Plenary,

Meeting date: Thursday, May 25, 2000

Official Report 664KB pdf

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Dyspraxia

We now move on to members' business. I ask members who are not taking part in the debate to leave the chamber quickly and quietly.

The final item of business is a members' business debate on motion S1M-653, in the name of Duncan Hamilton, on dyspraxia. The debate will be concluded after 30 minutes without any question being put. Members who wish to speak in the debate should press their request-to-speak buttons as soon as possible.

Motion debated,

That the Parliament notes the establishment of the first paid development worker within the field of dyspraxia in the UK, to be based in the Highlands and Islands; notes that the condition is estimated to affect up to ten per cent of the population; recognises that dyspraxia is often overlooked by GPs and is unknown to many in the teaching profession, and believes that greater recognition should be given to the condition by education and health professionals and that dyspraxia should be included in the current regime of pre-school screening.

First, let me put this debate in context. I am sure that some members will be unaware of the definition of dyspraxia and of what the motion tries to achieve. I am hugely grateful for the support that I have had from colleagues. Sixty-six members of Parliament have chosen to sign this motion, which I believe is the second highest number of signatories for any motion, with the exception of Mike Russell's motion on the Act of Settlement. That shows how seriously members are beginning to take dyspraxia. Support for the motion has come from all parties. There is no party or independent member in the Parliament who has not signed the motion and I therefore ask the Executive to see the debate not as a challenge or a threat, but in a spirit of co-operation, so that we are all pushing in the same direction.

It would be remiss of me not to thank the Dyspraxia Foundation for all its support and help in preparing for the debate. I do not want to emphasis the local angle of this debate too strongly, but it is a matter of great pride to me and to other members for the Highlands and Islands that the first paid development worker specifically devoted to dyspraxia will be in the Highlands and Islands.

This issue goes right to the heart of joined-up government. Although it is in some sense a health issue, which is why the Deputy Minister for Community Care is here to answer the debate, it also touches on aspects of education, social inclusion and justice. It is good to see the Deputy Minister for Children and Education here too. I wonder where the others are; perhaps they will drop in later.

It is important to make clear to members who may not be acquainted with the condition that dyspraxia is defined by the Dyspraxia Foundation as an impairment or immaturity of the organisation of movement. It is an immaturity of the brain resulting in messages not being properly transmitted to the body. It affects up to 10 per cent of the population in varying degrees and 70 per cent of those affected are male. It can cause a range of symptoms, including poor motor skills and co-ordination, clumsiness—which leads to the common misnomer "clumsy child syndrome"—awkward movement, limited concentration and poor listening skills. It can impact on the very self-esteem of those who suffer it.

Although the motion focuses on pre-school screening and that is the action point of the debate, dyspraxia is a lifelong condition and does not only affect children. Also, it cannot be cured. The best that can be offered is some radical improvement in the lives of sufferers if the condition is identified early and physiotherapy and other treatment is made available. It is important to note that dyspraxia often overlaps with other conditions such as dyslexia—with which members will, perhaps, be better acquainted.

Why have I lodged the motion? In a sense, this is merely the latest stage in a campaign to get greater recognition for dyspraxia, which has often been the forgotten condition. While awareness of dyslexia has moved ahead, dyspraxia has been shelved. The first point that I should make is that we must remove the stigma that still attaches to dyspraxia. It still attaches because many teachers and GPs are unaware of the condition. They do not know what to look for and they do not know what to do when they find it.

I see that Dr Richard Simpson is here. It would, perhaps, be useful to hear a GP's perspective on what we can do to raise awareness among GPs. It is not acceptable that some GPs—through no fault of their own—are not aware of a condition that affects up to 10 per cent of the population. There are hard-pressed teachers who have never been given appropriate training to deal with dyspraxia. It is most important that action is taken, specifically the introduction of pre-school screening for dyspraxia, as happens in respect of other conditions. I hope that the Executive will go down that route.

It is important to examine the effects of the condition within the spectrum of the social inclusion agenda. Members should note that the sketchy research that has been done on the condition suggests that up to 60 per cent of sufferers develop psychiatric illness. That is an astonishing figure. The research also shows that a high proportion of those with criminal records suffer from dyspraxia. The link comes from the diminution of sufferers' self-esteem. There seems to be a correlation between the social exclusion caused by the disease and problems in later life. It is reckoned that about 50 per cent of adults in prison suffer from dyspraxia to a greater or lesser extent. It is astonishing to think what that means in a divided society.

We should examine the matter compassionately and we should attempt to move forward as a society. That might result in a saving to the Parliament and the Executive. If dyspraxia is diagnosed early and the mechanisms are in place to deal with it, there will be a real long-term saving, because social exclusion is astonishingly expensive.

