Dyspraxia: Definition and Diagnosis
Dyspraxia, also known as Developmental Coordination Disorder (DCD), is a neurodevelopmental condition characterized by impaired ability to plan, organize, and execute coordinated movements in the absence of intellectual disability or known neurological disease. 1, 2
What is Dyspraxia?
Dyspraxia represents a specific motor planning and sequencing disorder that affects approximately 5% of children. 3 The condition manifests as:
- Inability to plan, organize, and execute skilled movements despite adequate strength, sensation, and comprehension 2, 4
- Motor coordination skills significantly below the expected level for age, as measured by validated standardized scales 3
- Functional impairment in activities of daily living, leisure activities, and academic achievement 3
The terminology has evolved from "clumsy child syndrome" through "dyspraxia" to the current preferred term "Developmental Coordination Disorder (DCD)." 1 However, it's critical to understand that dyspraxia specifically refers to problems with motor sequencing and selection, which represents a subset of coordination difficulties—not all children with coordination problems have true dyspraxia. 5
Diagnostic Criteria
The diagnosis requires three essential components to be present simultaneously: 3
Motor coordination deficits documented by standardized testing - Performance must be significantly below age-expected norms on validated motor skills scales 3
Functional impact on daily life - The motor difficulties must interfere with activities of daily living, school performance, or leisure activities 3
Exclusion of other causes - The deficits cannot be secondary to intellectual disability, visual impairment, or identifiable neurological conditions affecting movement 2, 3
Diagnostic Process
The diagnostic evaluation must involve both a physician trained in neurodevelopmental disorders and an occupational therapist. 3 The assessment includes:
Clinical History
- Detailed questioning of family and child regarding motor milestone achievement, current functional limitations in self-care, school tasks, and play activities 3
- Assessment for co-morbid conditions including learning disabilities, attention deficits, and language disorders, which commonly co-occur 5
Clinical Examination
- Observation of skilled gesture performance to identify impaired execution of purposeful movements 4
- Evaluation of motor planning and sequencing abilities rather than just general clumsiness 5, 4
- Assessment of writing skills and fine motor coordination 3
Standardized Testing
- Administration of validated, age-normed motor skills scales by trained professionals (typically occupational therapists) 3
- Documentation that performance falls significantly below age expectations on these standardized measures 3
Critical Diagnostic Pitfalls
Do not confuse dyspraxia with other movement disorders: 1, 4
- Dyskinesia involves involuntary, abnormal movements (chorea, dystonia, ballism) and is fundamentally different from dyspraxia's motor planning deficits 6
- Dysmetria represents cerebellar dysfunction with impaired distance measurement in movements, not motor planning problems 7
- General clumsiness or coordination difficulties without specific motor planning/sequencing deficits should not be labeled as dyspraxia 5, 4
Timing and Prognosis
Early identification is essential because while some children develop compensatory strategies, the majority retain motor difficulties into adulthood. 2 Children with significant functional impairment should be assessed as early as possible, as failure to address motor and commonly associated features may have major consequences in adult life. 2
The condition can be congenital or acquired at any age, though developmental dyspraxia by definition begins in childhood. 2