Valerie Dejean New York, NY phone 1-877-4AUTKID Discussion: Sensory Integration Dysfunction, Auditory Processing Disorder,Motor Planning, Dyspraxia home

What is Praxis?

 In all of the above endeavors, the girl employs praxis-theability of the brain to conceive, organize, and carry out a sequence ofevents. Praxis is the ability to self-organize. The term praxis and motorplanning are often used interchangeably however it is more accurate toconsider praxis the broader term that encompassed motor planning. As describedabove the conceiving, organizing, and executing functions of praxis canbe employed in motor events as in the case of dressing and writing. Theyalso can be employed in cognitive events as in organizing play, homework,and a term paper.

Praxis is a uniquely human quality that allows us to develop higher-levelskills and to interact purposefully with each other and the environment.An infant innately learns to sit, stand, walk, and babble. It is when thebaby breaks from the sensory motor aspect of object use-repeatedlybanging a spoon on the table-to purposeful object use-attemptingto eat with a spoon-that he begins to utilize praxis. Individualswith "Dyspraxia" have difficulty executing unfamiliar tasks, even thoughthere is adequate motor and conceptual capacity to do so. A child withDyspraxia that approaches the train table at the toy store might push atrain back and forth on a section of track or open and close a bridge repeatedly,yet typically will show little sense of purpose or intention. In short,praxis is necessary in order for behavior to become purposeful. If a childwith Dyspraxia cannot organize the steps in dressing he will not becomeindependent in this skill. In other words, praxis is necessary for behaviorto be effective.

Ideation. Organization, and Execution:

 In order to adapt effectively to his environment, a child musthave an idea of what he wants to do; he needs to have a plan of how hewill sequence and time his movements; and finally he needs to perform theaction. Praxis involves three processes: (1) ideation, having an "idea"of what to do, (2) organization, creating an internal plan of action, and(3) execution.

Ideation

 Ideation is one's ability to generate an idea of how onemight interact with an object or the environment. If an individual hasno idea what to do with an object, he cannot play or "interact" with thatobject. Individuals with difficulty in ideation often wander a room fullof toys, pausing briefly to push buttons or manipulate an object, yet neverengaging in creative play-they literally have no idea what to dowith each object.

 Ideation is a cognitive process believed to be largely dependentupon the brain's ability to respond properly to sensory input. Sensoryintegration provides the body with a body schema-essentially, amap of what the body can do. This map gives the brain all the informationit needs to decide what to do with the sensory input it receives. However,if this body map is compromised (inaccurate, incomplete or non-existent),the brain cannot respond properly to sensory input, and ideation becomesdifficult or impossible.

Organization

 The organization aspect of praxis-the "how to do it" step-isan internal plan of action that bridges ideation and execution. First,an individual decides what to do, and then a plan of action is determined.This plan must be sequenced and timed correctly in order to be successful.In most individuals, this process is automatic-an idea occurs followedrapidly by an action, with no awareness of the organizational plan thatformed in that split second to orchestrate the action. Individuals withDyspraxia, however, tend to organize themselves cognitively-theymust think through how to accomplish the desired action before they executeit.

Execution

 Execution is the motor part of praxis-the physical manifestationof the desired action. While it is not necessarily the major source ofdifficulty in developmental Dyspraxia, it is the only part that can beobserved. The Dyspraxic child at the train table demonstrates difficultyexecuting purposeful play, but it is likely that her true difficulty isin determining what to do (ideation) or how to do it (organization). Individualswith Dyspraxia have difficulty imitating actions, sequencing activities,and executing higher-level reasoning.

 How Does Praxis Relate to My Child? Or What Does Praxis Have toDo with My Child?

 Many children with developmental challenges have motor planningdifficulties. Difficulties with motor planning are often at the heart ofthese children's frustrations. As children grow, they move awayfrom simply experiencing the world and are instead called upon to masterit. Toys, tools and self-care activities become more complex, requiringmore intricate and sequenced motor planning behavior. Motor planning problemsmake it difficult for these children to master the use of objects, whichleads to an increasing sense of frustration. Academic tasks become increasinglycomplex and the self-organization required at the level of Junior HighSchool can be daunting.

These individuals often require repeated exposure to an activity inorder to master it-they are essentially organizing their actionsconsciously, since the body is less able to automatically determine thenecessary steps for execution. They aren't able to generalize theirexperiences to other situations because they have learned behaviors ina very "splintered off" fashion. Learning becomes exhausting, as essentiallythese individuals are working much harder than their peers to accomplishthe same thing, all of which places an enormous tax on the nervous system.