It is wrong to say that little can be done. We do not know exactly what causes the condition; more research must be done on that. A study was done in 1998 on the effect of physiotherapy. It suggested that an eight-week intensive course resulted in an improvement of between 50 and 90 per cent in a set range of skills. There can be astonishing improvements if the resources and the will to provide physiotherapy exist. When people's self-esteem is encouraged to grow, we will truly be seeing a policy of social inclusion.

It would be wrong to suggest that nothing can be done for sufferers. Highlighting the problem is not enough—there must be positive action. I will speak briefly about the Government's action on dyspraxia so far. I have pursued the matter for some months, but had only a limited response from the Executive about what it has managed to achieve. Resources have not been made available and no commitment has been made to pre-school screening. I urge the minister to remember that the introduction of such screening has no cost. It has cross-party support and would build on the Government's current policy on special educational needs. It is not a threat—it is something to be embraced.

I hope that the Executive will accept the motion and join the bandwagon that will ensure that dyspraxia is never ignored again.

I thank Duncan Hamilton for raising this issue. I am pleased to have the opportunity to speak in this debate, as I am one of the teachers mentioned in the motion: I taught for 35 years and did not know about dyspraxia for 30 of them. I still do not know much about it, because we do not have much information. That makes one feel silly when people's difficulties are diagnosed.

The same is true of dyslexia—it has been in the public domain for a long time, but we are not yet dealing with it in the right way. If Duncan Hamilton will forgive me, I would like to consider dyspraxia and dyslexia together. ME is another condition that is difficult to diagnose; it is in the air, but people do not have a clear sense of what it is, what we should do about it or when we need to do it.

All the conditions that I have mentioned must be properly recognised and taken seriously by the authorities. Good practice must also be recognised, documented and promulgated to everybody involved—parents, local authorities, teachers and families. Those people need clear information and guidance. If this debate helps to draw people's attention to that need, it will have done a great service.

I hope that under the Standards in Scotland's Schools etc Bill, which provides for the inspection of local authorities, one of the issues that will be considered by inspectors is how screening for these conditions is conducted. I recognise that the division of responsibilities in this area between health and education is unclear, but I do not think that either service should wash its hands of the issue and say that it belongs to the other. As Duncan Hamilton said, this is about joined-up government. If the issue is dealt with properly, that will have a joined-up effect on the individuals concerned.

I call on ministers to take a genuinely purposeful overview of these conditions, which have been marginalised but seriously impair the life chances and opportunities available to youngsters. I urge them to put in place a strengthened and comprehensive screening system as soon as parliamentary time allows and at as early a stage in children's development as is feasible.

When we were debating individual learning accounts, we discussed literacy and numeracy. This issue gets to the heart of that. If we can identify conditions early—even if we cannot cure them—we can, as Duncan Hamilton says, develop strategies that allow people to have better lives.

I congratulate Duncan Hamilton not only on securing this debate but on the strong support that members have shown for it.

This aspect of disability, like many others, is undergoing a transformation in respect of recognition and management. We are beginning to understand some of the neurological bases of dysfunctions, although in the case of dyspraxia they are still extremely obscure. Duncan Hamilton was right to say that the answer lies in management rather than curative treatment.

The first issue is early diagnosis. I am not convinced that at present the primary care teams are able to ensure that. However, the development of local health care co-operatives provides the opportunity for a degree of specialisation, which can be built on in individual primary care teams through health visitors, rather than general practitioners. I do not think that we will get general practitioners to recognise this condition easily.

As Duncan Hamilton has illustrated, the problem is that children suffering from dyspraxia are often excluded. Indeed, parents and teachers may punish them inadvertently for what is perceived as willing clumsiness but is in fact something they are unable to manage. Early recognition is important, as is appropriate management, to deal with the problem of subsequent exclusion and the consequences that that has for self-esteem.

I hope that health visitors will be given specific training in this area. That training should be carried out in a joined-up way. At present there is a major problem with the provision of cross-cutting, multidisciplinary training. We have paid lip service to that for many years, but here we have a condition that makes it possible for us to consider training teachers, nursery school teachers and health visitors in such a way as to give us a cross-cutting ability. I hope that the Executive will consider making that the subject of a pathfinder or pilot project.

I congratulate Duncan Hamilton not only on securing today's debate, but on the work that he has done in seeking to highlight dyspraxia, the issues it raises and the families it affects.

Until six years ago, my wife and I had no idea what dyspraxia was—quite simply, we had never heard of it. Our eldest son, Oliver, had grown up a happy and healthy boy and although we thought he was a bit clumsy and not good at catching a ball or anything that required manual dexterity, we did not think anything was wrong. That was until he started school, which for every parent is a milestone.

I vividly remember the first parents evening we went to for primary 1 pupils. Some suspicions that we had developed were confirmed. I noticed that around a classroom covered in pictures the children had made, there was not one by Oliver. The reason, as the teacher then told us, was that he never finished his work. It was not because he was not a bright boy; he simply did not have skills with pencils and paint brushes.

