Dyspraxia in adults

Dyspraxia is an inborn feature of how the brain works that makes movement hard to organise. In medical records it usually appears as developmental co-ordination disorder. The intention is perfectly normal and the willingness is there, but the instruction travelling from idea to muscle arrives with interference: the hand misses the door handle, the foot catches on the step, handwriting falls apart, and a task that looks simple eats twice the time and twice the energy it costs the person at the next desk. This is not an illness that started one day and might pass, and it is not the result of laziness. Dyspraxia is there from early childhood and stays into adult life; what changes is not the condition but how skilfully a person has learnt to work around it.

What it looks like in adult life

Almost nobody arrives saying «my co-ordination is poor». People arrive tired, with a long list of small inconveniences, each of which on its own sounds trivial:

• large movements — unsteadiness on uneven ground, collisions with door frames and table corners, a dislike of team sports, a running style that looks unusual from outside;
• fine movements — handwriting that is illegible by the bottom of the page, fastenings and shoelaces, shaving, make-up, assembling anything from instructions;
• space — difficulty judging whether the car will fit into a gap, getting lost easily in an unfamiliar building, crockery that falls and breaks more often than it should;
• driving — learning drags on, parking and changing lanes take enormous effort, and the journey is more exhausting than the working day itself;
• time and order — a job planned for an hour takes three; keys and documents vanish; a five-step task collapses halfway;
• speech — in some people unclear articulation, an uneven pace, trouble finding a word quickly;
• company — it is hard to hold a conversation, follow the other person's face and keep a cup steady all at once;
• reserves — nothing is left by the evening, because the movements never became automatic and every one of them demands attention.

Two people with the same diagnosis can have lists that barely overlap, and the lists change over the years: someone drives more confidently at thirty than at twenty and still cannot tie a tie. No single item is a diagnosis in itself — clumsy people with no dyspraxia at all also exist. What matters is the combination, how long it has been there and how much it gets in the way.

Why this is not laziness or low intelligence

Intelligence is not affected at all: among people with dyspraxia there are researchers, doctors, programmers and musicians. The difference lies elsewhere. What becomes automatic in most people and stops being noticed here remains conscious work. Every time a cuff has to be fastened or a car steered into a bend, attention is spent that other people put into the substance of the task. Hence the two things everyone around can see — tiredness and slowness — and the one they cannot: how much effort it took.

Many people carry a set of labels out of childhood: careless, inattentive, not trying. Labels stick, and as adults they often come to a doctor not about co-ordination but with anxiety and a settled belief that they are worth less than everyone else. That deserves its own attention, because it is precisely the part that responds well.

What tends to come with it

Dyspraxia rarely travels alone. One person may have several developmental differences at once, and that is the usual state of affairs rather than a rarity:

• attention deficit hyperactivity disorder;
• dyslexia — difficulty with reading and writing;
• dyscalculia — difficulty with numbers and arithmetic;
• autism spectrum disorder;
• speech and language difficulties carried over from childhood;
• anxiety disorders and depression.

It is worth looking at all of it together, because the help differs for each: for someone who has untreated anxiety alongside dyspraxia, working on movement alone will not make life any lighter.

Where it comes from

The exact cause is unknown. It has to do with how the connections formed in early development between the parts of the brain that plan a movement and check it against the result. The likelihood is higher in those born very preterm and with low birth weight; a family line can often be traced, with similar difficulties in a father or a brother. The diagnosis is made more often in men, though partly because it is spotted less often in girls: a quiet girl with poor handwriting does not disturb the class and never reaches a doctor.

What dyspraxia does not do: it does not progress, it does not turn into another disease and it does not shorten life. Upbringing cannot cause it and it cannot be caught from anyone.

When clumsiness appears for the first time it is no longer dyspraxia

This is the most important part of the page. Dyspraxia accompanies a person from childhood and stays steady. If co-ordination has deteriorated in an adult who used to be nimble, or is slowly getting worse year by year, the cause is something else and it needs to be found. That happens in multiple sclerosis, in tumours of the cerebellum, in vitamin B12 deficiency, in thyroid disease, with long-term heavy drinking, as a side effect of some medicines and in inherited ataxias.

