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What is praxis, how is it different from 'processing' and what may it have to do with supposed "attachment issues" of stubbornness and control in kids that seem to have bonded well and have other neurodevelopmental issues?
I bring this up here because I recently heard a new adoptive mom of a child from Eastern Europe say that her psychologist had told her that her son was using his speech problems to control her, and it was a sure sign of an attachment disorder. When he wanted to say something, and it was natural and automatic, he would be able to speak, but when they would ask him a question, or try to get him to respond, he would 'deliberately' mess it up in order, they supposed, to 'control' his mother. And there have been several posts that have included examples of similar issues, that the child is being stubborn or controlling because they aren't doing something on command... and that this is some sign of attachment disorder even though they seem to have bonded... Well, maybe not.
Praxis is the ability to perform complex voluntary motor tasks at the level expected for one's age, ability and training. (Note that I say MOTOR tasks. Not input processing, but motor output. Note that I say VOLUNTARY, not automatic.) Praxis requires that the brain be able to integrate the production of the motor activity. Recalled sensory patterns and sensory feedback are essential to the performance of motor tasks. *Apraxia* is an *inability* to do the voluntary complex motor task; *Dyspraxia* is *difficulty* performing the task.
One of the hallmarks of apraxia is the inability to follow a command. For example, a person who has had a stroke is being examined. The doctor says, "Show me how you drink a glass of water." The patient looks a bit confused, moves a bit, but can't show the doctor how he can drink water. Later, the patient is seen alone in his room automatically drinking a glass of water. Was he being stubborn? Did he have a psychological issue? Was it a control issue? No! It was an apraxia. He was not able to do the action voluntarily, on command, but he did it automatically with ease. The stimulus of having the familiar object in front of him, plus thirst, was enough to make him drink.
My birthdaughter has motor dyspraxias. Some doctors call her problem a Disorder of Motor Planning. One of her classic dyspraxias is her problem smiling on command. She has a beautiful natural smile, but you should see her class photos! Her face contorts - she can't smile voluntarily. Fortunately for us, she has a sunny disposition and smiles a lot anyway. When we want to take pictures, we have to distract her and tell jokes or tell her we are going to do something pleasant when it is done. Otherwise, we end up with a picture of a contorted face. If you tell her to pick up her pen and write something, she has a very hard time grasping the pen - her fingers contort, she will hold it in an awkward grasp. She is 8 years old, has a very high verbal IQ and has been getting PT and OT since she was 2 years old. This isn't just a matter of lack of training, or muscle weakness, or lack of intelligence, or a personality issue, or a control issue, or stubbornness, or being spoiled. She is dyspraxic.
My son, adopted from an orphanage at the age of 3 with a severe speech impairment has speech dyspraxia and Auditory Processing Disorder. Marc has heard the song Twinkle Twinkle Little Star every day for the last 3 1/2 years and he still reverses and transposes words and syllables. If you ask him to repeat a sentence, he will usually transpose at least one word. Is it just the result of a lack of input (stimulation) in his early years? No, it is also a result of a lack of output, the (Continued on page 23)
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