Gifted Issues Discussion homepage Forums Twice Exceptional Praxis

Hi Everyone,

I have been reading these forums for a few months now, but haven't been very active in participating. My DD is 2.5 and is in OT for eating issues. The range of foods she eats is very narrow, and if she has something in her mouth she doesn't like she will not just gag, but completely throw up to get rid of it. She is a little better about it now, however, because she just fully refuses to try anything new - ha!

Today, her therapist told me that she suspected this for a while, but it was confirmed to her that DD has praxis. I think that's the right term, anyway. I've only had about a 5 minute conversation with her about it. She said that basically, DD has trouble figuring out how to play with a toy or do a task without being shown or told how first, and that DD is very, VERY smart with an amazing memory and other skills that compensate for it so it has taken her a while to determine that is what is going on. She also said that it is something that would really affect her in school so recognizing it now will help her learn to deal with it sooner.

Is there anyone out there dealing with this issue?

You're talking about apraxia - praxis is the "movement plan" that she lacks. I think there are quite a few apraxic kids here - you'll probably have better luck finding the threads with the correct search terms. Good luck!

"Praxis" means difficulty with motor planning. Two of the terms you'll hear mentioned are apraxia and dyspraxia. If I understand correctly, apraxia means "absence" where "dyspraxia" means not-fully-functional. That's my totally non-technical explanation! In real terms, when I've talked to other parents etc, I more often hear the term "apraxia" related to speech/oral language, and dyspraxia related to other types of motor development. From the reading I've done, it seems that just as there are hundreds of different ways that our bodies use motor planning, there are as many and possibly thousands times more ways in which dyspraxia/apraxia can impact a person - so apraxia or dyspraxia in one person might look entirely different in another person with the same diagnosis.

Our ds12 is dyspraxic - his diagnosis is "Developmental Coordination Disorder". In his case, the challenge isn't quite that he has to be shown something to learn how to do it, but that he has a challenge with developing the automaticity that is required to do fine motor skills such as tying your shoes, handwriting etc. When he was very young, he was delayed in learning how to crawl, walk, talk etc. No one really thought much of it at the time because of several reasons - he was our first child and we were seeing all the things that were a-ok with him and not realizing that the little quirks in development were anything other than quirks; several of our family members were also late in developing the same skills and we wrote it off to either being the first child and not needing to do those things or taking after older family members (who most likely, in hindsight, were also dyspraxic!), and also because even before he could talk it was clear that he was very bright, and once he started talking he sounded like a little professor - it was clear he was a high IQ kid - so much of his quirkiness was chalked up to that.

In school the primary impact for our ds has been in handwriting - he uses a laptop and keyboarding across all subjects, including math. It seemed to take him a long time to learn math facts too, even though he's always been very quick at learning math concepts. He is also not terribly coordinated, so things like team sports and gym class are among the things he'd like to wipe off the face of the earth! He also has a few quirky things that most people wouldn't recognize as meaning anything, but they are related to his dyspraxia - he learned how to write in cursive in 4th grade but completely forgot it after not using it for the summer. Getting dressed takes him a long time. He thinks he's running when really he's just walking semi-fast and not really all that fast. He didn't learn how to blow his nose until he was 11 (in spite of trying like crazy for years). His stomach feels like it's full before it really is.

Now that you've read all of that you might be thinking - YIKES! or UGH. Try not to worry - there are also many *many* wonderful things I could write down about our ds if I had the time or wasn't going to run out of cyber-space to write it in. Being dyspraxic hasn't been the highlight of his life, but it also hasn't held him back from being the funny, bright, creative, loving, totally typically happy kid that he is. He's fine, and I'm sure your dd will be fine too

BTW, ds used to eat anything when he was really young, but starting at around 7 he became very picky at 7. He still has issues with texture etc at 12. I think that's not uncommon in kids with issues with praxis, but I could be mistaken.

Welcome to the forums - there are several other parents around who are dealing with similar issues, so you aren't alone.

Best wishes,

polarbear

ps - wanted to add a quick note for anyone who's reading this and dealing with dyspraxia - I mentioned my ds' intense dislike for gym and team sports, and fwiw he tends to naturally gravitate toward being a couch potato - but the difficulties he has in gym and with team sports due to motor planning haven't kept him from having an active and healthy set of activities to enjoy - he loves mountain biking and skiing and those are sports he can enjoy without having to keep up with other kids who don't have the same motor planning challenges.

