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!”

May is “Motor Month” here at I-ASC, which means the focus is all on movement: what it is, how nonspeakers experience it, and fun challenges to try new, purposeful skills! It’s a perfect time to try out your first yoga pose or practice digging out holes for your new garden (survivalist skills for the win!). While both fun and a great opportunity to meet your friendly neighborhood worms, we promise we aren’t challenging you to such tasks just for our own entertainment. Word from the neurodiverse and nonspeaking communicators that inspire these challenges is that-in addition to differences in sensory perception and processing-they experience varying effects from Apraxia, a neurological difference that affects one’s ability to plan, initiate, execute, adjust, and stop motor movements.

“That sounds pretty straight forward” you might say, but then get squinty-eyed as you observe you child walk, grasp a pen, say some words, and maybe even type in and locate his favorite Youtube video on the Ipad. How can such a person have a movement disorder? Well, that requires us to understand the difference between motor ability and the ability to motor PLAN. For example, someone who has motor weakness that affects ALL movement (ex. A person with Cerebral Palsy) has difficulty with motor ability. A person with Apraxia, on the other hand, HAS motor ability-they can react to sensory stimuli, respond to perceived danger or pleasure, and do things that have been very well practiced. However, they struggle with the ability to motor PLAN: they know what they want to do, but a breakdown happens between the thought and the action.

Let’s look at this a little more. 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 adjusting 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 your limbic system: you didn’t think about smiling or plan ahead to do so, it simply occurred involuntarily in response to the happiness you felt. It might even be difficult to stop doing it! 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 on their own even though the direction is understood.

When it comes to supporting our students with Autism and other sensory-movement differences, 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 neurodiverse people 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 we support neurodiverse learners in developing 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 differences, for as one of our spellers said:

“I change like the leaves. Nothing is as it seems.”

Bryana Williams, S2C Practitioner