What Are Dyspraxia and Apraxia?

Dyspraxia is the partial loss of the ability to coordinate and perform skilled purposeful movements. Apraxia is the complete loss of this ability. Dyspraxia and apraxia together are called Global Apraxia.

The root word “praxia” means execution of voluntary motor movements; the “dys” means partial ability or partial loss; the “a” means absence of something. In certain cases, dyspraxia and praxia may be acquired due to a stroke or head injury.

Dyspraxia was formerly known and still referred to as Developmental Coordination Disorder (DCD), which is the term to describe dyspraxia in children whose neurological development does not progress normally due to a motor-learning disability. In other words, the brain is unable to plan and coordinate motor movement; hence, there is a speech and/or motor-planning disorder.

The etiology of DCD is a motor neuron development and maturation problem in which the following areas may be affected:

• Gross and fine motor skills
• Motor planning and how to organize and execute movement
• Speech and language
• Ability to carry out activities of everyday living

Childhood Developmental Apraxia of Speech (DAS) or Developmental Verbal Dyspraxia (DVD) is a speech disorder in which the brain has difficulties getting the tongue, lips and jaw to move correctly for talking. Children with this disorder know what they want to say but cannot coordinate the muscle movements needed to make the sounds, syllables and words.

Childhood Apraxia of Speech (CAS) involves the “intelligibility” of the child’s speech such as:

• Distortions of consonants and vowels
• Distorted sound substitutions
• Repetition of words with error inconsistency
• Prosodic errors. Prosody refers to the pitch, rate and the rhythmic features of speech.

Symptoms of Dyspraxia and Apraxia in Babies and Toddlers

• Hypertonia or hypotonia (muscle tone)
• Delay in reaching developmental milestones – especially speech
• Impaired oral motor muscles such as the face and tongue which are needed to speak
• Not cooing as an infant
• Struggling to combine sounds
• Eating issues
• Difficulty in imitating a sequence of movement
• Difficulty in performing physical activities such as climbing stairs, running, hopping and jumping as compared to other children the same age
• Difficulty chewing solid food
• Difficulty with pincer grasp and holding a pencil/drawing. Drawings may appear immature for the child’s age
• Difficulty performing daily activities and self-care tasks such as getting dressed
• Taking longer to acquire new skills
• Falling over a lot and appearing clumsy
• Problem grasping the concepts of “in”, “on”, “in front of”, etc.
• Difficulty establishing relationships with peers
• Problems with social behavior
• Anxiety or agitation
• Delayed language development or problems with speech
• Less babbling than peers

Symptoms of Dyspraxia and Apraxia in School-Aged Children

• Difficulty participating in group situations
• Much better participation in a one-on-one setting
• Problems with math
• Handwriting problems (dysgraphia)
• Poor drawing skills
• Difficulty with expressing thoughts in writing
• Difficulty in copying things from the board in school
• Difficulty in dressing themselves and with zippers, buttons, snaps, tying shoe laces
• Difficulty holding a pencil, pen, drawing utensil, paint brush, and scissors
• Problems with organizing and planning
• Poor concentration
• Poor listening skills
• Inability to follow instructions
• Poor memory, both visual and auditory
• Avoidance of physical education in school or physical activities with friends
• Anger and frustration
• Poor social competence
• Academic problems in learning to read, write and spell
• At risk for bullying
• Low self-esteem
• Behavioral problems
• Prone to temper tantrums
• Poor physical fitness because of fine- and gross-motor coordination issues
• Poor ball skills
• Clumsiness
• Lack of coordination
• Feelings of nervousness, anxiety and frustration speaking in class
• Sensitivity problems with their mouths, such as not liking to brush teeth or eat crunchy foods
• Hypersensitive to touch, sounds and smells
• Impulsiveness
• Lacking of a sense of direction, position or time
• Stressed by new and unpredictable situations
• Preference for repetitive and familiar activities
• Difficulty in understanding what other people say
• Needing accommodations in class for assignments and longer time for tests

What Your Doctor May Tell You About Dyspraxia and Apraxia

Your child’s doctor may tell you that more boys than girls are affected but girls may experience more severe symptoms. The pediatrician may suggest a neurologist to perform a neurological exam and look for dysmorphic features. The doctor may ask your child to perform normal everyday tasks and observe your child’s play.

Your child’s doctor may want to do other tests to rule out associated conditions with this disorder such as:

• Autism Spectrum Disorder
• Dyslexia
• ADD/ADHD
• Sensory Processing Disorder
• Auditory Processing Disorder
• Cerebral Palsy
• Hypotonia

A multidisciplinary management plan may be initiated by your child’s doctor with other healthcare professionals such as an:

• Occupational therapist
• Physical therapist
• Educational psychologist
• Neuropsychologist
• Speech and language pathologist

If your child has dyspraxia or apraxia of speech, your child’s pediatrician may recommend an alternative or augmentative form of communication such as:

• Sign language
• Communication board
• ACC (Alternative Communication Device)
• An iPad or tablet

Another Way to Think About Dyspraxia and Apraxia

Methylation Issues

Children with dyspraxia and apraxia typically have a genetic mutation known as the MTHFR which creates methylation issues so that these children are unable to detoxify their body and brain from unwanted environmental toxins that have typically contributed to their conditions.

