If your child seems to trip over his own two feet — and injures himself a lot — he may have dyspraxia, as well as ADHD. Here’s what you should know.
BY CARA KOSCINSKI, MOT, OTR/L
Do you wonder why your child is not good at skipping, riding a bicycle, or catching a ball? You’re not alone. Parents often tell me, “My child gets injured every day. He seems to trip over his own two feet.” As a pediatric occupational therapist (OT) and a parent of two children with dyspraxia and ADHD, I understand parents’ frustration when children are clumsy or physically awkward at school and at home. Parents ask, “Where do we begin? Is it ADHD or something else?” Let’s start with what we know. ADHD overlaps with other conditions such as sensory processing disorder, anxiety/depression, and executive function disorder. These are called comorbid conditions, since they “come along with” ADHD. Dyspraxia does as well. Dyspraxia, known as a Developmental Coordination Disorder (DCD), is a motor disorder that affects fine and/or gross motor skills in children. Climbing on playground equipment and getting in and out of a car seat use gross motor skills. Children with dyspraxia appear awkward when moving their whole body, or use too much or too little force. Imagine not knowing how to adjust the pressure on a pencil or crayon in order to make a mark on your paper — or not being able to adjust movements of your arms to pour milk into a glass without spilling it. Some children have poor motor planning, sequencing, and perceptual skills. In order to complete a task, a child needs to know the necessary movements and adapt them to different situations. Copying a dance or a yoga routine, putting on a jacket, and knowing the order of steps needed to prepare a meal are critical skills. When a child has dyspraxia, he can’t imitate others, often mixes up the steps in a sequence, and can’t come up with new ideas during play. Up to 50 percent of children with DCD, which is more common in boys than girls, meet the diagnostic criteria for ADHD. Coordination difficulties affect all aspects of daily life. Brushing teeth, getting dressed, and doing laundry are examples. Although we are learning more about dyspraxia, it is often misunderstood or diagnosed improperly. Frustration comes when we do not know how to help our children. Well-intentioned professionals say, “Oh, he’s just a boy” or “She will come around eventually.” Parents know their children best, and knowledge is power. Dyspraxia greatly affects a child’s self-confidence and achievement, even in those who have an average or above-average IQ. We also know that many symptoms of ADHD cause frustration in daily living. How do you know if your child diagnosed with ADHD also has dyspraxia? [Self-Test: Could It Be Nonverbal Learning Disorder?] Teasing Out Dyspraxia Occupational therapists are trained to look for discrepancies in functional areas. When a child grows upset doing a task, or refuses to do it altogether, OTs look at the skills needed to do the task and try to determine patterns. All children want to succeed, and parents and teachers can play detective to intuit what our children experience. Make a list of things that are frustrating to your child. Ask his teacher to look for school tasks that cause stress or irritability. Teacher observations assist caregivers and therapists in determining how to help. Parents should look for the following signs of dyspraxia: Bumping into objects, tripping over nothing, seeming clumsy Knocking things over frequently Trouble navigating uneven surfaces and/or stairs Difficulty learning to ride a bicycle Trouble with fine motor skills — when handwriting, using scissors and eating utensils, such as a fork, spoon, or knife, tying shoes, buttoning clothes Becoming tired quickly Having poor posture or slumping over the desk while writing Many children with dyspraxia trade speed for accuracy, and as a result, work at a slower pace than their peers. Teachers may report that the student knows the information, but cannot complete the work in the allotted time. [Heads Up, Teachers: Red Flags for Learning or Developmental Disorders] There are some non-motor components of dyspraxia, too. Remember that these symptoms may mimic ADHD. Look for: difficulty with organization trouble remembering rules and instructions being “literal” and having difficulty with idioms, metaphors, and sarcasm problems with memory restricted play problems with perception and processing information OT to the Rescue Occupational therapists look for the exact point at which the child has the most difficulty. This is called “activity analysis.” We know how to make a task easier for a child to build confidence and sharpen the motor (movement) patterns on which more complicated skills are built. When our brains learn to perform a skill, we build new neural pathways. Repeated practice and successes reinforce each other, and children’s brains actually change. You can help a child who has been diagnosed with dyspraxia by trying the following: 1. Break complicated tasks into smaller steps. Master one before moving on to the next one. When teaching shoe tying, make sure your child can independently complete the first step of making the knot. 2. Use pictures or video modeling to illustrate the sequence of steps in doing a difficult task. 3. Use multi-sensory teaching. Add songs, movements, scents, and textures to learning a new task. Use a song or rhyme when learning to tie shoes. When learning how to form letters, trace a letter onto sandpaper, paint it, or form it with scented dough. 4. Create an obstacle course in or outside your home. Have your child try to complete the course without shoes to stimulate sensory receptors in the feet. Add beanbags, soft mats, swings, and cut pool noodles in half to make balance beams. Purchase a scooter board. The obstacle course builds motor skills in a fun way. Let your child plan the course and give her different commands, such as, “Now crawl like a puppy.” Imitating animals is fun and builds creativity and muscle strength. 5. Allow children to use pencil grips, scissors with self-opening handles, and other therapeutic tools that hone fine motor skills. Begin with verbal and physical cues, then ask your child to name the next step. 6. Look into Cognitive Orientation to daily Occupational Performance (CO-OP), an active treatment approach that uses mutual goal-setting, analysis of a child’s performance, and high-level cognitive (thinking) strategies to improve motor-based skills. Having both dyspraxia and ADHD is frustrating to anyone. If our body does not move the way we want it to, behavioral problems may occur. Keep a close eye on a child’s mood to detect signs of depression and anxiety. If you think your child has dyspraxia, contact a pediatrician, psychiatrist, or educational psychologist. While occupational therapists are among the team of professionals who assist in the evaluation and treatment of dyspraxia, OTs cannot make a diagnosis alone.