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Developmental dyspraxia – often labelled “clumsy child syndrome”

If you know a child who is clumsy, finds it hard to keep friends, is a messy eater and avoids PE, they could be affected by an extremely common disorder thought to affect up to 10% of the population.Jane Utting explains what developmental dyspraxia is, how to spot it and what can be done.

Developmental dyspraxia – often labelled “clumsy child syndrome” – is an immaturity in the way the brain processes information, so messages are not properly or fully transmitted. It is associated with problems of perception, language and thought. Boys are four times more likely to be affected than girls and around 2% will be affected severely. While there is no known cause or cure, the condition does sometimes run in families and can be diagnosed at any age. Current research suggests that dyspraxia is due to an immaturity of neurone development in the brain, not brain damage, as no clinical neurological abnormality will exist.

Children may improve as they get older and symptoms can lessen if appropriate treatment and advice is given. Exercise and computer programmes can also help with reading and spelling, which can sometimes be a difficulty.

Early recognition is therefore very important (see Symptoms, below), because it enables children to achieve their potential and may help them to be accepted by their peers and to avoid lowered self-esteem. A survey by the Dyspraxia Foundation revealed that besides learning and behavioural conditions, bullying can be a problem. Of 236 dyspraxic children questioned, half had been bullied – half of them every single day. None thought they were good at handwriting and 14 said they were not good at any subjects.

Carol (pictured here), the mother of a 13-year-old who is dyspraxic, said: “Sarah is bullied on what I suspect is a daily basis. It doesn’t have to be physical in nature and due to the school’s policy on this, it rarely is. It is more the undermining comments and remarks that go untold and undetected.

"These are the things that erode her confidence and self-worth. As a parent it is heart-breaking and I just long for the time when she is able to leave what has become the horror of secondary school." Carol first noticed something was not quite right around Sarah’s first birthday, as she was still not sitting up on her own and was very floppy. As she got older, her words were slurred and she always had a battered and bruised face from falling over.

When she reached four, Carol was convinced there was something was seriously wrong – by now Sarah still had poor balance and her clothes were always dirty and scruffy when she got home from school, with food down the front and holes in her tights. She also hesitated when asked questions and had an almost permanently blank expression.

After a fruitless visit to the GP – who asked Carol to explain why Sarah’s face was bruised when she went for help - she decided to find out for herself what was wrong. Soon afterwards she saw a TV programme on dyspraxic children and the penny dropped. After being diagnosed, Sarah was given a Statement of Special Educational Needs entitling her to valuable extra tuition.

Pam Williams, chair of the Dyspraxia Foundation, said: "Children with dyspraxia are being forced into a social underclass. They are being bullied because they are different and when this is combined with the difficulties they have in expressing themselves it can only lead to very low self-esteem and all the implications this has on a child’s development.

"Of particular concern is the difficulty these children have with handwriting. At school, writing is the key to communication ideas and these children become extremely frustrated at their difficulty in communicating with staff who, in a busy classroom environment, do not always have the time to spend with them."

Dr Madeleine Portwood, chair of the Dyspraxia Foundation’s education committee, said: "Many children who display signs of dyspraxia at an early age will find their problems persisting and getting worse, which will have a direct impact on future learning.

"Difficulties may be worsened by the fact that children are not given the chance to develop their motor skills through active, physical play and spend far too much time seated – either watching TV on playing on computers.

"Second is poor diet, with a particular focus on essential fatty acid deficiency, which has been linked with other learning conditions such as dyslexia and ADHD."

For some children, taking fish oil supplements can help. A ground-breaking trial in Durham showed great improvements in children with learning and behavioural conditions after they took the supplement eye q (see Getting help, below). This product, widely available in pharmacies and large supermarkets, is a combination of the omega 3 and omega 6 fatty acids, which are required for optimal eye and brain function.

Funded by Durham County Council in association with Oxford University, the trial followed 120 dyspraxic schoolchildren aged 6-12 – many also had ADHD and dyslexia. Half were given eye q and half a placebo and neither the participants nor the researchers knew which child was on which. After three months the group taking eye q had made great improvements, with reduced inattention, hyperactivity and impulsivity. Some 40% of the children made dramatic improvements in reading and spelling.

SYMPTOMS

The Dyspraxia Foundation lists the following symptoms to look out for.

By 3 years old:

Symptoms are evident from an early age. Babies are usually irritable from birth and may exhibit significant feeding problems. They are slow to achieve expected developmental milestones. For example, by the age of eight months they still may not sit independently.

Many children with dyspraxia fail to go through the crawling stages, preferring to ‘bottom shuffle’ and then walk. They usually avoid tasks which require good manual dexterity.

By 3 to 5:

Children with dyspraxia may demonstrate some of these types of behaviour:

* Very high levels of motor activity, including feet swinging and tapping when seated, hand-clapping or twisting. Unable to stay still.
* High levels of excitability, with a loud/shrill voice.
* May be easily distressed and prone to temper tantrums.
* May constantly bump into objects and fall over.
* Hands flap when running.
* Difficulty with pedalling a tricycle or similar toy.
* Lack of any sense of danger (jumping from heights, etc).
* Continued messy eating. May prefer to eat with their fingers, frequently spill drinks.
* Avoidance of constructional toys, such as jigsaws or building blocks.
* Poor fine motor skills. Difficulty in holding a pencil or using scissors. Drawings may appear immature.
* Lack of imaginative play. May show little interest in dressing up or in playing appropriately in a home corner or Wendy House.
* Limited creative play.
* Isolation within the peer group. Rejected by peers, children may prefer adult company.
* Left- or right-handedness still not established.
* Persistent language difficulties.
* Sensitive to sensory stimulation, including high levels of noise, tactile defensiveness, wearing new clothes.
* Limited response to verbal instruction. May be slow to respond and have problems with comprehension.
* Limited concentration. Tasks are often left unfinished.

