When a child is not just clumsy
Hannah is a delightful nine-year-old, slim and pale with a dreamy expression, but on occasion she drives her mother to distraction. Liam is 10, well-built, articulate and wants to fly jets when he grows up. Simon is 12, quiet spoken and worried looking; he goes to secondary school and hates every minute of it.
"A lot of the teachers just ignore me if I'm not sure what to do, even the learning support teachers. So I sometimes sit for 10 minutes with my hand up," he says. His mother is thinking of changing schools because he is so unhappy but it is a big step and both are apprehensive about the move.
All three children and many others - 8 to 10 per cent of the population, says Christine Macintyre of Edinburgh University, with boys outnumbering girls by 4:1 - suffer in varying degrees from a distressing condition known as dyspraxia. The children, their mothers and a teacher have come to the university to discuss with Dr Macintyre the possibility of setting up an information and self-help group in the Edinburgh area.
Dyspraxic children are usually labelled as clumsy, lazy, moody and attention-seeking. But it is not their fault. The children have a perceptual motor problem that makes everyday actions which most people perform without thinking, such as writing, tying shoelaces and kicking a ball, extremely hard work. And they get frustrated, upset and worn out with the constant effort to do what comes naturally to other children.
When Liam's mother sees him come through his school gates she can tell immediately what kind of day he has had. "If it's been bad he's like a bomb waiting to go off."
Dyspraxia often overlaps with other conditions: 50 per cent of dyspraxic children are also dyslexic. Research into the condition is continuing at Edinburgh University - where Dr Macintyre is working with a group of teachers to prepare guidelines for schools - and at other centres. Without help, dyspraxic children are certain to underachieve, says Dr Macintyre. "Everything they do is filled with first-time challenges. Imagine trying to learn to drive every minute of the day."
Dr Macintyre emphasises that dyspraxic children are bright but suffer from a condition which often goes unrecognised in schools, even though there are likely to be one or two children with some degree of dyspraxia in every class. If these children do not get the help and understanding they need, their self-esteem plummets and the adverse effects of this can last for many years.
School psychologists are not always aware of dyspraxia. "I had one psychologist phone me, wanting me to tell her all about it," says Hannah's mother, Lynda Luke.
Recognising children who might be dyspraxic is a vital step for parents and teachers towards helping them. They do not grow out of it and, as yet, there is no cure. The condition should be suspected in any child who is clumsy and seems also to be withdrawn or loud and disruptive or indeed both on different occasions. Children with dyspraxia cope in a variety of ways.
Teachers and parents should watch out for situations in which children are clearly not coping, such as team games where their lack of co-ordination can be humiliatingly obvious. Crossing the body midline with hands or feet can be difficult, creating problems with writing, pulling on socks or reaching to open a door.
Organising and planning are hard and made more so by poor short-term memory.
Dressing and undressing can be an ordeal - especially for parents - because the children often forget what they were trying to do and wander off before they have finished. In winter they might go out wearing only a T-shirt because it doesn't occur to them that they need a coat in the cold.
Their judgment of speeds and distances is often poor, so great care is needed in crossing the road. They can be very sensitive to touch, and bumps that others would barely register can cause pain and a seemingly excessive reaction.
Perhaps the worst aspect of the condition is that difficulties that were initially physical and perceptual end up affecting the child's whole life and the lives of those around him or her.
Many of these children have to endure constant harassment: "Pay attention!", "Hurry up!", "Why haven't you done what I told you?", "Do that again but neatly."
And behaviour developed to distract attention from their inadequacies can, in a school setting, also distract the teacher and everyone else in their classes.
Children with dyspraxia find it hard enough to learn how to make their bodies perform sensibly in an atmosphere of sympathy and understanding. Teachers and parents can do a great deal to help them overcome their perceptual and physical difficulties. Instead, often they are treated with impatience, hostility and blame.
"Once you know about dyspraxia," says primary teacher Cathy Michie, "and begin to recognise it in the children in your class, you can't go on treating them as if it is their fault. You want to help them learn to do the things they can't do. That's what being a teacher is about."
Tests for dyspraxia are not widely available. "If you keep nagging the school, they'll maybe do a dyslexia test," says Liam's mother, "and if that shows nothing, they tell you there isn't a problem."
Private centres for assessment and testing do exist but are very expensive. Assessment is normally carried out in occupational therapy departments of hospitals but, according to Dr Macintyre, these are swamped and take the line that unless a child is severely affected schools must cope.
Dr Macintyre has written to Jack McConnell, the education minister, and Susan Deacon, the minister for health and community care, explaining the urgent need for an educational assessment centre in Scotland. "Health and education together should be able to help these children and others with similar difficulties," she says.
* Identify and intervene
Dyspraxic children have a problem with co-ordination which should be addressed as early as possible. They do not grow out of it but they can be helped.
They have difficulty in knowing what to do, in getting organised and in getting jobs done. Teachers and parents should observe and record which activities cause problems. They should concentrate on the specific difficulties of each child and try to visualise the hurdles they will face. Appropriate strategies can then be devised.
Checklists and aids suitable for different age groups can be constructed, such as pictures and colour coding for infants, direction arrows or written instructions for older children.
Dyspraxic children often have poor control of their muscles. Physiotherapy and occupational therapy can improve muscle tone. If the small muscles around the mouth are affected, speech can be unclear and the child may dribble when leaning over to concentrate on writing. An inclined desk can to help counter this.
Many dyspraxic children find writing legibly hard work but have no trouble with the simpler actions needed to use a computer. In music classes, a sturdy instrument such as a xylophone is a good choice for a child who can't easily judge his or her own strength.
Because a dyspraxic child has problems with perception and perspective - he or she may see a table as being closer than it is so a cup crashes to the floor - everyday actions can be improved with practice, the repetition providing mental feedback for adjustment and correction.
Private tuition may be available in some areas. "We arranged tuition for Liam and I think it helped," said his mother, "but it cost a small fortune."
Intervention at school should start early and can be built into classroom routines. Many primary teachers already have "together time" during which the class performs simple actions such as touching heads, shoulders, knees and toes. Specific exercises aimed at dyspraxia, such as crossing the body midline, could be included.
It is important to raise awareness of dyspraxia among teachers and parents, concludes Dr Macintyre, to help them realise that many children have undiagnosed physical problems which cause them great difficulty, and to identify the children who are affected. "What we need," she says, "is more eyes that can see."
For further information, contact lecturer Christine Macintyre (0131 651 6428), teacher Cathy Michie (0131 449 6378) or parent Lynda Luke (0131 477 9326). Christine Macintyre has two relevant books: Dyspraxia in the Early Years, published by David Fulton, pound;14, and Dyspraxia 5-11, David Fulton, pound;15, released last month.
The guidelines for schools will be launched on June 8.
More information and a reading list is on the Dyspraxia Foundation's website www.emmbrook.demon.co.ukdyspraxhomepage.htm