Dyspraxia – Is it hiding in plain sight in early years?

Dyspraxia is a condition whose symptoms can be challenging to spot. However, early years settings have an important role to play, as Sal McKeown explains…

Dyspraxia has fallen off the radar in early years. My book How to Help Your Dyslexic and Dyspraxic Child was published in 2012. Dyspraxia was a common condition then. Nurseries were alert to children who were not making expected progress with sitting, walking and coordination.

Now people rarely mention it. In fact, I contacted over 20 nurseries to see if they had recent experience of a child with dyspraxia. Not one of them did.

Yet we know that children are arriving in Reception without many of the important physical skills that are part of being “school ready”.

It doesn’t help that we also call dyspraxia DCD (developmental coordination disorder), and this can confuse many people.

DCD is a medical term for the condition. Dyspraxia is what we see: “an observable difficulty in motor performance: both motor coordination and planning how to do that task”.

The NHS website points out that “Dyspraxia can be used to describe movement difficulties that happen later in life because of damage to the brain, such as from a stroke or head injury.”

Comments on forums show that parents often spot the signs before practitioners.

“He drops things, crashes into people and objects, stands on things. He lurches when he walks or runs.”

“My child can’t ride a tricycle and is not interested in trying to work it out.”

“I’ve really noticed the difference with his little sister, who is already confidently climbing the stairs.”

Why don’t we assess for dyspraxia earlier?

Occupational therapist Beth Smithson, who currently works for Sensory Integration Education, reflects on how referral patterns have shifted over the past two decades.

20 years ago, physical disabilities were a major cause of referral. Many presented with signs of cerebral palsy or developmental coordination disorder. People rarely mentioned autism.

Today, we often identify children with DCD later. Beth suggests this may be influenced by how different needs present in the classroom.

“Children with DCD are not going to disrupt a session. They might sit quietly in the background, overwhelmed and unable to engage with an activity. Their needs can be easily missed, not because they are less important, but because they’re less visible.”

Estimates vary, but autism is diagnosed in around 1% of the population. Dyspraxia affects up to 6%, with up to 2% severely affected.

Males are four times more likely to be dyspraxic than females. Research has shown it runs in families and frequently coexists with dyslexia.

While we rarely diagnose dyspraxia and DCD until a child is six, this is not the case in other countries. Research in Portugal, published in 2022, followed six children (five boys, one girl).

Signs of dyspraxia were identified at three or four years old. Early signs included a delay in developing a pincer grip. Five of the six went on to be diagnosed with ADHD, and five of the children experienced difficulties in school.

Diagnostic difficulties

DCD may present early. If a child cannot control their head by six months, there may well be a delay in all the motor skills: rolling, crawling, sitting and standing.

But it is not clear-cut, as Beth explains: “The problem is, do they lack something in their sensory motor system or is it the lack of opportunity and the lack of engagement? Are parents doing too much for the child, feeding, fetching?”

This is one reason why it normally takes at least a whole year of formal education before parents get a diagnosis.

The typical signs of DCD may not be obvious in early years. A child with dyspraxia can hit some of the early years milestones because they can learn repetitive motor tasks, such as kicking or catching a ball, running or going to the toilet.

However, they struggle to learn new patterns of motor skills, such as using cutlery, scissors or a paintbrush.

Environmental explanations

There may be other explanations for dyspraxia, such as environmental factors. Fuzz Dix is a Kids Matter Facilitator at St Luke’s in Tower Hamlets, where 57% of children are living in households in poverty.

She said: “It’s not uncommon to have maybe seven or nine people living in a one- or two-bedroom flat in our community. And so home is not a place where play can happen easily.”

Those with more space may not be able to heat more than one room, so children are not exploring the whole home.

Now more families need both parents to work and an increasing number work unsocial hours. Play is not a priority and activities such as ball pits, dancing, or music sessions are a luxury for some families.

Covid and its aftermath have affected development. During lockdown periods, children were indoors with little access to outside play for months and became more sedentary.

Paediatricians now see children whose nervous systems and motor skills are less developed than in previous years. Screen time has impacted them too.

Whereas parents would often give a toy to a baby in a pushchair so they had something to play with, these days they are as likely to put a phone in their hands.

This is affecting children’s motor skills, as well as their attention and concentration. Beth warns: “When you’ve got a three- or four-year-old with signs of what may be autism or ADHD, motor skills are not the parents’ priority. But we need to be aware of the connection. If we work on their motor skills, their regulation may get better and their behaviour might improve.”

Beth’s final advice is this: “I want early years staff to look at barriers to children’s participation and learning engagement through a motor lens. If a child keeps refusing to come and play in the home corner, let’s check that they have the motor skills to engage.

“Our motor skills are the way that we interact with the world around us. They are the basis for curiosity and our desire to learn.”

5 ways to respond to signs of DCD

1 If you spot an issue with motor skills, always mention it to parents. It is unprofessional not to share concerns with them, but always stress that the child may grow out of this phase.

2 Tactile toys and materials can stimulate sensors in the muscles and joints. Get out the putty, sand and playdough and encourage pulling, pushing, pinching, squishing, squeezing and kneading.

3 Make motor tasks achievable. Sit or stand next to the child, not in front of them, so they can copy your actions. Show and explain to them what you are doing so they can plan the task and rehearse the sequence in their head.

4 Scaffold physical tasks. Velcro gives the child a taste of independence, but then move on, step by step, to buttons and zips.

5 “Enjoyable movement” is key. Talk to families about what they could do together. Picnics, treasure hunts and dancing in the kitchen may be more appealing than climbing and swimming.

Sal McKeown is a freelance editor and journalist. Find out more at movementmattersuk.org. Manchester Metropolitan University has been researching dyspraxia. Access videos for teaching skills to older children and adults at watchmedoit.mmu.ac.uk