17th October 2003 at 01:00
Did you know?

* Dyspraxia - once called 'clumsy child syndrome' - simply means messages to and from the brain are not transmitted properly

* Running is a good example: the brain sends the message to move but the message isn't processed properly, making the child move in a clumsy or disorganised way

* It affects up to 6 per cent of people, at least 70 per cent of them male

* Dyspraxic children are often loners. They can become ostracised and victimised

* It doesn't go away; you never outgrow it, but it can improve with support

* A child with dyspraxia might not be able to ride a bike or learn to fasten shoelaces, but is often of above-average intelligence

* Signs a teacher might notice include poor handwriting and difficulties in tracing, copying, even in holding a pen

Dyspraxia is recognised across the world - although it's called developmental co-ordination disease elsewhere, apart from New Zealand and Ireland. The World Health Organisation calls it a "specific developmental disorder of motor function", but the condition has had several names:

"congenital maladroitness", "a disorder of sensory integration", "clumsy child syndrome", "motor sequencing disorder", "developmental co-ordination disorder". Today, the word dyspraxia is recognised as a convenient identification for any developmental motor difficulties experienced by children.

Many parents complain of a lack of sympathy and understanding among teachers. It is just a phase, they are told; your child will grow out of it; it is not a real condition; it is a middle-class excuse for poor behaviour. "Seventy-five per cent of teachers think dyspraxic children are lazy. More than 50 per cent of schools think dyspraxic children are disruptive. More than 33 per cent of schools blame dyspraxia on bad parenting," claims one parent on a website. The figures might be dubious, but it is a sign of how parents believe the condition is trivialised. The Dyspraxia Association in Ireland says: "Families must deal with their child being misunderstood by the general community and in the educational system." But perceptions are changing and the condition is becoming more readily acknowledged.

What is it?

Dyspraxia is a neurological disorder affecting the processes involved in planning and carrying out movements. Messages to and from the brain are simply not transmitted properly. Some children have stability problems with their hips and shoulders, or visual problems that affect their hand-eye or foot-eye co-ordination. Running is a good example: the brain sends the message to move but the message isn't processed properly, making the child move in a clumsy or disorganised way. A lack of co-ordination makes the child appear to be running through sand. A child with dyspraxia might be unable to ride a bike or fasten shoelaces. Matthew Alden-Farrow, a dyspraxic boy who has his own website, says: "While pouring a drink of orange juice it will miss the cup! I don't know why, but the cup never seems to be where I think it is."

Physical symptoms are easily recognised, but all messages can be affected - emotional and social, as well as those associated with movement and learning. Consequences can be wide-ranging. It is a disability, though a hidden one. It can cause confusion, misunderstanding, social clumsiness and bullying.

Who has it?

The child with dyspraxia is often a loner, and is usually a boy - 70 per cent of those with the condition are male. He may have emotional difficulties because he is unable to understand or express his feelings. A small problem can become a tragedy, moving the child to tears. He can focus intensely on future events such as birthdays, or on topics that interest him, and can repeat plans and ideas obsessively. He may constantly repeat questions and their answers to fix them in his mind. These symptoms and their associated frustrations can make him seem immature.

There is an overlap with attention deficit hyperactivity disorder (ADHD), and pragmatic language difficulties that can affect the child's ability to socialise and make friends easily. He probably isn't very good at the things a boy is supposed to be good at. He might be poor at sport; even simple actions such as kicking and throwing can be challenging. And the sort of relationships boys establish, competitive and teasing, are difficult to master, because affected children have trouble distinguishing between serious comments and jokes. The brain interprets what is said but doesn't decode the social context quickly enough. When dyspraxic boys try to emulate this fundamental basis of male interaction, they usually get it wrong and cause offence. They can become ostracised and victimised.

What causes it?

It's not known, but several areas of the brain may be involved. It runs in families and several genes may be to blame. Environmental influences, including diet, may also be implicated.

Who has it?

Dyspraxia affects up to 6 per cent of people, most of them male. Teachers can therefore assume that every class has at least one child with the condition. In specialist provision, the incidence could well be over 50 per cent.

What happens?

The brain doesn't form effective connections, which means it takes longer to process information. The brain knows what it wants to do, but is not quite sure how to go about it. In an athlete, for example, messages are transmitted clearly and instantly. In a child with dyspraxia, the message seems to be wearing heavy boots. As a result, he can appear slow and disengaged when, in fact, he is often of above-average intelligence. He takes longer to process information and respond to it. Sometimes his planning (or praxis) can disappear mid-task. So he has to start all over again. A skill mastered today can be forgotten tomorrow. So, when achievement does not match obvious intelligence, sufferers may be labelled lazy. But many children with dyspraxia actually have a problem with a "wobbly framework". They have less stability in their hips and shoulders, making it difficult for them to use their feet or hands accurately.

The diagnosis

The condition has a wide-ranging definition; not all children who have it share a common set of symptoms. Each is affected in a slightly different way. It is the range of symptoms and their seriousness that leads to a diagnosis.

Parents may have suspected that something is wrong from early on in the child's life. A weak sucking reflex can be an early indicator; certainly a failure to reach developmental milestones can be significant. This could be learning to crawl or learning to speak. There could be feeding difficulties; problems co-ordinating eating and swallowing. The child will appear healthy and alert and have no outward signs of difficulties.

Early years teachers can be the first people parents share their concerns with, so awareness is essential. Signs a teacher might notice, and which should be brought to parents' attention, include problems fastening shoelaces and buttons, tracing, copying, even holding a pen. Affected children could have difficulty balancing and sitting still, and may have ungainly movements or posture. They might play with younger children or seek the company of adults. If they are excited or distressed they may become less articulate.

