Dyspraxia and NDD

Dyspraxia means difficulty with praxis, or motor control. It can effect both fine and gross motor skills. Fine motor skills are those of dexterity, small motor activity: as in writing, sewing, refined ball skills both hand and foot. Gross motor skills are those primarily related to large body movements: as in walking, running, skipping, swimming etc.

As can be seen in the section “Primitive Reflexes”, it can readily be appreciated how many of the actions of the retained Primitive Reflexes will disturb normal motor function, and how the underdeveloped Postural Reflexes will cause poor adjustment or equilibrating righting reflexes. More specifically the action of the Moro Reflex will cause unwanted arm, hand, leg and body extension whenever the head is jerked backwards, or whenever there is a sudden visual or auditory stimulus. These reactions must be compensated for leaving the individual frequently with over tensed muscles, especially in the neck. The persistence of greater sensitivity for peripheral vision, rather than central vision, also generated by the Moro Reflex, will result in difficulties with hand eye co-ordination and will cause ease of distractibility at moments when hand eye co-ordination is being tested. So that the child will not only have difficulty focusing on the ball, they may also look away from the ball as another object has impinged upon their enlarged peripheral field. The movement of the ball as it approaches the eyes maybe sufficient to initiate the Moro response, so that the arms are flung back, the back extends backwards, with no obvious appearance of trying to catch the ball. To offset this reaction the individual may look away, or close their eyes, making catching almost impossible.

Any residual presence of the Rooting Reflex, with it’s maintained link between hand and mouth, frequently results in mouth movements whenever the hand is used. Sucking when writing, or protrusion of the tongue when sewing are examples of this type of effect. Frequent licking around the mouth, resulting in redness or sores, is another symptom of immature development of the mouth reflexes, as is dribbling, noisy eating, spitting whilst talking and poor control of the mouth for speech. Synchronising breathing and speaking or eating may also present difficulties.

Any residual ATNR may increase neck rigidity, it will also cause difficulty with all hand, arm, and hand eye co-ordination tasks. Each and every time the head is moved there will be an unwanted, but automatic, movement within the arm and hand. When eating it will be difficult to guide the hand to the mouth, to even maintain a grip upon the fork. Any activity involving holding and fine motor skill with the hands will be seriously impacted by the presence of the Palmar Grasping Reflex. The ATNR decreases the ability to maintain simultaneous bilateral movements, so that the individual will have difficulty manipulating both knife and fork, preferring frequently to put one or other down. Similar difficulties will be experienced when writing, sewing, especially threading the needle, and doing buttons and bows. Arm and hand extension, related to horizontal head movement, will cause difficulties in holding the pen. The usual compensatory actions of increasing the muscles in the hand and arm to promote flexion will create cramps, inhibition with a free flowing movement. The writing will frequently be better on the left hand side of the page becoming more illegible toward the right, for a right hander. This is because when writing on the left of the page the head is centrally placed with no direct trigger upon the ATNR. However, as the ATNR creates difficulties crossing the midline the writer may tilt the page so that they write away from themselves, this also mitigates the need to generate increased flexion as compensation. As the ATNR maintains an immature link with the hand and eye, maintaining focus will be difficult, so that copying will be effected, the eye following the hand rather than the work. A similar effect will inhibit racket skills, catching, throwing. A strongly retained ATNR, still present in the legs, will create problems with foot ball skills, balance problems as one leg extends and the other flexes in response to head movement. Any continued presence of the Plantar Reflex will effect running, kicking, even standing still. The ATNR will prevent good cross patterning skills so that the individual will appear clumsy, have poor techniques in walking, marching, swimming, skiing, skating, in fact anything that requires movement or balance relating to opposite sides.

A retained TLR will cause balance difficulties, so that even (especially) standing still is impossible. Posture and adjustment movements will be poor and due to the effect of the TLR upon near vision they with great difficulty in following a moving object with the eyes. Kicking will be very difficult due to both balance and adjustment difficulties and an individual with a retained TLR frequently has very poor control of the lower body, especially the legs. The TLR makes it difficult to hold the hands above the head, without bending backward, so that climbing, swinging are both ineffectual. The reflex also makes it difficult to shift the position from forward to back or back to forward, reaction times for these activities are clumsy and slow. This has a major impact upon sport of any kind. These children are often those not selected for the team, or left till last. The TLR creates a spatial difficulty so that individuals with this reflex are clumsy, finding it difficult to judge distance, they bump into things, knock them over, hit their head on the end of the swimming pool when performing the backstroke, each and every time, despite many looks back. The same spatial difficulty will make it difficult to organise things, especially arranging things neatly on paper. They may copy in a haphazard manner, jumping from item to item with no sequential follow through.

The STNR will also create postural difficulties, cause poor lower body motility. It will also create difficulties with hand eye co-ordination, especially related to catching and throwing as distance is difficult to gauge. Sitting working at a desk is especially hard for anyone with a retained STNR as the head down position will automatically trigger the action of bending of the arms, with lowering of the head and extension of the hips and knees. The individual will be restless, fidgety, wind their legs around the chair, sit on their legs, anything to pin the legs down, or they will tip the chair back in direct response to the action of the STNR in the lower body. They will prefer to stand, to lie, anything but sit. They will squat on the floor with legs beneath them in a typical but painful looking stance. The head and shoulders will lower to the desk as the arms bend, creating difficulty with writing, difficulty with vision, and generating greater pressure upon the paper with torn pages as the nib gouges through, broken pencils, blots and squiggles.

Dyspaxic children are visually identifiable as different from other children, for this reason they are frequently teased, bullied, isolated by other children. The retained Primitive Reflexes and underdeveloped Postural Reflexes not only make rapid adjustments in physical skills difficult, they also impact rapid mental agility. They do not appear street wise, have poor mechanisms to defend themselves physically, mentally and emotionally. For all of these reasons they can frequently be very distressed and unhappy children as they both recognise and are recognised for their difference.

Although some children are diagnosed as dyspraxic it rarely exists in isolation, many also have classical symptoms of dyslexia; just as many with dyslexia have symptoms of dyspraxia. For this reason I suggest that any parent who has a child with dyspraxia reads the section “Dyslexia and NDD”.