Dyspraxia- Motor Planning Disorder

 By Valerie Dejean, Director, Spectrum Tomates Center and Certified Tomatis Consultant

 What does Praxis look like in my child?

 A three-year-old child is learning to dress herself. She puts on her underpants and then her pants, making sure each foot goes into a different leg and that her pocket is in the back. She next puts on her shirt, making sure the opening is in the front. Next come the socks and then the shoes. The same girl, a little older now, approaches a train table in a toy store. Although she has never seen one before she knows all about trains from her storybooks and videos. She picks up a train and begins to push it along the tracks. She drives the train over bridges and through tunnels, then rapidly increases the complexity of her play by pausing at railroad crossings, opening bridges, and parking in the "train garage."

 She extrapolates from her past experiences to create appropriate actions at the train table.

A little older yet, she is learning how to write, first in print and then in cursive. Still older yet, she organizes six different homework assignments from six different teachers. Still older yet, she organizes her thoughts and time to write an end of the year term paper. What is Praxis? In all of the above endeavors, the girl employs praxis: the ability of the brain to conceive, organize, and carry out a sequence of events. Praxis is the ability to self-organize. The term praxis and motor planning are often used interchangeably however it is more accurate to consider praxis the broader term that encompassed motor planning. As described above the conceiving, organizing, and executing functions of praxis can be employed in motor events as in the case of dressing and writing.

They also 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-level skills and to interact purposefully with each other and the environment. An infant innately learns to sit, stand, walk, and babble. It is when the baby breaks from the sensory motor aspect of object use:repeatedly banging a spoon on the table: to purposeful object use:attempting to eat with a spoon:that he begins to utilize praxis.

Individuals with "Dyspraxia" have difficulty executing unfamiliar tasks, even though there is adequate motor and conceptual capacity to do so. A child with Dyspraxia that approaches the train table at the toy store might push a train 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 child with Dyspraxia cannot organize the steps in dressing he will not become independent in this skill. In other words, praxis is necessary for behavior to be effective. Ideation. Organization, and Execution: In order to adapt effectively to his environment, a child must have an idea of what he wants to do; he needs to have a plan of how he will sequence and time his movements; and finally he needs to perform the action.

 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 one might interact with an object or the environment. If an individual has no idea what to do with an object, he cannot play or "interact" with that object. Individuals with difficulty in ideation often wander a room full of toys, pausing briefly to push buttons or manipulate an object, yet never engaging in creative play:they literally have no idea what to do with each object. Ideation is a cognitive process believed to be largely dependent upon the brain's ability to respond properly to sensory input. Sensory integration provides the body with a body schema:essentially, a map of what the body can do. This map gives the brain all the information it 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 becomes difficult or impossible.

Organization The organization aspect of praxis:the "how to do it" step:is an 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 followed rapidly by an action, with no awareness of the organizational plan that formed in that split second to orchestrate the action.

 Individuals with Dyspraxia, however, tend to organize themselves cognitively:they must think through how to accomplish the desired action before they execute it. Execution Execution is the motor part of praxis:the physical manifestation of the desired action. While it is not necessarily the major source of difficulty in developmental Dyspraxia, it is the only part that can be observed. The Dyspraxic child at the train table demonstrates difficulty executing purposeful play, but it is likely that her true difficulty is in determining what to do (ideation) or how to do it (organization).

Individuals with Dyspraxia have difficulty imitating actions, sequencing activities, and executing higher-level reasoning.

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

 Many children with developmental challenges have motor planning difficulties. Difficulties with motor planning are often at the heart of these children's frustrations. As children grow, they move away from simply experiencing the world and are instead called upon to master it. Toys, tools and self-care activities become more complex, requiring more intricate and sequenced motor planning behavior. Motor planning problems make it difficult for these children to master the use of objects, which leads to an increasing sense of frustration. Academic tasks become increasingly complex and the self-organization required at the level of Junior High School can be daunting.

These individuals often require repeated exposure to an activity in order to master it:they are essentially organizing their actions consciously, since the body is less able to automatically determine the necessary steps for execution. They aren't able to generalize their experiences to other situations because they have learned behaviors in a very "splintered off" fashion.

Learning becomes exhausting, as essentially these individuals are working much harder than their peers to accomplish the same thing, all of which places an enormous tax on the nervous system.

Learning can be challenging for these children as motor planning problems decrease a child's ability to imitate the actions of others.

Some Dyspraxic children find it easier to develop their own way of doing something as opposed to attempting to learn someone else's way or "the right way." These children can then be described as unconventional or less kindly as oppositional, all of which can make social interaction more difficult. The children end up feeling misunderstood and the adults are scratching their heads as to why this bright child isn't performing at their potential.

 Dyspraxia can affect speech and language development in some subtle as well as some not so subtle ways. As a child develops, language becomes increasingly complex, requiring rapidly sequenced movements of the tongue and jaw, all of which must be coordinated with breathing. A motor planning disorder can effect articulation and compromise intelligibility. Dyspraxia can compromise language development, as phonemes must be organized into words, words into sentences, and words into paragraphs in order for an individual 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 sense of self-esteem. Children with Dyspraxia have very few feelings of mastery. Learning is not intrinsically rewarding. They never have the sense of effortless accomplishment.

 Since this is a hidden disorder - they don't look different on the outside from their friends - they're left to feel that something is wrong with them. They feel "stupid" and it is difficult to talk them out of this, as that's what their experience feels like. They are often labeled as lazy by misunderstanding adults and this can become a self-fulfilling prophecy as these children start to "give up" in light of repeated failure.

 How can the Spectrum Tomates Center Help? At the Spectrum Tomates Center we have been using the Tomatis Method of "listening training" since 1992. The Spectrum Tomates Center pioneered using Tomatis's developmental theories in conjunction with the sensory integration theories of Dr. A. Jean Ayres, in what we have called the Spectrum Center Method. Through this unique perspective we create an individualized program for each client that enable him or her to overcome communication, behavioral, organizational or learning difficulties. Dyspraxia is secondary to an underlying sensory integration disorder and the Spectrum Tomates Center Listening Training programs increases an individual's motor planning ability by improving his overall sensory processing.

 Improved sensory processing 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 needs to conceive of an idea, organize a plan, and execute an action. If you feel your child has dyspraxia or motor planning issues, contact the Spectrum Tomates Center at (845) 915-3288 to discuss your situation or to schedule an initial evaluation. Or mail us at Spectrum Tomates Center, 233 Route 17, Suite 4, Tuxedo Park, NY 10987-0698 Copyright 2010