Developmental coordination disorder
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|Developmental coordination disorder|
|Classification and external resources|
Developmental coordination disorder (DCD) also known as developmental dyspraxia is a chronic neurological disorder beginning in childhood that can affect planning of movements and co-ordination as a result of brain messages not being accurately transmitted to the body. Developmental coordination disorder is diagnosed in the absence of other neurological impairments like cerebral palsy, muscular dystrophy, multiple sclerosis or Parkinson's disease.
- 1 Classification
- 2 Signs and symptoms
- 3 Associated disorders
- 4 Diagnosis
- 5 Epidemiology
- 6 History
- 7 Notable cases
- 8 See also
- 9 References
- 10 Further reading
- 11 External links
Developmental coordination disorder is classified (by doctors) in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a motor disorder, in the category of neurodevelopmental disorders.
Signs and symptoms
Various areas of development can be affected by developmental coordination disorder and these will persist into adulthood, as DCD has no cure. Often various coping strategies are developed, and these can be enhanced through occupational therapy, psychomotor therapy, physiotherapy, speech therapy, or psychological training.
In addition to the physical impairments, developmental coordination disorder is associated with problems with memory, especially working memory. This typically results in difficulty remembering instructions, difficulty organizing one's time and remembering deadlines, increased propensity to lose things or problems carrying out tasks which require remembering several steps in sequence (such as cooking). Whilst most of the general population experience these problems to some extent, they have a much more significant impact on the lives of dyspraxic people. However, many dyspraxics have excellent long-term memories, despite poor short-term memory. Many dyspraxics benefit from working in a structured environment, as repeating the same routine minimises difficulty with time-management and allows them to commit procedures to long-term memory.
People with developmental coordination disorder sometimes have difficulty moderating the amount of sensory information that their body is constantly sending them, so as a result dyspraxics are prone to sensory overload and panic attacks.
Many dyspraxics struggle to distinguish left from right, even as adults, and have extremely poor sense of direction generally.
Moderate to extreme difficulty doing physical tasks is experienced by some dyspraxics, and fatigue is common because so much extra energy is expended while trying to execute physical movements correctly. Some (but not all) dyspraxics suffer from hypotonia, low muscle tone, which like DCD can detrimentally affect balance.
Gross motor control
Whole body movement, motor coordination, and body image issues mean that major developmental targets including walking, running, climbing and jumping can be affected. The difficulties vary from person to person and can include the following:
- Poor timing
- Poor balance (sometimes even falling over in mid-step). Tripping over one's own feet is also common.
- Difficulty combining movements into a controlled sequence.
- Difficulty remembering the next movement in a sequence.
- Problems with spatial awareness, or proprioception.
- Some people with developmental coordination disorder have trouble picking up and holding onto simple objects such as pencils, owing to poor muscle tone and/or proprioception.
- This disorder can cause an individual to be clumsy to the point of knocking things over and bumping into people accidentally.
- Some people with developmental coordination disorder have difficulty in determining left from right.
- Cross-laterality, ambidexterity, and a shift in the preferred hand are also common in people with developmental coordination disorder.
- Problems with chewing foods.
Fine motor control
Fine-motor problems can cause difficulty with a wide variety of other tasks such as using a knife and fork, fastening buttons and shoelaces, cooking, brushing one's teeth, styling one's hair, shaving, applying cosmetics, opening jars and packets, locking and unlocking doors, and doing housework.
Difficulties with fine motor co-ordination lead to problems with handwriting, which may be due to either ideational or ideo-motor difficulties. Problems associated with this area may include:
- Learning basic movement patterns.
- Developing a desired writing speed.
- Establishing the correct pencil grip
- The acquisition of graphemes – e.g. the letters of the Latin alphabet, as well as numbers.
Developmental verbal dyspraxia
Developmental verbal dyspraxia (DVD) is a type of ideational dyspraxia, causing speech and language impairments. This is the favoured term in the UK; however, it is also sometimes referred to as articulatory dyspraxia, and in the United States the usual term is childhood apraxia of speech (CAS).
Key problems include:
- Difficulties controlling the speech organs.
- Difficulties making speech sounds
- Difficulty sequencing sounds
- Within a word
- Forming words into sentences
- Difficulty controlling breathing, suppressing salivation and phonation when talking or singing with lyrics.
