Clumsy Awkwardness (Dyspraxia)

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Maybe you know someone who always trips and bumps into many objects (maybe more that once a day). He or she can’t live a day without spilling food, tripping on the floor, bumping into walls or posts or even other people, or misplacing or dropping things. Or maybe you have watched anime, J-dorama, and K-drama series, even Hollywood films and American TV series, with a lot of clumsy protagonists.

Very funny, right?

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Not really. It DOES hurt to the clumsy person. Literally and figuratively hurt. Although clumsy people  are funny, they usually struggle to finish tasks completely, keep balance, and use a skill without much difficulty everyday despite their conscious efforts. This condition is called developmental coordination disorder (DCD) or dyspraxia (also known as motor skills disorder or specific developmental disorder of motor function).

What is dyspraxia?

Dyspraxia is the term used when someone has an inability to carry out and co-ordinate skilled, purposeful movements and gestures with normal accuracy. Someone with dyspraxia has difficulty planning and organising their thought processes (planning what to do and how to do it).[1] Although most people do expreience accidents and mistakes, a person with dyspraxia (dyspraxic) does experience accidents and mistakes more frequently than the neurotypical person. It doesn’t necessarily mean that the dyspraxic is dumb or airheaded as it is portrayed in media.

Dyspraxia is a common disorder affecting fine and/or gross motor coordination in children and adults. It may also affect speech. DCD is a lifelong condition, formally recognised by international organisations including the World Health Organisation.[2] Because it is lifelong, most daily activities become difficult to the dyspraxic person.

But mistakes happen to everyone including me. Maybe dyspraxics should just learn to practice.

Er, yes, but dyspraxics DO experience more dificulty than the rest of us. Here’s why.

Dyspraxia is a chronic neurological disorder beginning in childhood that can affect planning of movements and co-ordination as a result of brain messages not being accurately transmitted to the body.[3] It is like broken electrical wires that cannot deliver electric current properly to the appliance that may cause malfunction.

What causes dyspraxia?

Nothing is known about the exact cause of dyspraxia, but some factors have been hypothesized as causes of dyspraxia. These include immaturity of the nerves at the time of conception. Dyspraxia may be caused by a problem with the nerve cells that send signals from the brain to muscles. Children who were born prematurely, had low birth weights or were exposed to alcohol in the womb may be more likely to have dyspraxia.[4]

Certain neurones in the brain, called motor neurones, do not seem to develop and mature as quickly in someone with dyspraxia. As a result, they are not as effective in transmitting information from the brain telling the muscles to move.[1] Because of this, dyspraxics have weak motor coordination that makes it hard for them to do movements correctly or smoothly.

What are the symptoms of dyspraxia?

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Oops! You really don’t know whether this girl is stupid or is dyspraxic.

Symptoms vary per person and also its severity. But here is the list of general symptoms of dyspraxia:

Gross Motor Symptoms – the general whole body movement like running and dancing is difficult to execute by the dyspraxic[3]:

-Poor timing[5]
-Poor balance[5][6] (sometimes even falling over in mid-step). Tripping over one’s own feet is also common.
-Difficulty combining movements into a controlled sequence.
-Difficulty remembering the next movement in a sequence.
-Problems with spatial awareness,[6][7] or proprioception.
-Some people with developmental coordination disorder have trouble picking up and holding onto simple objects such as pencils, owing to poor muscle tone and/or proprioception.
-This disorder can cause an individual to be clumsy to the point of knocking things over and bumping into people accidentally.
-Some people with developmental coordination disorder have difficulty in determining left from right.
-Cross-laterality, ambidexterity, and a shift in the preferred hand are also common in people with developmental coordination disorder.
-Problems with chewing foods.

Fine Motor Symptoms – movements of only body parts (arm, hand) that do small work like sewing, using knife and fork, combing hair, and applying cosmetics – these are also difficult to the dyspraxic.[3] Handwriting also is not coordinated. Problems associated with this area may include[3]:

-Learning basic movement patterns.[8]
-Developing a desired writing speed.[9]
-Establishing the correct pencil grip[9]
-The acquisition of graphemes – e.g. the letters of the Latin alphabet, as well as numbers.

Image courtesy of wikipedia.org

Example of fine motor skill deficit in dyspraxia shown in this girl completing a globe puzzle.

