210 Innnovations and Insights

Within the boarding environment, all pupils are encouraged to develop personal
organizational skills in a ‘safe’ structured framework, with an expectation that they
will take increased responsibility for themselves as they mature. This is achieved
by a consistent reward system, whereby they are taught how to organize their
personal belongings, and are then marked on a daily basis accordingly. If full marks
are achieved by the end of the week, then children are rewarded with a late evening
video session. Dyspraxic pupils are helped to achieve at the same standard as
others.
Other interventions have included the use of the Alexander Technique for the
severest of dyspraxic pupils. This has shown improvements in kinaesthetic
awareness, appreciation of personal space and, therefore, improved social skills,
as well as better handwriting (Lyons, Payton and Winfield, 1999).
Currently, a club is being run for a small group of pupils based on the
intervention programme formulated by Madeline Portwood (Chairperson of the
Education Committee of the Dyspraxia Foundation). This includes ‘fun’ activities
to enhance both fine and gross motor control, and motor planning. These activities
are specifically designed to meet the needs of the individual child. An example
might be the ‘Smartie Run’ to improve balance, encourage stretching and develop
motor planning skills. Bowls, each containing different coloured sweets, are placed
at various heights around the room. The child runs from bowl to bowl in sequence,
picking up a sweet and replacing it with one collected from a previous bowl. This
is a timed activity, with the child verbalizing his actions and attempting to collect
as many sweets as possible in a given time.
The club is run on a daily basis, after school, with the children working in pairs
for 10–15 minutes at a time. It is too early to comment on the success of this
intervention.
Although dyspraxic children have always been with us, the formal identification
of such difficulties is a fairly recent phenomenon. In an ideal world, the
occupational therapy service would provide for the needs of the dyspraxic child.
However, such services are scarce and we feel that it is incumbent upon the school
to provide what it can to meet the needs of such children.
References
Aughton, T. (1998) Dyslexia and physical education. The Dyslexia Handbook 1998.
Lyons, C., Payton, P. and Winfield, M. (1999) A study of the possible benefits of the
Alexander Technique for children exhibiting comorbidity of dyslexia/dyspraxia. Dyslexia
Review, 11(2, Autumn).

Dyslexia and Developmental

Verbal Dyspraxia
Marion McCormick

T
his article looks at the overlap between dyslexia and verbal dyspraxia.
Clinical manifestations are initially described, followed by an examina-
tion of the overlap.

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Dyspraxia 211

CLINICAL MANIFESTATIONS: SIMILARITIES

Both conditions share some common themes:

“ Controversial diagnoses.
“ Clinical parameters are difficult to define.
“ Diagnosis is usually made with reference to a set of criteria, and is thus
symptom clusters, rather than unitary diagnoses.
“ They are both developmental in nature, and thus the symptomatology
and pattern of relative strengths and weaknesses vary over time and with
intervention.
“ They both occur in childhood.
“ Both can occur as a sequel to neurological insult and have an acquired
form.
“ Both can co-occur with other conditions.

CLINICAL MANIFESTATIONS: DIFFERENCES

Dyslexia
The spoken language problems experienced by children with dyslexia are
frequently ‘hidden’. These children are often conversationally competent,
with a complete, or almost mature, range of phonological contrasts. Lan-
guage difficulties are frequently evident, although these may be subtle or at
a high level, e.g. word finding difficulties.
However, the most frequently reported area of deficit is that of phonolog-
ical processing skills. These are ‘those cognitive skills that underlie the
processing and production of speech’ (Stackhouse and Wells, 1997).

Developmental Verbal Dyspraxia

The term ‘developmental verbal dyspraxia’ (DVD) is that which is most
widely used in this country. Although there is significant controversy about
each element of the definition (see Ozanne, 1995), it is generally held to
cover the main components of the disorder. The spoken language problems
experienced by children with DVD are evident from the early stages of
speech and language development. The earliest manifestations may be with
feeding difficulties in infancy, and may be accompanied by more pervasive
motor programming deficits in fine motor development. The speech and
language difficulties manifest predominantly in: delayed expressive lan-
guage, difficulty in producing speech sounds in isolation, severely reduced
intelligibility in connected speech, and inconsistent productions of familiar
words.
DVD has been defined as ‘a phonological disorder resulting from a
breakdown in the ability to control the appropriate spatial/temporal proper-
ties of speech articulation’ (Crary, 1984). Research shows that it can no
longer be assumed that children described as verbally dyspraxic, have only
one focus of breakdown at the level of motor programming (Dodd, 1995).
Psycholinguistic investigations have shown more than one level of output

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212 Innnovations and Insights

difficulty, which accounts for the persisting nature of this difficulty, which:
“ Affects self monitoring
“ Impairs rehearsal of new words for speech or spelling, therefore, there is
a high incidence of associated input difficulties.
“ Results in inconsistent/distorted output, which may have an adverse
effect on auditory processing skills and the developing lexicon.

A UNIFYING APPROACH? IS THERE AN OVERLAP BETWEEN

DYSLEXIA AND DVD?