- Slow language development
People who have developmental coordination disorder may also have one or more of these co-morbid problems:
- Attention deficit hyperactivity disorder (ADHD) (inattention, hyperactivity, impulsive behaviour).
- Autism spectrum disorder
- Dyscalculia (difficulty with mathematics),
- Dysgraphia (an inability to write neatly and/or draw),
- Dyslexia (difficulty with reading and spelling),:28
- Hypotonia (low muscle tone)
- Sensory processing disorder
- Specific language impairment (SLI)
- Visual perception deficits
However, they are unlikely to have problems in all of these areas. The pattern of difficulty varies widely from person to person, and it is important to understand that an area of major weakness for one dyspraxic can be an area of strength or gift for another. For example, while some dyspraxics have difficulty with reading and spelling due to an overlap with dyslexia, or numeracy due to an overlap with dyscalculia, others may have brilliant reading and spelling or mathematical abilities. Some estimates show that up to 50% of dyspraxics have ADHD.
Sensory processing disorder
Sensory Processing Disorder (SPD) concerns having abnormal oversensitivity or undersensitivity to physical stimuli, such as touch, light, sound, and smell. This may manifest itself as an inability to tolerate certain textures such as sandpaper or certain fabrics and including[clarification needed] oral toleration of excessively textured food (commonly known as picky eating), or even being touched by another individual (in the case of touch oversensitivity) or may require the consistent use of sunglasses outdoors since sunlight may be intense enough to cause discomfort to a dyspraxic (in the case of light oversensitivity). An aversion to loud music and naturally loud environments (such as clubs and bars) is typical behavior of a dyspraxic individual who suffers from auditory oversensitivity, while only being comfortable in unusually warm or cold environments is typical of a dyspraxic with temperature oversensitivity. Undersensitivity to stimuli may also cause problems. Dyspraxics who are undersensitive to pain may injure themselves without realising. Some dyspraxics may be oversensitive to some stimuli and undersensitive to others.
Specific language impairment
Specific Language Impairment (SLI), research has found that students with developmental coordination disorder and normal language skills still experience learning difficulties despite relative strengths in language. This means that for students with developmental coordination disorder their working memory abilities determine their learning difficulties. Any strength in language that they have is not able to sufficiently support their learning.
Students with developmental coordination disorder struggle most in visual-spatial memory. When compared to their peers who don’t have motor difficulties, students with developmental coordination disorder are seven times more likely than typically developing students to achieve very poor scores in visual-spatial memory. As a result of this working memory impairment, students with developmental coordination disorder have learning deficits as well.
Assessments for developmental coordination disorder typically require a developmental history, detailing ages at which significant developmental milestones, such as crawling and walking, occurred. Motor skills screening includes activities designed to indicate developmental coordination disorder, including balancing, physical sequencing, touch sensitivity, and variations on walking activities.
Screening tests which can be used to assess developmental coordination disorder include:-
- Movement Assessment Battery for Children (Movement-ABC - Movement-ABC 2)
- Peabody Developmental Motor Scales- Second Edition (PDMS-2)
- Bruininks-Oseretsky Test of Motor Proficiency (BOTMP-BOT-2)
- Motoriktest für vier- bis sechsjährige Kinder (MOT 4-6)
- Körperkoordinationtest für Kinder (KTK)
- Test of Gross Motor Development, Second Edition (TGMD-2)
- Maastrichtse Motoriek Test (MMT)
Currently there is no single gold standard assessment test.
A baseline motor assessment establishes the starting point for developmental intervention programs. Comparing children to normal rates of development may help to establish areas of significant difficulty.
However, research in the British Journal of Special Education has shown that knowledge is severely limited in many who should be trained to recognise and respond to various difficulties, including developmental coordination disorder, dyslexia and deficits in attention, motor control and perception (DAMP). The earlier that difficulties are noted and timely assessments occur, the quicker intervention can begin. A teacher or GP could miss a diagnosis if they are only applying a cursory knowledge.
"Teachers will not be able to recognise or accommodate the child with learning difficulties in class if their knowledge is limited. Similarly GPs will find it difficult to detect and appropriately refer children with learning difficulties."
