1862Boston Children's Hospital, Boston, MA, USA.
J Child Neurol. 2021 Mar;36(3):210-221. doi: 10.1177/0883073820966913. Epub 2020 Oct 25.
The term is clearly understood in adult behavioral neurology, with assessment of gesture central to the diagnosis. In contrast, the concept of "developmental dyspraxia" has been more problematic. In an effort to better specify its potential significance, we describe preliminary practice-based evidence for understanding developmental dyspraxia acquired within a theoretical framework informed by both adult behavioral neurology and a neuroconstructivist appreciation of neurodevelopmental disorders. Specifically, we describe the experience of a diagnostic clinic for children with learning disorders that adopted this framework and compare clinical characteristics of children diagnosed with dyspraxia with those of children diagnosed with dyslexia during the same time period.
The dyspraxia diagnosis was based on the presence of impaired gesture and/or cognitive problems with planning. Over the target period, 71 children were diagnosed with dyspraxia and 114 children were diagnosed with dyslexia. Twenty-nine of the 71 children with dyspraxia were also diagnosed with dyslexia. Domains assessed included early developmental milestones, neurologic findings, cognition, speech and language, academic skills, and psychosocial functioning.
Compared to the dyslexia group, children with dyspraxia (with or without dyslexia) had more problems with speech and language planning and planning in everyday life. Children with dyspraxia without dyslexia had more frequent early motor delays and deficits in visuospatial production than the other groups. The dyslexia groups predictably demonstrated poorer single word reading and phonologic processing compared to the dyspraxia only group (all < .01).
A neurologic finding of impaired gesture in children with learning disorders may signal a broader neurodevelopmental profile of developmental dyspraxia with both theoretical relevance and meaningful implications for evaluation and treatment. Cognitive problems with planning are particularly relevant.
“发育性运动障碍”这一术语在成人行为神经学中被明确理解，其评估主要集中在手势上，这是诊断的关键。相比之下，“发育性运动障碍”的概念则更为复杂。为了更好地确定其潜在意义，我们在一个理论框架内描述了初步的基于实践的证据，该框架既受到成人行为神经学的影响，也受到神经发育障碍的神经建构主义观点的影响。具体来说，我们描述了一个为学习障碍儿童设立的诊断诊所的经验，该诊所采用了这一框架，并比较了在同一时期被诊断为运动障碍和阅读障碍的儿童的临床特征。
运动障碍的诊断基于存在受损的手势和/或认知规划问题。在目标时间段内，共有 71 名儿童被诊断为运动障碍，114 名儿童被诊断为阅读障碍。其中 29 名运动障碍儿童也被诊断为阅读障碍。评估的领域包括早期发育里程碑、神经系统发现、认知、言语和语言、学业技能和社会心理功能。
与阅读障碍组相比，同时患有运动障碍（或不伴有阅读障碍）的儿童在言语和语言规划以及日常生活规划方面存在更多问题。不伴有阅读障碍的运动障碍儿童比其他组更早出现运动延迟和视空间生产缺陷。阅读障碍组在单词阅读和语音处理方面明显比仅运动障碍组差（均<0.01）。
在学习障碍儿童中发现的神经学上的手势受损可能表明存在更广泛的发育性运动障碍神经发育模式，这既有理论意义，也对评估和治疗有重要意义。规划方面的认知问题尤其相关。
