Dyspraxia in Adulthood

Developmental dyspraxia is an impairment or immaturity of the organisation of movement. It is associated with problems of perception, language and thought. The term dyspraxia comes from the word praxis, which means 'doing, acting'. It includes what to do and how to do it.

Other names include Developmental Co-ordination Disorder (DCD), Perceptuo-Motor Dysfunction, and Motor Learning Difficulties. It used to be known as Minimal Brain Damage and Clumsy Child Syndrome.

The condition is thought to affect up to eight percept of the population in varying degrees. Dyspraxia sometimes runs in families. There may be an overlap with ADHD (Attention Deficit Hyperactivity Disorder), Dyslexia and Asperger's Syndrome.

People with impaired co-ordination and/or perception often find routine tasks such as driving, household chores, cooking and grooming difficult. They usually have a combination of the problems described below.

Gross motor co-ordination skills i.e. large movements:

• Poor balance - difficulty riding a bicycle and going up and down hill.
• Poor posture and fatigue - difficulty standing for a long time as a result of weak muscle tone; floppy, unstable round the joints (some people with dyspraxia may have flat feet).
• Poor integration of the two sides of the body - leading to difficulty with some sports involving jumping and cycling.
• Poor hand-eye co-ordination causing difficulty with team sports especially where catching a ball and batting are involved; difficulties with driving a car.
• Lack of rhythm shown when doing activities such as dancing and aerobics.
• Clumsy gait and movement, difficulty changing direction, stopping and starting.
• Exaggerated 'accessory movements' such as flapping arms when running.
• Tendency to fall, trip, bump into things and people.
• Probably late reaching the milestones in childhood i.e. sitting, crawling (often absence of crawling) and walking.

Fine motor co-ordination skills i.e. small movements:

• Lack of manual dexterity, poor at two handed tasks - causing problems with using cutlery, domestic chores such as cleaning, cooking, ironing, playing musical instruments and craft work.
• Poor manipulative skills causing difficulty with typing, handwriting and drawing.
• People with dyspraxia may have a poor pen grip, press too hard when writing and have difficulty when writing along a line.
• Inadequate grasp - causing difficulty using tools and domestic implements, as well as difficulties with locks and keys.
• Difficulty with dressing and grooming such as putting on make up, shaving, doing hair, fastening clothes and tying shoelaces.
• Poorly established hand dominance - may use either hand for different tasks at different times.

Speech and language:

• They may talk continuously and repeat themselves. Some people with dyspraxia have difficulty with organising the content and sequence of their language.
• They may be late learning to talk and have unclear speech.
• Uncontrolled pitch, volume and rate. Some people may be unable to pronounce some words.

• Tracking - difficulty in following a moving object smoothly with eyes without excessive head movement. Tendency to lose the place while reading.
• Poor relocating - cannot look quickly and effectively from one object to another (for example, looking from a TV to a magazine).

Perception i.e. interpretation of the different senses:

• Poor visual perception. Over-sensitivity to light.
• Difficulty distinguishing sounds/screening them from background noise. Tendency to be over-sensitive to noise.
• Over sensitive or under sensitive to touch; this can result in the dislike of being touched and/or an aversion to over-loose or tight clothing.
• Over or under sensitive to smell and taste, temperature and pain.
• Lack of awareness of body position in space and spatial relationships that can result in bumping into and tripping over things and people as well as dropping and spilling things.
• Little sense of time, speed, distance or weight - leading to difficulties driving, cooking etc.
• Inadequate sense of direction; difficulty discriminating right from left leading to poor map reading.

Learning, thought and memory:

• Difficulty planning and organising thought.
• Poor memory - especially short-term memory; may forget and lose things.
• Unfocused and erratic; can be messy and cluttered.
• Poor sequencing causing problems with maths, spelling and essay writing.
• Accuracy problems - causing difficulty with copying sounds, writing, movements and proof-reading.
• Difficulty following instructions, especially more than one at a time.
• Difficulty with concentration - may be easily distracted.
• May do only one thing at a time properly, though may try to do many things at once.
• Slow to finish a task - may daydream and wander about aimlessly

Emotion and behaviour:

• Difficulty listening to people especially in large groups - can be tactless, interrupt frequently. Problems with team work.
• Difficulty picking up non-verbal signals or judging tone or pitch of voice in themselves and or others. Tendency to take things literally. May listen but not understand.
• Slow to adapt to new or unpredictable situations, sometimes avoiding them altogether.
• Impulsive - tendency to be easily frustrated, wanting immediate gratification.
• Tendency to be erratic - have good and bad days.
• Tendency to opt out of things that are too difficult.
• As a result, they tend to get stressed, depressed and anxious easily and may have difficulty sleeping. They are prone to low self-esteem, emotional outbursts, phobias, fears, obsessions, compulsions and addictive behaviour.