Developmental coordination disorder is a lifelong neurological condition that is more common in males than in females, with a ratio of approximately four males to every female. The exact proportion of people with the disorder is unknown since the disorder can be difficult to detect due to a lack of specific laboratory tests, thus making diagnosis of the condition one of elimination of all other possible causes/diseases. Approximately 5–6% of children are affected by this condition.
Collier first described developmental coordination disorder as 'congenital maladroitness'. A. Jean Ayres referred to developmental coordination disorder as a disorder of sensory integration in 1972, while in 1975 Dr Sasson Gubbay called it the 'clumsy child syndrome'. Developmental coordination disorder has also been called minimal brain dysfunction although the two latter names are no longer in use.
Other names include: Developmental Apraxia, Disorder of Attention and Motor Perception (DAMP) Dyspraxia, Developmental Dyspraxia, Motor Learning Difficulties, Perceptuo-motor dysfunction, Sensorimotor dysfunction.
The World Health Organisation currently lists developmental coordination disorder as Specific Developmental Disorder of Motor Function.
Living people who have publicly stated they have been diagnosed with developmental coordination disorder include actor Daniel Radcliffe, photographer David Bailey, singer Florence Welch, and UK politician Emma Lewell-Buck.
- Polatajko, H.; Fox, M.; Missiuna, C. (1995). "An International Consensus on Children with Developmental Coordination Disorder". Canadian Journal of Occupational Therapy 62 (1): 3–6. doi:10.1177/000841749506200101. ISSN 0008-4174.
- Barnhart, RC.; Davenport, MJ.; Epps, SB.; Nordquist, VM. (Aug 2003). "Developmental coordination disorder". Phys Therapy 83 (8): 722–31. PMID 12882613.
- "Consensus Statements". CanChild.
- Blank R, Smits-Engelsman B, Polatajko H, Wilson P (January 2012). "European Academy for Childhood Disability (EACD): recommendations on the definition, diagnosis and intervention of developmental coordination disorder (long version)". Dev Med Child Neurol 54 (1): 54–93. doi:10.1111/j.1469-8749.2011.04171.x. PMID 22171930.
- Zwicker JG, Missiuna C, Harris SR, Boyd LA (November 2012). "Developmental coordination disorder: a review and update". Eur. J. Paediatr. Neurol. 16 (6): 573–81. doi:10.1016/j.ejpn.2012.05.005. PMID 22705270.
- Henderson, SE; Henderson, L (2003). "Toward an understanding of developmental coordination disorder: terminological and diagnostic issues". Neural Plast 10 (1–2): 1–13. doi:10.1155/NP.2003.1. PMC 2565424. PMID 14640303.
- Gibbs J, Appleton J, Appleton R (June 2007). "Dyspraxia or developmental coordination disorder? Unravelling the enigma". Arch. Dis. Child. 92 (6): 534–9. doi:10.1136/adc.2005.088054. PMC 2066137. PMID 17515623.
- Kirby A, Sugden DA (April 2007). "Children with developmental coordination disorders". J R Soc Med 100 (4): 182–6. doi:10.1258/jrsm.100.4.182. PMC 1847727. PMID 17404341.
- Magalhães LC, Missiuna C, Wong S (November 2006). "Terminology used in research reports of developmental coordination disorder". Dev Med Child Neurol 48 (11): 937–41. doi:10.1017/S0012162206002040. PMID 17044965.
- Kirby A, Edwards L, Sugden D, Rosenblum S (2010). "The development and standardization of the Adult Developmental Co-ordination Disorders/Dyspraxia Checklist (ADC)". Res Dev Disabil 31 (1): 131–9. doi:10.1016/j.ridd.2009.08.010. PMID 19819107.
- Pearsall-Jones JG, Piek JP, Levy F (October 2010). "Developmental Coordination Disorder and cerebral palsy: categories or a continuum?". Hum Mov Sci 29 (5): 787–98. doi:10.1016/j.humov.2010.04.006. PMID 20594606.
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 74–7. ISBN 978-0-89042-555-8.
- Alloway TP, Rajendran G, Archibald LM (2009). "Working memory in children with developmental disorders". J Learn Disabil 42 (4): 372–82. doi:10.1177/0022219409335214. PMID 19380495.