Developmental Verbal Dyspraxia or Childhood Apraxia of Speech:

This symptom involves dificulty in language expression not as a result of muscle weakness, paralysis, or deafness, but of the brain having difficulty coordonating the muscle movements to say sounds, syllables, and words.[10]

Key problems include[3]:

-Difficulties controlling the speech organs.
-Difficulties making speech sounds
-Difficulty sequencing sounds
-Within a word
-Forming words into sentences
-Difficulty controlling breathing, suppressing salivation and phonation when talking or singing with lyrics.
-Slow language development

These are general symptoms. Here are the signs of dyspraxia per age range[4]:

Waring Signs in a Toddler:

Is a messy eater, preferring to eat with fingers rather than a fork or spoon
Is unable to ride a tricycle or play ball
Is delayed at becoming toilet trained
Avoids playing with construction toys and puzzles
Doesn’t talk as well as kids the same age and might not say single words until age 3

Warning Signs in Preschool or Early Elementary School:

Often bumps into people and things
Has trouble learning to jump and skip
Is slow to develop left- or right-hand dominance
Often drops objects or has difficulty holding them
Has trouble grasping pencils and writing or drawing
Has difficulty working buttons, snaps and zippers
Speaks slowly or doesn’t enunciate words
Has trouble speaking at the right speed, volume and pitch
Struggles to play and interact with other kids

Warning Signs in Grade School or Middle School:

Tries to avoid sports or gym class
Takes a long time to write, due to difficulty gripping pencil and forming letters
Has trouble moving objects from one place to another, such as pieces on a game board
Struggles with games and activities that require hand-eye coordination
Has trouble following instructions and remembering them
Finds it difficult to stand for a long time as a result of weak muscle tone

Warning Signs in High School:

Has trouble with sports that involve jumping and cycling
Tends to fall and trip; bumps into things and people
May talk continuously and repeat things
May forget and lose things
Has trouble picking up on nonverbal signals (gestures, body language, figures of speech) from others

How is dysraxia diagnosed?

A diagnosis of dyspraxia can be made by a clinical psychologist, an educational psychologist, a pediatrician, or an occupational therapist. Any parent who suspects their child may have dyspraxia should see their GP (general practitioner, primary care physician), or a special needs coordinator first.[11]

Assessment for dyspraxia includes developmemtal history, intellectual abilities, and gross and fine motor skill testing.[11] There, the assessor will test specific skills including hand grip, balance, and touch sensitivity. This will be compared to the developmental milestones of the typical child. Comparing children to normal rates of development may help to establish areas of significant difficulty.[3]

However, dysraxia is very hard to diagnosed becauuse it does not present symptoms obviously like ADHD (being hyperactive) or autism (being aloof). It is also difficult because the dysraxia/DCD is not recognized yet in most parts of the world except in English-speaking countries and some parts of Europe (in Scandinavia, dyspraxia is called deficits in attention, motor control and perception (DAMP)[12]). Especially when the health care peovider is not completely aware of the disorder, the diagnosis may not be made clearly and dyspraxia may be missed.

How is dyspraxia treated?

There is no cure for dyspraxia, but there are a lot of mamagement techniques needed to cope with dyspraxia. The earlier the detection, the better the outcome of dyspraxia management. Therapies include occupational therapy, speech and language therapy, and physical therapy. Other strategies include educational modification like one-on-one coaching[13] so it will be easier fof the dyspraxic to acquire skills and knowledge.

For adults, structure and routine at work stations can help a dyspraxic employee get the work done. Office technology like ergonomic office furniture and electronic gadgets and word processors can also help. Breaking own their work into manageable chunks and to use different coloured folders for different tasks to help with organisation. Allowing regular breaks can improve productivity.[14]

If the diagnosis is made during late childhood to adulthood, the dyspraxic has already acquired anxiety, depression, or emotional disturbances due to repetitive failure at school or work, social isolation, and discrimination made be colleagues, schoolmates, and teachers. Usually, dyspraxics have low sense of self-esteem, thus, psychological counselling is also recommended. Medications like antidepressants can also help.

What happens if dyspraxia is not diagnosed?

If dyspraxia has not given intervention, life will be hard for the dyspraxic. He or she will continually struggle at school especially with skills like art, music, physical education or gym, and crafting. Because dyspraxics cannot read nonverbal communication, they are often struggling in making and keeping friends and romantic relationships, which in turn may leave the dyspraxic isolated and depressed. By the time the dyspraxic reaches adulthood, he or she has the high risk of unemployment, underachievement, and divorce or having unstable relationships.

Awareness of dyspraxia

Interest in studying dyspraxia started in the 1960s[15], although the term dyspraxia is not yet coined. In 1972, A. Jean Ayres called dyspraxia disorder of sensory integration.[3][16][17] Dr Sasson Gubbay called it the ‘clumsy child syndrome’ in 1975.[3][18][19][20] Dyspraxia is only coined
by the American Psychiatric Association (APA) in 1987[21], though Samuel Orton first coined developmental dyspraxia in 1937.[22]

Since dyspraxia is only a recent diagnosis, still most people are not yet aware of the condition, which may conclude that there are people with undiagnosed dyspraxia and may be struggling in their everyday lives. More awareness is needed to recognize dyspraxia especially in most parts of the world.

How common is dyspraxia?

According to Dyspraxia Foundation USA, 1 out of 10 people have dyspraxia[23]. It is 4 times more common in males than in females, and it is hereditary.[3]

Can a dyspraxic be successful?

