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Sally Payne explains how occupational therapists can work in partnership with schools to support children with dyspraxia/DCD

Developmental coordination disorder (DCD), also known as dyspraxia in the UK, is one of the most common developmental disorders of childhood, affecting around five to ten per cent of the school-aged population, two per cent to a severe degree. However, poor awareness of the condition means that children’s difficulties are often dismissed as developmental immaturity, leading to delays in accessing the early intervention and support that a child needs.

What is dyspraxia/DCD?

DCD affects fine and gross motor coordination; however, difficulties often extend beyond the motor domain to affect memory, perception, planning, organisation and speech. For this reason, many parents and adults prefer to use the term dyspraxia, feeling that the term DCD detracts from the wider difficulties experienced. 

Difficulties associated with the condition make it hard for individuals to carry out everyday activities that others take for granted, such as learning to ride a bike, handwriting, tying shoe laces, using kitchen equipment and taking a telephone message. Whilst it was once thought that dyspraxia was something that children outgrew, it is now recognised as a lifelong condition for many of those affected that can have serious negative consequences for the individual, their family and society, if appropriate support is not provided in childhood.  

Early support

Early intervention is vital to ensure that children with dyspraxia develop the fundamental movement and organisational skills that they need to carry out daily activities, including those necessary for successful school performance. It can be difficult, though, for parents to access help for their child as demand for occupational therapy, physiotherapy, educational psychology and other relevant services often exceeds supply. At the same time, teachers are expected to meet the needs of more students with a wider range of strengths and difficulties in their classrooms. It is essential, therefore, that the health, education and the voluntary sectors work together to support young people with dyspraxia, particularly during their formative primary school years. If everyone involved pulls together, it is possible to improve these children’s school performance, their achievement and consequently their self-esteem within the school setting. 

The role of the occupational therapist

Occupational therapists are the health professional most likely to be involved with children with DCD and they play an important role in its diagnosis and treatment. DCD is formally recognised by the World Health Organisation and criteria for diagnosis are described in the Diagnostic and Statistical Manual (American Psychiatric Association, 2013). Occupational therapists contribute to the diagnosis by administering standardised tests of motor function (for example, the Movement Assessment Battery for Children) and gathering evidence of the impact of a child’s difficulties on everyday life from the young person, parents/carers and teachers. DCD cannot, however, be diagnosed by an occupational therapist alone and it is essential that a medical doctor is involved to exclude other conditions that could account for a child’s difficulties. 

Securing a diagnosis, where appropriate, helps by providing an explanation for a child’s difficulties. Diagnosis can also help families and professionals to access resources and support to maximise a child’s potential. Even when a child with coordination and organisational difficulties does not receive a diagnosis, occupational therapists can help by addressing the presenting functional difficulties and identifying ways to enable the young person to carry out important activities of daily living at home, at school and in their leisure time, or by referring on to other agencies where appropriate. 

Assessments

Occupational therapists typically begin their assessment by identifying the everyday activities that a young person does well and those that they find difficult. They then move on to explore factors that might explain the child’s difficulties. For children with dyspraxia these factors might include poor balance and core stability, limited hand and grip strength, poor spatial awareness and difficulty sequencing movements in the right order to complete a task. Problems with working memory, planning and attention might also be identified. Understanding these component difficulties and their impact on a child’s daily life helps the therapist to make recommendations and offer interventions to address areas of concern.

Interventions

Interventions offered by occupational therapists fall into three categories:

Individual skills
The first group of interventions focus on the individual, for example developing gross and fine motor coordination, using both hands together and developing hand strength. Occupational therapists also think ahead, helping children to develop the foundation skills that they will need to manage more complex activities as they get older. This is particularly important for children with coordination difficulties who need extra opportunities to practice and master skills compared to their peers.

Activities
The second area of intervention focuses on activities such as pencil grip and control, using cutlery and getting dressed. Difficulties might be addressed by recommending alternative equipment or finding another way of achieving the task.

Environment
The final avenue for intervention is the environment. Environmental interventions include organising equipment so that it is easier for the child to find or reach, recommending more suitable seating or providing training so that the adults who live and work with the child respond to their needs with greater understanding. 

Whatever the intervention approach, the aim is to enable children to master and carry out the meaningful, functional activities that make up their daily routines at home, at school and at play now and in the future. 

Working in partnership with schools

Partnership working between therapists, young people, families and teachers is key to the Children and Families Act (2014) aim of producing better outcomes for young people with SEN and disabilities, including those with dyspraxia. Working collaboratively will help ensure that children’s needs are identified early, that limited resources are used effectively and that therapeutic activities are meaningful and relevant. Embedding therapy into a child’s daily routine also provides opportunities for over-learning which is vital for young people with dyspraxia. 

Occupational therapists work in partnership with schools by:

  • gathering information about the impact of a child’s motor and organisational difficulties within their own environment, ensuring that therapy recommendations are contextualised and meaningful
  • recommending fine and gross motor programmes to support the development of fundamental movement skills. Some therapy teams provide training to enable teachers and teaching assistants to deliver motor programmes, meaning that they can be delivered over several shorter sessions over the course of the week and integrated into PE lessons 
  • recommending or delivering school-based programmes to develop skills such as cutting and the perceptuo-motor skills that underpin handwriting
  • suggesting task adaptations such as alternative pencils and other school tools, such as scissors and rulers. Although these are usually recommended for an individual child, it is suggested that schools purchase several pieces of the same equipment and make them available to any child who may benefit
  • adjusting a child’s seating to facilitate a better working posture. Providing furniture that enables a child to sit with their bottom back, feet flat and elbows resting comfortably on the table (without hunched shoulders) will allow them to use their hands more effectively for fine motor tasks such as writing and manipulating tools and equipment. Good seating will also help their attention and concentration
  • helping teaching staff to re-frame a student’s behaviour in the context of their underlying motor and organisational difficulties, thus helping teachers to adjust their teaching methods and identify ways to enable a student to be more productive at school. 

Strategies for the classroom

One confusing aspect of dyspraxia is that no two people with dyspraxia are the same, as each individual has a unique set of strengths, difficulties, motivations and circumstances. Strategies that a teacher or therapist has successfully used with one child may not therefore help another.

There are, though, a number of practical ways to support pupils with dyspraxia in the primary classroom:

  • incorporate physical activity into classroom routines, such as a hand workout before a handwriting session and a five minute wake and shake activity for all children at the start of the day and after lunch
  • provide “motor break” opportunities for pupils who need movement to help them concentrate, such as wiping tables, handing out books or taking a message to the school office
  • have a fine motor table or activity box available for all children to access 
  • provide a variety of writing tools and encourage children to choose the ones that they find most comfortable
  • carry out a “seat audit” to check that all children are sitting appropriately. Provide lower tables and chairs where possible, or put a firm step underneath children’s feet 
  • reinforce task instructions with a task organiser sheet on the pupil’s desk, describing each stage of the task and what to do when the task is finished. 

Further information

Sally Payne is Head Paediatric Occupational Therapist with the Heart of England Foundation NHS Trust. She has recently completed a PhD study at Coventry University exploring the lived experience of teenagers with DCD/dyspraxia. She was previously Chair of the Dyspraxia Foundation and continues to support the organisation as a Trustee and Editor of the Professional Journal:
www.dyspraxiafoundation.org.uk

Dyspraxia Awareness Week

11 to 17 October 2015
This year, Dyspraxia Awareness Week will focus on how dyspraxia affects males and females differently. Practical resources for teachers, parents and adults and information about the second Funky Friday fundraising event are available to download from:
www.dyspraxiafoundation.org.uk


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