 Learning can be challenging for these children as motor planningproblems decrease a child's ability to imitate the actions of others.Some Dyspraxic children find it easier to develop their own way of doingsomething as opposed to attempting to learn someone else's way or"the right way." These children can then be described as unconventionalor less kindly as oppositional, all of which can make social interactionmore difficult. The children end up feeling misunderstood and the adultsare scratching their heads as to why this bright child isn't performingat his potential.

Dyspraxia can affect speech and language development in some subtleas well as some not so subtle ways. As a child develops, language becomesincreasingly complex, requiring rapidly sequenced movements of the tongueand jaw, all of which must be coordinated with breathing. A motor planningdisorder can effect articulation and compromise intelligibility. Dyspraxiacan compromise language development, as phonemes must be organized intowords, words into sentences, and words into paragraphs in order for anindividual to express his thoughts and feelings. For the child with Dyspraxia,ideating and organizing language can be a tremendous challenge.

Dyspraxia has a tremendous negative impact on a child's senseof self- esteem. Children with Dyspraxia have very few feelings of mastery.Learning is not intrinsically rewarding. They never have the sense of effortlessaccomplishment. Since this is a hidden disorder - they don't lookdifferent on the outside from their friends - they're left to feelthat something is wrong with them. They feel "stupid" and it is difficultto talk them out of this, as that's what their experience feelslike. They are often labeled as lazy by misunderstanding adults and thiscan become a self-fulfilling prophecy as these children start to "giveup" in light of repeated failure.

 Symptoms of Dyspraxia

 _ Poor imitative ability.

 Difficulty with imitative behavior is a key indicator of dyspraxia.We certainly see imitation difficulties in the Autistic/PDD population.

_ Difficulty with sequenced activity. Yes and no with autistic children- may be able to sequence all the steps to turn on the computer or videofor favorite show or game. So is it a sequencing problem? Yet these samechildren can't organize a simple interaction

 The amount of sequencing in an activity is a good discriminativemeasure to separate out the children with solely organizational problemfrom the children with execution difficulties.

 Learning routine and how one fits into the routine may take longer.Children with difficulties may perform slowly, or not be able to performat all, when asked to follow multi-stepped directions. This is often aproblem

 _ Organize themselves cognitively vs. automatically.

 These children organize themselves cognitively, rather than performtasks automatically. It's as though the function of driving a stickshift car never becomes automatic. This are working double time to thinkeverything through. This often is just too hard and becomes a source offrustration for them. With the autistic child it often requires that theyorganize themselves visually (if they have a good visual system or perhapsmore specifically a good visual memory)

 _ Require a longer exposure to learn a new activity.

 They may require a longer exposure to a new activity in orderto learn it. They may initially use trail and error approaches to a taskuntil they can generate a motor plan about how to approach the activity.

_ Difficulty with executive functions of higher level reasoning.

 This can also carry on to higher levels of reasoning. They canhave difficulty organizing their thoughts and language. This is often truewhen autistic children start to speak - sentence structure is disorganizedor syllables are of. The jargon speak as it becomes more organized is moreunderstandable.

 _ Low self-esteem.

 Finally, sensory integration disorders in general, but particularlydyspraxia, can contribute to low self-esteem and anxiety. These childrencan see they are not doing as well as their peers, however since it isa "hidden difficulty" they may see themselves as "dumb" not recognizingthat they may be working twice as hard to compensate.

Being dyspraxic is the meaning of feeling stupid and these childrenoften describe themselves as feeling this way when in actuality their bodiesare not listening to them. Often explaining this to them can be very helpful.(Darnel)

 The cost of compensation may be a sense of frustration and theawareness that their body is not keeping up with the tasks that their goodlittle minds are able to conceptualize.

 Autistic children are very frustrated. I think it is harder towork with the oblivious child. I rather have a little frustration. It meansthe child is more aware of living in a disorganized body.

 Dyspraxia is secondary to an underlying sensory integration disorderand the Sensory Integration therapy increases an individual's motorplanning ability by improving his sensory integration. Improved sensoryintegration provides the brain with a better body schema (map of abilities)and a clearer sense of self (one must have a sense of "self" and "other"in order to interact), which in turn gives our brains the tools it needsto conceive of an idea, organize a plan, and execute an action.