I must protest however at the statement “in the rest of the country such provision is unheard of”. In the 14 years since I went into paediatric occupational therapy caseloads in all children’s centres have been transformed by the number of children referred with developmental co-ordination disorder. Annually several hundred therapists attend the numerous study days, workshops and conferences organised throughout the country.

In our children’s centre more than 100 children are assessed and treated each year. We also have a long waiting list. Our treatment options include individual home programmes individual treatment sessions, group sessions after school and holiday group sessions. At present we are working to improve our support for parents. We work with class teachers, area support teams and teaching auxiliaries. We also liaise closly with the team of specialist advisory teachers.

The diagnosis of dyspraxia has led to a long and unresolved debate. Some professionals (myself included) use the term very specifically to describe those children who have difficulties in motor-planning and sequencing. The Diagnosis and Statistical Manual (American Psychiatric Association 1994) definition of developmental co-ordination disorder is perhaps more generally useful and less misleading. “Performance of daily activity that requires motor co-ordination is substantially below that expected, given the child’s chronological age and measure of intelligence.”

Delay in developing co-ordination skills may be accompanied by sensory perceptual delay, (visual, auditory or tactile) and difficulties with self-organisation and sequencing. Each child’s cluster of difficulties is different, and likewise their response to treatment is variable.

MOIRA BYRNE 39 Logan Road Bristol