A defect in the methylation process can cause many issues including language and cognitive impairment, as shown here and here. The easiest yet most effective way to support your child’s methylation process is through the skin, where there is maximum absorption of nutrients.

Nutritional Deficiencies

Vitamins, minerals and nutrient deficiencies are crucial contributing factors to dyspraxia and apraxia because the brain is typically starving in children with these conditions. The perfect storm that can create the starving brain can consist of:

• Nutritional (vitamins and minerals) deficits
• Malabsorption issues of nutrients and fats
• Environmental allergies
• Food sensitivities and intolerances
• Poor gut bacteria in the microbiome
• Lack of fats in the diet for the brain

All of these may be contributing factors to learning and behavioral issues, and the inability to plan and coordinate motor movements.

Fatty Acid Deficiencies

Dyspraxia and apraxia have been found to have an underlying fatty acid deficiency and abnormal fatty acid metabolism. In addition, many children with dyspraxia or apraxia have been found to have low cholesterol. Fats are critical! The brain is 60% fat and requires good fats to function efficiently. About 50% of a child’s intake of food in the first two years is consumed for brain growth, and good fats are essential for the growing brain.

Essential Fatty Acids (EFA) provided in the diet and by supplementation are essential and a key underlying factor to proper brain and eye functioning for children with dyspraxia and apraxia.

Some of these beneficial EFAs are:

• Omega-3 fatty acids such as:
  • DHA (docosahexaenoic acid)
  • EPA (eicosapentaenoic acid)
  • ALA (alpha linolenic acid)
• Omega-6 fatty acids such as:
  • GLA (gamma linolenic acid)
  • CLA (conjugated linoleic acid)

EFAs need to convert in the body to the long-chain Highly Unsaturated Fatty Acids (HUFA) for proper brain and eye functioning. The conversion of EPA to HUFA can be blocked due to:

• Excess saturated fats
• Hydrogenated fats
• All trans fatty acids, which are poor-quality fats found in processed foods
• Zinc deficiency
• Stress hormones such as cortisol, adrenaline, norepinephrine and epinephrine

The conversion can also be impaired in children with eczema, asthma and other allergic conditions. Hyperactive children typically cannot convert EFAs to HUFA because these children are typically zinc deficient, and zinc deficiency leads to poor EFA processing in the body. Salicylates (food additives) can block the conversion of EFAs to prostaglandins, which are important in brain function; many children with ADD/ADHD have a sensitivity to salicylates.

Males have a greater need for EFAs; hence more boys have dyspraxia or apraxia than girls.

Children do not “outgrow” essential fatty acid deficiencies; those deficiencies can manifest as neuropsychiatric mood disorders such as:

• Anxiety
• Depression
• Mood swings
• Aggressive behaviors

Neurotransmitter Deficiencies

Without enough good fats, neurotransmitters in the brain – the messengers that send information to the brain cells – cannot do their job. Poor fat intake means a possible brain disconnect that affects the entire body – emotional, behavioral, cognitive and language.

Neurotransmitters create muscle strength and muscle growth needed for motor movement. Amino acids, both essential and non-essential, are needed to create neurotransmitters. Animal-based protein such as fish, meat, poultry, dairy and eggs all contain complete proteins and provide essential amino acids the body needs and cannot make itself.

A vegetarian diet does not contain complete protein and lacks good quality fats found in these proteins, so supplementation may be needed. Whole foods rich in protein, complex carbohydrates and healthy fats all contribute to healthy brain functioning.

Research About Nutritional Deficiencies in Dyspraxia and Apraxia

DHA Supplementation

Research published in the American Journal of Clinical Nutrition showed that after taking DHA tuna oil and thyme oil for three months, 15 children with dyspraxia made significant improvement in their hand-eye coordination in areas such as dexterity, balance, coordination and fine motor movements. Thyme oil greatly increases the efficiency of DHA; it is an antioxidant and protects the oils against oxidation.

Vitamin E and Omega-3 Fatty Acid Supplementation

A study from Nationwide Children’s Hospital of 187 children between the ages of 2 and 15 and diagnosed with verbal apraxia received vitamin E (800 IU/day) and omega-3 fats (560 mg DHA + 1390 mg EPA/day) while having blood drawn to measure for digestion (absorption issues as well as digestive inflammation).

