ArticlePDF Available

An Investigation of Dyspraxia: What We Know and Why the Research Is So Far Behind

Authors:

Abstract

A brief overview of Dyspraxia (also known as Developmental Coordination Disorder, DCD) written for the St. Anne's Academic Review (STAAR), University of Oxford.
!
http://st-annes-mcr.org.uk/staar/ - Issue 7
STAAR |47
An Investigation of Dyspraxia:
What We Know and Why the Research Is So Far Behind
Emily Meachon
Developmental Coordination Disorder (DCD), also known as dyspraxia, is a
condition prevalent in approximately 10% of the population, with a prevalence rate of 1 in
10 students in the United Kingdom (Colley, 2006; HDCD, 2017; DSM, 2013). DCD is marked
primarily by a delay or disorder in movement execution and planning, however it is often
associated with additional deficits in attention and perception (Colley, 2006). In the UK,
DCD is categorized as a specific learning difficulty (SpLD) alongside Attention-Deficit
Hyperactivity Disorder (ADHD), dyslexia, and dyscalculia, a disorder of arithmetic
(Malpas, 2012). Unlike other SpLDs, the causes of DCD are unknown and the condition is
not well understood. In fact, research on DCD has been observed to be significantly behind
by comparison to similar developmental disorders and SpLDs (Bishop, 2010; Gomez &
Sirigu, 2015). More specifically, SpLDs like dyslexia and ADHD are recognizable to the
public and more popular in research despite their prevalence rates to be about the same as
DCD in the United Kingdom (Malpas, 2012; Bishop, 2010; Holden et al., 2013). This begs the
question: why is the research so far behind when it comes to Developmental Coordination
Disorder?
There are several existing features which may explain the lack of interest and likely
discouragement in the research of DCD. Primarily, DCD is highly complex, often interacting
with other SpLDs, mood disorders and more, and each case of DCD can be unique
(Dyspraxia Foundation, 2017). The complexity of the condition and variation in symptom
presentation makes it quite difficult to examine and treat. Additionally, a lifelong prognosis
for those affected by dyspraxia has led many to seek treatment for individual symptoms
and a unified cure is unlikely to exist (Colley, 2006). Thus, clinicians have settled into a
pattern of treating affected people with respective symptom-by-symptom interventions.
These temporary solutions, though often costly, may provide the façade that research on
the condition is not as warranted. Furthermore, a general lack of public awareness about
the disorder, likely a result from ambiguous nomenclature for the condition among medical
professionals, prevents people from joining forces to encourage and fundraise for research
on DCD. For example, ADHD is well-known to the public and receives significant attention
in funding and research despite the condition having a similar prevalence rate as DCD.
Other factors, such as an under-diagnosis for the condition, and variation in diagnostic
criteria across cultures could also explain some of the gaps in research on DCD.
The purpose of this paper is to delve into the inconsistencies and ambiguities of DCD
in order to highlight the gaps currently existing in the understanding of the condition with
regard to affected populations in the United Kingdom. The reasons for lack of research
interest in DCD will be explored in greater detail and several solutions will be proposed.
This investigation can serve as a guide for future research, inform others about a lesser
understood condition, and assist those who are in search of a comprehensive outline of
DCD.
An Investigation of Dyspraxia!
http://st-annes-mcr.org.uk/staar/ - Issue 7
STAAR |48
Inconsistencies
Nomenclature
Developmental Coordination Disorder can be a difficult condition to explore in
research due to numerous inconsistencies in its nomenclature, prevalence and
epidemiology. In nomenclature, there has been significant debate among medical
professionals on the precise term to be used for DCD, which has been referred to with
phrases and names such as ‘motor learning difficulties,’ ‘developmental dyspraxia,’
‘sensory integrative dysfunction,’ ‘disorder of attention motor control and perception (or
DAMP),’ ‘clumsy child syndrome’ and more (Carslaw, 2011; Colley, 2006).