There is overwhelming research evidence to show that:

“ Unresolved phonological and/or language problems in infancy or early
childhood lead to an increased risk of literacy problems in the school
aged child.
“ Children with literacy problems are frequently found to have persisting
language difficulties.
“ The rate of co-occurrence of speech/ language, with literacy difficulties is
high.
This degree of association implies a common origin, or locus of difficulty.
Several parallels may be drawn between spoken phonological acquisition
and emergent spelling. In both fields, the nature of the task is similar. An
important task facing children, both in learning spoken phonology and
spelling, is first to isolate meaningful units, and then to work out how the
units differ from one another (i.e. the syntagmatic or successive, and the
paradigmatic or simultaneous relations between sounds and graphemes).
The skills needed to address the task — segmentation, sequencing and cate-
gorization—are the same for both speaking and spelling.
Before learning to read and spell, children have already established a
speech processing system to deal with their spoken language (Pring and
Snowling, 1986). The term ‘speech processing’ ‘refers to all the skills in-
cluded in understanding and producing speech’ (Stackhouse and Wells,
1997). Phonological processing skills constitute a subset of these skills, and
the term refers to the ability to identify and manipulate aspects of phonolog-
ical information (the sounds of language) for mental operations involving
spoken and written language.
This same speech processing system is also the foundation for written
language development. Thus, deficits in the speech processing system will
have an impact on the development of a child’s literacy skills. When children
begin to acquire literacy, they need to apply their current phonological
knowledge and learning strategies to relate written representations of words
to their internal representation of spoken words. Spelling is especially
dependent on speech processing skills, as it is a process that depends on
retrieval of information stored in the lexicon, rather than on recognition of
partial cues, as in reading. Thus, spelling difficulties are often more obvious
than reading problems in children with speech and literacy problems.
Preliterate children have implicit knowledge about the nature of the

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Dyspraxia 213

phonological system of their native language. They are able to discern and
utilize abstract phonological processing strategies for rhyme detection and
production, and are able to perform phoneme synthesis and deletion. When
they are faced with the challenge of acquiring literacy, that knowledge needs
to be made explicit. Implicit language knowledge involves the abstraction
and use of linguistic rules, whereas explicit language knowledge involves
the ability to examine and manipulate these rules at a conscious level. The
child needs to recognize, and mentally represent, relationships and regulari-
ties between linguistic units that they have not previously discerned. If
applied to phonological development, the implications of this hypothesis are
that covert reorganization of phonological knowledge may be initiated by
the initial stages of literacy acquisition.
Stackhouse and Wells (1997) introduced a psycholinguistic framework for
investigating the processing skills underlying children’s speech and lan-
guage problems. This framework is derived from ‘a theoretical model of
speech processing from which hypotheses are generated about the level of
breakdown that gives rise to disordered speech output . . . It allows (one) to
locate a speech processing difficulty at the level of input, representation or
output’. The framework also includes a phase model of speech development,
which is compared with Frith’s model of literacy development, and the
relationships between phases of speech development and literacy develop-
ment are set out.
On the basis of the above discussion, one hypothesis would be that both
dyslexia and dyspraxia arise from a similar pool of core deficits in phonolog-
ical processing skills, but that these difficulties impact at different stages of
the developmental continuum. Dyspraxic difficulties, which are often overt
and severe in terms of the amount of disruption caused to emergent speech
and language skills, arise earlier, thus having a pervasive effect on the
developing system, and thus on the development of implicit language skills.
Whereas dyslexic difficulties are frequently covert in the early stages of
linguistic development, and become apparent only when the acquisition of
literacy necessitates the reorganization of phonological knowledge into an
explicit, integrated system that allows the development of more abstract
processing skills.
Stackhouse and Snowling (1992) compared the results of tests performed
on dyspraxic children with those of dyslexic children who had normal
speech. The findings showed that the dyspraxic children’s spelling diffi-
culties were more serious than those of the dyslexics, and suggested that ‘the
persistence of speech production difficulties have particularly devastating
consequences for the acquisition of literacy’.
They are similar in that literacy development has been arrested within the
logographic phase, but different in that their phonological difficulties are perva-
sive to an extent which may well preclude the development of literacy along
normal lines (Snowling, 1987).
The conclusion that can be drawn from these studies is that ‘the degree of
reading and spelling deficit observed in any given child is associated with
the severity and pervasiveness of the phonological deficit to which he or she
is subject’ (Snowling, 1987).

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214 Innnovations and Insights

References
Crary, M.A. (1984) Neurolinguistic perspective on developmental verbal dyspraxia.
Communicative Disorders, 9, 33–49.
Dodd, B. (1995) Differential Diagnosis and Treatment of Children with Speech Disorder. Whurr
Publishers Ltd.
Ozanne, A. (1995). In B. Dodd (Ed), Differential Diagnosis and Treatment of Children with
Speech Disorder. Whurr Publishers Ltd.
Pring, L. and Snowling, M. (1986) Developmental changes in word recognition: an
information processing account. Quarterly Journal of Experimental Psychology, 38a: 395 – 418.
Snowling, M. (1987) Dyslexia: A Cognitive Developmental Perspective. Basil Blackwell Ltd.
Snowling, M. and Stackhouse, J. (1996) Dyslexia, Speech and Language: A Practitioner’s
Handbook. Whurr Publishers Ltd.
Stackhouse, J. (1997) Developmental verbal dyspraxia. I. A review and critique. European
Journal of Disorders of Communication, 27, 19–34
Stackhouse, J. and Snowling, M. (1992). Barriers to Literacy development in two cases of
developmental verbal dyspraxic. Cognitive Neuropsychology, 9, 273 – 299.
Stackhouse, J. and Wells, B. (1997) Children’s Speech and Literacy difficulties: A Psycholinguistic
Framework. Whurr Publishers Ltd.
Thomson, M. and Watkins, S. (1998) Dyslexia: A Teaching Handbook. Whurr Publishers Ltd.
Vance, M. (1996) In J. Stackhouse and M. Snowling (Eds) Dyslexia, Speech and Language. A
Practitioner’s Handbook. Whurr Publishers Ltd.

Copyright © 2000 John Wiley & Sons, Ltd. Dyslexia 6: 202 – 214 (2000)