Call an ambulance straight away — in Europe the single number is 112 — if within minutes or hours there has been:

• a drooping face, weakness of an arm or a leg on one side, slurred or absent speech;
• sudden unsteadiness that makes walking or standing impossible;
• double vision, loss of sight, severe dizziness with vomiting;
• an extremely severe headache that came on instantly;
• any of the above after a blow to the head.

Do not put a medical appointment off indefinitely if:

• unsteadiness, tremor or clumsiness are building up over weeks and months;
• handwriting has changed noticeably over the past year;
• numbness, weakness in the legs or trouble passing urine have joined the clumsiness;
• a child has lost skills they already had — has stopped walking steadily or speaking in sentences.

How the diagnosis is confirmed

There is no blood test and no scan that shows dyspraxia. The diagnosis is assembled from history and observation, and most of that history is childhood: when you started walking, at what age you managed a bicycle, how writing went in the first school years, what teachers wrote in the exercise books. Parents and old school papers help here more than any piece of equipment.

A movement specialist then joins in — an occupational therapist or a physiotherapist — who looks at balance, precision and the sequencing of actions, and goes through the actual tasks of your day. A neurologist examines you to rule out other causes; where one is suspected, blood tests or an MRI scan are arranged. If questions about attention, reading and arithmetic sit alongside, a neuropsychological assessment is added.

It is worth preparing for the appointment: spend a couple of weeks noting down what exactly went wrong and when. For an adult the diagnosis is not only an explanation of the past. It opens the door to justified adjustments in study and exams and to a concrete conversation with an employer about how the workplace should be set up.

What genuinely helps

There is no medicine that acts on dyspraxia itself, and nobody should promise you one. Drugs come into it only where something alongside is treatable with them — marked anxiety or attention deficit hyperactivity disorder. Everything else is learning and adaptation, and it works well:

• occupational therapy — going through your real tasks: how to hold a knife, how to lay out the kitchen, how to shorten the morning routine;
• regular physical activity — swimming, an exercise bike, strength work, yoga or tai chi for balance; the type matters less than the consistency;
• cognitive behavioural therapy — for when the obstacle is not the hand but the dread of the hand and years of accumulated «I am worse than others»;
• speech and language therapy if difficulties with speech go back to childhood;
• touch typing and voice dictation instead of struggling with handwriting.

Tricks that people with dyspraxia work out for themselves and that are worth copying:

• keys, documents and phone in one fixed place, with no exceptions;
• a calendar with reminders and written lists for any day with several steps;
• build a margin into every time estimate and do not overlap tasks;
• shoes without laces or with elastic laces, clothes without tiny buttons;
• heavy stable crockery, a non-slip mat under the chopping board, knives and tools with thick handles;
• contrasting tape on the edge of the steps where you regularly trip;
• asking for instructions in writing rather than dictated in passing in the corridor.

And something discussed less often: contact with other people living with the same thing gives more than any single adaptation. Knowing you are not the only person who at forty cannot tie a tie removes the part of the problem that weighs heaviest.

Online consultation

Dyspraxia is not diagnosed in a single conversation, still less a remote one: it needs movement to be assessed in person. But on this subject an online appointment settles several things that do not require travelling anywhere. The main one is separating a lifelong feature from a new neurological illness: the doctor will go through whether it was always like this or whether something has changed, and if it has changed, will say how urgent it is. Then, who to see next — a neurologist, an occupational therapist, a specialist in attention and learning — and what to prepare for the face-to-face appointment so as not to waste it. Online is also a convenient place to discuss what sits alongside: the insomnia, the anxiety, how to raise the matter at work. If what you describe does not fit a lifelong feature, you will be referred for an in-person examination, and that is the right outcome of the consultation, not a refusal to help.

This material is for information only and does not replace medical advice.