The first time my older son's occupational therapist mentioned "dyspraxia," I had absolutely no idea what it meant. She responded to my blank stare with, "it means difficulty with motor planning." Nope. still not following.

Like most things sensory-processing related, it took me a while to grasp what dyspraxia was and how it was impacting my son. Part of the difficulty was due to the fact that it's not an "official" diagnosis which means it doesn't have a set definition.

Developmental Coordination Disorder (DCD) is the official diagnosis and is often used interchangeably with dyspraxia. It's estimated to impact between 5-15 percent of school-aged children (more common in boys) and is often comorbid with ADHD, dysgraphia, sensory processing disorder, anxiety and Autism, yet it remains poorly understood and is therefore underdiagnosed by medical and educational professionals. Sometimes referred to as a "hidden disability," it occurs on a spectrum and affects kids differently.

DCD has made certain aspects of my son's life more challenging, but catching it early and intervening has made all the difference. My goal is to break it down for you so you can A.) determine whether it is part of your child's behavioral and learing challenges and B.) know how to intervene.

What is Dyspraxia/ DCD?

Dyspraxia is a neurological disorder that causes kids to have trouble with movement. Kids with DCD have difficulty with coordination as well as fine motor (handwriting, buttoning, zipping) and gross (crawling, walking, jumping) motor skills and motor planning (sequencing of movements).

These kiddos often appear clumsy and awkward, may avoid movement, be late on motor milestones, have difficulty imitating others, use too little or too much force during fine motor activities and have trouble coming up with new ideas during play.

For example, my son was slightly delayed in his early motor milestones (rolling, sitting, crawling) and moved his body awkwardly. However, his delays were not significant enough for our then pediatrician to identify them as an early red flag, as is often the case due to lack of awareness.

As a toddler, he preferred to play with the same toys (cars and trucks) day after day and had trouble coming up with creative and imaginary play. He had difficulty with things like playing patty cake, clapping,

In preschool, when the teacher would sing songs with accompanying hand motions, my son would sit there with a look of confusion, unable to follow along. Meanwhile all the other kids were happily singing and mimicking the hand motions. It broke my heart. Had I not informed his teacher about his sensory challenges and dyspraxia, it would have been easy for her to judge him as being defiant or just plain lazy. Instead, she did things to make it easier for him, like slow down the songs and hand motions and make sure he was sitting right in front of her.

When he started kindergarten it became immediately apparent that writing was going to be a big challenge. His writing is actually very neat, but it's extremely laborious and takes him such a long time that he avoids it like the plague which impacts his performace in and enjoyment of school.

Dyspraxia impacts the following areas of development: movement, balance, coordination, organization, sensory processing, planning, memory, attention, language, speech, social and emotional.

What are signs of Dyspraxia?

It's true that all kids develop at a different pace and that there's a range for what's considered "normal" when it comes to motor development. Unless your child has extremely overt delays, which many kids with dyspraxia don't, they likely won't be flagged by his or her pediatrician. This makes it all the more important for us parents to educate ourselves and advocate for our kids.

The following is a list of common signs of DCD at different ages:

Infancy/ Toddlerhood

• Slightly or significantly delayed motor milestones (rolling, sitting, crawling)
• "Funky" crawl
• Irritable
• Feeding issues
• Difficulty crossing midline (reaching across body)
• Difficulty with bilateral coordination (clapping, reaching for and grabbing toes)
• Frequently falls and/or trips

Preschool

• Unable to sit still
• Poor fine motor skills- difficulty holding a pencil, using scissors, coloring
• Poor expressive language
• Frequently bumps into things
• Lack of imaginative/ creative play
• Tends to get very excited
• Is exceptionally loud
• Prone to tantrums
• Left or right handedness still not established
• Difficulty concentrating/ short attention span
• Messy eater
• Speech delays/ articulation issues
• Sensory overresponsive
• Slow to respond to verbal instructions/ difficulty following sequence of steps
• Difficulty playing mimicking games
• Trouble going up and down stairs
• Plays too roughly
• Difficulty throwing a ball
• Lack of interest in playing with other kids
• Accident prone

School-aged

• Difficulty forming friendships
• Trouble completing schoolwork
• Dislikes/ complains about P.E.
• Difficulty with handwriting/ barely legible writing/ takes forever to write
• Low frustration tolerance/ easily distressed
• Trouble following directions
• Difficulty cutting food/ using utensils
• Hand flapping when excited
• Difficulty sleeping/ frequent nightmares
• Avoids playing sports
• Seeks out younger kids to play with
• Resistant to changes in how or when tasks are done
• Slow to respond even when knows the answer

Tweens and Teens

• Difficulty learning to drive
• Avoids/ struggles with typing and texting
• Difficulty with transition to middle an highschool (trouble getting used to new schedule, finding classes, remembering teachers names)
• Difficulty keeping up with peers
• Difficulty playing sports
• Low self-esteem
• Trouble concentrating
• Poor organization skills
• Academic/ learing challenges
• Appears lazy and non-compliant
• Difficulty picking up on non-verbal communication

What are common strengths of a dyspraxic child?

