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Autism affects social behavior and preferred patterns of activities, while dyspraxia leads to physical clumsiness and coordination struggles. How are the two linked?

Are you an autistic adult or the parent of an autistic child, and have you noticed a pattern of physical clumsiness and uncoordinated motor movements? Your quest for information may have sent you down a rabbit hole that ultimately landed you on something called dyspraxia. You may now wonder if there's an overlap between autism and this motor coordination disorder, want to know what their differences and similarities are, and, ultimately, whether you or someone you care about could have dyspraxia. 

Let's take a closer look!

What is dyspraxia?

"Dys", a word with Greek origins, means "bad" or difficult". "Praxis", meanwhile, can be translated in different ways, but in this case means something like "doing". If you're with us so far, it's not hard to understand why the condition has also been referred to as "clumsy child syndrome" (though it can affect adults as well).

Either way, the diagnostic criteria for the condition, which appears in the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5) under a third name — developmental coordination disorder — include:

  • An affected person's coordinated motor skills are significantly below their general developmental level and what would be expected in the context of the opportunities they have had to learn and practice using these skills. This means someone with dyspraxia will be clumsy. The DSM-5 lists dropping objects and bumping into things as examples. There's more to it, though, as their motor skills may also be physically slow. A person with dyspraxia may have trouble doing things like catching a ball or adequately using a knife and fork. 
  • To be diagnosed with dyspraxia (or developmental coordination disorder), a person's life has to be significantly negatively impacted by these symptoms. 
  • The symptoms must appear during childhood.
  • The symptoms shouldn't have another identifiable cause — like physical disability or neurological disorders. 

That's all there is to the official diagnostic criteria, but dyspraxia is more complex than that. One study described it as "an enigma to many people, both professional and lay", and makes it clear that there is no universally agreed-on set of characteristics. Though the study warns that clumsiness may indeed fall into the range of normal development and some people are wrongfully diagnosed with dyspraxia, around two percent of the population suffers from severe dyspraxia and a further 10 percent live with a milder form. 

So, who is at risk? Babies born prematurely, with a low birth weight, and those whose mothers drank alcohol during pregnancy seem to be disproportionately affected. Genetic factors also contribute. Notably, dyspraxia is likely to be more severe in people also diagnosed with ADHD. 

What does dyspraxia have to do with autism spectrum disorder?

It's a decent question. Autism spectrum disorder is, after all, a lifelong neurodevelopmental condition characterized by two completely different things — challenges in social communication and interaction, and restricted, representative patterns of behavior and interest. In simpler terms, this means that people on the autism spectrum will, to lesser or greater degrees, find it hard to communicate with neurotypical people and struggle to maintain social relationships. Autistic people have a strong need for routines and sameness, preferring to engage in the same kinds of activities over and over again and struggling with change. They "stim" — make repetitive movements or sounds — to help regulate their emotions. 

Autism can be diagnosed with and without intellectual impairment and language delays, but nothing about its core features — or diagnositic criteria, for that matter — is connected with physical clumsiness. Despite that, unusual nonverbal communication or body language is a feature of autism. To neurotypical people, the way an autistic person moves may look wooden or robotic. It may even come across as clumsy. 

Further, the DSM-5 makes a superbly interesting observation when it says that autistic people may simply be "uninterested in participating in tasks requiring complex coordination skills, such as ball sports". This, it goes on to say, may mean any evaluation of an autistic person's motor skills may yield observations that suggest they're behind their peers in terms of motor skills. This may not, however, actually "reflect core motor competence". In other words, any individual autistic person may appear to be clumsy and lack motor skills simply because they've prioritized the development of other skills and haven't worked much on their physical competence. (If you scroll back up to the dyspraxia section, you'll see that this excludes a diagnosis of developmental coordination disorder.)

Dyspraxia and autism can coexist in the same person, mind you. Anyone who meets the diagnostic criteria for both can be given a dual diagnosis. Not many studies have investigated the overlap between autism and dyspraxia, but those that do exist have indicated that people on the autism spectrum are indeed more likely than others to also have dyspraxia — about eight times more likely, in fact!

Also fascinating is the fact that the same study found that people diagnosed with dyspraxia but not autism have more autistic traits than those without dyspraxia. The researchers speculated that, because both conditions are linked to an "atypical development of neurons within the cerebral cortex", they may be caused by shared mechanisms. 

Where does this leave you?

Dyspraxia and autism have, as we've seen, some touching points — people on the autism spectrum may either be or seem physically clumsy and be uncoordinated, while people with dyspraxia display autistic traits like difficulties in empathetic social communication more often than others. 

They are, however, ultimately two different conditions. Having one doesn't mean you'll have the other, but it does make this more likely. People who meet the diagnostic criteria for both dyspraxia and autism spectrum disorder can be diagnosed with both conditions. 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA
  • Photo courtesy of SteadyHealth

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