Apraxia

About the difference between apraxia and autism, they are totally different neurological entities that can be seen independently (autism without apraxia, and apraxia without autism) and can also both occur in the same child. I assume you know that autism is a bio-chemical disorder that is characterized by significant impairments in social interaction and communication, and restricted and repetitive patterns of behaviors or interests. This makes autism a disorder that affects many "systems" involved in everyday functioning (it is a "multisystems developmental disorder"). Apraxia means that the child has difficulty planning and carrying out voluntary motor movements. Gross motor-wise, it can affect a child's ability to figure out how to sit in a chair, stand up, catch a ball, or do a somersault. Fine motor-wise, it can affect his or her ability to button, zip, write, draw, point at objects or pictures, etc.Speech-wise, it affects a child's ability to produce the patterns of sounds in words or, even more basic, to voluntarily coordinate the speech mechanism for blowing, voicing (the hum in sounds such as "b" or "g"), or imitating the formation of a sound that is modeled. However, children with ONLY apraxia are basically very social -- apraxia involves motor functioning only.

Children with verbal apraxia (oral-motor apraxia) could initially LOOK LIKE they may be autistic (I have gotten children with a tentative PDD diagnosis). This is because they have an incredibly keen sense of how hard it is for them to talk and, thus, they avoid talking by avoiding social contact. However, if you play with them and don't demand speech, they may begin playing with you enthusiastically. They are relieved that they won't be required to talk -- it is too frustrating for them and they know they'll fail. (The key with these kids, I find, is to engage them in exciting play of their choice, relieve their anxiety about speaking, and slowing introduce sounds, syllables, or simple words into play that they love. I gently encourage them to try vocalizing or verbalizing something during the exuberance of the play that matches the level of excitement. Then we build on their attempts and their success.)

Motor apraxic children may show problems in social interaction because they cannot always make the movements that would bring them in contact with people. For example, a child may have trouble reaching up to touch the mother's face, make the movements for patticake, or turn to face the speaker. Usually, though, motor apraxia does not cause the child to AVOID social interaction (avert eyes or face, or move away from others) or become self-absorbed. (Of course, a child who is also over-reactive to auditory, visual, tactile stimuli might avoid stimulating social interaction but would not be autistic.)

What can make things confusing is that children in the autistic spectrum frequently have one or both of these other problems: apraxia (motor and/or verbal) and sensory sensitivities! But children with apraxia or with sensory sensitivities are not necessarily autistic.

Phyllis B. Rubin, CCC-SLP, PsyD

Speech/Language Pathologist

Clinical Psychologist