The significant confusion caused by the lack of a universal term for the condition
pushed scientists and medical professionals to create a single specific title for the condition,
now known as Developmental Coordination Disorder (DCD). DCD became the official
name for the condition in 1994 and is now the most common term for the condition,
appearing in the Diagnostic and Statistical Manual in the USA (Carslaw, 2011). However,
some confusion still exists because the terms ‘Developmental Dyspraxia’ or simply
‘Dyspraxia’ are still common in the mental health sector, especially in the UK (Dyspraxia
Foundation, 2017). The disparity of nomenclature and subsequent spread in the literature
on DCD can contribute to a weaker understanding of the condition compared to the more
consistently-named related SpLDs and disorders.
Prevalence & Comorbidity
It is a challenge to classify the prevalence of DCD, because like many other
psychological disorders, it is prevalent far beyond the finite number of people who are able
to be diagnosed with the condition. In the United Kingdom, the prevalence rate for DCD
ranges between 1.4 and 19% with the variation dependent upon the particular diagnostic
criteria used by practitioners (Carslaw, 2011).
Furthermore, DCD has high comorbidity – or presence of at least two health
concerns- with several disorders. In a review of cases of comorbidity to DCD, Visser (2003)
found that symptoms of ADD/ADHD, reading disability (RD) and specific language
impairments (SLI) most frequently coexist with DCD. The most significant case of co-
occurrence is observed for ADHD, which is estimated to have an overlap of approximately
50% with DCD (Goulardins et al., 2015). In other words, about half of those who have DCD
also have ADHD. It has also been observed that many with Autism Spectrum Disorder
exhibit symptoms often comorbid with dyslexia and DCD (Caeyenberghs et al., 2017; Gooch
et al., 2014). The precise comorbidity rates with other disorders remain rather unclear. This
gap could be due to the lack of proper assessment for DCD in past screening methods for
SpLDs as well as a general lack of knowledge of DCD among the medical professional
populations (Wilson et al., 2012). It is clear that increasing awareness of DCD among
physicians, paediatricians, and generally across the medical community would assist in
proper and timely diagnoses for those suffering from DCD.
! ! An Investigation of Dyspraxia
http://st-annes-mcr.org.uk/staar/ - Issue 7
STAAR | 49
Etiology
The precise origins, or etiology, of DCD remain unknown however certain biological
patterns exist. In rare cases, DCD might be acquired through brain injury such as stroke
Primarily, DCD has been observed to be inheritable and is speculated to be linked to the
underdevelopment cells in the brain known as neurones (Colley, 2006). The genetic
etymology and continuous nature of the disorder signifies that sufferers will be affected by
symptoms of DCD throughout their lifetimes (Gomez & Sirigu, 2015). However, current
research has not found a single clear explanation of DCD through any neurological
abnormalities (Dyspraxia Foundation, 2017). Overall, the literature on the etiological
features of DCD is largely lacking and future research should consider investigating this
area in greater detail.
It has been argued by Goulardins et al. (2015) and Lange (2017) that DCD and ADHD
may have a similar if not the same etiology due to their high overlap, but the researchers
concluded that the two disorders require distinct treatment even if they stem from similar
genetic causes.
Diagnosis and Treatment
The diagnosis of DCD must be performed by psychologists. Neurologists and
paediatricians with specialisation in DCD also can assess and diagnose potentially
dyspraxic patients. Often the signs of DCD are noticed in school settings when children
begin formal learning and perform numerous activities which can be demanding on fine
and gross motor skills. Thus, the diagnosis often takes place between six to twelve years of
age. However, in some cases it can be diagnosed earlier (Carslaw, 2011). There is some
debate over the causes of DCD, and the symptoms of the condition are extensive, often
overlapping with many other conditions necessitating an intensive diagnostic process.
Those who have DCD are frequently affected by comorbid disorders such as ADD/ADHD,
dyslexia, anxiety, depression, and more (Colley, 2006). Given that DCD and related
disorders have symptoms across modalities of perception, mood, attention, learning, and
more, it can be incredibly difficult to treat the symptoms at once. Currently, the treatment
for DCD is on a per-symptom basis as there is no cure nor synchronised treatment for all
symptoms of DCD alone.