Thanks ElizabethN and polarbear! Proper terms would help! I would suppose this is why I didn't not find much searching Google. Like I said, I only had a few minute conversation with the therapist (with a screaming 5 week old in my ear) so I still don't know very much. I'm still a little confused because my DD doesn't seem to have any motor skill delay. In fact, she has been ahead with all her milestones and started writing letters when she was 20 months old, but she does, however, have a little trouble with front-to-back balance. More research is in order!

My DD also had her first visit with a chiropractor yesterday and she said her neck was in really rough shape and the nerves that control some of the functions she is having sensory issues with (balance, among others) is what was worst. She said we may start to see her sensory issues improve somewhat with chiropractic treatment.

MoN - is the stiffening or the fluid response to a balance challenge the dyspraxic response?

We have a lot of the type of issues that polarbear mentioned, with DS9. It was only a couple of years ago, maybe less, that I finally looked up that term, "apraxia", that people here talked about, and figured out that's what DS had!

I have always described it as a total lack of kinesthesia (body sense). He didn't learn to tie his shoes till he was 8, and he still can't ride a bike. When I would try to teach him something like how to hold his fingers in the right position for something (like holding a pencil, etc.), he would look at my fingers and do something totally different with his, even though it was obvious he was concentrating really hard on trying to make his fingers look like mine. There was just no connection between what his brain was telling his body to do and what his body was actually doing.

He's gotten better over the years, and he seems to have a better sense of balance these days, but there are still some trials.

It can be really frustrating -- all the things the brain can do, but the body lags behind.

The actor who plays Harry Potter is dyspraxic. (Not sure that's the right way to say it). My now 3.5 yr old was dx almost a year ago. It has taken a long time to find an OT who works with sensory integration. However after a few months of some decent OT work we have seen a big change. I wish we could have started sooner. I will say more later but I am on small phone running out of batteery...one thing I will say is dyslexia runs rampant in my family from very severe to mild. I watch my little one and it looks like dyslexia of physical coordination.

Nautigal, there is a test called "finger tapping" that is used in diagnosing fine motor dyspraxia - the tester taps different combinations of fingers together and asks the person being tested to copy what they see. Our ds can't do this - he tries his best, but has to look at his hand, hold it in different positions while he studies it and then inevitably taps a completely different set of fingers together.

flower, we have dyslexic relatives in my dh's family... as well as relatives I suspect are undiagnosed dyslexic and dyspraxic.

polarbear

My son was diagnosed with dyspraxia at age 11 but his difficulties seemed to have more to do with his low muscle tone and loose joints which caused him to fatigue faster than other kids. He could not practice skills as long as other kids because of the low endurance. I would say he got about half as much practice but since he seemed to learn twice as fast as other kids for most things it didn't seem that much of a problem.

He wouldn't do jigsaw puzzles, didn't like coloring, and he didn't like to draw but he learned to write his name before he turned 5. His handwriting was legible but sloppy and he had trouble coloring in the lines and cutting with a knife and buttoning but I think it had more to do with his loose finger joints.

At four he was able to learn dances for musical theater but I did notice that he e seemed to have a hard time with learning to do hand motions with dances if he had to do them quickly but he learned to compensate for that by naming the motion and saying it in his head so I guess he compensated by using verbal memory and it worked well for him. He had to learn the dance first this way and then he could add the singing that was also required. His balance has always been good. He is usually able figure out a way to compensate for his disabilities if given the chance but then people had trouble believing he had a disability when they saw him perform. We had trouble getting his doctors to approve PT or OT until he was 11 and finally got the diagnosis of dyspraxia and then they said it was too late for OT so we have just had to figure out a lot of things on our own with the help of people on message boards like this one.

Polar, who can diagnose dyspraxia? is that a neuropsych thing, or an OT thing?

I've never seen an OT give this test, but it sounds very revealing...