I realize the list of red flags is long and daunting. If you suspect or already know your child has dyspraxia, you may be thinking, oh my gosh, my poor kid, these challenges seem so overwhelming! But, like most things in life, there's a flip side.

Because their challenges force them to find creative solutions in order to adapt, dyspraxic children are often more empathic, detail-oriented and determined than their non-dyspraxic peers. They also tend to be extremely creative when it comes to problem solving and are able to see the "big picture."

I'm amazed by the way my son's mind works. He is detail-oriented to the point that if he says I've forgotten something, even if I don't think I did, I will immediately go check because he's always right. Or if we remember things differently, I immediately know my memory is off because his is always spot on. The joke in our family is, "listen to Hunter, he's always right!" Ha! It reminds me that every challenge also has its accompanying benefits.

How is Dyspraxia diagnosed?

Dyspraxia can be officially diagnosed by a pediatrician, pediatric neurologist or a child psychiatrist. Other professionals including physical and occupational therapists, child psychologists, and educational psychologists can assess for and identify DCD, but can't make an official diagnosis.

When assessing for DCD, evaluators will use specific tests to look at strength, balance, coordination, motor planning, fine motor control and range of motion. They will also look at cognitive skills, emotional development and how your child's gross and fine motor development progressed through infancy and toddlerhood.

The most common ages for assessment are five and six.

What is the treatment for Dyspraxia?

The primary treatment for DCD is occupational therapy (OT), also called Sensory Integration Therapy (OT-SI). Though your child won't "outgrow" DCD, with the right intervention, he will definitely improve. The earlier he/she is diagnosed, the better and faster his/her improvement will be.

My son received occupational therapy from the time he was 11 months until he was almost 7 and he has made incredible progress. He still doesn't love sports and he struggles with handwriting, but he is well-liked by his peers, has fewer meltdowns, is showing more self-confidence, and does not appear uncoordinated in the slightest. In fact, recently as he was riding his scooter with a girlfriend's son, my girlfriend commented, "Hunter is so coordinated!" I nodded with a smile, and replied, "You're right, he is pretty coordinated."

What do I do if I suspect my child has dyspraxia?

The first person to talk with is your pediatrician. Having said that, there's a good chance he or she will have no idea what you're talking about and/or will dismiss your concerns! But, if she has awareness about dyspraxia, she will be able to give you referrals to either an occupational or physical therapist.

If you can't get a referral from your pediatrician and you can afford to pay out of pocket, google "sensory integration therapy" and see what comes up in your area. When looking for a local clinic, make sure their website specifically mentions sensory integration (not all OT's have this speciality). Once you find a reputable clinic, make an appointment for an assessment. Be sure to ask if they take insurance as many clinics do.

If paying out of pocket is not an option, you can have your child tested through the school and push for either an IEP or a 504 plan to get formal accomodations. At the very least, discuss your child's challenges with his teacher and brainstorm ways that she may be able to give him extra support in the classroom. She may be able to break up school work into smaller steps, lessen the amount of writing he's required to do, allow extra time to complete tasks, use simple language and instructions and provide plenty of praise and encouragement to help boost his self-esteem.

Tips for parents

Parenting a child with dyspraxia comes with its own unique set of challenges, believe me, I know! Homeschool has definitely illuminated my son's challenges with handwriting, especially since he's more comfortable expressing his frustrations with me than he is when he's at school (Read: flat out refusing to do his work)!

On one hand, I don't want to be too accomodating. On the other hand, I have to find a way to limit the number of power struggles and to help him enjoy learning at home. The struggle is real!

The following are strategies you can use at home to help your child:

• Break large tasks into smaller ones (instead of- get dressed, brush your teeth, comb your hair and get your shoes on - break it down to two things at a time or even one)
• Simplify activities
• Have realistic expectations and goals (ie. instead of hoping he scores a goal at the soccer game, celebrate the fact that he even got out on the field to play!)
• Give lots and lots of encouragement and positive reinforcement
• Praise participation over competition
• Avoid judging and shaming
• Give extra time to complete new tasks
• Use a visual schedule
• Provide lots of time for active play - as much park time as possible!
• Work on your patience (easier said than done!)
• Lots of deep breaths! (ha!)

Identifying and getting the right intervention for your child's dyspraxia is imperative for improving his functioning. It won't magically make his challenges disappear, but over time it will make things easier for both of you.

Please leave any questions or comments below, I'd love to hear from you.