A Sensory-Based Motor Disorder
Children diagnosed with dyspraxia, a motor planning disorder, which is sometimes also referred to a Developmental Coordination Disorder, have particular problems learning new (nonhabitual) motor skills and activities, but once learned, these skills are generally readily available. The difficulty is most often about planning or knowing how to go about doing a task, but the individual may also have difficulty coming up with an idea about what they want or need to do.
The work of Dr. Jean Ayres and subsequent researchers suggests that Developmental Dyspraxia most commonly has a sensory-based underlying cause. It is a sensory processing disorder involving those sensory systems that provide us basic information about our bodies. Because these individuals have a limited sense or awareness of their bodies, as a result they have significant difficulty determining how to make the body do (motorically) what they want it to. Intelligence is not in question here. Before a body can make use of itself as a tool to perform a task, it needs to know precisely where it is and only then can it (the body) plan and determine what it needs to do with any accuracy.
Dyspraxia is seen most frequently as causally related to underlying dysfunction of the tactile and proprioceptive systems in particular, which in combination is called the somatosensory system, involving the input received from touch/skin receptors (tactile) and the position/movement receptors in and around the joints and muscles (proprioception). The vestibular system (movement and gravitational receptors in the inner ear) may also be involved is these processing limitations. Without these sensory systems processing accurate information within the brain, it is impossible for the individual’s brain to know precisely where the body is from moment to moment (poor body awareness). Unable to calculate one’s position, it is impossible for the brain to then plan for and respond through the motor centers with the series actions that produce appropriate motor responses. The body and subsequently the person become and remain confused, ineffective, and frustrated until intervention is available to support a reversal and work towards normalization.
Some behaviors that can be observed are:
- Body awareness is poor, bumping into objects and other people, tripping and falling, knocking over objects like a glass of milk, or unable to pour without spilling, running into the door jamb or furniture, breaking toys and equipment without meaning to Clumsiness, awkwardness, accident proneness, ‘bull-in-the-china-shop’
- Poor fine motor skills such as handwriting, difficulty learning to use/manipulate scissors, or coordinating pencil and paper
- Difficulty dressing and using clothing fasteners – buttons, hooks, tying shows, etc.; not knowing what to put on first and next; or shoes on the wrong feet, clothes on backwards, etc.
- Difficulty learning to use toothbrush, or bathe without assistance or supervision, messy eating and drinking, difficulty using utensils so may only finger feed
- Poor gross motor skills such as kicking, catching, throwing balls, learning to ride a bike, & learning peer sports is a struggle
- Difficulty imitating movements such as "Simon Says", or following more than a one-step direction is confusing and overwhelming
- Trouble learning any multiple sequence of movements to accomplish a task
- Lacking a sense of personal space, standing and talking too close to others
- Difficulty recognizing and responding to other’s body language and facial expressions
- May talk a lot and have much to say but without logical sequencing of ideas, has difficulty explaining a situation to another without confusion
- Difficulty organizing home and school work and play spaces
- Chaotic and messy bedrooms, desks, play areas, book-bags, etc.
- Difficulty prioritizing tasks and projects, homework, remembering and following time schedules, understanding and following either written or verbal instructions
Additional areas of development affected by dyspraxia:
- Emotional-relational and social skills: Because this is not an intellectual disability, these children are often severely frustrated. They want to be like their peers but can’t make it happen. They just don’t ‘make the cut’, are different and can easily become the butt of jokes and bullied. These are kids that often deal with serious anxiety, may be easily angered and enraged because they have tried and may be mistakenly seen as not trying hard enough.
- Teachers may not understand the disability and become frustrated with the child’s apparent frustration and confusion. Many of the children will have given up trying and are then seen as lazy and ‘couch potatoes’. Their self-confidence has taken so many hits/hurts that they just can’t set themselves up just one more time and fail again. Instead they’d rather refuse, resist and are considered oppositional, uncooperative, etc.
- Social skills are often hampered because these children are unable to engage in the same games and play skills with peers without confusion. They may be left out, passed over because of their struggles and ineptness. The desire to be with their peers is or has been there but with the repetitive failure and/or rejection, motivation and self-confidence often dies. Instead these are children that are often happier with older or younger children where they have less need to compete, less chance of failing with the younger set, and there is apt to be more understanding and tolerance from those that are older.
- Communication and language skills may be affected in several ways. There may be articulation issues secondary to poor body awareness in the oral-facial structures. The ability to coordinate these mouth and facial muscles in order to create a sequence of sounds to form a word or sequence or words may be problematic.
- A form of aphasia may also be an issue, where it is difficult to organize a series of logical ideas/thoughts in order to create a full and meaningful sentence. It may then be difficult to sequence a series of sentences which attempt to communicate multiple ideas and which then frame and explain a situation or some concern to another person.
- Academics are often affected by the child’s emotional-relational issues, a lack of healthy self-confidence given the child’s expectation of failure. Anxiety and the stress that this produces will impact on performance, motivation and initiative.
- The child will likely not have the motor planning skills required in school for handwriting, but also for the visual-motor challenges necessary for attending to a teacher and simultaneously coordinating visual attention between the ‘black’ board, textbook, paper and pencil, computer screen, etc.
- Understanding and following a teacher’s verbal and/or written directions, explanations, are apt to be confusing and overwhelming.
- Reading and writing require motor planning and may be a struggle especially when a child is asked to do both simultaneously.
- Attention span may be short or highly distractible. There may be an overriding need for self-regulatory input/sensory stimulation to stay alert and posturally erect. This need may preclude any concentration on what the teacher is saying or the book is presenting.
Treatment for Dyspraxia:
Because this disorder is a sensory-based motor disorder the treatment approach will most often incorporate a sensory integration approach to remediate these issues but will also offer intervention designed to support positive changes in other collaterally affected areas. Hands-on therapy sessions along with a home program designed by the treating therapist and which is monitored frequently and regularly is considered essential to keep the intensity and responsiveness to the intervention optimal.
When appropriate it will be important to involve the supports of related professional services such as speech therapy, a mental health therapist/counselor, and good academic supports from a special educator or a tutor who understands the needs of this individual or will work with guidance from a knowledgeable educator and/or occupational therapist.