- Biggs, Victoria (2005). "3 A Survival Guide to School". Caged in chaos : a dyspraxic guide to breaking free. London ; Philadelphia: Jessica Kingsley Publishers. ISBN 978-1-84310-347-9. OCLC 57316751.
- Missiuna C, Gaines R, Soucie H, McLean J (October 2006). "Parental questions about developmental coordination disorder: A synopsis of current evidence". Paediatr Child Health 11 (8): 507–12. PMC 2528644. PMID 19030319.
- Geuze RH (2005). "Postural control in children with developmental coordination disorder". Neural Plast. 12 (2–3): 183–96; discussion 263–72. doi:10.1155/NP.2005.183. PMC 2565450. PMID 16097486.
- Wilson PH, McKenzie BE (September 1998). "Information processing deficits associated with developmental coordination disorder: a meta-analysis of research findings". J Child Psychol Psychiatry 39 (6): 829–40. doi:10.1017/s0021963098002765. PMID 9758192.
- Polatajko HJ, Cantin N (December 2005). "Developmental coordination disorder (dyspraxia): an overview of the state of the art". Semin Pediatr Neurol 12 (4): 250–8. doi:10.1016/j.spen.2005.12.007. PMID 16780296.
- Rosenblum S (2013). "Handwriting measures as reflectors of executive functions among adults with Developmental Coordination Disorders (DCD)". Front Psychol 4: 357. doi:10.3389/fpsyg.2013.00357. PMC 3693067. PMID 23805113.
- Lacquaniti F (August 1989). "Central representations of human limb movement as revealed by studies of drawing and handwriting". Trends Neurosci. 12 (8): 287–91. doi:10.1016/0166-2236(89)90008-8. PMID 2475946.
- Vargha-Khadem F, Gadian DG, Copp A, Mishkin M (February 2005). "FOXP2 and the neuroanatomy of speech and language" (PDF). Nat. Rev. Neurosci. 6 (2): 131–8. doi:10.1038/nrn1605. PMID 15685218.
- Bacon C, Rappold GA (November 2012). "The distinct and overlapping phenotypic spectra of FOXP1 and FOXP2 in cognitive disorders". Hum. Genet. 131 (11): 1687–98. doi:10.1007/s00439-012-1193-z. PMC 3470686. PMID 22736078.
- Scharff C, Petri J (July 2011). "Evo-devo, deep homology and FoxP2: implications for the evolution of speech and language". Philos. Trans. R. Soc. Lond., B, Biol. Sci. 366 (1574): 2124–40. doi:10.1098/rstb.2011.0001. PMC 3130369. PMID 21690130.
- Fliers EA, Franke B, Buitelaar JK (2011). "[Motor problems in children with ADHD receive too little attention in clinical practice]". Ned Tijdschr Geneeskd (in Dutch and Flemish) 155 (50): A3559. PMID 22186361.
- Gillberg C, Kadesjö B (2003). "Why bother about clumsiness? The implications of having developmental coordination disorder (DCD)". Neural Plast. 10 (1–2): 59–68. doi:10.1155/NP.2003.59. PMC 2565425. PMID 14640308.
- Dziuk MA, Gidley Larson JC, Apostu A, Mahone EM, Denckla MB, Mostofsky SH (October 2007). "Dyspraxia in autism: association with motor, social, and communicative deficits". Dev Med Child Neurol 49 (10): 734–9. doi:10.1111/j.1469-8749.2007.00734.x. PMID 17880641.
- Jeste SS (April 2011). "The neurology of autism spectrum disorders". Curr. Opin. Neurol. 24 (2): 132–9. doi:10.1097/WCO.0b013e3283446450. PMC 3160764. PMID 21293268.
- Miyahara, M. (2013). "Meta review of systematic and meta analytic reviews on movement differences, effect of movement based interventions, and the underlying neural mechanisms in autism spectrum disorder". Front Integr Neurosci 7: 16. doi:10.3389/fnint.2013.00016. PMC 3607787. PMID 23532374.
- Pieters, S.; Desoete, A.; Van Waelvelde, H.; Vanderswalmen, R.; Roeyers, H. (2012). "Mathematical problems in children with developmental coordination disorder". Res Dev Disabil 33 (4): 1128–35. doi:10.1016/j.ridd.2012.02.007. PMID 22502838.