Yes with early detection and mamagement. Dyspraxics can also have strengths like in literature, music, acting, math, and science, and computer studies too. Below are some people with diagnosed or suspected dyspraxia[24]:

Sir Isaac Newton
Pablo Picasso
George Orwell
Ernest Hemingway
Emily Bronte
G. K. Chesterton
Jack Kerouac
Richard Branson
David Bailey
Daniel Radcliffe
Albert Einstein
Robin Williams
Samuel Taylor Coleridge
Bill Gates
Marilyn Monroe
Stephen Fry
Florence Welch of Florence + The Machines

If that’s so, can I also count Jennifer Lawrence? She is clumsy particularly at the Oscars.

Image courtesy of dailymail.co.uk

Well, I guess so…

Who knows? Maybe your clumsy best friend might actually write the sweetest romance novel ever or be an award-winning actor or become a Nobel laureate in medicine.

How about Mr. Bean?

Image courtesy of buzzfeed.com

Er?…

Reference:
1. http://www.patient.co.uk/health/Dyspraxia.htm
2. http://www.dyspraxiafoundation.org.uk/about-dyspraxia/
3. http://en.m.wikipedia.org/wiki/Developmental_coordination_disorder
4. https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/dyspraxia/understanding-dyspraxia#item2
5. Missiuna C, Gaines R, Soucie H, McLean J (October 2006). “Parental questions about developmental coordination disorder: A synopsis of current evidence”. Paediatr Child Health 11 (8): 507–12. PMC 2528644. PMID 19030319.
6. Geuze RH (2005). “Postural control in children with developmental coordination disorder”. Neural Plast. 12 (2–3): 183–96; discussion 263–72. doi:10.1155/NP.2005.183. PMC 2565450. PMID 16097486
7. Wilson PH, McKenzie BE (September 1998). “Information processing deficits associated with developmental coordination disorder: a meta-analysis of research findings”. J Child Psychol Psychiatry 39 (6): 829–40. doi:10.1017/s0021963098002765. PMID 9758192.
8. Lacquaniti F (August 1989). “Central representations of human limb movement as revealed by studies of drawing and handwriting”. Trends Neurosci. 12 (8): 287–91. doi:10.1016/0166-2236(89)90008-8. PMID 2475946.
9. Polatajko HJ, Cantin N (December 2005). “Developmental coodination disorder (dyspraxia): an overview of the state of the art”. Semin Pediatr Neurol 12 (4): 250–8. doi:10.1016/j.spen.2005.12.007. PMID 16780296.
10. http://en.m.wikipedia.org/wiki/Developmental_verbal_dyspraxia
11. http://www.medicalnewstoday.com/articles/151951.php
12. Hellgren L, Gillberg C, Gillberg IC, Enerskog I (October 1993). “Children with deficits in attention, motor control and perception (DAMP) almost grown up: general health at 16 years.” Dev Med Child Neurol 35 (10):881-92. doi:10.1111/j.1469-8749.1993. PMID 8405717
13. http://www.webmd.boots.com/children/guide/dyspraxia?page=2
14. http://www.dyspraxiafoundation.org.uk/dyspraxia-adults/workplace-employers/
15. http://www.dyspraxia.ie/aboutus_history
16. Ayres AJ (1972). “Types of sensory integrative dysfunction among disabled learners”. Am J Occup Ther 26 (1): 13–8. PMID 5008164.
17. Willoughby C, Polatajko HJ (September 1995). “Motor problems in children with developmental coordination disorder: review of the literature”. Am J Occup Ther 49 (8): 787–94. doi:10.5014/ajot.49.8.787. PMID 8526224.
18. Gibbs J, Appleton J, Appleton R (June 2007). “Dyspraxia or developmental coordination disorder? Unravelling the enigma”. Arch. Dis. Child. 92 (6): 534–9. doi:10.1136/adc.2005.088054. PMC 2066137. PMID 17515623.
19. Gillberg C, Kadesjö B (2003). “Why bother about clumsiness? The implications of having developmental coordination disorder (DCD)”. Neural Plast. 10 (1–2): 59–68. doi:10.1155/NP.2003.59. PMC 2565425. PMID 14640308.
20. Gubbay SS (October 1978). “The management of developmental apraxia”. Dev Med Child Neurol 20 (5): 643–6. PMID 729912.
21. Addy L, Dixon G (2013). “Making Inclusion Work for Children with Dyspraxia: Practical Strategies for Teachers.” Routledge. ISBN 1134378033.
22. Davis AS (2010). “Handbook of Pediatric Neuropsychology.” Springer Publishing Company. ISBN 0826157378.
23. http://www.dyspraxiausa.org/
24. http://www.aucklanddyspraxia.org.nz/drupal/Article%20-%20Famous%20Dyspraxics

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