In retrospect, it is clear that we saw all the other symptoms that Duncan mentioned, but what could be done about it? We found ourselves in a continuing struggle over the next five years to get the support our child needed. We had a struggle to get him assessed by an educational psychologist, a struggle to get learning support, a struggle to get occupational therapy, and a struggle to keep the support once he had it.

We lived in East Ayrshire at that time. The council's position was that it had enough people with special needs and it certainly did not want any more. Oliver was a bright boy. The council thought he was coping. He was not the least-achieving pupil in the school. I remember trying again and again to get over the message that it was not good enough that Oliver could cope with the difficulties and that it was his right to achieve his full potential.

We continued to fight and, with the support of people such as Graham Robertson of the Dyspraxia Foundation—which I should have declared I am a member of—we were given access to pioneering work by people such as Madeline Portwood. We passed it to the school, to the hands of Mrs Rowley, who was Oliver's supportive learning support teacher, and to Alison Gemmell, who was the head teacher of Fenwick Primary.

The positive message that I want to add to this debate is that those measures all made a difference. Occupational therapy, the learning support teacher and the exercises we did endlessly at home made a difference. Oliver's ability to write has improved, his thought process has evolved, his motor skills are greatly improved and while he will never be his hero, David Beckham, he can participate in sports.

Minister, I do not want other parents to be in the situation that we were in. We were lucky. We were able to work the system. We had the time, resources and energy to phone the school and education department every five minutes to pursue people in authority, to take Oliver to Cardiff to the innovative Discovery Centre, and to find a behavioural optometrist in Scotland. Members may not know what that is, but there are few in Scotland and they are important to this condition. That is why pre-school assessment is so important: because, following Oliver's experience, we were able to get pre-school assessment for our younger son, Lewis. He got support and occupational therapy at nursery at age three. Because of that early intervention, he no longer needs support. He is now five and a half. We should be aiming for that for all children with this disorder.

To conclude, everyone in Scotland has a right to achieve their full potential. My sons are proof that people with dyspraxia can do that if the help and support is available. The minister needs to make that happen for everyone.

The minister just has to take the example of Lewis and put it into practice for all children. That is what this debate is about.

In two weeks' time, when we consider stage 3 of the Standards in Scotland's Schools etc Bill, we will be putting the presumption to mainstream into legislation. That makes it all the more important that we have in place the structures necessary to identify and support all children entering education in Scotland, no matter what condition they suffer.

We have heard what dyspraxia is, but I wish to draw the minister's attention to the research done by Mitchell and Wood—two physiotherapists—on a simple test to identify dyspraxia. The test is so simple that suitably qualified and trained pre-school staff could be in the front line of identifying young children with dyspraxia. It is so simple that it can be incorporated into the current pre-school screening that is done by health visitors, to which Dr Simpson referred.

We must ensure that, once we have identified the children, they have all the help they need. It is now readily available; as it was for Lewis, but not for Oliver. We have to ensure that teachers understand the situation and that all the appropriate therapists are available for the children where and when they are needed. Most often, that will be in school.

I visited a special needs school this morning. I make a plea that we ensure that children with special needs have access to facilities outwith school, so that they have equal access to leisure.

I heartily congratulate Duncan Hamilton on securing this debate. I would like to hear from the minister that the simple tests that have been identified by Mitchell and Wood will be incorporated into pre-school screening.

I would like to join in the general congratulations for Duncan Hamilton on securing this debate today. It will help to raise the profile of dyspraxia in Scotland.

As we have heard, dyspraxia is a complex condition. It is not fully understood even among some medical professionals. It is not entirely neglected: 97 research projects on various aspects of dyspraxia are taking place in the UK today. Some are aimed at improving the condition in adults; although most of the debate has focused on children, this is a lifelong condition, as Duncan Hamilton correctly said. There is also a much wider body of research into conditions such as dyslexia and attention deficit hyperactivity disorder, which are associated with dyspraxia. In Scotland, the Royal Aberdeen children's hospital is doing research into dyspraxia and there are eight ADHD projects—one at Ninewells hospital in Dundee and seven at the Yorkhill hospital in this city.

Dyspraxia is not easy to diagnose, partly because it has so many symptoms that can be present in any combination. We have heard about many of the symptoms during the debate—general clumsiness, confusion between right and left, extreme sensitivity to touch, poor short-term memory and body awareness, and difficulty with learned tasks such as using a pencil or cutlery, or getting dressed. Dyspractic children can often have speech problems, which can be very severe. In spite of that, they are usually of average or above average intelligence. Many of the problems may appear at some point in the development of young children who are not dyspractic, which all adds to the difficulty of diagnosis.