DeeDee

DeeDee, I think both OT and neuropsychs can diagnose dyspraxia. The finger tapping test our ds had was part of a neuropsych exam and was used to determine why his coding subtest speed on the WISC was so low relative to his other subtest scores. Due to the type of task, a low coding score could mean a fine motor impairment or a visual challenge - the finger tapping showed fine motor challenge.

The actual diagnosis he received from the neuropsych is "Developmental Coordination Disorder" which is a diagnosis in the DSM and is the terminology used by psychs. If you were to ask his neuropsychiatrist if he is dyspraxic, she would say yes, but what she labels it for diagnosis is DCD.

polarbear

It could be a little bit of both (loose joints + neurological disconnect). My ds has really *really* loose finger joints - they bend backwards when he plays piano.

I think what is apparent here in these posts and also when you read about dyspraxia in general is that there are multiple causes and many many different ways in which it impacts people.

polarbear

Wow.

I definitely need to meet with her therapist to try and understand this because my DD doesn't sound like the kids you're describing, and I've not been able to google much info on apraxia/dyspraxia that does match her. Her balance issues are the OT's observations, not mine. She LOVES anything that is a physical challenge. We are going to enroll her in gymnastics as soon as we get a chance because she loves that sort of thing. She figured out how to do flips on her own, she loves balance beam type things and hanging from monkey bars. She can stick a landing like a gymnast. At the park, there are half-tires mounted to the ground and she jumps from one to the next better than kids noticeably older. This summer we have put her in the pool with an arm and chest float and she taught herself how to swim. She even jumps off the diving board and goes down water slides. She's so brave it scares me to watch her sometimes, but she ends up being really good at whatever she tries. I am completely unathletic, though, so anything would impress me!!

Her fine motor skills have always seemed advanced to me. She uses utensils well and her writing is, honestly, more legible than my husband's. She learned over 500 asl signs by 2 years old and could do a knob style puzzle when she was 8 months old. When we went to Disney World, she had just turned 2 and to keep her entertained in the stroller, we gave her a LeapPad (which has a touch screen and a very small stylus). Random people videotaped her 2 different times because they just couldn't believe what she was doing (totally weirded me out!). I didn't think there was anything out of the ordinary about it until we were getting comments multiple times a day about how they couldn't believe someone so small was using such a toy.

I'm genuinely not trying to brag, I just want you to understand why I'm confused.

Her therapist did tell me about a sand toy she was having trouble with. It is a spiral that you pour sand in the top and it comes out the bottom. She said she kept trying it over and over, but it wasn't working and she couldn't seem to understand why. She suggested to her that it was upside-down, so DD looked at it, flipped it, and it worked. That seems weird to me because she recognizes all the time when things are upside-down, sideways, or just out of place and says "Uh-oh! We have to fix it!"

Our OT has done finger tapping as part of the battery on both children. Interesting, I assumed it was part of the standard battery they did (California something or other?). He was quite insistent that my 2nd child is exceptionally well integrated, nothing more than low tone and hypermobility at work, and in fact that the only reason she wasn't more disabled was the degree to which she could compensate. I have worried sporadically about whether he was missing dyspraxia or dysgraphia (she just got an A for the participation/behaviour parts of PE and an E for the actual physical skills). But she did exceptionally well at the finger tapping, the OT seemed to find it highly entertaining actually. Also all the posture copying (he would pose himself and she had to copy a mirror image of his pose).

I agree with master of none. FWIW, with each of my children, we've had other parents/teachers/private professionals express concerns at one time or another that didn't seem to fit with what we saw in our children. Sometimes they were out in left field, sometimes they were onto something, and sometimes they were spot-on about something we just hadn't seen. Almost always they were looking at our child through *their* lens of experience, and there can be so many different reasons that a child acts a certain way or exhibits a type of specific behavior etc.

I think in this case, I'd ask more questions of your OT re her observations and comments. Also ask her to define specifically what she was suggesting (did she use the word "praxis", did she mean apraxia/dyspraxia, etc). If she has a set of concerns or observations that she's collected over time when working with your ds, I'd consider having another professional evaluate your ds if you can swing it with your insurance.

