Dyspraxia

What do we mean by Dyspraxia? Dyspraxia is a general term. It means that the person has difficulty motor planning and intentionally controlling muscular movement. We are using the term in its general sense.

Dyspraxia can take different forms and it can create some confusion. The child’s motor ability is not the same as her ability to motor plan. There are many things that the child can do. But can she do what she wants to do when she wants to do it? Perhaps not always. She may have trouble intentionally performing certain actions. It may take her time and a lot of effort to succeed at performing an action. She might have some motor movements that are patterned and she may have difficulty stopping the patterns or changing these patterns when she intends to. When she is not trying, she may be quickly successful at various motor actions.

If a child sees something that they want at the top of the stairs, the child might climb up the stairs and grab the desired item. But, if they are asked to focus on going up a stair, they might have difficulty doing it. There are two different kinds of intention involved. In one case, there is a desire and the body is following the desire. In the other case, there is a focus on the movement. Sometimes with dyspraxia, the child can act according to the desire, but it is difficult to focus on the movement and be successful.

Another characteristic of this form of dyspraxia, is that the child might have certain movements that are habitual and routine movements. The strength of the routine can be much more powerful than the person’s ability to motor plan. All of us have had the experience of going into automatic pilot and driving to the place that we habitually go to, rather than to the place that we are supposed to go to. We say, “Silly me,” and turn the car around. Luckily this doesn’t happen so much that it impairs our day to day functioning. But this dynamic could be severe enough for the child that it might impair his functioning. He might have a number of movements that he does, not because he particularly wants to, but because his automatic pilot is stronger than his intentional pilot is.

Some of the children who are most involved in repetitious movements as self-stimulating rituals are dyspraxic. If a child is in good rapport, appears to be trying and is having difficulty responding to a clear request, she may be dyspraxic. Other signs of dyspraxia:

· Child takes your hand to perform an action (as if your hand will work better than theirs)

· Delays in responding to requests – does it, but after time has gone by

· Often the child appears unusual in their movements – can appear stiff, clumsy, or delayed in their motor skills. (Sometimes many motor skills appear to be normal.)

· Child is extremely inconsistent – sometimes performing an action smoothly, and sometimes having great difficulty responding.

· Difficulty learning series of movements

· Difficulty imitating

· An action takes a long time to learn. Then the child often responds with that learned action even when it is not appropriate

· Most dyspraxic children are considered to be either cognitively impaired, or willfully uncooperative due to their difficulties responding

· Often, when writing or typing, the same scribble or key combinations appear over and over again

· A child might leave the table repeatedly because they have a motor pattern for getting up and going. A child might bring things to their mouths repeatedly because they have this motor pattern. Often these children will welcome your breaking of the pattern, rather than appearing angry if you obstruct

· Often there is a strong sense that the child understands much more than they are demonstrating. Sometimes this comes from seeing differences in the quality of attentiveness when they are spoken to in more sophisticated ways. Sometimes it is because the child sporadically responds to sophisticated requests.

· Often there is poor bilateral coordination. Often there is no clearly dominant hand.

· There may be poorer performance of tasks that involve alternating contraction and extension of opposing muscle sets. For example, if a child is asked to put an object in the bucket, they might pick it up, put it over the bucket and not let go because grasping and then letting go involve opposing muscle sets.

· Sometimes, when a dyspraxic child does respond, the movement is quick and impulsive. Slow and controlled movement may be rarely seen.

Because speech is the finest motor controlled combination of movements that the human body can perform, speech is affected. Words are very difficult to learn. Oral motor imitation is difficult. The same sound might be repeated over and over, etc. (Some speech therapists refer to limb dyspraxia versus speech dyspraxia. They suggest that these dyspraxias can exist together or independently.)

