Dyspraxia: identification and remediation

Dr. Lindsay Peer CBE 
(Published in Special Children Magazine 2002)
Dyspraxia may be defined as: Motor difficulties caused by perceptual problems, especially visual – motor and kinesthetic -motor difficulties [1]. It is one of the group of conditions currently identified through scientific research widely known as specific learning difficulties (SpLD). At one time dyspraxia was described as the ‘clumsy child syndrome’. It is estimated that approximately 10% of any given population is dyslexic and up to half of them may experience some dyspraxic tendencies. There are other people who are purely dyspraxic. 
The Symptoms of Dyspraxia
As in the case of dyslexia, dyspraxia is not linked to I.Q. and therefore affects children and adults of all levels of ability. People often assume that the dyspraxic child or adult is someone who is limited in that which they can achieve. This is without doubt untrue; dyspraxia does not limit intellectual achievement. Teachers and parents will often have in their classes dyspraxic children and young people who are highly able, creative and inquisitive.
Physiologically, part of the brain is immature; this prevents the dyspraxic child moving quickly and efficiently from the earliest engagement with a task to its completion. This often gives the impression of a slower thinking person; this is an inaccurate impression. As these children and adults sometimes find the manipulation of tongue, lips and teeth intricate, language can sometimes take longer to be produced. In other cases, they can be very verbal asking numerous questions. When there are language difficulties, there is often a sense of frustration that accompanies the child. In some cases the frustration leads to unacceptable behaviour which needs to be managed. 
Other areas of difficulty include:
  • Lack of organisational and sequential skills
  • Perceptual skills
  • Weakness with speed of processing language
  • Physical difficulties including control of body movements, e.g. balancing, walking at speed, running, unaware of bumping into other children, furniture or walls. At an early stage, many dyspraxic children do not crawl but prefer to pull themselves along the floor in a ‘snake-like’ fashion or ‘bottom – shuffle’. These co-ordination difficulties sometimes reappear at a later stage when the child tries to learn to swim or to ride a bicycle.
  • Difficulties producing neat handwriting and figures in mathematics on pages that are well organised
  • Difficulty with movements that demand fine motor control movements
  • Difficulties tying shoe laces and buttoning up clothes
  • Difficulty dealing with high levels of noise
  • Difficulty in expressing ideas on paper even though they may be verbally quite articulate.
  • Weakness with social relationships
  • Weakness in concentration
There is a need for both a cognitive test as well as motor skills screening test. From the results of these tests, an educational programme can be successfully developed to help the child learn in the way that is most effective for them.
Cognitive tests used by psychologists would include the British Ability Scales or the WISC -111 [3] – and motor skills tests would include the Movement Assessment Battery for Children or The Bruininks-Oseretsky Test of Motor Proficiency [4].
Additionally a questionnaire to families and to schools would be of great benefit in the development of the profile of the child (see 1). Continuous assessment, which monitors provision, is essential in order to give the learner the greatest chance for success academically, socially and emotionally. Experience has taught us that parents benefit from this feedback as they see their children making progress in an empathetic environment [5] and teachers benefit as the children’s sense of success improves attention and behaviour.
Effective progress
Any measurable changes should focus on the list of difficulties as outlined above. It is important that three groups of people are involved in the management of the education process: 
First, the school, with class teachers and teaching assistants aware of the issues and working together on small measurable steps to success. 
Second, the parent whose involvement is important if at all possible, in terms of understanding the rationale for and supporting the school programme. 
Third, the child, who needs to understand the condition and the issues and commits to the process. In other words he owns part of the process and is not experiencing something that is being done to him with or without his co-operation. Dyspraxic learners need to be told their areas of strength and given goals to work toward. All targets need to be both discussed with the child and small enough so that successes can be measured and quantified. 
Self-esteem and bullying
In my experience when peers bully SpLD children in school, it often tends to be the dyspraxic child who suffers the most. This group of young people tends not to be good at sport or at the creative arts, which often means that they are not selected by their peers to represent the group. Additionally the tendencies that they display - that the uninitiated might associate with clumsiness - often makes them the butt of much derision. Their ‘street cred’ as one young person said to me, is non-existent. The combination of difficulties will add to a lower sense of self-esteem particularly where the learner is bright. These children have reported to me that any asides made in the classroom situation are often picked up by classmates, and are repeated frequently and in a sarcastic tone in the playground. I have heard many heart-breaking stories over the years directly from these children in a variety of settings. They have described being ‘picked on’ in a variety of ways and have often used the word ‘ bullied’. Descriptions may include anything from taunting and hiding or damaging personal equipment, to bullying which would include physical abuse and theft. They appear to be less able than other groups to assert themselves and deal positively with these problems. They have described a profound fearfulness of attempting to deal with such situations and are unaware of the steps they can take to effectively take steps towards dealing with bullying. 
In common with the other SpLDs, there is a tendency towards heredity of the condition, so the chances are that at least one of the child’s parents may well have experienced a similar situation in their own school days. A generation ago was a time when terms such as dyslexia and dyspraxia were unheard of; the consequences for such learners in those days was in many cases dire. Many parents have expressed to me the overwhelming emotions of dread that they feel when they enter the school gates, at a time when they are attempting to discuss issues with staff and head teachers relating to their own children. They feel as though history is repeating itself. If parents’ memories and subsequent emotions are openly expressed in the home environment, many children elect not to tell their parents, in an attempt to protect them from further pain. So the cycle continues. 
Over the years researchers and practitioners have become aware of the contribution that self-esteem makes towards factors such as motivation, academic achievement and peer relations. Learning difficulties across the spectrum may often contribute to negative reactions in these key areas for educational success, particularly when they are on the SpLD spectrum. This is due to the ‘hidden’ nature of the conditions.
It is clear that our perception of ourselves can influence how well we do in school and in adult life. It is up to us therefore to ensure that we do all we can to influence positively learners’ self-concept.
Research [2] tells us that children with learning difficulties placed in mainstream schools may well suffer from low self-esteem. Conversely those that receive special education provision may well find that its very nature contributes to enhanced self-esteem. As the current trend and philosophy of government, in addition to the desire of many parents, is towards ‘inclusion’ of as many children as possible into mainstream schools, it is our duty to be aware of the issues outlined above and make appropriate provision.
School policy should include working with staff and peer groups to ensure that all are consciously aware of the need to engage in activities and change attitudes geared towards raising the self-esteem of those who are struggling.
Both dyspraxic and dyslexic learners find themselves attempting to learn in a world that is too fast for them. Their sometimes hidden disabilities so often mean that their needs are unidentified and as a consequence are unaddressed. They have a right to succeed, as do all learners – and it is in our hands to ensure that that happens.
[1] Portwood, M. (1996) Developmental Dyspraxia: A practical manual for parents and professionals.
Published by Durham County Hall.
[2] Humphrey N. Teacher and pupil ratings of self-esteem in developmental dyslexia.
British Journal of Special Education. Vol. 29, No.1, March 2002.
[3] WISC –111 The Psychological Corporation
[4] Bruininks, R.H. (1978) Bruininks-Oseretsky test of motor proficiency. Circle Pines, American Guidance Service.
[5] Achieving Dyslexia Friendly Schools – a resource pack.Published by the British Dyslexia Association, Reading.
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