Remarkably, 181 families (97%) reported “dramatic improvements” in multiple areas of behavior that included:

• Speech
• Imitation
• Coordination
• Eye contact
• Behavioral issues
• Sensory issues
• Digestive symptoms

Five families saw no improvement, and one family reported a worsening of symptoms that caused them to stop supplementation with one week. The blood tests showed many the children also suffered from food allergies, especially gluten; researchers found that 70% of the children had a gluten allergy compared to only 12% of the rest of the general population. 83% of families reported digestive problems in their children before the study, suggesting that allergies, digestive issues, apraxia and behavioral issues may all be interrelated and possibly improved with vitamin E, omega-3 fat supplementation and a gluten-free diet.

Signs of Fatty Acid Deficiencies:

In infants:

• Extreme restlessness
• Crying
• Poor sleep patterns
• Difficulties in feeding
• Colic
• Constant thirst
• Frequent tantrums
• Head banging
• Rocking the crib

In children:

• Excessive thirst
• Frequent urination
• Rough or dry skin and hair
• Dandruff
• Soft or brittle nails
• Atopic allergies (eczema)
• Chronic infections
• Visual disturbances when reading, sensitivities to bright light, night blindness
• Attentional problems – distractibility, focus and concentration issues, poor memory
• Emotional sensitivity – excessive mood swings or undue anxiety
• Sleep issues with both falling asleep and getting up
• Hyperactive and impulsive
• Uncooperative, defiant, disobedient, oppositional
• Often interrupts frequently

Laboratory Testing:

While lab tests cannot identify developmental delays, they can pinpoint potential root causes of your child’s delays. Laboratory testing may include blood, urine, stool or saliva with the intent on:

• Correcting underlying deficiencies and dysfunctions
• Restoring body and brain functioning
• Improving problematic behavioral or developmental symptoms

so that the child may attain their greatest potential and have the best quality of life possible.

Important testing of various contributing factors include:

• Heavy-metal testing
• Mitochondrial dysfunction
• Food sensitivities and intolerances
• Environmental allergies and excessive histamine
• Poor digestion and processing of foods, especially carbohydrates
• Leaky gutand malabsorption
• Intestinal dysbiosis, including SIBO (Small Intestinal Bacteria Overgrowth), yeast overgrowth and bacterial imbalances
• Abnormal intestinal flora
• Impaired ability to detoxify
• Oxidative stress
• Toxic overloadfrom heavy metal toxicity, pesticides, chemical preservatives, Genetically Modified Organisms (GMOs) and other environmental pollutants
• Immune dysregulation
• Inflammation
• Low muscle tone
• Nutrient and mineral deficiencies
• Persistent pathogens– virus, bacterial, fungal, parasitic
• Neurotransmitter imbalances
• MTHFR genetic mutationand poor methylation process
• Automatic dysregulation – sympathetic overdrive “fight or flight”
• Insufficient fats in the brain
• Biochemical stress
• Developmental vision problems
• Auditory and language processing difficulties
• Speech delays and speech deficits
• Abnormal gait
• Low cholesterol
• Imbalances in the right and left hemisphere of the brain

Dyspraxia/Apraxia Healing Checklist

Heal the gut:

The first step is to heal the gut – the gastrointestinal tract and its microbiome – which is the hub of the good bacteria (probiotics) in the body. By healing the gut, the immune system can be improved because 70% of the immune system is found in the gut.

A baby’s microbiome can be disrupted by a mother’s poor diet, antibiotics, NSAIDS (non-steroidal anti-inflammatory drugs) and usage of birth control pills because mothers transfers their poor microbiome to their baby. Mothers who use preconception antibiotics may have babies with serious gut issues, which can lead to behavioral problems and developmental delays.

Antibiotics kill bad bacteria but also good bacteria (probiotics) as well as white blood cells, which protect the immune system, in the process. Antibiotics don’t discriminate, causing the intestinal flora and good bacteria to be destroyed, leaving the immune system compromised and unable to protect the body from future infection.

Constant usage of NSAIDs, which are common anti-inflammatories such as Motrin, Tylenol and ibuprofen, in either the pregnant mother or child can result in leaky gut syndrome and/or SIBO (Small Intestinal Bacterial Organism), which can lead to autoimmunity. Leaky gut and SIBO can lead to an inability to absorb nutrients and minerals needed for the brain and the body.

If the gastrointestinal tract and the microbiome have too many pathogenic viruses, bacteria, yeast and/or parasites, then the vagus nerve may transport these pathogens to the brain, causing the brain to have imbalances in the neurotransmitters and delays in the child’s development.

A compromised immune system before three years of age can cause developmental regression. Chronic infections, such as Lyme disease, viruses, pathogenic bacteria and mold, compromise the immune system, causing excessive inflammation, disrupting development and affecting the brain and a child’s development.

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