- Van Waelvelde, H.; Hellinckx, T.; Peersman, W.; Smits-Engelsman, BC. (Aug 2012). "SOS: a screening instrument to identify children with handwriting impairments". Phys Occup Ther Pediatr 32 (3): 306–19. doi:10.3109/01942638.2012.678971. PMID 22515913.
- Susan J. Pickering (2012). "Chapter 2. Working Memory in Dyslexia". In Tracy Packiam Alloway; Susan E. Gathercole. Working Memory and Neurodevelopmental Disorders. Psychology Press. ISBN 978-1-135-42134-2.
- Elbasan B, Kay 305 Han H, Duzgun I (April 2012). "Sensory integration and activities of daily living in children with developmental coordination disorder". Ital J Pediatr 38 (1): 14. doi:10.1186/1824-7288-38-14. PMC 3395584. PMID 22546072.
- Biggs, Victoria (2005). "2 The Hidden People at Home". Caged in chaos : a dyspraxic guide to breaking free. London ; Philadelphia: Jessica Kingsley Publishers. ISBN 978-1-84310-347-9. OCLC 57316751.
- Alloway, TP; Archibald, L (2008). "Working Memory and Learning in Children with Developmental Coordination Disorder and Specific Language Impairment". Journal of Learning Disabilities 41 (3): 251–62. doi:10.1177/0022219408315815. PMID 18434291.
- Schoemaker, MM.; van der Wees, M.; Flapper, B.; Verheij-Jansen, N.; Scholten-Jaegers, S.; Geuze, RH. (Mar 2001). "Perceptual skills of children with developmental coordination disorder" (PDF). Hum Mov Sci 20 (1–2): 111–33. doi:10.1016/s0167-9457(01)00031-8. PMID 11471393.
- Barkley, Russell A. (1990). Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment. New York: Guilford Press. ISBN 0-89862-443-6. OCLC 21335369.
- Miller LJ, Anzalone ME, Lane SJ, Cermak SA, Osten ET (2007). "Concept evolution in sensory integration: a proposed nosology for diagnosis" (PDF). Am J Occup Ther 61 (2): 135–40. doi:10.5014/ajot.61.2.135. PMID 17436834.
- Alloway, TP (2007). "Working Memory, Reading and Mathematical Skills in Children with Developmental Coordination Disorder". Journal of Experimental Child Psychology 96 (1): 20–36. doi:10.1016/j.jecp.2006.07.002. PMID 17010988.
- Alloway, TP; Temple, K (2007). "A Comparison of Working Memory Profiles and Learning in Children with Developmental Coordination Disorder and Moderate Learning Difficulties". Applied Cognitive Psychology 21 (4): 473–487. doi:10.1002/acp.1284.
- Cools, W.; Martelaer, KD.; Samaey, C.; Andries, C. (2009). "Movement Skill Assessment of Typically Developing Preschool Children: A Review of Seven Movement Skill Assessment Tools". J Sports Sci Med 8 (2): 154–168. PMC 3761481. PMID 24149522.
- Wright, HC.; Sugden, DA. (Dec 1996). "A two-step procedure for the identification of children with developmental co-ordination disorder in Singapore". Dev Med Child Neurol 38 (12): 1099–105. PMID 8973295.
- Venetsanou, F.; Kambas, A.; Ellinoudis, T.; Fatouros, I.; Giannakidou, D.; Kourtessis, T. (2011). "Can the movement assessment battery for children-test be the gold standard for the motor assessment of children with Developmental Coordination Disorder?". Res Dev Disabil 32 (1): 1–10. doi:10.1016/j.ridd.2010.09.006. PMID 20940096.
- Ellinoudis, T.; Evaggelinou, C.; Kourtessis, T.; Konstantinidou, Z.; Venetsanou, F.; Kambas, A. (2011). "Reliability and validity of age band 1 of the Movement Assessment Battery for Children--second edition". Res Dev Disabil 32 (3): 1046–51. doi:10.1016/j.ridd.2011.01.035. PMID 21333488.