Symptoms
Overall, those affected by DCD often experience symptoms involving the lack of
coordination in motor functions, resulting in the difficulty or inability to execute smooth
gross and/or fine movements. Though many affected by DCD also experience symptoms
involving perception, memory, and more, the presence of DCD varies greatly across
intelligence levels, signifying that it is unlikely intelligence is significantly different due to
having DCD (Dyspraxia Foundation, 2017). More specifically, studies of IQ levels of
children with DCD concluded that there is some weakness in working memory and
processing speed however, this deficit could be further explained by motor difficulties
(Sumner, Pratt & Hill, 2016). The literature and understanding of the cause of DCD in the
An Investigation of Dyspraxia!
http://st-annes-mcr.org.uk/staar/ - Issue 7
STAAR |50
context of motor functions is not yet extensive enough to properly explain its full range of
effects on other cognitive processes.
Symptoms of DCD are presented in various stages depending on the age of the afflicted
person and can arise in countless variations. Though the condition is not reversible, it is
possible for the symptoms of an individual with DCD to change overtime based upon
environmental factors (Dyspraxia Foundation, 2017).
Most diagnostic criterion sustain several major categories of DCD symptoms, in the UK this
includes primary symptoms such as: gross motor coordination, fine motor coordination,
speech and language, eye movements, perception, learning, thought and memory
(American Psychiatric Association, 2013). Furthermore, secondary symptoms, or those
which may arise as a result of struggling with primary symptoms, include emotional and
behavioural reactions (Colley, 2006).
Symptoms in the realm of gross motor coordination, or large and more holistic
movements could include difficulties with balance, poor posture and fatigue, a lack of
rhythm in activities such as dancing, and an overall clumsy demeanour (Colley, 2006). The
fine motor coordination symptoms, or those involving precise movements, include trouble
with handwriting and typing, difficulty with grooming procedures, and a general lack of
manual dexterity (Dyspraxia Foundation, 2017). Manual dexterity in particular can affect
tasks like cooking, cleaning, and crafting, causing certain academic and professional skills
to be a great challenge for dyspraxics. Speech and language symptoms include difficulty
controlling the volume, tone and pitch of one’s voice, and trouble organising speech in order
and content. Furthermore, those with DCD may have trouble visually tracking or relocating
objects (Colley, 2006). In perceptual symptoms, those with DCD may exhibit oversensitivity
to light, touch, and smells, and might generally lack an awareness of their body in space
such that they could bump into and trip over objects (Dyspraxia Foundation, 2017). Finally,
in the sector of learning, thought, and memory, dyspraxics could be slow to complete tasks,
struggle to maintain concentration, have poor short-term memories, and have trouble
following more than one instruction at a time (Colley, 2006). Some have noted that there are
several positive aspects of DCD in that many affected people learn to develop sophisticated
coping techniques, resulting in creativity and determination in their demeanours (Colley,
2006; Dyspraxia Foundation, 2017).
Presentation of the numerous symptoms of DCD can also vary based on the age of
the sufferer. For example, a toddler with DCD may exhibit signs of the condition by being
late in reaching certain milestones for motor functions such as crawling and walking, they
may have difficulties walking up and down stairs, and might exhibit trouble in sorting
games (Dyspraxia Foundation, 2017). At a young school-age, an affected child may avoid
physical education activities, perform poorly in a classroom but significantly better when
working on an individual basis, and could struggle copying notes from the blackboard
(Dyspraxia Foundation, 2017). Some of these symptoms may shift or manifest uniquely into
adulthood.
These symptoms are merely the beginning of the extensive lists of difficulties
experienced by those with DCD. Often, several symptoms are relatable to those in the
! ! An Investigation of Dyspraxia
http://st-annes-mcr.org.uk/staar/ - Issue 7
STAAR | 51
general population, but this does not necessarily signify an individual is affected by DCD.
In order to be diagnosed with DCD, a high majority of the primary symptoms in the full list
of diagnostic criteria must be exhibited on a frequent basis.
Treatment
Frequently the treatment for DCD involves a multifaceted approach with several
professionals involved in various forms of therapy and training. Additionally, depending
on the age of the affected person, family, teachers, and employers may be involved in the
treatment to assist in creating more accessible environments for work, study, and daily life.