The condition often co-exists with dyscalculia (a learning difficulty in mathematics), ADHD, dyslexia and Asperger's syndrome.

What happens next?

When children are diagnosed, they should be interviewed by an educational psychologist with a view to having a statement drawn up. An individual education plan (IEP) will help teachers respond to and plan for children, and will provide support and advice for parents. More importantly, it will reassure the child that his needs and frustrations have been recognised.

This is important. As the charity Dyspraxia Connection states: "If it is not recognised that the child has dyspraxia, this can lead to secondary behavioural problems. It is much easier to act the class clown or become an aggressor to hide any limitations."

Diagnosis can clear the way for more classroom support; extra time can also be offered for key stage exams. Statementing has important consequences for funding and can provide essential support for a family. There is a good chance that the child will go on to further education: universities are becoming aware that they will have adults with dyspraxia as well as dyslexic students on their courses, and are increasingly informed and supportive.

What teachers can do

Dyspraxia may not be identified until secondary school. Here, an alert and informed PE teacher can have an important role to play, both in spotting symptoms and providing support. It is important for boys that they are not humiliated in physical activity, for it is generally the arena in which they form judgments about each other.

The dyspraxic child needs encouragement and clearly defined and achievable goals, no matter how simple. PE staff, who themselves are clearly achievers in their subject, can do a great deal to preserve self-esteem and the reputation of the student with his or her peer group. Effective supervision of changing rooms is important to prevent bullying; dyspraxic pupils need plenty of time to get changed and may need discreet help when getting dressed.

Children with dyspraxia are often bright pupils who respond best to structured situations; in fact, the fundamentals of good teaching are those to which they will respond most readily. Tasks need to be carefully planned and broken down into a simple, logical sequence. Small steps are needed: like any child finding his or her way through a task, they should not be confused with too much simultaneous information. Other steps that will help include:

* minimising distractions by seating dyspraxic pupils at the front of the classroom and away from main through-routes;

* keeping overhead projector screens and boards free of clutter to help them focus on essential information;

* encouraging and repeating instructions to remind them of the task and the sequence;

* if there are handwriting issues, trying to find a pen that the child finds easy to hold - triangular-shaped pens may be successful - and if written work is sometimes too untidy, allowing them to use a pencil.

Mistakes can be easily erased and the finished product will look more acceptable to the child. If handwriting is a serious problem, encourage keyboard and computing skills (see case study);

* suggesting pupils use transparent pencil cases, which make it easier to check that equipment is in order;

* using Post-it notes to help planning and sequencing;

* being particularly aware of health and safety issues - such as balancing on a stool - especially if you are a teacher in a practical subject such as design technology;

* using a buddy system to integrate dyspraxic pupils. Drama groups are a good way of building friendships and self-belief;

* smoothing primary-secondary transfer by making sure information is passed quickly between schools, and that children don't get lost in the more complex surroundings of a secondary school.

Practical advice

Some parents have found that intensive one-to-one swimming lessons ease the condition. The water provides enough support to allow the child's limbs to be moved purposefully in a planned sequence. Slowing the process down makes it easier to remember, and provides a model for other activities.

An exercise bike provides the co-ordination of cycling without the danger.

Computer games can help to develop hand-eye co-ordination. And there is evidence that dietary supplements can bring significant improvements in some children. Research by Dr Alexandra Richardson, a senior research fellow in neuroscience at Mansfield College, Oxford, indicates that a range of conditions, including dyslexia and dyspraxia, may be improved by increasing intake of highly unsaturated fatty acids, especially the essential fatty acid Omega-3. Fish oils and evening primrose oil may have a beneficial effect. There has also been a suggestion of a link with wheat allergies.

The Dyscovery Centre in Cardiff was set up by GP Amanda Kirby after her son was diagnosed with the condition when he was three years old. It was born out of her frustration with attitudes towards him, and what she sees as a failure to accept his difficulties as a real condition. "I knew he was different from my older son," she says. "He didn't start crawling when he was supposed to crawl. He was late walking. He was slow talking. He was a very floppy baby. We finally went to see a paediatric neurologist, who gave the diagnosis." The centre provides training courses for teachers and assesses children and adults for dyspraxia. It sees children from all over the world and uses a range of specialists, such as occupational therapists and behavioural optometrists, which indicates how wide-ranging the condition can be.

Long-term prospects

The condition doesn't go away. It is present from birth and continues into adult life, although maturity can bring improvements. One of the dangers is that those affected avoid physical activity and become unfit. They might find mastering new skills difficult and be daunted by even average workload. Sufferers should use a PC and a personal organiser. DIY, cooking and driving might be problematic, and they may find relationships difficult. They can also be prone to depression and anxiety.

Are there any benefits?

Many children with dyspraxia have above-average intelligence. And, as with many disabilities, the frustrations can help them develop self-awareness and understanding. Emotional awareness as a consequence of facing their own difficulties has led many into careers in social work and counselling.

Interestingly, according to the Dyspraxia Foundation, some doctors blame undiagnosed dyspraxia for their illegible handwriting.

How can the child with dyspraxia succeed?

If the keys to success for anyone are a determination to succeed and a supportive learning environment, he or she will bring the former. It is up to schools to provide the latter. The first stage is understanding.

Main text: Geoff Brookes, deputy head, Cefn Hengoed school, Swansea. Photographs: GettyAlamy. Additional research: Tracey Thomas Next week: parents at war

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