Minimizing Motor Issues

There are a number of ways to help minimize motor challenges. One is to be aware of ergonomics. It is important to have the child in a chair that fits him. If his legs are at a 90 degree angle when he sits in the chair with his feet flat, then the chair is at a good height. Many children with dyspraxia do better with a back to the chair. If they have some support, they have one less motor task. (Don’t use a chair that fully supports The child, or she will not develop her support muscles.) When he is sitting straight, the table height should be at or slightly below the elbows when his arms are bent an a 90 degree angle (upper arm hanging straight down.) The Tripp Trapp chair that we use can be ordered from www.backcarebasics.com. (I think that the chair is made in your part of the world, so this is probably not the best place to order it from.)

Be aware of where you present the work. Present materials at a height where the child’s arms are relaxed and can be moved easily, like on the table. Also present the materials not too far from her body so that her arms don’t have to be extended, but not so close that she is jammed up. If the articles that she is to point to are out at arm’s length, that makes it much more difficult. She would have to extend and support her own arm, as well as get to the correct target.

When you present materials, also consider the child’s midline. Her midline goes from her nose to her navel. The midline should be called the mid-”plane.” It is a geometric plane that bisects the child, separating the right and left half of her body. If you present two choices, and she is indicating with her right hand, you might want to put the two choices more to the right so that her right arm doesn’t have to cross her midline to get to one of the choices. Experiment and be more acutely aware of posture and positioning, and when she appears to have greater or less success.

Helping the child overcome motor difficulties

There are several things that you can do to help the child overcome her motor difficulties.

1) Attitudinal work: Attitudinal work will be to help the child enjoy making effort with his body – controlling his movements, moving and doing motor tasks, building strength, control, and coordination to whatever degree he can. Encourage him to never get frustrated. Help him not to quit, and to keep trying. Let him know that you know that he is smart – and that sometimes it is hard for him to show it. Create an attitudinal environment where you love challenges. Improvement and effort is highly valued. If he has success, that is great and it is valued – but success in a task is not the source of good feeling. The source of good feeling is determination, persistence, and great effort each day. Sometimes tasks will not be cognitively challenging for him, but will help him develop coordination and control. Let him know that those tasks are not about how smart he is, but about how controlled he is in his movements.

2) Use a learning/task rhythm and routine. Discrete Trial Teaching can be very useful. If you put some life into it, and some warmth, this teaching method has the potential to help the child tremendously. The idea is, establish attending, make a clear request, give her a specified time to respond (3 to 5 seconds). If she does not respond, prompt her. If you use this routine a lot, she will come to know the routine. This can help with dyspraxia because the task is more clear, the timing is more clear – if she is confused, she knows that the answer is coming in the prompt. If you fully prompt the child by taking her body through the action, she can physically experience what it is like to do the task. If the child doesn’t have to figure out the ever-changing rhythm and order to the tasks, she can put more energy into motor planning. If you ask her to point to an item in a book and she doesn’t, after 4 seconds, form her hand into a point and help her point to the picture. As you continue with the activity, fade the prompt.

3) Warning the child: Warn the child – tell him a minute or more in advance what you will be asking of him next. This could help him to prepare. This could help him with motor delays.

4) Physical prompts can be used. If the child is having some difficulty, you might prompt her by moving her through the task. This is a physical prompt. You might tell her that you are going to “show her.” Then, take her hand or whatever body part is being used for the task and help her through the task. If she resists your prompt, stop the prompt. Consider telling her that she wasn’t quite ready. Tell her that you will give her a few seconds, and then you will try again. Wait a few seconds, and then try again.

5) Make Requests: If you are simply more aware that helping the child have more physical control is a goal, then you will find ways to help him achieve it. The more he responds to your requests, the more he will be overcoming motor problems. If he wants to grab something and he does, that might not involve a certain kind of motor planning. If you ask him to grab something and he does, he is using himself differently because it was your idea. The more frequently he motor plans, the more intensely he motor plans, over a length of time – he will get better at motor planning. Frequency, intensity and duration are key.

6) Impulsivity: Sometimes the child may do an action very quickly as if she is throwing herself at the task. When asked to point to a picture, she might tap her finger on the photo several times in rapid succession. This is not a well-controlled movement. Exaggerate pointing in control one time. If she does rapid and repetitious movement, help her go more slowly and in control.