Primarily, a psychologist will work with individuals affected by DCD to further their
understanding of the condition and relieve any emotional troubles which may be related to
coping with DCD. The professionals who are further involved in treatment are dependent
upon the symptoms presented by an affected individual and can include speech therapists,
occupational therapists, behavioural optometrists and physiotherapists in addition to the
psychologists involved in the diagnosis (Colley, 2006).
Conclusion
There is a wide gap in the research on DCD, as the etiology of the condition is still
unknown, and much disparity in nomenclature over the years continues to affect the
accessibility and interest in DCD. The general research interest gathers around buzzword
disorders such as ADHD and dyslexia, while DCD is lacking in research despite its presence
in the same family as these disorders (SpLDs) and equal prevalence rate. This is problematic
because those affected by the condition are treated on a symptom-by-symptom basis and
with a lifelong prognosis, overcoming many symptoms can be costly and a time-burden.
Those with DCD who are fortunate enough to be diagnosed, might find trouble in
sustaining long-term multi-faceted treatment plans and would benefit from a stronger
understanding of their condition by medical professionals.
The vast number of people affected by DCD may face significant trouble in the
workplace, school, and in daily life on an ongoing basis. The emotional toll on dyspraxics
and economic toll in their respective industries could be reversed significantly with a better
understanding of DCD. The understanding of DCD can be increased through raising
awareness among the general public through campaigns and charities. Furthermore, a
stronger inclusion of DCD in the school curriculum for students in studying education,
psychology, and other related courses could be beneficial.
It is important that research delves much deeper into the causes of the condition so
that it can be determined with confidence if it has a biological or environmental root such
that adjustments to the influence can be made by means of prevention and treatment. We
have countless tools to examine these areas in psychology and neuroscience, however
research interest is lacking. Increasing knowledge on DCD among the general population
would support widened interest, as well as the disorder becoming a stronger focus point in
the general psychological education.
An Investigation of Dyspraxia!
http://st-annes-mcr.org.uk/staar/ - Issue 7
STAAR |52
References
American Psychiatric Association (2013) DSM 5: American Psychiatric Association.
Bishop, D. V. M. (2010). Which Neurodevelopmental Disorders Get Researched and Why? PLoS
ONE, 5(11).
Carslaw, H. (2011). Developmental coordination disorder. InnovAiT, 4(2), pp. 87-90.
Caeyenberghs, K, Taymans, T., Wilson, P. H., Hosseini, H., van Waelveide, H., (2016). Neural
signature of developmental coordination disorder in the structural connectome independent of
comorbid autism. Developmental Science, 19(4), pp. 599-612.
Colley, M. (2006). Living with Dyspraxia. London, UK: Jessica Kingsley Publishers. [Biggs, Colley &
Kirby]
Dyspraxia Foundation (2017). Dyspraxia at a glance… What is dyspraxia? Retrieved from:
<http://dyspraxiafoundation.org.uk/about-dyspraxia/dyspraxia-glance/>
Gomez, A., & Sirigu, A. (2015). Developmental coordination disorder: core sensori-motor deficits,
neurobiology and etiology. Neuropsychologia, 79(B), pp.272-287.
Goulardins, J. B., Rigoli, D., Licari, M., Piek, J. P., Hasue, R. H., Oosterlaan, J., Oliveria, J. A., (2015),
Attention deficit hyperactivity disorder and developmental coordination disorder: Two separate
disorders or do they share a common etiology. Behavioural Brain Research, 292, pp.484-492.
HDCD (2017). For Highland’s Children integrated children’s services guidance for children with
special needs: Volume 1 Developmental Co-ordination Disorder.
Holden, S. E., et al. (2013). The prevalence and incidence, resource use and financial costs of treating
people with attention deficit/hyperactivity disorder (ADHD) in the United Kingdom (1998 to
2010). Child and Adolescent Psychiatry and Mental Health, 7(34).
Malpas, M. (2012). Adults and Dyslexia 40 years on… Retrieved from:
<http://www.bdadyslexia.org.uk/common/ckeditor/filemanager/userfiles/About_Us/Adult
s-and-Dyslexia-report-2012.pdf> [British Dyslexia Association]
Visser, J. (2003). Developmental coordination disorder: a review of research on subtypes and
comorbidities. Human Movement Science, 22, pp.479-493.
