ADLs. They may feel burdensome to their parents because of their lack of independence [*].
• Social isolation: Children with dyspraxia typically experience bullying by their peers. Sometimes, they may even get teased at home by their siblings. As a result, these children may socially withdraw from others, minimizing their participation in athletic activities and other forms of play [*][*].
• Obesity: Finally, children with dyspraxia may reduce their participation in physical activities, which may lead to obesity. Overall, this leads to the child suffering from a poor quality of life in terms of physical health [*].

How Is Dyspraxia Diagnosed in Children?

To evaluate whether a child with suspected dyspraxia does, in fact, have this disorder, an interdisciplinary approach is needed, which includes the involvement of pediatricians, pediatric psychiatrists, pediatric neurologists, and occupational and physical therapists [*].

The first question that needs to be addressed when evaluating a child for dyspraxia is whether the child has an underlying physical or neurological disorder. This is because the DSM-5-TR diagnostic criteria indicate that dyspraxia should not be diagnosed if the motor coordination difficulties are better explained by another medical condition. Then, the second question to be answered is whether the child's symptoms fit the clinical presentation of dyspraxia. To determine this, different assessment tests are used. Moreover, collateral sources of information are needed to diagnose a child with dyspraxia properly.

How Is Dyspraxia in Children Treated?

The diagnosis of dyspraxia in children is paramount so that the affected individual can receive the proper treatment. Generally, treatment for dyspraxia aims to help children learn motor skills, focusing on functions such as muscle strength, sensory integration, and visual-motor perception [*].  Some of the treatment options for dyspraxia are the following.

Occupational Therapy

Occupational therapy is a type of intervention that helps people who have sensory, physical, or cognitive difficulties. The goal of care is for children with dyspraxia to be able to perform ADLs independently. Although studies have reported that children with dyspraxia need to attend at least 32 sessions before there could be any notable improvements, most children undergo occupational therapy for about 1-2 years  [*].

Task-Oriented Physical Therapy

The task-oriented approach to physical therapy involves a set of interventions that strive to enhance the performance of children with dyspraxia in specific motor tasks through practice. Moreover, it is designed to be individualized and goal-oriented. The aim of the task-oriented approach is for the child with dyspraxia to achieve functionality and not necessarily normality [*]. A secondary goal of this approach is to improve the affected child's self-esteem, body image, and willingness to participate in communal activities [*].

How to Support a Child With Dyspraxia

Although dyspraxia is a chronic condition, affected individuals can still learn ways to manage their symptoms, and parental and educational support will go a long way in helping these children achieve improvements in their quality of life. There are many ways to support a child with dyspraxia, such as the following:

• Educate yourself: Educators need to understand and be aware of the symptoms of dyspraxia in children so that they can aid the child in school. Parents should also be educated as well by being more informed about their child's socioemotional needs. This is especially important because the child may feel conflicted between their need for autonomy and their need for support [*]. Finally, educating yourself about dyspraxia will also pave the way for the affected child to understand their condition. This may reduce the likelihood that they will suffer from a sense of personal inadequacy.
• Communicate: Communication between parents and educators is crucial so that they can keep up to date with the child's motor and other associated problems, as well as with the child's progress.
• Provide appropriate accommodations: Parents and teachers can provide accommodations to teach certain skills that may be affected by the symptoms of dyspraxia in children. One accommodation is to provide extra time for them to complete activities. Another is to rearrange the child's environment so that they can better succeed. Finally, some children may learn better if you scaffold the task at hand. In other words, you can break down the task into smaller chunks and provide a structure or tool to assist them in completing each chunk of the task.
• Work from a strengths-based perspective: Although dyspraxia in children can affect a variety of areas that require the performance of ADLs, these children also display unique strengths, such as problem-solving skills, resilience, and creativity. By focusing on these strengths, you can help bolster the child's self-esteem [*].
• Spend more time with the child: Finally, it is important to devote time to the child so that you can support their learning. It has been found that parental involvement positively impacts children's achievement, especially during the period of early education [*].

Can Dyspraxia in Children Be Prevented?

Unfortunately, dyspraxia in children cannot be prevented from developing at all because its symptoms are not acquired in nature. However, the symptoms of dyspraxia, if identified and intervened with early, can be mitigated. Furthermore, although it may not be possible that all complications of dyspraxia can be prevented, early diagnosis and treatment can nevertheless lead to a better prognosis, or outcome, for the affected child [*].

Frequently Asked Questions

Do you still have some more questions regarding dyspraxia? Perhaps the following sections may address those questions and concerns.

Is dyspraxia considered a disability?

From the perspective of the U.S. legal system, dyspraxia is considered a disability. According to the Americans With Disabilities Act (ADA), for a condition to be considered a disability, it must be a physical or mental impairment that significantly interferes with functioning in at least one major life activity [*]. Given that dyspraxia negatively affects performance in various activities, such as school, leisure, and self-care, it is considered a disability.

What's the difference between dyspraxia and apraxia?

The key difference between dyspraxia and apraxia is its origin. Apraxia, which refers to the loss of ability in areas of movement, is acquired. In other words, individuals with apraxia once had no problems with performing movements but eventually developed such difficulties. For example, people who have suffered from traumatic brain injury may develop apraxia. Meanwhile, dyspraxia is a developmental condition in which affected individuals have difficulties in acquiring new motor skills [*].

Can adults have dyspraxia?

Adults can experience dyspraxia as well, not just children. However, dyspraxia in adults is often a result of the failure to detect its symptoms early on in childhood. When an adult has dyspraxia, the most frequently reported problem involves estimating distances. This may manifest in activities such as crossing the road or driving [*].

The Bottom Line

Dyspraxia in children is a motor coordination-related disability that is of a developmental origin. Although it may appear as awkwardness or clumsiness, dyspraxia can affect the acquisition of new motor skills, as well as negatively impact a person's self-esteem and participation in social and physical activities. Fortunately, treatments, such as physical and occupational therapy, are available for individuals with dyspraxia. In addition, parents and educators can also help affected persons who have dyspraxia by providing support at home and in school. They can also teach the child coping skills. Coping skills worksheets can support the child in managing negative feelings commonly associated with disabilities such as dyspraxia.

References:

1. Pedro A and Goldschmidt T. Managing dyspraxia: Pre-school teachers' perceptions, experiences, and strategies. 2019.
2. Gibbs et al. Dyspraxia or developmental coordination disorder? Unravelling the enigma. June 2007.
3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed., text revision). 2022.
4. O'Dea Á, Stanley M, and others. Children and young people's experiences of living with developmental coordination disorder/dyspraxia: A systematic review and meta-ethnography of qualitative research. 2021.
5. Castellucci G and Singla R. Developmental coordination disorder (dyspraxia). 24 February 2024.
6. Van Staden C. Parents, educators and children: Perceptions on dyspraxia. 2013.
7. Bidwell V. Developmental coordination disorder (dyspraxia): What helps, what hinders in the school years for later achievement and wellbeing? 2022.
8. Petrila J and Brink T. Mental illness and changing definitions of disability under the Americans With Disabilities Act. 2001.