Praxis – How apraxia, dyspraxia and childhood coordination disorder are connected and result in impaired sensory motor planning in autism
Dyspraxia – This is an umbrella term for neurogenic impairments that involve the planning, executing, and sequencing of movements
Limb or motor apraxia – involves programming of hand or whole-body movements like tying shoes, riding a tricycle or bike, clumsiness, feeding self, swimming
Verbal apraxia –programming of articulators to perform rapid sequence of motor movements needed for speech sounds
Oral apraxia – involves non speech movements like puckering, blowing bubbles, licking lips, latching, or breastfeeding
Disruption of sensory and motor integration has been dismissed by many doctors and researchers in this field as being the underlying problem in autism, but impaired praxis (dyspraxias / childhood coordination disorder) is at the core of many symptoms. It is our profound privilege to have worked with thousands of families without a doubt, the majority of autism symptoms are caused by impaired sensory motor planning, impaired praxis. Praxis means “doing” or “acting”. It is the combination between the brain’s ability to create a motor plan and execute that plan properly. Motor plans are intricate; they break down actions into small steps that the brain and body then executes in order instructing the brain to fire brain chemicals and stimulate neurons in a complicated sequence. Praxis is like a firework display. People diagnosed with autism don’t have enough “help” to set off the fireworks in an organized and swift manner. They have all the fireworks. Sometimes all the fireworks get set off at once and sometimes none will go off at all. There is a lack of energy to coordinate in their brain and body because their neurotransmission (brain function) is unique. It is one thing to light up a “burning schoolhouse” firework in your backyard and yet another to create timed fireworks accompanied with coordinated symphonies as seen in some of the world’s most impressive firework displays. Our brains are all capable of this. In autism, genetic weaknesses, environmental toxins, harmful microbes in the gut, nutrient deficiencies and carbohydrate addiction all decrease the brain’s capacity to fire coordinated and complicated communication to muscles to support praxis.
Speech pathologists and occupational therapists often use the term motor planning to simplify the therapy that they are using to support language, sensory integration or motor skills. Praxis is an extremely complicated and neurologically taxing process. A process that requires adequate energy production from coming up with an idea, plan the motor steps needed to execute, check in with the sensory system to identify any sensory information that is needed to execute those coordinated motor movements, execute the movements and collect data or feedback on any changes that need to be made to improve speed or effectiveness of coordinated movements in future.
Impaired praxis or dyspraxia is why your child isn’t responding to their name. They know their name (we promise you they know their name and many other things that it is your job to excavate out with all the tools at your disposal). Suboptimal praxis is why your child “can’t” follow a single, simple, request. No requests are simple when praxis is so complicated. The simplest request will require dozens of steps in a motor plan, a plan that is only executed once the sensory system accepts it and there is enough energy to coordinate all the steps. For most of us, praxis happens swiftly with little of our awareness.
Neuroscientist like Daniel Wolpert’s Ted Talk simplifies this concept; we have a brain for only one reason and that is movement. The sensory system and the motor system are a connected track in the brain requiring cooperation to support movement. Let’s say you want to get up from my chair. Which muscles do you need to use? Which order do they fire in so that you can smoothly stand up? What sensory considerations does your brain have to assess? Are you standing up on ice? Or is there a banana peel that would require you to stabilize a different set of muscles to prevent falling? Does your heart have to pump faster to compensate for change in position? Are you holding an infant in one arm? Infinite variables go into a simple movement like getting up out of your chair.
The autism world is telling us that when asked to perform “simple” tasks, they are not able to coordinate the sensory processing and the motor planning required to execute the task, thereby showing they understand. A motor plan is like a draft that has to be reviewed before being published. If the sensory system is required for motor planning and 90% of children diagnosed with autism have sensory issues, we need to start spreading this information like wildfire because we have tens millions of people on the planet locked in a brain that won’t do what it’s told.
Motor planning is a process supported by repetition and feedback. Damage to motor planning results in higher levels of repetition in an attempt to strengthen or heal that area. Think of the difference between a 4-year-old who attempts to skate and a professional hockey player who not only navigates with great speed on the ice forwards and backwards but does so with a puck! The professional hockey player has fine-tuned their praxis. The 4-year-old will fall down thousands of times before he or she will have the ability to win Olympic Gold.
What if your child with autism can’t get their body to do what they are asking it to?
What can you do to help?
Biomedical treatment with omega 3 and omega 6 essential fatty acids, fat soluble vitamins like vitamin E, methyl B12 injections, diet and improved microbiome health are changing the lives of people diagnosed with autism and other developmental concerns. It addresses the obstacles to optimal praxis and introduces supports to dramatically improve praxis by addressing methylation impairment, oxidative stress, immunoexcitotoxicity and cell danger response.
Contributed by:
Sonya Doherty, ND
Doctor of Naturopathic Medicine
Chief Medical Officer at Treat Autism
Natural Care Clinic