Wilson, B. N., Neil, K., Kamps, P. H., et al. (2012). Awareness and knowledge of developmental co-
ordination disorder among physicians, teachers and parents. Child Care Health Development, 39(2)
pp.296300
... Non esiste una cura per la disprassia, ma può essere trattata e gestita con una combinazione di terapie regolari e intensive, tra le quali la fisioterapia, la logopedia, la psicoterapia ecc. (Meachon, 2017). ...
... Mentre il DCD è spesso considerato un termine generico per descrivere le difficoltà di coordinazione motoria, la disprassia può comprendere difficoltà anche nel pianificare, organizzare ed eseguire i movimenti nel giusto ordine. La disprassia può influenzare anche il linguaggio e la sua articolazione, la percezione e il pensiero(Meachon, 2017; ...
Thesis
Il presente lavoro offre una trattazione del concetto di neurodiversità articolata nei seguenti punti: • origine del termine. Partendo dal saggio Don’t mourn for us di J. Sinclair, viene presentato un exursus storico sulla nascita del termine attraverso l’analisi dei contributi di importanti promotori del movimento della neurodiversità (i.e. J. Singer, H. Blume, T. Armstrong e S. Baron-Cohen); • superare il modello medico della disabilità e le ideologie dell’ableismo. Dalla visione negativa della disabilità sostenuta dal modello medico hanno avuto origine le ideologie dell’ableismo, un insieme di pratiche e di atteggiamenti che hanno finito col svalutare e limitare il potenziale delle persone con disabilità, assegnando loro un valore marginale nella società. Per superare questa visione, la neurodiversità, rifacendosi al modello sociale, invita ad abbandonare i pregiudizi legati alla disabilità per scoprire e valorizzare i punti di forza delle persone neurodiverse; • le neurominoranze della neurodiversità. Considerare la diversità neurologica una “differenza normale” nel continuum dello spettro umano consente di affermare che tutti (neuritipici e neurodivergenti) possono essere definiti neurodiversi. In questo contesto, è però possibile distinguere neurotipi dominanti e neurotipi minoritari (o neurominoranze); • neurodiversità, un umbrella term. Nato nell’ambito del movimento per i diritti delle persone autistiche, il termine neurodiversità racchiude oggi diverse condizioni neurologiche (i.e. ASD, ADHD, disprassia, iperlessia ecc.); • punti di forza e di debolezza della neurodiversità. Il concetto di neurodiversità focalizza l’attenzione sulle modalità di operare tipiche della condizione di diversità neurologica, atipiche ma funzionali, sottolineandone i punti di forza e non solo di debolezza. Ad esempio, le persone con ADHD mostrano spiccati livelli di creatività e innovazione, mentre quelle con ASD sfoderano una particolare creatività e performance strabilianti nell’utilizzo delle tecnologie informatiche; • il vantaggio competitivo della neurodiversità. Adottando appositi accomodamenti e valorizzando i punti di forza legati alle diverse condizioni neurologiche, le neurominoranze possono rappresentare un vantaggio competitivo a livello aziendale. Non a caso alcuni colossi hi-tech hanno creato specifici programmi di neuroinclusione per favorire l’espressione del potenziale delle neurominoranze; • l’inclusione scolastica degli alunni neurodiversi. La scuola può giocare un ruolo chiave nella promozione della neurodiversità. È necessario, però, andare oltre l’attuale approccio ai bisogni educativi speciali, progettato principalmente per diagnosticare la disabilità e individuare le modalità più opportune per rimediare ai deficit degli studenti. Occorre, al contrario, focalizzarsi sulle abilità degli studenti e sulla valorizzazione dei loro punti di forza, creando ambienti di apprendimento attraverso l’UDL, le tecnologie assistive ecc..
... If we consider the importance that this clinical condition has in developmental terms because of its impact on the construction of higher cognitive functions from the first years of life [21], it is clear that dyspraxia must be diagnosed as quickly as possible [22]. For this reason, it is of great interest to develop a technologically assisted diagnostic system [23] which, through the use of technological tools and computational systems, is able to recognize children potentially at risk of developing the disorder in question [24]. ...
