Dyspraxia is a specific developmental disorder of motor function, defined as an impairment or immaturity in the planning and organization of movements. Dyspraxia also affects children with above-average intelligence.
The disorder was first recognized in the medical field at the beginning of the 20th century, initially described as "congenital clumsiness". Later, dyspraxia was defined in the 1947 edition of The American Illustrated Medical Dictionary as "partial loss of the ability to execute coordinated movements". In the International Classification of Diseases (ICD-10), it is referred to as a specific developmental disorder of motor function.
A child with dyspraxia demonstrates a mismatch between their motor abilities and their age. They have difficulty acquiring complex motor skills, and their gross motor skills are delayed (especially in imitating demonstrated movements). Subsequently, they experience difficulties with tasks that require fine motor skills.
Dyspraxia is not a joint mobility disorder; its basis lies in the difficulties in perceiving the body map, and processing kinesthetic, tactile, and vestibular stimuli. Gross motor skills are delayed in development, and the child has difficulties imitating observed movements. Gross motor skills involve movements of the whole body, large muscle groups, such as walking, stair climbing, running, jumping, swimming, etc. Subsequently, the child has difficulty acquiring fine motor tasks, such as writing, sewing, buttoning, tying shoelaces, playing with a ball (with hands or feet).
Children with this disorder have difficulty learning to eat with a spoon, speak clearly and intelligibly, dress themselves, ride a bike, and so on. They suffer from feelings of inferiority. Because difficulties in coordinating movements and clumsiness persist into adulthood, an unrecognized disorder can negatively affect a person's entire life.
A child with this disorder is often labeled as clumsy, uncoordinated, or unskillful (Zelinková, 2007). A. Kirby summarizes the findings on dyspraxia as follows. Dyspraxia is not a disease; it is more a collection of symptoms that do not have a uniform cause. There are no known genetic causes, and no significant neurological findings. The most common manifestations are muscle weakness and inflexibility or decreased muscle tone accompanied by increased flexibility and mobility (Kirby, 2000).
Symptoms of dyspraxia in children from birth to three years old include hyperactivity, sleep and feeding problems. Often, the child does not go through the crawling stage, later sits, then begins to walk, and even the development of speech is delayed (in 70% of cases).
Other significant indicators of developmental deficits in children already at birth are feeding and food. The sucking reflex is often weakened, and breastfeeding is unsuccessful. Subsequently, choking and gagging occur during meals. The child prefers pureed or liquid food. A complicating factor in independent feeding is poor coordination of hand-to-mouth movements. The child has difficulty feeding themselves, spills liquid food or drink, and struggles to chew.
Speech development is also one of the first areas where parents become aware of their child's difficulties. They notice that the child does not experiment with sounds, and reflexive and imitative babbling is delayed. Delayed speech development is caused by difficulties in performing and coordinating movements of the articulatory organs: lips, tongue, soft palate, and teeth.
In later years, children with dyspraxia often experience difficulties with:
Gross motor skills: movements of the whole body and motor coordination during walking, running, jumping, throwing and catching a ball, riding a bike or scooter.
Fine motor skills: tabletop games, their selection and execution, use of tools (hammer, pliers, scissors, etc.), drawing freely and copying basic shapes.
Speech: level of articulation and understanding of speech.
Self-care: eating, dressing.
Social behavior: engagement in a group, relationship with adults.
Source: (Zelinkova, 2007)
Primary reflexes and dyspraxia
Symptoms of dyspraxia can also be caused or worsened by persistent primary reflexes.
The Tonical labyrinthine reflex (TLR) causes:
Poor gross motor skills
Changes in muscle tone (often hypotonic) and balance problems, which make it difficult for the child to stand still.
Problems focusing their eyes on close objects and following moving objects with their eyes (for example, kicking a ball will be difficult for the child due to poor balance and eye focusing).
Children appear clumsy and slow.
Problems with estimating distances, often causing them to bump into things and fall.
Difficulty maintaining a straight posture while writing and reading. They may need to support their head with their hand or lie face down on the table. Leaning forward helps the child apply more pressure with the pencil on the paper, which often results in holes in the paper or broken pencil tips.
The Symmetrical tonic neck reflex (STNR) causes:
Problems with balance and hand-eye coordination.
Inability to sit still and straight on a chair. Tilting their head forward (necessary for reading) immediately triggers the STNR reflex, causing their arms to bend and their legs to stretch. These children tend to be nervous and restless, and they often wrap their legs around the chair legs, sit on their heels, or do anything to stabilize their legs.
They often rock back and forth on the back legs of the chair as a reaction to the reflexive leg stretching - "rocking on the chair."
The Moro reflex causes:
unwanted movements of the arms, legs, and whole body extension (tilting) whenever the head is tilted or when an unexpected visual or auditory stimulus appears. These reactions are usually compensated for by higher muscle tone, especially in the neck area.
increased sensitivity to visual and auditory stimuli.
the child may not be able to catch a ball because they cannot focus properly on the ball or maintain attention when another object enters their peripheral field of vision. The approaching ball can also trigger the Moro reflex - the child lifts their arms and tilts their trunk - it looks like the child is not even trying to catch the ball. This reflex does not occur when the child (even unconsciously) looks away from the approaching ball or even closes their eyes.
The Rooting and Suck Reflex and the associated Babkin Response (Palmar-Oral Reflex) cause:
mouth movements whenever the hand is used - i.e. sucking movements when the child writes or protruding the tongue when sewing may be an example.
frequent licking of the lips (causing redness and dryness around the lips), as well as drooling, smacking, spitting, poor articulation, and difficulty synchronizing breathing movements during speaking or eating.
The Asymmetrical Tonic Neck Reflex (ATNR) causes:
higher muscle tension in the neck area and leads to problems with arm activity and hand-eye coordination
worse fine motor skills
difficulty for the child to simultaneously move both sides of the body (for example, the child may find it difficult to manipulate both a fork and a knife at the same time and prefers to use them alternately)
a cramped pencil grip
poorer hand-eye coordination (the child may have difficulty copying something from the board into their notebook or catching and throwing a ball).
poorer cooperation between the brain hemispheres. If the hemispheres don't cooperate properly and don't complement each other, the brain consumes far more energy (which would otherwise be used by the body), and the child becomes tired more quickly.
Article author: Marja Volemanová
Sources used:
Kirby, A. (2000). Nešikovné dítě. Praha: Portál.
Volemanová, M (2019). Přetrvávající primární reflexy, opomíjený faktor problémů učení a chování. Statenice: INVTS.
Zelinková, O. (2007). Dyspraxie. Pedagogika roč. LVII.