7) Fluency: When the child is starting to really master some task, he may want to pick up speed. Accurate and controlled speed is fluency. If the child is getting good at responding to certain requests, alternate them, and pick up speed. (Look for his cue. He may start to go faster.) Randomize the requests and ask him to go a little faster. If he is smooth and relatively fast in his movement (not blurting and impulsive) and if he can control his movement and change it to fit the task, then he is fluent. You can make this fun. This can add interest and challenge to simple activities. Example: Because one child liked to put things in a basket, we made a color box to put things in sorted by color. When she was correctly identifying the colors and putting the blocks in, she wanted to pick up speed. She maintained her accuracy and was not repetitious in her movements even when she went faster. She appeared to be practicing fluency. She may have been motivated to experience herself as competent. She may have been making the task more stimulating and cognitively challenging by speeding it up. She may have been showing off. My bet is that she was doing all three. Practicing fluency can make a task more cognitively challenging and more fun and a greater source of pride in accomplishment.

8) Create motor challenges: Set up motor problems for him: obstacles and unusual situations, and cheer his efforts. Give him something for lunch that he has to cut. Use toys that require new motor actions like handling controls. Bring in tasks that require using tools that are new to the child, etc. Create new motor tasks. (For more ideas, one resource is Developmental Dyspraxia by Madeleine Portwood – available through www.amazon.com You will notice that your child’s dyspraxia is probably different than the dyspraxia described in the book, but the principles are good, and some of the ideas are appropriate.)

9) Physical Contact: Along with making sure that her body is well-supported if she is doing a fine motor task, you might see if she appears to do better when she is in physical contact with another person. Sometimes try having an arm around her, or sitting shoulder to shoulder for more challenging tasks. Does she do better with contact? Try other forms of physical contact while she is doing a task. If you are working alone, you can put your hand on her back or leg as she is working. You can position the chair and table in the corner of the room, and sit close to her, in contact. Many people have noticed that a number of children with dyspraxia do better when they are in physical contact with another person. Even if she does better with physical contact, treat this like a prompt and fade the contact as she becomes more competent.

10) Cognitively challenging, motorically easy: One of the challenges with children who have motor control difficulties, is that they are mentally faster than their bodies. For them, most communication and play take place at a speed that they can not physically keep up with, and they give up on it. The things that they can do well with their bodies, are simpler and less sophisticated than what their minds are capable of. In the child’s case, this could result in his lounging around and not doing much, or engaging in some repetitious activities that don’t really engage his mind. A challenge is to “probe” and find activities that might be cognitively stimulating. When you do this, it is important to design the tasks so that he can respond motorically. So, for example, we worked with a boy who was dyspraxic. He seemed to love dinosaurs and played with them or looked at them. When it was clear that the boy could choose between two items, we put two dinosaurs in front of him, and asked him to pick up the Tyrannosaurus. His parents were shocked when he consistently picked up the correct dinosaur based on it’s scientific name.

Probing: We didn’t know if the boy had the receptive language ability or knew the names. We flatly asked him to do the task and found out that he had the skill. This is not teaching. This is called probing.

The more the child is doing simple motor tasks, the more you can probe her understanding of letters, numbers, ability to identify, awareness of gender, general knowledge, seasons, food groups, etc.

Also, you can design tasks that are cognitively challenging and motorically easy. Multiple choice questions with an array of two or three possible answers is an example. Play a tape of a sound (a train). Give him a choice of two or three items, and ask him to give you the one that makes the sound. Place three written names in front of him and ask him to point to his. Also to point to the name Mama, Papa, etc. These tasks are motorically simple, but more cognitively challenging.

Dyspraxic children require many more trials to create motor patterns. They require more time to practice using motor patterns when appropriate, and not using the pattern when not appropriate. Over time, and with practice, the dyspraxic child can become more and more adept at controlling their bodies. When they do, they begin to show the cognitive ability that they always had, but could not demonstrate. When this happens, they command more respect, and gain the belief of others in their abilities. With more control comes better expressive communication.

If you have the determination and the opportunity to help a dyspraxic child gain motor control, you help them benefit more and more from the world around them, even as you receive the benefit of their growing ability to give to you.

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