- Schoemaker, Marina M; Niemeijer, Anuschka S; Flapper, Boudien C T; Smits-Engelsman, Bouwien C M (2012). "Validity and reliability of the Movement Assessment Battery for Children-2 Checklist for children with and without motor impairments". Developmental Medicine & Child Neurology 54 (4): 368–375. doi:10.1111/j.1469-8749.2012.04226.x.
- Venetsanou, F.; Kambas, A.; Aggeloussis, N.; Serbezis, V.; Taxildaris, K. (Nov 2007). "Use of the Bruininks-Oseretsky Test of Motor Proficiency for identifying children with motor impairment". Dev Med Child Neurol 49 (11): 846–8. doi:10.1111/j.1469-8749.2007.00846.x. PMID 17979863.
- Venetsanou, F.; Kambas, A.; Aggeloussis, N.; Fatouros, I.; Taxildaris, K. (Aug 2009). "Motor assessment of preschool aged children: A preliminary investigation of the validity of the Bruininks-Oseretsky test of motor proficiency - short form". Hum Mov Sci 28 (4): 543–50. doi:10.1016/j.humov.2009.03.002. PMID 19443065.
- Lucas, BR.; Latimer, J.; Doney, R.; Ferreira, ML.; Adams, R.; Hawkes, G.; Fitzpatrick, JP.; Hand, M.; Oscar, J.; Carter, Maureen; Elliott, Elizabeth J (2013). "The Bruininks-Oseretsky Test of Motor Proficiency-Short Form is reliable in children living in remote Australian Aboriginal communities". BMC Pediatr 13: 135. doi:10.1186/1471-2431-13-135. PMID 24010634.
- Kambas, A.; Venetsanou, F.; Giannakidou, D.; Fatouros, IG.; Avloniti, A.; Chatzinikolaou, A.; Draganidis, D.; Zimmer, R. (2012). "The Motor-Proficiency-Test for children between 4 and 6 years of age (MOT 4-6): an investigation of its suitability in Greece". Res Dev Disabil 33 (5): 1626–32. doi:10.1016/j.ridd.2012.04.002. PMID 22543059.
- Kirby, Amanda; Davies, Rhys; Bryant, Amy (2005). "Do teachers know more about specific learning difficulties than general practitioners?". British Journal of Special Education 32 (3): 122–126. doi:10.1111/j.0952-3383.2005.00384.x. ISSN 0952-3383.
- Gaines, Robin; Cheryl Missiuna; Mary Egan; Jennifer McLean (2008-01-22). "Educational outreach and collaborative care enhances physician's perceived knowledge about Developmental Coordination Disorder". BMC Health Services Research 8: 21. doi:10.1186/1472-6963-8-21. PMC 2254381. PMID 18218082. Retrieved 2011-07-20.
- Ayres AJ (1972). "Types of sensory integrative dysfunction among disabled learners". Am J Occup Ther 26 (1): 13–8. PMID 5008164.
- Willoughby C, Polatajko HJ (September 1995). "Motor problems in children with developmental coordination disorder: review of the literature" (PDF). Am J Occup Ther 49 (8): 787–94. doi:10.5014/ajot.49.8.787. PMID 8526224.
- Gubbay SS (October 1978). "The management of developmental apraxia". Dev Med Child Neurol 20 (5): 643–6. PMID 729912.
- Irvine, Chris (2008-08-17). "Harry Potter's Daniel Radcliffe has dyspraxia". The Daily Telegraph (London). Retrieved 2010-05-16.
- Hussey, Patrick (15 May 2008). "Interview: Florence & The Machine". Run Riot. Retrieved 7 March 2010.
- Irvine, Chris (2013-09-28). "'I’d love to wear eyeliner, but that requires a steady hand’ Labour MP Emma Lewell-Buck struggled with clumsiness, until a diagnosis of dyspraxia helped her become a politician". The Daily Telegraph (London). Retrieved 2013-09-28.
- Human Movement Science (2003). "Developmental Coordination Disorder: Mechanisms, measurement and management". ScienceDirect.com. Retrieved 14 September 2013.
- Children with Developmental Coordination Disorder: At home, at school, and in the community - CanChild Centre McMaster University
- Developmental Verbal Dyspraxia - Pam Williams of Nuffield Hearing and Speech Centre
- UK Dyspraxia Foundation - What is dyspraxia?
- USA Dyspraxia Foundation - What is dyspraxia?