Understanding Apraxia: The Importance in Autism and Other Sensory-Movement Disorders
“What do you mean my child has a ‘motor disorder’? He moves just fine!”
This month has seemed especially full of opportunities to speak with families and professionals about the fact that many (if not all) of our students with Autism are experiencing a combination of 1) sensory perception and processing differences and 2) Apraxia (or dyspraxia), a disorder that affects one’s ability to plan, initiate, execute, adjust, and stop motor movements. Now, this explanation in and of itself is difficult enough to grasp given that most people are still familiar with the traditional view of Autism as a disorder of behavioral, cognitive, and linguistic/social development. What makes it even trickier, though, is this idea of Apraxia: how can a student that can walk, grasp a pen, say some words, and maybe even type in and locate his favorite Youtube video on the Ipad have a movement disorder?
As I’ve alluded to in previous posts, we as humans have a really hard time ignoring each other’s behavior; after all, we rely on what people do and say to determine things like their intent, state of mind, and perceived intelligence. Most of the time, this system works, because most people have voluntary control of their behavior (i.e. motor system). We can assume that someone who looks at us, scowls, and says “Go away”, probably does want us to go away! But for someone who has difficulty with one or more of the aspects of Apraxia (planning movements and movement sequences, initiating them, executing them appropriately and making adjustments if needed, and stopping them), the tie between what her or she does versus what was intended becomes much fuzzier. This is because the brain has multiple avenues through which a certain motor movement can be triggered, depending on the context. Here’s an example:
You’re with a group of friends when someone says something hilarious, which makes you instantly smile and laugh!
You’re taking family photos, and smile when the photographer tells the group to say “cheese”
In the first example, your smile is an emotional response that was triggered by areas of your limbic system, which is a subcortical (i.e. non-conscious) part of your brain: you didn’t think about smiling or plan ahead to do so, it simply occurred involuntarily in response to the happiness you felt. However, in the second example, your smile was a planned, purposeful action that you initiated through your own thoughts. Your pre-frontal cortex considered the situation (I am waiting to take a picture), and gave your motor system the “ok” to smile when you were given the necessary cue (i.e. “say cheese”).
Unlike motor paralysis or weakness which affects all movement, Apraxia only affects this second pathway. This means a person is still able to physically complete movements (sometimes even highly complex ones) that are involuntarily triggered by an emotion or certain sensory stimuli. However, if someone were to then tell that person to do something (meaning the movement is now cognitively planned through the frontal cortex), he or she may not be able to even though he or she fully understood what was being asked (Apraxia does not affect someone's cognitive ability, only their brain's ability to develop and activate the correct motor plan for a given behavior).
When it comes to supporting our students with Autism and other sensory-motor disorders, recognizing this is HUGE. It explains why something that may seem so simple to us as neurotypicals (ex. Touch the red block) can be such a monumental task for a person with Apraxia. Even though we technically consider the above example to be a one-step direction, it requires several sequenced and coordinated movements to accomplish (direct the eyes to the row of blocks, visually scan for the red one, stop scanning and focus on the red block, initiate a lift of the arm from the shoulder, aim the arm toward the block, extend the pointer finger while curling the others under the palm, touch the block with the tip of the pointer finger). Add in the sensory perception differences that many with ASD experience, and the process becomes even more complicated. For instance, it might be extremely difficult to get your arm to start lifting if you cannot even feel it!
Reaching this realization means that we, as allies and advocates of those with sensory movement differences, have to change how these students are supported in learning new skills. In addition to presuming competence, we have to act as a make-shift motor planning centers, helping them build the neurological pathways that allow them to communicate their thoughts, set their own goals, and explore new tasks. We have to acknowledge and accept that our students’ successes are dependent on our skills as coaches and communication partners. And last but certainly not least, we must continue to educate others on Autism, Apraxia, and other sensory movement disorders, for as one of our Nashville spellers said:
“I change like the leaves. Nothing is as it seems.”
Check out some of the following resources on Apraxia/Dyspraxia, motor planning, and the brain!