Many of these characteristics are not unique to people with dyspraxia and not even the most severe case will have all the above characteristics. But adults with dyspraxia will tend to have more than their fair share of co-ordination and perceptual difficulties.

Assessment and diagnosis

The above list is not intended to replace diagnosis by a doctor. If you suspect you have dyspraxia you should consult your GP, in the first instance, with a view to being referred to an educational or clinical psychologist, occupational therapist, speech therapist or counsellor. Write your symptoms down, take a friend or relation to support you and be persistent. You can refer yourself to a private therapist or doctor.

Treatment

There is no cure for dyspraxia but there are many strategies that can help. Occupational therapists will look at fine motor and perceptual skills, together with activities of daily living such as household tasks and organisational skills, and help develop strategies to improve these. They can suggest suitable equipment to help with these tasks. Speech therapists can help with speech or language problems and also sometimes with communication and social skills. Counselling can help to overcome some of the problems. Drugs such as anti-depressants can be of use where depression and anxiety are a big problem.

Remember:

• A diagnosis can help you come to terms with your problems, put things into perspective and improve you self-esteem.
• Think positively and keep your sense of humour.
• Many people with dyspraxia are very creative, determined, persistent and intelligent.
• Try assertiveness and self-development classes or join a self-help or support group.
• Break down large tasks into smaller components to make them more manageable.
• Try to carry out some kind of relaxation exercise every day such as yoga or the Alexander Technique.
• Try going to the fitness gym to improve your muscle strength and co-ordination.
• Do any sport/activity that might improve your co-ordination and manual dexterity such as computer games, bowling, swimming, rock climbing, walking and aqua aerobics. Find something that you really enjoy doing.
• Use diaries, calendars, post it notes to plan your day/week/month. Prioritise things you have to do first. Finish one task before you start another. Mind maps and flow charts can also be of use.
• Use any implement in the home to help you carry out your daily tasks such as electric toothbrushes, electric shavers, kettle-tippers, special tin openers and potato peelers, word processors with spell checks and lap-top computers.
• If you are leaning a new sequence of actions, see that you get clear, precise instructions. Use a video if this helps.

Useful numbers and addresses:

• Citizens Advice Bureau - See telephone directory for your local office. Provides an advocacy service for the disabled and disadvantaged or can put you in touch with your local agency. Your local library can also help.

• Benefit Enquiry Line (Freephone: 0800 88 2200)
  For further information about benefits, and in particular, Incapacity Benefit and Disability Living Allowance which those with moderate or severe dyspraxia may be entitled to.

• Disability Services Team
  (Formerly PACT - Placement Assessment and Counselling Team) For further details ask at your local Job Centre. They will investigate and note any problems you might have in seeking work or are having in work.

• SKILL (National Bureau for Students with Disabilities) (Freephone: 0800 3285050)
  3rd Floor, Chapter House, 18-20 Crucifix Lane, London SE1 3JW Advice on all aspects of post-16 education, training and employment for students with disabilities.

• Disability Living Foundation (Helpline: 0870 6039177)
  For advice and information for equipment to help you in your everyday life from jar and tin openers to electric toothbrushes. There are branches all over the country.

• Dyscovery Centre (Tel: 02920 628333)
  4a Church Road, Whitchurch, Cardiff CF14 2DZ
  www.dyscovery.co.uk
  A centre which specialises in dyspraxia (DCD) and assesses and treats adults.

• RADAR (Tel: 0207 250 3222)
  250 City Road, London EC1V 8AF They publish information on education and employment for disabled people.

• The Disability Law Service (Tel: 0207 791 3131)
  39-45 Cavell Street, London E1 2BP Advices on education, benefits, employment and community care.

• Other organisations include Mind and Mencap, which help people with mental and learning problems. See your local directory for their phone number.

For further information please read:

• Living with Dyspraxia - A guide for adults and professionals. Published by the Adult Support Group, 2000
• Developmental Dyspraxia. Identification & Intervention A Manual for Parents & professionals Madeleine Portwood 2nd edition. Published by David Fulton, 1999
• Perceptuo-Motor Difficulties. Theory & Strategies to help children, adolescents and adults. Dorothy Penso. Published by Chapman and Hall, 1993
• The Hidden Handicap. Dr Amanda Kirby. Published by Sovereign Press, October 1999