Pre-school children:

If dyspraxia is not identified, problems can persist and affect the child’s life at school. Increasing frustration and lowering of self-esteem can result.

By 7 years old problems may include:

* Difficulties in adapting to a structured school routine.
* Difficulties in PE lessons.
* Slow at dressing. Unable to tie shoe laces.
* Barely legible handwriting.
* Immature drawing and copying skills.
* Limited concentration and poor listening skills.
* Literal use of language.
* Inability to remember more than two or three instructions at once.
* Slow completion of class work.
* Continued high levels of motor activity.
* Hand flapping or clapping when excited.
* Tendency to become easily distressed and emotional.
* Problems with co-ordinating a knife and fork.
* Inability to form relationships with other children.
* Sleeping difficulties.
* Reporting of physical symptoms, such as migraine, headaches, feeling sick.

By 8 to 9:

Children with dyspraxia may have become disaffected with the education system. Handwriting is often a particular difficulty. By the time they reach secondary education their attendance record is often poor.

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GETTING HELP

* The Dyspraxia Foundation can put you in touch with support sources in your area and has a range of leaflets and books. Call 01462 454986, visit www.dyspraxia
foundation.org.uk or e-mail dyspraxia@dyspraxia
foundation.org.uk

* Pre-school children: talk to your GP and health visitor, who can refer your child to a paediatrician or Child Development Centre.

* School-age children: talk to your GP, school nurse, school doctor or Special Needs Co-ordinator, who can make referrals for assessments. For a copy of the Department of Education and Employment’s booklet, Special Educational Needs: A Guide For Parents, call: 020 7925 5000.

* Adults: Your GP may refer you to a clinical psychologist, consultant neurologist, physiotherapist or occupational therapist. The Dyspraxia Foundation’s adult support group, tel: 020 7435 7891.

* eye q is available in capsule and flavoured liquid and sachet form, priced from £7.99. For more information, see www.equazen.com. Full details of the Durham trial are on www.durhamtrial.org

Ryan, 11, lives in Kingsbury, north-west London, with his mother Susan, 38, father Alan, 36, and sisters Alice, six, and 18-month-old Nancy.

“Ryan’s birth was very difficult for both of us,” says Susan. “He was born by ventouse and because he was my first child I had nothing to compare him to. I noticed that he’d want the TV on too loud and his nursery school teacher said when she gave instructions to the class – like ‘put your coats on and go outside’ – he would still be sitting down after the others had left the room.

“When he was nearly four I took him to the doctor and, because he’d had quite a few ear infections, glue ear was diagnosed. After hearing tests at the hospital, a paediatrician suggested that Ryan needed grommets and we thought the deafness was affecting how he responded. Although this helped, his speech and language were still quite bad. After the grommets we thought he would catch up but he didn’t.

The special needs co-ordinator was excellent and also said Ryan wasn’t progressing as quickly as had been hoped. We knew there was a problem but couldn’t put our finger on it. I put it down to his traumatic birth. Then my husband read a newspaper article about a boy with dyspraxia who suffered lots of falls.

Ryan’s co-ordination still wasn’t good and he often stumbled but he was a very happy little boy with no behavioural problems. Everything was done with a smile, although he was slightly emotionally detached and was always behind in his potty training.

After the article I took him back to the doctor and said I thought he might have dyspraxia. He was again referred to a paediatrician who officially diagnosed him. To find out more I looked on the Internet and discovered the Dyspraxia Foundation, which has been great. It’s comforting to know that Ryan isn’t the only child out there and the organisation is a useful source of information and advice.

Last June, after fighting for a long time, Ryan got a Statement of Special Educational Needs, which means he gets individual support for eight-and-a-half hours a week. He has caught up considerably and goes swimming and horse-riding to help his balance, which was recommended by the Foundation. Thankfully Ryan hasn’t been teased or bullied.

He’s been with the same group of children since nursery and his school, which is a small one, has been excellent. I think sometimes he has felt set apart in sport. It took him a long time to kick a ball and we never thought he would ride a bike or tie his shoelaces but now he loves football and cycling.

He gets on in a group but doesn’t really have one-to-one relationships so we are teaching him to speak and contribute to a group and not be on the edge. In the last year or so his confidence has come along. When he starts secondary school in September he will get the same amount of individual support and this will be reviewed next year.

After reading an article about fish oils we started giving him eye q liquid, which seems to have helped his speech and language. It also seems to make him more alert – tiredness is his main problem and it seems to keep him going a bit longer.

Ryan likes Shakespeare and has written a few poems for homework. I asked him if he would like to sit down with me and write one about his feelings. This is the result:

'Sometimes at school I get confused,
And then I get abused,
What to write, which way to go,
I don’t really know,
But I know I am the best,
Even though I can’t tell East from West,
Although I get muddled up and in a pile,
The best thing about me is my smile!!'