Written By: Jonathan Andrews
It has been well documented in various studies that a large number of people across the autistic spectrum experience symptoms of Developmental Coordination Disorder (DCD), commonly called dyspraxia– a special educational need affecting gross and fine motor skills, including traits such as handwriting, uneven gait and slurred or stuttering speech, and difficulties with activities like tying shoelaces (and making sure they stay tied!), swimming and riding a bike, among others. It can also manifest in a person adopting a more ‘sedentary’ nature, as they view themselves as deficient at sports and so lose interest in participating in them or exercising; another trait well documented among those with autism diagnoses. In fact, the overlaps between the two are well documented,across numerous sources, and so many people are affected that the National Autistic Society has even compiled a guide for those who are ‘affected by’ both diagnoses.
Yet while many of these people would have enough traits to qualify for a formal diagnosis of dyspraxia, their ASD diagnoses means this often isn’t possible. As the Dyspraxia Foundation notes, while it is very common for autistic people to experience traits and symptoms of dyspraxia, policy guidelines make it very difficult for someone to be diagnosed with both. Only if traits are exceptionally severe are dual diagnoses made, and even then this is still technically against policy and carried out for pragmatic reasons; officially, a diagnosis even of PDD-NOS, often considered to be the mildest form of autism, precludes a dyspraxia diagnosis.
The rationale for this – that clinicians understand coordination issues to be part of autism, so there is no need for a second diagnosis which will overlap with the existing one – bears some merit within the psychiatric, academic world, but becomes tenuous once one considers popular (mis)conceptions of autism and dyspraxia – and it is these conceptions that shape the everyday society most autistic people live in. As YouGov polling demonstrates, when most people think of autism, they don’t think of coordination issues. They might just think of autistic people as being “weird”, “rude”, or “naughty”; or, if they have more interest, experience and understanding, they’d probably think of people with rigid, obsessive behaviours, who find it very difficult to understand others and take part in social conversations and activities.
Rarely will someone think of things like coordination issues, or even sensory differences – the areas where autism and dyspraxia most overlap – because the public view of autism doesn’t focus on these. While the person diagnosing might register this aspect of autism, it’s far less likely that their teachers or classmates will – so unless the person or their parents are very good advocates with a mastery of the ins-and-outs of autism and dyspraxia, along with an ability to communicate this clearly to others (especially difficult since general dyspraxia awareness itself is very low), it is far more likely these difficulties will simply go overlooked.
Moreover, it makes it far more difficult for those with symptoms of dyspraxia but no diagnosis to have their needs met – a diagnosis is essential to access services like Personal Independence Payment,Disability Living Allowance and speech therapy (for those with verbal dyspraxic traits, which can make pronunciation very difficult). The individual might well be aware – many autistic people with significant dyspraxia/DCD traits choose to self-identify as dyspraxic even if policy denies them official diagnosis on a technicality – but this won’t help when services request evidence.
I’ve also heard the policy against dual diagnoses being defended as a tactic to prevent “labelling” children – which, again, doesn’t stand up to scrutiny. Autism is just as much a ‘label’ as dyspraxia, if not moreso given the stereotypes that accompany any mention of the word – so all that happens is that people receive a label which doesn’t make others aware of their coordination issues; in short, a label that doesn’t work. I have known of good practitioners who work around this by including specific reference to dyspraxic traits in their report on the autism diagnosis – in fact, this happened to me – but this is by no means universal, and without assistance like this, parents and those diagnosed come away lacking an understanding of their traits. If their diagnosis and reports don’t mention dyspraxia by name, why would they assume it’s an issue? Why would anyone else, like service providers, accept it without evidence? Such a policy serves only to deprive people of assistance, and – perhaps more importantly – self-understanding.
I can’t change diagnostic policy overnight, but by writing this I hope I’ve helped make more people aware of this issue of ‘silent dyspraxia’ and the affect it has on tens of thousands of people across the UK. And anyone reading this can help too – if you’re an employer, for instance, the next time someone with autism is offered a role in your organisation, it would help to look at potential adjustments beyond just the social sphere. If you’re a teacher with autistic pupils – frankly, pretty much every teacher, given that at least 1 in 100 people have autism, if not many more – you can be more aware of these differences and how they might affect the pupil’s learning. And even if you’re none of these, and don’t even know or work with anyone with autism or dyspraxia, you’ll help just by being aware, letting others know, and keeping it in the back of your mind that ‘autism’ doesn’t mean ‘socially deficient’ – it’s a wide and complex spectrum, which includes coordination issues.