Chapter
The authors in this chapter intend to give an experimental clinical model for the study of the embodied cognition using dyspraxia. Starting from illustrating the essential aspects of the Embodied Cognition Theory, they highlight the overcoming of the classic cognitive division between mind and body, underlining how these two entities are intertwined in unexpected ways. Then, through the clinical description of dyspraxia, understood as an inability to carry out a pragmatically oriented action, the authors propose an understanding of this disorder according to the Embodied Mind theory. They affirm that dyspraxia consists of a pathogenic process in which that phase of movement in which the mind identifies itself is altered, thus dyspraxic disorder presupposes an alteration of unconscious processes. Therefore, dyspraxia is an alteration of the intentional movement and of the aimed action, it excludes the problem of the automatic response and since the conscious intention of the dyspraxic subject is safeguarded, it is very interesting to analyse in which movement phase programming this alteration occurs. To better explore this matter, the authors proposed a Laboratory Virtual Instrumentation Engineering Workbench based vast research program on the emergence of the mind from the body using dyspraxia as an experimental model.
Article
Full-text available
This report highlights three important issues in the control of CRE. First, although CRE are commonly sent to CDC as part of surveillance programs or for reference testing, isolates that are resistant to all antimicrobials are very uncommon. Among >250 CRE isolate reports collected as part of the Emerging Infections Program, approximately 80% remained susceptible to at least one aminoglycoside and nearly 90% were susceptible to tigecycline (2). Second, to slow the spread of bacteria with resistance mechanisms of greatest concern (e.g., gene encoding NDM or mcr-1) or with pan-resistance to all drug classes, CDC recommends that when these bacteria are identified, facilities ensure that appropriate infection control contact precautions are instituted to prevent transmission and that health care contacts are evaluated for evidence of transmission (3). Third, the patient in this report had inpatient health care exposure in India before receiving care in the United States. Health care facilities should obtain a history of health care exposures outside their region upon admission and consider screening for CRE when patients report recent exposure outside the United States or in regions of the United States known to have a higher incidence of CRE (1).
Book
This book brings together the work of leading experts in argumentation in science education. It presents research combining theoretical and empirical perspectives relevant for secondary science classrooms. Since the 1990s, argumentation studies have increased at a rapid pace, from stray papers to a wealth of research exploring ever more sophisticated issues. This volume constitutes a unique collection and covers fundamental issues in argumentation such as cognitive, methodological and epistemological aspects; classroom-based research in teaching and learning of argumentation in science classrooms; and argumentation in context such as in socio-scientific and moral contexts. The book’s underlying premise is that argumentation is a significant aspect of scientific inquiry and plays an important role in teaching and learning of science. Argumentation also contributes to the agenda of informed citizenship where students are encouraged and supported in evidence-based reasoning in their everyday lives. "Arumentation appeared as a major theme in science education research during the mid-1990s. Since that time, researchers working on themes such as the nature of science in science education, science education for citizenship, and language in the science classroom have all addressed argumentation in their work. This book brings together key lines of work and key scholars, presenting a state-of-the-art review of argumentation in science education." Professor John Leach The University of Leeds, UK
Article
Antibiotic resistance is a natural feature of diverse microbial ecosystems. Although recent studies of the antibiotic resistome have highlighted barriers to the horizontal transfer of antibiotic resistance genes between habitats, the rapid global spread of genes that confer resistance to carbapenem, colistin and quinolone antibiotics illustrates the dire clinical and societal consequences of such events. Over time, the study of antibiotic resistance has grown from focusing on single pathogenic organisms in axenic culture to studying antibiotic resistance in pathogenic, commensal and environmental bacteria at the level of microbial communities. As the study of antibiotic resistance advances, it is important to incorporate this comprehensive approach to better inform global antibiotic resistance surveillance and antibiotic development. It is increasingly becoming apparent that although not all resistance genes are likely to geographically and phylogenetically disseminate, the threat presented by those that are is serious and warrants an interdisciplinary research focus. In this Review, we highlight seminal work in the resistome field, discuss recent advances in the studies of resistomes, and propose a resistome paradigm that can pave the way for the improved proactive identification and mitigation of emerging antibiotic resistance threats.