There is no standard accepted treatment for dyspraxia and unfortunately no known cure. The main source of help for a dyspractic child is, as we have heard, in occupational therapy, physiotherapy and educational support, which can help the child to cope with his or her difficulties and to achieve his or her potential to a much greater degree.

I am not sure that we can say that the incidence of dyspraxia in Scotland is as high as 10 per cent. The Dyspraxia Foundation's website estimates that 2 per cent of families in the UK are affected by the condition. I make that point not to be critical, but to acknowledge further the difficulties of evidence-gathering on a condition that is not well understood.

On the ground that very few people know what symptoms they are looking for, I would have thought it likely that the incidence of dyspraxia could be even higher.

That is entirely possible. The condition is poorly understood.

The only statistics that are held centrally are for people who are discharged from hospital with a primary or secondary diagnosis of dyspraxia. A primary diagnosis means that dyspraxia was the reason for referral to the hospital; a secondary diagnosis means that the patient has been admitted for another reason but has been found to have dyspraxia too.

There were only 117 diagnoses of dyspraxia in 1999 and a further 25 diagnoses of specific development disorder of motor function, which may include some with dyspraxia. In some ways those statistics have little value. For example, they do not include out-patients; conversely they may include more than one admission of the same person.

Whatever the incidence of dyspraxia, I can understand and sympathise with the desire of families affected by the condition to see it included in the pre-school screening programme. There is no doubt that the earlier any developmental difficulty is diagnosed, the earlier the child can be helped.

I will respond in a little detail to the proposal in the motion. The Executive is advised on screening programmes by the national screening committee, which has a children's sub-group. National in this context means the whole of the UK, to give a broader statistical base. This is an eminent committee of experts that has continued to operate since devolution last year. The Executive has representatives on the national screening committee and the sub-group and both have Scottish members appointed for their expertise in particular areas.

When the national screening committee and the children's sub-group consider new possibilities for screening programmes, they work to overall criteria that include requirements that there should be a diagnostic test that is simple, quick and easy to interpret and accurate and that there should be a recognised standard treatment for the condition. Neither of those factors is generally considered to apply to dyspraxia at present.

I refer the minister to the research published at the end of 1999 by two physiotherapists, Mitchell and Wood, which identified what to me—as a layman—appears a very simple test for the detection of dyspraxia. Could that be brought to the national screening committee's attention?

I would be very surprised if it was not aware of the research, but I will ensure that it is aware of it.

The children's sub-group of the national screening committee does not have any immediate plans to include dyspraxia in its programme of conditions that may be included in national screening programmes in the future. It would be dishonest to say anything different in this debate. That is not to say that it ignores developmental disorders. Its future programme includes dyslexia, speech and language delay and conduct disorders, which are—as we have heard—all conditions that are often closely linked to dyspraxia. If screening programmes for those conditions are introduced in time, children with dyspraxia may benefit indirectly.

There is some movement down the route that Duncan Hamilton asked for, although dyspraxia is a less immediate destination than the motion desires. I make the point that the map is a clinical one, not a political one. There is no standard accepted medical treatment to help dyspraxia, but educational support can help almost all children with dyspraxia; that has been graphically described during the debate. In schools, a learning support teacher is often involved. If necessary, referrals can be made to community child health and to educational psychology. A medical officer and a psychologist can see the child, meet the parents and decide what needs to be done. If it is felt that dyspraxia is the problem, an occupational therapist can be called in to advise the teacher on ways to help the child.

Does not Iain Gray accept the point that I made: that parents who have the time, energy and resources can drive through support for their children, but that parents who are not in that position—who are, as the Executive often says, excluded—are not able to do so and accept what the establishment, the school or the health board say? Is not the minister putting some children at a disadvantage?

I take Mr Mundell's point. I make it clear that the situation that he described in his personal case is not acceptable. That level of difficulty in getting the required support is not acceptable.

Many of the possibilities of support arise through school. I will comment on what we can do to make that more effective for others in future. Children with dyspraxia will be among those who will benefit from the £12 million inclusion programme that was announced by Peter Peacock in the debate on special educational needs. Members who were in the chamber will recall that he recognised that in-service training for teachers was crucial for the early diagnosis of dyspraxia. That has been one of the points—although, I agree, not the central one—that has been raised in the debate. He pledged that resources would be made available to work towards increasing the effectiveness of in-service training. Today, Peter Peacock and I have agreed that he will refer the matter of dyspraxia to the national special educational needs advisory forum and seek its advice on how we can ensure that what we do is effective.

In conclusion, I congratulate Duncan Hamilton on bringing this little-understood condition to our attention today. Our debate and the number of signatories to the motion, as well as research, greater recognition among teachers and the work that is beginning in the Highlands and Islands, to which the motion refers, will move us a little way along the path of better understanding, which must underpin an improved response to dyspraxia in the future.

Meeting closed at 17:40.