As I mentioned above, it doesn't sound like your ds is dyspraxic, but dyspraxia can be *very* different in how it impacts children and in how it impacts an individual across functionalities. My ds is a gifted artist - he has drawn pictures for fun since he was very very little, the type of pictures that make adults say "Wow!" He started building amazing Lego creations when he was not quite a year old. He was alert from day one - very alert compared to other babies we've known. There were signs of his dyspraxia at a very young age, but we (parents) never saw them because we only saw the side of things we noticed, and we didn't know to notice anything else (does that make sense?). None of our friends or family ever had a clue he was dyspraxic, and none of his early teachers did (preschool or elementary). We found out when he was 8 - when his teacher suggested he had ADHD. That was a suggestion that hit us out of left field and our first reaction was "no way" - and we found a ton of reasons why he didn't have ADHD online... and ultimately no, he doesn't have ADHD, but the teacher was seeing *something* and it led us to very valuable info about our ds.

Anyway, I always believe the #1 expert on any of our children is us (the parents). OTOH, people outside our family who spend time with our children may have valuable insight, so I wouldn't pass on the opportunity to try to understand what the OT was seeing.

Sorry I think I sounded a bit preachy or dramatic - didn't mean to! Problem is *I'm* clearly challenged with saying anything concisely lol!

Best wishes,

polarbear

After a bit more research, I think I found what the OT was talking about - Ideational Praxis/Dyspraxia/Apraxia. I learned from a friend who has a child with speech apraxia that, at least in the state of NC, they can't be officially diagnosed with this type of thing until they are 3 years old, so that may be why she didn't use the dyspraxia/apraxia terms.

I've decided I'm going to hold off on further research until we meet with DD's therapist again Wed. so as not to research the wrong thing and get too upset. It sounds kind of scary to me.

This sounds like a great idea.

Well, after talking with DD's OT again I'm even more confused. She kept using the terms praxis and motor planning, but what she is describing sounds more like a lack of creativity or problem solving to me. An example she used was that if she is given a new toy/tool/object she can't figure out how to play with it, she has to be shown. She said she is so smart and has such a great memory that she tricks us in to thinking she can. Her example was to give her a bucket of water and a few little plastic animals and just let her go at it and see how or if she will play, thinking that she really couldn't play unless I showed her a few things to do first.

First, this sounds NOTHING like any praxis/motor planning that I've been able to find and if someone can direct me towards info regarding this I would be grateful.

Second, I see her play creatively with stuff all the time, however, it does usually relate to stories she has seen on tv or in books.

She also shows creativity with speech by saying phrases and then changing all the vowel sounds to the same thing (like all words will have the short a sound) or adding extra syllables to certain words at the end of phrases in a song, etc. I realize that is likely not part of motor planning, but it sounds like it goes with the same process the OT is talking about with figuring out new ways to play, except that's with words, not toys. Am I making any sense at all? I'm so confused.

We spent most of DD'S last session discussing this rather than her getting therapy and I still fail to see how this is motor planning. Help!

Mary I am not an expert on dyspraxia NOR have I seen your child, but I think that it's really really easy for gifted children to compensate astonishingly for any weakness they might have. I am pretty sure I am not the only child who wished things had been pointed out to me sooner, or that I had noticed things sooner myself. My favourite saying now is "If in doubt check it out!".

I remember thinking thank goodness my own child is co-ordinated and physically able, has good posture, etc and didn't turn out like me. Because she was seemingly developmentally advanced in many gross and fine motor skills, an amazing climber, various other things. I had her assessed by an OT because I knew she had sensory issues. I was utterly confused to learn that she had numerous gross and fine motor developmental issues. She's very good at learning motor skills she can learn her own way in her own time. She's pretty much in capable of learning motor skills in a group scenario in a typical fashion. Teaching herself playground equipment, big tick, skiing lessons, balls sports, etc - massive, massive fail.... Sometimes it does take a professional to point out things we aren't seeing. Maybe you need to find out whether she is the right person to fully asses what she is seeing, or who is, and have it formally assessed and then explained to you. She's not severe and she can compensate but she definitely does have significant motor planning issues that show up most in diffiultly learning new skills or executing anything that requires speed (ie ball sports).

This article may be helpful: http://www.icdl.com/started/therapies/documents/Chapter8.pdf

HappyChef, the most important thing to keep in mind is that if you don't fully understand something the OT is saying to you, it is *completely* reasonable for you to tell her to stop and say it in different (jargonless) terms.